The Journal of bone and joint surgery. American volume
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Patients' expectations of medical care are linked to their requests for treatment and to their assessments of outcome and satisfaction. Our goals were to measure patients" preoperative expectations of knee surgery and to develop and test patient-derived knee expectations surveys. ⋯ Patients have multiple expectations of knee surgery in the areas of symptom relief and improvement of physical and psychosocial function, and these expectations vary according to the diagnosis. We developed two valid and reliable surveys that can be used preoperatively to direct patient education and shared decision-making and to provide a framework for setting reasonable goals. Reexamining patients' responses postoperatively could provide a way to assess fulfillment of expectations, which is a crucial patient-derived measure of outcome and satisfaction.
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J Bone Joint Surg Am · Jul 2001
Randomized Controlled Trial Comparative Study Clinical TrialMechanical prophylaxis against deep-vein thrombosis after pelvic and acetabular fractures.
Deep-vein thrombosis is a common complication following pelvic and acetabular fractures. The hypothesis of this study was that pulsatile mechanical compression is superior to standard sequential mechanical compression for decreasing the prevalence of deep-vein thrombosis in patients with pelvic or acetabular fracture. ⋯ Pulsatile compression was associated with fewer deep-vein thromboses than was standard compression, with the difference representing a trend but not reaching significance with the number of patients studied.
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J Bone Joint Surg Am · Jul 2001
The Internet as a communication tool for academic orthopaedic surgery departments in the United States.
The Internet's appeal as an affordable, accessible medium for information transfer makes it a potentially useful tool for practicing physicians. In the past several years, Internet-based health-care companies have proliferated, and many medical centers have established individual web sites. The purpose of the present study was to evaluate academic orthopaedic surgery departments in the United States with respect to Internet visibility and content. ⋯ Academic orthopaedic surgery departments in the United States underutilize the Internet as a source of clinical and educational services. In addition, existing orthopaedic web sites are difficult to access with use of popular search engines. Thus, academic orthopaedic surgery departments in the United States are missing a valuable opportunity to promote awareness of their institutions and to become educational resources for the community.
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J Bone Joint Surg Am · Jun 2001
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPrevention of venous thromboembolic disease following primary total knee arthroplasty. A randomized, multicenter, open-label, parallel-group comparison of enoxaparin and warfarin.
Patients treated with total knee arthroplasty are at high risk for the development of venous thromboembolism postoperatively. This study compared the efficacy and safety of two common thromboprophylactic agents, enoxaparin (a low-molecular-weight heparin) and warfarin. ⋯ A fixed 30-mg subcutaneous dose of enoxaparin, administered twice daily, with the first dose administered within eight hours after the completion of surgery, was significantly more effective than adjusted-dose warfarin in reducing the occurrence of asymptomatic venous thromboembolism, including proximal deep-vein thrombosis, in patients undergoing total knee arthroplasty. With the numbers available, there was no significant difference between groups with regard to the occurrence of major hemorrhagic complications; however, the rate of overall hemorrhagic complications was higher in the enoxaparin group.
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J Bone Joint Surg Am · Jun 2001
The effect of surgically implanted bullet fragments on the spinal cord in a rabbit model.
Whether or not to remove bullets or bullet fragments from the spinal column of a neurologically intact patient has been a subject of continual debate. The controversy is due in part to a lack of information about the long-term effects of bullet fragments on spinal cord tissue. Although many studies have demonstrated the toxic effects of metal fragments on brain tissue, to our knowledge no one has evaluated the effects of the metals contained in commercially available bullets on spinal cord tissue. ⋯ In our study, copper fragments caused local neural toxicity involving as much as 10% of the spinal cord area, suggesting that there may be a scientific basis for removal of copper fragments lodged in the spinal cord, even in the absence of a neurological deficit.