The Journal of arthroplasty
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Blood transfusion after joint arthroplasty occurs in up to two thirds of patients. We conducted a systematic review of the literature to determine the methodological quality of published randomized controlled trials (RCTs). We searched MEDLINE, EMBASE, and Cochrane to identify RCTs in arthroplasty with blood conservation as the primary outcome from 2001 to 2007. ⋯ Epidemiology affiliation (P = .003), funding support (<.001), and year of publication (<.001) were the predictors of reporting quality, predicting 46% of the variability (R(2) = 0.46). This suggests poor reporting quality of trials in blood conservation. The inclusion of an epidemiologist or a biostatistician for the design of a trial is strongly recommended.
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The statistical analysis of a study's results is critical to its interpretation. Often confused, 2 types of t tests exist for dependent or independent samples. We reviewed randomized controlled trials that included patients undergoing bilateral total hip or knee arthroplasty (dependent samples) that used the t test for analysis. ⋯ Of the 30 studies that compared a pure sample of only bilateral patients, 18 (60%) incorrectly used the independent t test. Of the 10 studies with mixed samples, 8 (80%) used the independent t test. The extent to which the incorrect use of this statistical test led to misleading conclusions is uncertain; however, our findings highlight the misuse of statistical tests in the arthroplasty literature.
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This systematic review compared 2 treatments for hip disease in active young patients: modern metal-on-metal total hip resurfacing and standard total hip arthroplasty. We conducted a literature search to identify relevant randomized and clinical controlled trials and included 968 patients from 4 trials in our analysis. ⋯ Hip function scores were similar between the 2 groups, but the resurfacing group showed higher activity levels. These results have provided insufficient evidence to determine whether modern metal-on-metal total hip resurfacing offers clinical advantages over standard total hip arthroplasty.
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The use of aspirin for venous thromboembolism (VTE) prophylaxis after major orthopaedic surgery is controversial. The hypothesis of the present study is that aspirin will decrease the rate of operative site bleeding without increasing thromboembolic events when aspirin is used for VTE prophylaxis after major orthopaedic surgery. ⋯ The operative site bleeding relative risks of VKA, LMWH, and pentasaccharides versus aspirin, are 4.9, 6.4, and 4.2, respectively. A pooled analysis of RCTs supports the use of aspirin for VTE prophylaxis after major orthopaedic surgery.
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Improvements in materials and fixation have addressed many of the limitations of resurfacing total hip arthroplasty (THA). The functional demands and the longevity of arthroplasty patients are increasing. Many patients have embraced the functional capacity, bone conservation, and revision options of hip resurfacing. ⋯ The procedure is now also conservative on the acetabular side, and revision of the cementless acetabular component is rare. The operative parameters of femoral resurfacing revisions (conversion to a THA) are similar to that of a primary THA. Bearing technology will continue to evolve.