Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Oct 2018
What is the Minimum Clinically Important Difference for the WOMAC Index After TKA?
The WOMAC score is a validated outcome measure for use in patients undergoing TKA. Defining meaningful changes in the WOMAC score is important for sample-size calculations in clinical research and for interpreting published studies. However, inconsistencies among published studies regarding key definitions for changes in the WOMAC score after TKA potentially could result in incorrectly powered studies and the misinterpretation of clinical research results. ⋯ Level III, diagnostic study.
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Clin. Orthop. Relat. Res. · Oct 2018
Comparative StudyThe Growing Executive-Physician Wage Gap in Major US Nonprofit Hospitals and Burden of Nonclinical Workers on the US Healthcare System.
In an era of increasing healthcare costs, the number and value of nonclinical workers, especially hospital management, has come under increased study. Compensation of hospital executives, especially at major nonprofit medical centers, and the "wage gap" with physicians and clinical staff has been highlighted in the national news. To our knowledge, a systematic analysis of this wage gap and its importance has not been investigated. ⋯ IV, economic and decision analysis.
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Clin. Orthop. Relat. Res. · Oct 2018
Are Sonication Cultures of Antibiotic Cement Spacers Useful During Second-stage Reimplantation Surgery for Prosthetic Joint Infection?
Organisms may persist on polymethylmethacrylate (PMMA) spacer surfaces, and subclinical infection is postulated to be a source of infection recurrence. Several small patient series have shown a high proportion of positive sonication cultures on PMMA spacers at the second stage of a two-stage revision. However, the association between a positive sonication culture and the risk for recurrence of infection after two-stage exchange is not fully elucidated. ⋯ Level III, diagnostic study.
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Clin. Orthop. Relat. Res. · Oct 2018
High Risk of Venous Thromboembolism After Surgery for Long Bone Metastases: A Retrospective Study of 682 Patients.
Previous studies have shown that venous thromboembolism (VTE) is a complication associated with neoplastic disease and major orthopaedic surgery. However, many potential risk factors remain undefined. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Oct 2018
Comparative StudyExternal Beam Irradiation Preferentially Inhibits the Endochondral Pathway of Fracture Healing: A Rat Model.
External beam irradiation is an accepted treatment for skeletal malignancies. Radiation acts on both cancerous and normal cells and, depending on the balance of these effects, may promote or impair bone healing after pathologic fracture. Previous studies suggest an adverse effect of radiation on endochondral ossification, but the existence of differential effects of radiation on the two distinct bone healing pathways is unknown. ⋯ This work suggests that there may be a rationale for compression plating rather than intramedullary nailing of long bone fractures in select circumstances where bony union is desirable, adjunctive radiation treatment is required, and bone stock is sufficient for plate and screw fixation.