Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Nov 2018
Comparative Study Observational StudyEarly Maturity as the New Normal: A Century-long Study of Bone Age.
Epiphyseal fusion (EF) marks the completion of longitudinal bone growth, a critical milestone monitored during treatment of skeletal growth and/or developmental disorders. Recently, a trend toward accelerated skeletal maturation in children has been documented. Because current methods for assessing skeletal maturation include children in their reference populations born as early as the 1930s, the timing of EF events in contemporary patients may differ substantially from those standards. ⋯ Level II, prognostic study.
-
Clin. Orthop. Relat. Res. · Oct 2018
What Are the MCIDs for PROMIS, NDI, and ODI Instruments Among Patients With Spinal Conditions?
As new Patient-Reported Outcomes Measurement Information System (PROMIS) instruments are incorporated into clinical practice, determining how large a change on these instruments represents a clinically relevant difference is important; the metric that describes this is the minimum clinically important difference (MCID). Prior research on MCIDs of the Neck Disability Index (NDI) and Oswestry Disability Index (ODI) has produced values ranging from 5 to 10 points, but these measures have not been presented in relation to MCID values of PROMIS instruments. ⋯ Level I, diagnostic study.
-
Clin. Orthop. Relat. Res. · Oct 2018
What is the Minimum Clinically Important Difference for the WOMAC Index After TKA?
The WOMAC score is a validated outcome measure for use in patients undergoing TKA. Defining meaningful changes in the WOMAC score is important for sample-size calculations in clinical research and for interpreting published studies. However, inconsistencies among published studies regarding key definitions for changes in the WOMAC score after TKA potentially could result in incorrectly powered studies and the misinterpretation of clinical research results. ⋯ Level III, diagnostic study.
-
Clin. Orthop. Relat. Res. · Oct 2018
Comparative StudyThe Growing Executive-Physician Wage Gap in Major US Nonprofit Hospitals and Burden of Nonclinical Workers on the US Healthcare System.
In an era of increasing healthcare costs, the number and value of nonclinical workers, especially hospital management, has come under increased study. Compensation of hospital executives, especially at major nonprofit medical centers, and the "wage gap" with physicians and clinical staff has been highlighted in the national news. To our knowledge, a systematic analysis of this wage gap and its importance has not been investigated. ⋯ IV, economic and decision analysis.
-
Clin. Orthop. Relat. Res. · Oct 2018
Are Sonication Cultures of Antibiotic Cement Spacers Useful During Second-stage Reimplantation Surgery for Prosthetic Joint Infection?
Organisms may persist on polymethylmethacrylate (PMMA) spacer surfaces, and subclinical infection is postulated to be a source of infection recurrence. Several small patient series have shown a high proportion of positive sonication cultures on PMMA spacers at the second stage of a two-stage revision. However, the association between a positive sonication culture and the risk for recurrence of infection after two-stage exchange is not fully elucidated. ⋯ Level III, diagnostic study.