Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2012
Does international normalized ratio level predict pulmonary embolism?
Preventing pulmonary embolism is a priority after major musculoskeletal surgery. The literature contains discrepant data regarding the influence of anticoagulation on the incidence of pulmonary embolism after joint arthroplasty. The American College of Chest Physicians guidelines recommend administration of oral anticoagulants (warfarin), aiming for an international normalized ratio (INR) level between 2 and 3. However, recent studies show aggressive anticoagulation (INR > 2) can lead to hematoma formation and increased risk of subsequent infection. ⋯ Level III, therapeutic study. See Instructions to Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Feb 2012
Review Meta AnalysisNonoperative versus operative treatment for thoracolumbar burst fractures without neurologic deficit: a meta-analysis.
Decision-making regarding nonoperative versus operative treatment of patients with thoracolumbar burst fractures in the absence of neurologic deficits is controversial. Lack of evidence-based practice may result in patients being treated inappropriately and being exposed to unnecessary adverse consequences. ⋯ Level II, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.
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Clin. Orthop. Relat. Res. · Feb 2012
Randomized Controlled Trial Multicenter StudyCeramic bearings for total hip arthroplasty have high survivorship at 10 years.
Ceramic bearings were introduced to reduce wear and increase long-term survivorship of total hip arthroplasty. In a previous study comparing ceramic with metal-on-polyethylene at 5 to 8 years, we found higher survivorship and no osteolysis for the ceramic bearings. ⋯ Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Feb 2012
Multicenter StudyPelvic discontinuity treated with custom triflange component: a reliable option.
Pelvic discontinuity is an increasingly common complication of THA. Treatments of this complex situation are varied, including cup-cage constructs, acetabular allografts with plating, pelvic distraction technique, and custom triflange acetabular components. It is unclear whether any of these offer substantial advantages. ⋯ Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Feb 2012
Multicenter StudyAge and obesity are risk factors for adverse events after total hip arthroplasty.
Defining the epidemiology of adverse events after THA will aid in the development of strategies to enhance perioperative care. ⋯ Older and obese patients should be counseled regarding their increased risk for the development of adverse events after THA. The cause of the decline in the rate of adverse events between two time periods is unclear and warrants further investigation to confirm and identify the cause.