The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2007
Antibiotic dosing before primary hip and knee replacement as a pay-for-performance measure.
There is a trend toward linking the reimbursement for health care services to clinical outcome. One such pay-for-performance proposal that affects orthopaedic surgeons is linking reimbursement for hip and knee replacements to measures such as the percentage of patients receiving antibiotics before surgery. We analyzed the risk factors associated with failing to optimally administer preoperative antibiotics before primary hip and knee arthroplasty. ⋯ Approximately 13% of the patients did not receive optimal antibiotic therapy before total hip and knee replacement. Surgeons can improve their performance score for this measure by focusing antibiotic strategies on patients receiving a hip replacement and on complex cases, by developing systems for antibiotic dosing with the anesthesia team, and by improving documentation.
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J Bone Joint Surg Am · Feb 2007
Review Meta Analysis Comparative StudyArthroscopic compared with open repairs for recurrent anterior shoulder instability. A systematic review and meta-analysis of the literature.
Both arthroscopic and open surgical repairs are utilized for the management of anterior glenohumeral instability. To determine the evidence supporting the relative effectiveness of these two approaches, we conducted a rigorous and comprehensive analysis of all reports comparing arthroscopic and open repairs. ⋯ The available evidence indicates that arthroscopic approaches are not as effective as open approaches in preventing recurrent instability or enabling patients to return to work. Arthroscopic approaches resulted in better function as reflected by the Rowe scores in the randomized clinical trials. The study design and the arthroscopic technique had substantial effects on the results of the analysis.
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J Bone Joint Surg Am · Feb 2007
The use of the reverse shoulder prosthesis for the treatment of failed hemiarthroplasty for proximal humeral fracture.
Humeral hemiarthroplasty is an established treatment for patients with selected fractures of the proximal part of the humerus. However, a subset of patients have development of glenoid arthritis and rotator cuff deficiency due to tuberosity failure. To date, there has been no reliable salvage procedure for this problem. ⋯ The Reverse Shoulder Prosthesis offers a salvage-type solution to the problem of failed hemiarthroplasty due to glenoid arthritis and rotator cuff deficiency following tuberosity failure. The early results reported here are promising. In cases of severe proximal humeral bone deficiency, augmentation of the Reverse Shoulder Prosthesis with a proximal humeral allograft may improve patient satisfaction.
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Following total knee arthroplasty, some patients who fail to achieve >90 degrees of flexion in the early perioperative period may be considered candidates for manipulation of the knee under anesthesia. The purpose of this study was to assess the outcomes of manipulation following total knee arthroplasty. ⋯ Manipulation generally increases ultimate flexion following total knee arthroplasty. Patients with severe preoperative pain are more likely to require manipulation.