Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Mar 2015
UHMWPE wear debris and tissue reactions are reduced for contemporary designs of lumbar total disc replacements.
Lumbar total disc replacement (L-TDR) is a procedure used to relieve back pain and maintain mobility. Contemporary metal-on-polyethylene (MoP) L-TDRs were developed to address wear performance concerns about historical designs, but wear debris generation and periprosthetic tissue reactions for these newer implants have not been determined. ⋯ In this preliminary study, short-term results suggest there was no significant influence of fixed- or mobile-bearing designs on wear particle characteristics of contemporary L-TDRs, but conventional UHMWPE has notably improved the wear resistance of these devices compared with historical UHMWPE.
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Clin. Orthop. Relat. Res. · Mar 2015
Who leaves the hospital against medical advice in the orthopaedic setting?
Patients who leave the hospital against medical advice are at risk for readmission and for a variety of complications and are likely to consume more healthcare resources. However, little is known about which factors, if any, may be associated with self-discharge (discharge against medical advice) among orthopaedic inpatients. ⋯ Level III, prognostic study. See the Instructions for Authors for complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Mar 2015
Injury risk to extraosseous knee vasculature during osteotomies: a cadaveric study with CT and dissection analysis.
Realignment osteotomies about the knee may be performed as distal femoral or proximal tibial osteotomies; both may be performed either on the medial or lateral sides of the knee, in closing- or opening-wedge fashion. Although rare, injury to neurovascular structures may occur, and the proximity of the vascular structures to the osteotomy saw cuts has been incompletely characterized. ⋯ This study clarifies that the genicular arteries on the opposite side of the surgical field, which cannot be seen and protected during the procedure, can be at risk of injury, particularly when the cortical hinge is compromised. Additional studies are necessary to address the potential risk of the dissection needed for plate placement and injuries related to drilling and screw placement during osteotomies around the knee.
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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.