The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Feb 2020
Randomized Controlled Trial Multicenter StudyAutologous Iliac Bone Graft Compared with Biphasic Hydroxyapatite and Calcium Sulfate Cement for the Treatment of Bone Defects in Tibial Plateau Fractures: A Prospective, Randomized, Open-Label, Multicenter Study.
Bone-graft substitutes are commonly used for the augmentation of traumatic bone defects in tibial plateau fractures. However, their clinical performance compared with that of autologous bone-grafting, the gold standard in bone defect reconstruction, still remains under debate. This study investigates the differences in quality of life, pain, and radiographic outcomes in the treatment of tibial plateau fracture-associated bone defects with either autologous bone grafts or a bioresorbable hydroxyapatite and calcium sulfate cement (CERAMENT BONE VOID FILLER [CBVF]; BONESUPPORT). ⋯ Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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J Bone Joint Surg Am · Jan 2020
Multicenter Study Comparative StudyConventional Versus Highly Cross-Linked Polyethylene in Primary Total Knee Replacement: A Comparison of Revision Rates Using Data from the National Joint Registry for England, Wales, and Northern Ireland.
There is evidence to support the use of highly cross-linked polyethylene (HXLPE) in patients undergoing total hip arthroplasty. However, the benefits for those undergoing total knee arthroplasty are uncertain, with conflicting reports based on previous cohort analyses. The purpose of the present study was to compare the revision rates following primary total knee arthroplasty with use of HXLPE as compared with conventional polyethylene (CPE) using data from the National Joint Registry (NJR) for England, Wales and Northern Ireland. ⋯ Therapeutic Level III. See Instructions for Authors for a complete list of levels of evidence.
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J Bone Joint Surg Am · Dec 2019
Multicenter Study Comparative StudyArtificial Intelligence Distinguishes Surgical Training Levels in a Virtual Reality Spinal Task.
With the emergence of competency-based training, the current evaluation scheme of surgical skills is evolving to include newer methods of assessment and training. Artificial intelligence through machine learning algorithms can utilize extensive data sets to analyze operator performance. This study aimed to address 3 questions: (1) Can artificial intelligence uncover novel metrics of surgical performance? (2) Can support vector machine algorithms be trained to differentiate "senior" and "junior" participants who are executing a virtual reality hemilaminectomy? (3) Can other algorithms achieve a good classification performance? ⋯ The significance of these results lies in the potential of artificial intelligence to complement current educational paradigms and better prepare residents for surgical procedures.
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J Bone Joint Surg Am · Nov 2019
Multicenter StudyThree-Column Classification for Acetabular Fractures: Introduction and Reproducibility Assessment.
The Judet-Letournel classification has been widely used to diagnose acetabular fractures since it was proposed. However, there has been growing evidence of incompleteness and comprehension difficulty in this classification, which may adversely affect its clinical use. The purposes of this study were to introduce a novel 3-column classification system for acetabular fractures and to evaluate its reliability and reproducibility. ⋯ The 3-column concept of the acetabulum proposed in this study is helpful to master acetabular fractures for less experienced surgeons. The novel classification system could assist with acetabular fracture diagnosis and the choice of surgical approaches.
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J Bone Joint Surg Am · Oct 2019
Randomized Controlled Trial Multicenter Study Comparative StudyNot All Garden-I and II Femoral Neck Fractures in the Elderly Should Be Fixed: Effect of Posterior Tilt on Rates of Subsequent Arthroplasty.
Internal fixation is currently the standard of care for Garden-I and II femoral neck fractures in elderly patients. However, there may be a degree of posterior tilt (measured on preoperative lateral radiograph) above which failure is likely, and primary arthroplasty would be preferred. The purpose of this analysis was to determine the association between posterior tilt and the risk of subsequent arthroplasty following internal fixation of Garden-I and II femoral neck fractures in elderly patients. ⋯ Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.