The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2006
Randomized Controlled Trial Multicenter Study Comparative StudyPhysical therapy alone compared with core decompression and physical therapy for femoral head osteonecrosis in sickle cell disease. Results of a multicenter study at a mean of three years after treatment.
Osteonecrosis of the femoral head is a common complication in patients with sickle cell disease, and collapse of the femoral head occurs in 90% of patients within five years after the diagnosis of the osteonecrosis. However, the efficacy of hip core decompression to prevent the progression of osteonecrosis in these patients is still controversial. ⋯ In this randomized prospective study, physical therapy alone appeared to be as effective as hip core decompression followed by physical therapy in improving hip function and postponing the need for additional surgical intervention at a mean of three years after treatment.
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J Bone Joint Surg Am · Sep 2006
Multicenter StudyPhysician incentives for academic productivity. An analysis of orthopaedic department compensation strategies.
Changes in the health-care industry have led to increasing demand for physician-driven clinical volume. This environment has altered the traditional balance among teaching, research, and service responsibilities for faculty in residency training programs. As economic pressures mount and budgets shrink, academic departments are exploring ways of paying faculty that would help to maintain the global mission of the organization. The purpose of this study was to examine the compensation strategy for faculty in academic orthopaedic surgery departments in the United States with a focus on compensation methods for academic productivity. ⋯ Most, but not all, departments accounted for academic productivity in their compensation system. Most programs used the chair's discretion to determine academic bonuses, but several departments had developed point systems. There are common themes with regard to this issue, including the importance of the academic mission, the need for clinical revenues, the value of flexibility and transparency, and the importance of culture and leadership.
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J Bone Joint Surg Am · Apr 2006
Multicenter StudyPredictors of functional outcome two years following revision hip arthroplasty.
Little is known about factors that might predict functional outcome following revision hip arthroplasty. The purpose of this study was to identify predictors of pain and physical function at two years following revision total hip arthroplasty and to evaluate whether the time that the patient waited for the surgery and whether the patient had complications were significant predictors of outcome. ⋯ Patients with better preoperative pain scores and fewer comorbidities have better outcomes following revision total hip arthroplasty. Although the time that the patient waited for the revision was not predictive of the ultimate WOMAC pain and function scores, we believe that performing revision arthroplasty before the patient has substantial functional compromise potentially improves the outcome.
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J Bone Joint Surg Am · Feb 2006
Randomized Controlled Trial Multicenter StudyEvaluation of a single-dose, extended-release epidural morphine formulation for pain after knee arthroplasty.
DepoDur is a single-dose, extended-release epidural morphine formulation designed to provide forty-eight hours of pain relief. The drug offers potential advantages over continuous epidural infusions, particularly in patients being treated with anticoagulation therapy. The purpose of this study was to evaluate the efficacy and safety of single-dose epidural DepoDur for pain control following knee arthroplasty. ⋯ With appropriate patient selection and monitoring, perioperative single-dose epidural DepoDur was a safe and effective analgesic alternative to postoperative intravenous patient-controlled analgesia following knee arthroplasty, with younger patients benefiting from the 20-mg dose. Additional studies of 10 to 15-mg doses for older patients are warranted.
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J Bone Joint Surg Am · Feb 2006
Randomized Controlled Trial Multicenter Study Comparative StudyRandomized comparison of reduction and fixation, bipolar hemiarthroplasty, and total hip arthroplasty. Treatment of displaced intracapsular hip fractures in healthy older patients.
Orthopaedic surgeons vary in their management of displaced intracapsular fractures of the hip in healthy older patients. The aim of this investigation was to determine the functional, clinical, and resource consequences of three different types of surgical treatment. ⋯ Arthroplasty is more clinically effective and cost-effective than reduction and fixation in healthy older patients with a displaced intracapsular fracture of the hip. The long-term results of total hip replacement may be better than those of bipolar hemiarthroplasty.