Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2019
Comparative StudyRevisions of Modular Metal-on-metal THA Have a High Risk of Early Complications.
The risk of early complications is high after monoblock acetabular metal-on-metal (MoM) THA revisions. However, there is a paucity of evidence regarding clinical complications after isolated head-liner exchange of modular MoM THA. ⋯ Level IV, therapeutic study.
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Clin. Orthop. Relat. Res. · Feb 2019
Can Machine Learning Methods Produce Accurate and Easy-to-use Prediction Models of 30-day Complications and Mortality After Knee or Hip Arthroplasty?
Existing universal and procedure-specific surgical risk prediction models of death and major complications after elective total joint arthroplasty (TJA) have limitations including poor transparency, poor to modest accuracy, and insufficient validation to establish performance across diverse settings. Thus, the need remains for accurate and validated prediction models for use in preoperative management, informed consent, shared decision-making, and risk adjustment for reimbursement. ⋯ Level III, diagnostic study.
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Clin. Orthop. Relat. Res. · Feb 2019
Comparative StudyNo Difference Between Low- and Regular-dose Aspirin for Venous Thromboembolism Prophylaxis After THA.
Aspirin is established as an effective prophylaxis for venous thromboembolism (VTE) after THA; however, there is no consensus as to whether low- or regular-dose aspirin is more effective at preventing VTE. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Feb 2019
Comparative StudySpinal Fusion Is Associated With Changes in Acetabular Orientation and Reductions in Pelvic Mobility.
The importance of spinopelvic motion and its influence on THA stability are well recognized but poorly defined. With dynamic motion, compensatory changes in spine and pelvic positions are required to keep the necessary balance between the axial skeleton and lower extremity to maintain an erect posture. Although prior studies have shown spinal fusions to be an independent risk factor for hip dislocations after primary THA, the direct impact of fusion levels on spinopelvic motion remains unknown. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · Feb 2019
Comparative Study2018 John Charnley Award: Analysis of US Hip Replacement Bundled Payments: Physician-initiated Episodes Outperform Hospital-initiated Episodes.
The Centers for Medicare & Medicaid Services (CMS) launched the Bundled Payment for Care Improvement (BPCI) initiative in 2013 to create incentives to improve outcomes and reduce costs in various clinical settings, including total hip arthroplasty (THA). This study seeks to quantify BPCI initiative outcomes for THA and to determine the optimal party (for example, hospital versus physician group practice [PGP]) to manage the program. ⋯ Level II, economic and decision analysis.