Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Aug 2011
ReviewHistory and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene.
Highly crosslinked polyethylene (HXLPE) was introduced to reduce wear and osteolysis in total joint arthroplasty. While many studies report wear and osteolysis associated with HXLPE, analytical techniques, clinical study design and followup, HXLPE formulation and implant design characteristics, and patient populations differ substantially among investigations, complicating a unified perspective. ⋯ HXLPE liner studies consistently report lower femoral head penetration and an 87% lower risk of osteolysis. Reduction in femoral head penetration or osteolysis risk is not established for large-diameter (>32 mm) metallic femoral heads or ceramic femoral heads of any size. Few studies document the clinical performance of HXLPE in knees.
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Clin. Orthop. Relat. Res. · Aug 2011
Short-term and long-term orthopaedic issues in patients with fragility fractures.
Patients with impaired bone quality who suffer a fragility fracture face substantial challenges in both their short- and long-term care. In addition to poor bone quality, many of these patients have multiple medical comorbidities that alter their surgical risk and affect their ultimate functional recovery. Some medical issues can contribute to the altered bone quality and must be addressed to prevent future fractures. ⋯ Recognition of patients with impaired bone quality and proper treatment of their special needs in both the short and long term are essential for their best opportunity for maximal functional recovery and prevention of future fractures.
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Prevalence rates of most musculoskeletal pain conditions are higher among women than men. Reasons for these prevalence disparities likely include sex differences in basic pain mechanisms and gender differences in psychosocial factors. ⋯ A MEDLINE search was conducted using the terms "pain" or "musculoskeletal pain" and "gender differences" or "sex differences" with "health care," "health services," and "physician, attitude." Articles judged relevant were selected for inclusion. WHERE ARE WE NOW?: Higher pain prevalence in women is consistently observed but not well understood. The relative contributions of sex differences in pain mechanisms and gender differences in psychosocial factors (eg, coping, social roles) to explaining differences in prevalence are not yet clear. Gender disparities in the amount of healthcare use for pain may be partially explained by the experience of higher-intensity pain in women. Pain intensity also seems to be a major factor influencing treatment, especially the prescription of medications for acute pain. However, clinicians' gender stereotypes, as well as the clinician's own gender, appear to influence diagnostic and treatment decisions for more persistent pain problems. WHERE DO WE NEED TO GO?: The ultimate goal is optimal pain control for each individual, with gender being one difference between individuals. HOW DO WE GET THERE?: Further research is needed to address all three major purposes, with particular attention to whether gender-specific pain treatment may sometimes be warranted.
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Clin. Orthop. Relat. Res. · Jul 2011
ReviewDefining racial and ethnic disparities in pain management.
Substantial pain prevalence is as high as 40% in community populations. There is consistent evidence that racial/ethnic minority individuals are overrepresented among those who experience such pain and whose pain management is inadequate. ⋯ Racial/ethnic minority patients with pain need to be empowered to accurately report pain intensity levels, and physicians who treat such patients need to acknowledge their own belief systems regarding pain and develop strategies to overcome unconscious, but potentially harmful, negative stereotyping of minority patients.
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Clin. Orthop. Relat. Res. · Jul 2011
Does a multidisciplinary team decrease complications in male patients with hip fractures?
Men with hip fractures are more likely to experience postoperative complications than women. The Medical Orthopaedic Trauma Service program at New York Presbyterian Hospital utilizes a multidisciplinary team approach to care for patients with hip fractures. The service is comanaged by an attending hospitalist and orthopaedic surgeon, with daily walking rounds attended by the hospitalist, orthopaedic resident, physical therapist, social worker, and a dedicated Medical Orthopaedic Trauma Service physician assistant. ⋯ Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.