Clinical orthopaedics and related research
-
Clin. Orthop. Relat. Res. · Dec 2016
Comparative StudyEstimating the Societal Benefits of THA After Accounting for Work Status and Productivity: A Markov Model Approach.
Demand for total hip arthroplasty (THA) is high and expected to continue to grow during the next decade. Although much of this growth includes working-aged patients, cost-effectiveness studies on THA have not fully incorporated the productivity effects from surgery. ⋯ Level III, economic and decision analysis.
-
Clin. Orthop. Relat. Res. · Nov 2016
Comparative StudySurgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA.
Patients with morbid obesity, defined as a BMI greater than 40 kg/m2, and super obesity, defined as a BMI greater than 50 kg/m2, increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care. Until recently, analysis of higher BMI data was limited to small cohorts from hospital-based data banks, based on BMI or height and weight only, often as part of a multivariate analysis. On October 1, 2010 the Centers for Medicare & Medicaid Services added a fifth digit to the BMI data, V85.xx, in the Medicare data bank, which allowed data mining of cases of patients with higher BMI. To our knowledge, our study is the first large retrospective Medicare data mining study, which allows us to examine BMI levels greater than 40 and 50 kg/m2 to delineate risks, complications, and costs for these patients. ⋯ Level III, therapeutic study.
-
Clin. Orthop. Relat. Res. · Nov 2016
Satisfying Results of Primary Hip Arthroplasty in Patients With Hip Dysplasia at a Mean Followup of 20 Years.
Developmental dysplasia of the hip (DDH) is a common cause of secondary osteoarthritis (OA) in younger patients, and when end-stage OA develops, a THA can provide a solution. Different options have been developed to reconstruct these defects, one of which is impaction bone grafting combined with a cemented cup. To determine the true value of a specific technique, it is important to evaluate patients at a long-term followup. As there are no long-term studies, to our knowledge, on THA in patients with DDH using impaction bone grafting with a cemented cup, we present the results of this technique at a mean of 15 years in patients with previous DDH. ⋯ Level IV, therapeutic study.
-
Clin. Orthop. Relat. Res. · Nov 2016
Cement Augmentation in Sacroiliac Screw Fixation Offers Modest Biomechanical Advantages in a Cadaver Model.
Sacroiliac screw fixation in elderly patients with pelvic fractures is prone to failure owing to impaired bone quality. Cement augmentation has been proposed as a possible solution, because in other anatomic areas this has been shown to reduce screw loosening. However, to our knowledge, this has not been evaluated for sacroiliac screws. ⋯ In osteoporotic bone, the addition of cement to sacroiliac screw fixation might improve screw anchorage. However, larger mechanical studies using these findings as pilot data should be performed before applying these preliminary findings clinically.
-
Clin. Orthop. Relat. Res. · Nov 2016
Randomized Controlled Trial Multicenter StudyCORR® ORS Richard A. Brand Award: Clinical Trials of a New Treatment Method for Adhesive Capsulitis.
Conservative and even surgical management of adhesive capsulitis often is prolonged and painful. Management of adhesive capsulitis is lacking evidence-based controlled clinical trials. ⋯ Level II, therapeutic study.