Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Jul 2019
What are the Optimal Cutoff Values for ESR and CRP to Diagnose Osteomyelitis in Patients with Diabetes-related Foot Infections?
Distinguishing osteomyelitis from soft-tissue infection of the foot is important because osteomyelitis is associated with more operations, amputation, and prolonged antibiotic exposure. Both erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are routinely ordered inflammatory biomarkers for evaluating foot infection. When initial evaluation is inconclusive, advanced imaging is indicated, and high clinical or radiographic suspicion of osteomyelitis may indicate bone biopsy to identify organisms and antibiotic sensitivity. Although ESR and CRP levels are helpful for distinguishing osteomyelitis from soft-tissue infections in patients with diabetes-related foot infections, parameters regarding optimal cutoff values for those tests have not, to our knowledge, been defined. ⋯ Level III, diagnostic study.
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Clin. Orthop. Relat. Res. · Jul 2019
Comparative StudyThe EQ-5D-5L Is Superior to the -3L Version in Measuring Health-related Quality of Life in Patients Awaiting THA or TKA.
As a generic measure of health-related quality of life among patients awaiting THA or TKA, the three-level version of the EQ-5D (EQ-5D-3L), which has three response levels of severity (no problems, some problems, and extreme problems/unable) to five questions, is widely used. Previous studies indicated that the ceiling effect of the EQ-5D-3L limits its application. The five-level version of the EQ-5D (EQ-5D-5L) was developed to enhance the measurement properties of the tool by adding two levels: slight problems and severe problems. However, only a few small studies have compared the EQ-5D-3L and EQ-5D-5L in patients awaiting THA and TKA. ⋯ Compared with the three-level version, the five-level version of the EQ-5D differentiates between patients awaiting THA and TKA much better based on their mobility, which is a key health aspect or outcome in these patients. Our findings suggest that the EQ-5D-5L is more appropriate for this population.
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Clin. Orthop. Relat. Res. · Jul 2019
Comparative StudyAre Patients Who Undergo THA for Infection at Higher Risk for 30-day Complications?
Value-based payment models, such as bundled payments, continue to become more widely adopted for total joint arthroplasty. However, concerns exist regarding the lack of risk adjustment in these payment and quality reporting models for THA. Providers who care for patients with more complicated problems may be financially incentivized to screen out such patients if reimbursement models fail to account for increased time and resources needed to care for these more complex patients. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Jul 2019
Drain Use is Associated with Increased Odds of Blood Transfusion in Total Shoulder Arthroplasty: A Population-Based Study.
In the absence of evidence supporting its benefit, the American Academy of Orthopaedic Surgeons (AAOS) strongly recommends against closed wound drainage in TKA; however, drain usage remains common in other joints, including the shoulder. While an extensive body of research exists for drain use in lower extremity joint arthroplasty, large-scale data on drain use and its association with benefits and complications in shoulder arthroplasties is lacking. Such data may be particularly valuable given the rapidly increasing demand for shoulder arthroplasties. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Jul 2019
High Risk of Symptomatic Venous Thromboembolism After Surgery for Spine Metastatic Bone Lesions: A Retrospective Study.
Cancer and spinal surgery are both considered risk factors for venous thromboembolism (VTE). However, the risk of symptomatic VTE for patients undergoing surgery for spine metastases remains undefined. ⋯ Level III, therapeutic study.