Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 2013
Tracked ultrasound snapshots in percutaneous pedicle screw placement navigation: a feasibility study.
Computerized navigation improves the accuracy of minimally invasive pedicle screw placement during spine surgery. Such navigation, however, exposes both the patient and the staff to radiation during surgery. To avoid intraoperative exposure to radiation, tracked ultrasound snapshots-ultrasound image frames coupled with corresponding spatial positions-could be used to map preoperatively defined screw plans into the intraoperative coordinate frame. The feasibility of such an approach, however, has not yet been investigated. ⋯ Tracked ultrasound may allow accurate computer-navigated pedicle screw placement while avoiding ionizing radiation in the operating room; however, further studies that compare this approach with other navigation techniques are needed to confirm the practical use of this new approach.
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Clin. Orthop. Relat. Res. · Nov 2013
ReviewHealth policy implications of outcomes measurement in orthopaedics.
An emphasis on "value" over volume in health care is driving new healthcare measurement, delivery, and payment models. Orthopaedic surgery is a major contributor to healthcare spending and, as such, is the focus of many of these new models. WHERE ARE WE NOW?: An evaluation of "value" in orthopaedics requires information that has not traditionally been collected as part of routine clinical practice. ⋯ In the United States, we should make comparable investments in registries to measure patient-reported outcomes. To address escalating costs, we need to improve the accuracy of cost data by applying modern cost accounting processes. HOW DO WE GET THERE?: Orthopaedists should take a leadership position in the promotion and implementation of value-based health care by advocating for the use of registries to measure risk-adjusted patient specific outcomes, negotiating with payors for value-based payment incentives and applying modern cost accounting processes to control costs rather than waiting for public and private payors to define components of the value equation that will affect how orthopaedic surgeons are evaluated and compensated in the future.
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Clin. Orthop. Relat. Res. · Nov 2013
Image guided core needle biopsy of musculoskeletal lesions: are nondiagnostic results clinically useful?
The clinical utility of nondiagnostic core needle biopsies is not fully understood. Understanding the clinical and radiologic factors associated with nondiagnostic core needle biopsies may help determine the utility of these nondiagnostic biopsies and guide clinical decision making. ⋯ Nondiagnostic core needle biopsy results in musculoskeletal lesions are not entirely useless. At times, they can be supportive of benign processes and can help avert unnecessary surgical procedures.
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Clin. Orthop. Relat. Res. · Nov 2013
Randomized Controlled TrialDoes vitamin D improve osteoarthritis of the knee: a randomized controlled pilot trial.
Animal, epidemiologic, and human clinical studies suggest a putative role for vitamin D in osteoarthritis (OA). Inadequate sunlight exposure and lower serum levels of 25(OH)D appear in some reports to be associated with an increased risk for progression of knee OA. ⋯ The results above suggest there is a small but statistically significant clinical benefit to vitamin D treatment in patients with knee OA, although we recommend a long-term study to determine whether these changes are clinically important and whether they will be sustained with time. Further studies with long-term radiologic evaluations are needed.