Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2019
Comparative StudySpinal Fusion Is Associated With Changes in Acetabular Orientation and Reductions in Pelvic Mobility.
The importance of spinopelvic motion and its influence on THA stability are well recognized but poorly defined. With dynamic motion, compensatory changes in spine and pelvic positions are required to keep the necessary balance between the axial skeleton and lower extremity to maintain an erect posture. Although prior studies have shown spinal fusions to be an independent risk factor for hip dislocations after primary THA, the direct impact of fusion levels on spinopelvic motion remains unknown. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · Feb 2019
Comparative Study2018 John Charnley Award: Analysis of US Hip Replacement Bundled Payments: Physician-initiated Episodes Outperform Hospital-initiated Episodes.
The Centers for Medicare & Medicaid Services (CMS) launched the Bundled Payment for Care Improvement (BPCI) initiative in 2013 to create incentives to improve outcomes and reduce costs in various clinical settings, including total hip arthroplasty (THA). This study seeks to quantify BPCI initiative outcomes for THA and to determine the optimal party (for example, hospital versus physician group practice [PGP]) to manage the program. ⋯ Level II, economic and decision analysis.
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Clin. Orthop. Relat. Res. · Feb 2019
What is the Natural History of the Triangular Fibrocartilage Complex Tear Without Distal Radioulnar Joint Instability?
The triangular fibrocartilage complex (TFCC) tear is a common cause of ulnar-side wrist pain; however, its natural course is not well understood. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · Feb 2019
2018 Frank Stinchfield Award: Spinopelvic Hypermobility Is Associated With an Inferior Outcome After THA: Examining the Effect of Spinal Arthrodesis.
Many patients undergo both THA and spinal arthrodesis, and those patients may not fare as well as those who undergo one procedure but not the other. The mechanisms of how spinal arthrodesis affects patient function after THA remain unclear. ⋯ In patients with spinal arthrodesis who have undergone THA, spinopelvic hypermobility is associated with inferior outcomes, including hip instability. Spinopelvic hypermobility should be routinely assessed because these patients may have a narrow zone of optimum cup orientation that would require new technology to define and assist the surgeon in obtaining it.Level of Evidence Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Jan 2019
Comparative StudyThe 2018 Chitranjan S. Ranawat, MD Award: Developing and Implementing a Novel Institutional Guideline Strategy Reduced Postoperative Opioid Prescribing After TKA and THA.
Opioid prescription management is challenging for orthopaedic surgeons, and we lack evidence-based guidelines for responsible opioid prescribing. Our institution recently developed opioid prescription guidelines for patients undergoing several common orthopaedic procedures including TKA and THA in an effort to reduce and standardize prescribing patterns. ⋯ Level II, therapeutic study.