The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Apr 2014
rhBMP use in cervical spine surgery: associated factors and in-hospital complications.
Widespread use of recombinant human bone morphogenetic protein (rhBMP) in cervical spine surgery has continued despite the U.S. Food and Drug Administration's 2008 notification regarding its adverse effects. Our study goals were to analyze how patient, surgical, and institutional factors influenced rhBMP use in cervical spinal fusion surgery and to examine the cervical-spine-specific in-hospital complications associated with rhBMP use. ⋯ Indications for rhBMP use for cervical spinal fusion are multifactorial. Its use is associated with a significantly higher likelihood of cervical-spine-specific complications.
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J Bone Joint Surg Am · Apr 2014
Younger age is associated with a higher risk of early periprosthetic joint infection and aseptic mechanical failure after total knee arthroplasty.
Although early aseptic mechanical failure after total knee arthroplasty has been reported in younger patients, it is unknown whether early revision due to periprosthetic joint infection is more or less frequent in this patient subgroup. The purpose of this study was to determine whether the incidence of early periprosthetic joint infection requiring revision knee surgery is significantly different in patients younger than fifty years of age compared with older patients following primary unilateral total knee arthroplasty. ⋯ Patients younger than fifty years of age had a significantly higher risk of undergoing revision due to periprosthetic joint infection or to aseptic mechanical failure at one year after primary total knee arthroplasty.
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J Bone Joint Surg Am · Apr 2014
ReviewLack of diversity in orthopaedic trials conducted in the United States.
Several orthopaedic studies have suggested patient race and ethnicity to be important predictors of patient functional outcomes. This issue has also been emphasized by federal funding sources. However, the reporting of race and ethnicity has gained little attention in the orthopaedic literature. The objective of this study was to determine the percentage of orthopaedic randomized controlled clinical trials in the United States that included race and ethnicity data and to record the racial and ethnic distribution of patients enrolled in these trials. ⋯ Few orthopaedic randomized controlled trials performed in the United States reported data on race or ethnicity. Among trials that did report demographic race or ethnicity data, the inclusion of minority patients was substantially lower than would be expected on the basis of census demographics. Failure to represent the true racial diversity may result in decreased generalizability of trial conclusions across clinical populations.
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J Bone Joint Surg Am · Apr 2014
Randomized Controlled TrialPercutaneous pin removal in the outpatient clinic--do children require analgesia?: a randomized controlled trial.
Percutaneous pins used in the surgical fixation of fractures in children are often removed in the outpatient clinic without the administration of analgesia. Pin removal can be a cause of anxiety for children, parents, and caregivers. Relatively little is known about the requirement of analgesia for this procedure. In a randomized controlled trial, we evaluated whether oral acetaminophen or ibuprofen reduced the pain experienced during pin removal. ⋯ Neither acetaminophen nor ibuprofen significantly reduced the pain score or heart rate associated with percutaneous pin removal in children as compared with the placebo. The oral analgesics administered were clinically equivalent to the placebo. These results suggest that non-narcotic analgesia use does not significantly reduce pain or heart rate associated with percutaneous pin removal in children.
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J Bone Joint Surg Am · Apr 2014
Multicenter StudyIs there a "July effect" in surgery for adolescent idiopathic scoliosis?
Prior studies in various medical and surgical specialties have suggested that the changeover of medical trainees in the United States at the end of the academic year, or so-called "July effect," negatively impacts the quality of patient care, including increasing morbidity and decreasing efficiency. We analyzed whether the outcomes of surgery for adolescent idiopathic scoliosis involving physicians-in-training as first assistants were affected by the time of year the surgery was performed. ⋯ Overall, the data did not provide evidence to support a July effect. Our results suggest that surgery for adolescent idiopathic scoliosis during July and August yields safety and outcomes equal to that of other months.