Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2012
Perioperative clopidogrel and postoperative events after hip and knee arthroplasties.
Hip and knee arthroplasties are widely performed and vascular disease among patients having these procedures is common. Clopidogrel is a platelet inhibitor that decreases the likelihood of thrombosis. It may cause intraoperative and postoperative bleeding, but its discontinuation increases the risk of vascular events. There is currently no consensus regarding the best perioperative clopidogrel regimen that balances these concerns. ⋯ Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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The requirement of obtaining informed consent before medical procedures is well established. With patients having greater access to information through information technology and owing to other factors, disclosure that goes beyond the traditional elements of the risks, benefits, and alternatives to an intervention is demanded from physicians. ⋯ Judicial decisions have subtly expanded the doctrine of informed consent beyond its traditional limits, at least in some cases. As informed consent law continues to develop, physicians should ask if information would be material to a reasonable patient while making medical decisions; if so, such information should be disclosed.
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Clin. Orthop. Relat. Res. · May 2012
Closed medical negligence claims can drive patient safety and reduce litigation.
Medical liability reform is viewed by many physician groups as a means of reducing medical malpractice litigation and lowering healthcare costs. However, alternative approaches such as closed medical negligence claims data may also achieve these goals. ⋯ Tort reform, in the form of legislatively prescribed limits on damages arising from lawsuits, is not the only means of addressing the incidence and costs related to medical malpractice litigation. As the experience of anesthesia and obstetric physicians has demonstrated, safety guidelines derived from analyzing past medical malpractice litigation can achieve the same goals while also promoting patient safety.
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Clin. Orthop. Relat. Res. · May 2012
Limited intraobserver and interobserver reliability for the common measures of hip joint congruency used in dysplasia.
A congruent hip frequently is cited in the literature as a prerequisite for performing a reconstructive pelvic osteotomy for hip dysplasia. The designation as congruent is important as incongruent joints generally are regarded as requiring a salvage-type procedure. Several measures of congruency are described in the literature, but it is unclear whether these measures are reliable. ⋯ Hip congruency has long been cited as a requirement for a reconstructive pelvic osteotomy, but based on the above findings, there is no clear agreement regarding what comprises a congruent joint. Thus, better criteria are needed to assess preoperative hip congruency to determine the role of congruency in patient outcomes after surgery for hip dysplasia.
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Clin. Orthop. Relat. Res. · May 2012
CD4 count is associated with postoperative infection in patients with orthopaedic trauma who are HIV positive.
Since the advent of effective antiretroviral therapy, the number of people with AIDS has increased and a certain percentage of these patients will require emergent orthopaedic surgery. Little is known regarding orthopaedic infections and the association of CD4 counts with postoperative infection in patients with HIV infection who experience orthopaedic trauma. ⋯ Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.