Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jun 2019
Can Machine Learning Algorithms Predict Which Patients Will Achieve Minimally Clinically Important Differences From Total Joint Arthroplasty?
Identifying patients at risk of not achieving meaningful gains in long-term postsurgical patient-reported outcome measures (PROMs) is important for improving patient monitoring and facilitating presurgical decision support. Machine learning may help automatically select and weigh many predictors to create models that maximize predictive power. However, these techniques are underused among studies of total joint arthroplasty (TJA) patients, particularly those exploring changes in postsurgical PROMs. QUESTION/PURPOSES: (1) To evaluate whether machine learning algorithms, applied to hospital registry data, could predict patients who would not achieve a minimally clinically important difference (MCID) in four PROMs 2 years after TJA; (2) to explore how predictive ability changes as more information is included in modeling; and (3) to identify which variables drive the predictive power of these models. ⋯ Machine learning has the potential to improve clinical decision-making and patient care by helping to prioritize resources for postsurgical monitoring and informing presurgical discussions of likely outcomes of TJA. Applied to presurgical registry data, such models can predict, with fair-to-good ability, 2-year postsurgical MCIDs. Although we report all parameters of our best-performing models, they cannot simply be applied off-the-shelf without proper testing. Our analyses indicate that machine learning holds much promise for predicting orthopaedic outcomes. LEVEL OF EVIDENCE: Level III, diagnostic study.
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Clin. Orthop. Relat. Res. · Jun 2019
Postoperative Thromboprophylaxis With New Oral Anticoagulants is Superior to LMWH in Hip Arthroplasty Surgery: Findings from the Swedish Registry.
Although the use of thromboprophylaxis is well established, there is no consensus on the preferred thromboprophylaxis regimen after THA; large, population-based studies offer an opportunity to examine this problem in a robust way that can complement results from randomized trials. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Jun 2019
Biography Historical ArticleArtiFacts: Gerhard Küntscher's Marrow Nail.