Bulletin of the NYU hospital for joint diseases
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While much literature has focused on the management of osteonecrosis of the femoral head, far less information is available regarding the treatment and outcomes of this disease in the proximal humerus. To a great extent, management of humeral head osteonecrosis has been inferred from studies involving the femoral head. ⋯ Regardless of the underlying etiology, the common pathway involves disruption of the arterial inflow or the venous outflow of the bone, with resultant osseous cell death. The general treatment strategies for humeral head osteonecrosis include nonoperative modalities for symptomatic early disease, with surgical intervention reserved for more advanced disease or those with recalcitrant pain.
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Clavicle fractures remain one of the more common fractures encountered in the orthopaedic office. Nonoperative management remains the standard of care in most cases. ⋯ When operative reduction and fixation is indicated, there are numerous techniques to aid the surgeon patient care. This article reviews the midshaft clavicle fracture and discusses recent outcome studies on patients with fracture shortening and approaches to operative management.
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Bull NYU Hosp Jt Dis · Jan 2009
ReviewResurfacing versus conventional total hip arthroplasty - review of comparative clinical and basic science studies.
Although standard total hip arthroplasties have a long and successful history as the standard of care for advanced, symptomatic osteoarthritis, there is increasing patient demand and surgeon interest in femoral bone conserving resurfacing alternatives. The purpose of this study was to assess the state of the research that directly compares the outcomes of conventional total hip arthroplasty procedures with the current generation of metal-on-metal resurfacing hip arthroplasties. ⋯ While there is still much debate and room for additional research on this topic, multiple midterm clinical results suggest that resurfacing hip arthroplasty represents a safe, effective alternative to conventional total hip arthroplasty, especially for younger, active patients.
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Bull NYU Hosp Jt Dis · Jan 2009
Comparative StudyResurfacing matched to standard total hip arthroplasty by preoperative activity levels - a comparison of postoperative outcomes.
Some studies have suggested that resurfacing patients are generally more active postoperatively than their conventional total hip arthroplasty (THA)counterparts, but controversy remains over whether this is a reflection of preferential use of resurfacing for younger and higher-activity patients. We hypothesized that, when controlling for preoperative activity levels, in addition to relevant clinical and demographic factors, resurfacing provides similar results to conventional hip arthroplasty. ⋯ The results of this study suggest that patients treated with hip resurfacing arthroplasty have a significantly higher postoperative activity level, as compared to those treated with conventional THA, when controlled for preoperative factors.
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Bull NYU Hosp Jt Dis · Jan 2009
Safety reporting in randomized clinical trials - a need for improvement.
The reporting of adverse events (AEs) in randomized clinical trials (RCTs) is often lacking in the publication of trials. Part of the problem is the way safety data are reported in RCTs. Reporting of "time to event," use of standardized incidence ratios for comparison to normal population or disease controls, use of "patient years" when reporting AE, and adequate sample size and power calculations are some of the problems that need to be addressed and improved in RCTs.