Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Dec 2017
What Adverse Events and Injuries Are Cited in Anesthesia Malpractice Claims for Nonspine Orthopaedic Surgery?
Malpractice claims that arise during the perioperative care of patients receiving orthopaedic procedures will frequently involve both orthopaedic surgeons and anesthesiologists. The Anesthesia Closed Claims database contains anesthesia malpractice claim data that can be used to investigate patient safety events arising during the care of orthopaedic patients and can provide insight into the medicolegal liability shared by the two specialties. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Dec 2017
Comparative StudyCurrent Total Knee Designs: Does Baseplate Roughness or Locking Mechanism Design Affect Polyethylene Backside Wear?
Tibial baseplate roughness and polyethylene-insert micromotion resulting from locking-mechanism loosening can lead to polyethylene backside wear in TKAs. However, many retrieval studies examining these variables have evaluated only older TKA implant designs. ⋯ Our study showed that in the complex interplay between baseplate surface finish and locking mechanism design, a polished baseplate with a robust locking mechanism had the lowest backside damage and linear wear. However, improvements in locking mechanism design in nonpolished baseplates potentially may offset some advantages of a polished baseplate. Further retrieval analyses need to be done to confirm such findings, especially analyzing current crosslinked polyethylene. Additionally, we need mid- and long-term studies comparing TKA revisions attributable to wear and osteolysis among implants before understanding if such design differences are clinically relevant.
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Clin. Orthop. Relat. Res. · Dec 2017
What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?
Despite extensive research regarding risk factors for adverse events after total joint arthroplasty (TJA), there are few publications describing the timing at which such adverse events occur. ⋯ Level III, therapeutic study.
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Clin. Orthop. Relat. Res. · Dec 2017
Comparative StudyPerioperative Risk Adjustment for Total Shoulder Arthroplasty: Are Simple Clinically Driven Models Sufficient?
There is growing interest in value-based health care in the United States. Statistical analysis of large databases can inform us of the factors associated with and the probability of adverse events and unplanned readmissions that diminish quality and add expense. For example, increased operating time and high blood urea nitrogen (BUN) are associated with adverse events, whereas patients on antihypertensive medications were more likely to have an unplanned readmission. Many surgeons rely on their knowledge and intuition when assessing the risk of a procedure. Comparing clinically driven with statistically derived risk models of total shoulder arthroplasty (TSA) offers insight into potential gaps between common practice and evidence-based medicine. ⋯ Clinicians can utilize our results to understand that clinician intuition may not always offer the best risk adjustment and that factors impacting TSA unplanned readmission and adverse events may be best derived from large data sets. However, because current analyses explain limited variation in outcomes, future studies might look to better define what factors drive the variation in unplanned readmission and adverse events.
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Clin. Orthop. Relat. Res. · Dec 2017
What Are the Frequency, Associated Factors, and Mortality of Amputation and Arthrodesis After a Failed Infected TKA?
For patients with failed surgical treatment of an infected TKA, salvage operations such as arthrodesis or above-knee amputation (AKA) may be considered. Clinical and institutional factors associated with AKA and arthrodesis after a failed TKA have not been investigated in a large-scale population, and the utilization rate and trend of these measures are not well known. ⋯ Level III, therapeutic study.