Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Mar 2015
Medical services and associated costs vary widely among surgeons treating patients with hand osteoarthritis.
There are substantial variations in medical services that are difficult to explain based on differences in pathophysiology alone. The scale of variation and the number of people affected suggest substantial potential to lower healthcare costs with the reduction of practice variation. Our study assessed practice variation across three affiliated urban sites in one city in the United States and related healthcare costs following the diagnosis of hand osteoarthritis (OA) in patients. ⋯ Level III, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Mar 2015
Observational StudyIs there a difference in total knee arthroplasty risk of revision in highly crosslinked versus conventional polyethylene?
Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and associated osteolysis in total knee arthroplasty (TKA). However, there is limited clinical evidence that HXLPE is more effective than conventional polyethylene (CPE) in TKA. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Mar 2015
Topical tranexamic Acid does not affect electrophysiologic or neurovascular sciatic nerve markers in an animal model.
Tranexamic acid is a safe and effective antifibrinolytic agent used systemically and topically to reduce blood loss and transfusion rate in patients having TKA or THA. As the hip does not have a defined capsule, topical application of tranexamic acid may entirely envelop the sciatic nerve during THA. Accidental application of tranexamic acid onto the spinal cord in spinal anesthesia has been shown to produce seizures; therefore, we sought to investigate if topical application of tranexamic acid on the sciatic nerve has a deleterious effect. ⋯ Topical tranexamic acid is effective in decreasing patient blood loss during THA, and results from our in vivo rat model study suggest there may be no electrophysiologic and histologic effects on the sciatic nerve, with the numbers available, up to 1 month.
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Clin. Orthop. Relat. Res. · Mar 2015
Diabetes confers little to no increased risk of postoperative complications after hip fracture surgery in geriatric patients.
Diabetes and hip fractures in geriatric patients are common, and many elderly patients have a history of diabetes. However, the influence of diabetes on surgical complications may vary based on which particular type of diabetes a patient has. To our knowledge, no prior study has stratified patients with diabetes to compare patients with noninsulin-dependent and insulin-dependent diabetes regarding rates of postoperative adverse events, length of hospitalization, and readmission rate after surgical stabilization of hip fractures in geriatric patients. ⋯ Level III, case-control study. See Instructions for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Mar 2015
What are the 5-year survivorship outcomes of compressive endoprosthetic osseointegration fixation of the femur?
Aseptic complications such as stress shielding leading to bone loss are major problems associated with revision of cemented and uncemented long-stem tumor endoprostheses. Endoprosthetic reconstruction using compressive osseointegration fixation is a relatively new limb salvage technology designed to enhance osseointegration, prevent stress shielding, and provide fixation for short end-segments. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.