The Journal of arthroplasty
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Multicenter Study
Are metal ion levels a useful trigger for surgical intervention?
The purpose of this study was to determine if cobalt and chromium ion levels can predict soft tissue damage at total hip revision. This study included 90 metal-on-metal total hip patients with preoperative cobalt and chromium ion levels. Tissue damage noted at revision surgery was graded on a 4-point scale. ⋯ The area under the curve was 0.37 for cobalt and 0.44 for chromium. The length of time to revision significantly correlated with tissue damage (P = .001). Ion levels are unreliable predictors of periarticular soft tissue damage and should not be used in isolation as surgical intervention triggers.
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Although current evidence is limited, obstructive sleep apnea (OSA) has been suggested as a risk factor for morbidity after primary joint arthroplasty. Our objective was to determine if patients with OSA have a higher likelihood of postoperative in-hospital complications or increased costs after revision arthroplasty. The Nationwide Inpatient Sample was used to identify 258,455 patients who underwent revision total hip arthroplasty or revision total knee arthroplasty between 2006 and 2008. ⋯ Multivariate analysis with logistic regression modeling was used to compare patients with and without OSA. Obstructive sleep apnea was associated with increased in-hospital mortality (odds ratio, 1.9; P = .002), pulmonary embolism (odds ratio, 2.1; P = .001), wound hematomas or seromas (odds ratio, 1.36; P < .001), and increased postoperative charges ($61,044 vs $58,813; P < .001). Further research is warranted.
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The purpose of this study was to validate a screening and management protocol to identify and reduce risk of renal, pulmonary, and delirium complications. A cohort study comparing incidence of perioperative complications on a consecutive series of patients undergoing total knee arthroplasty with a historical control group was conducted. The study cohort was evaluated prospectively to identify and reduce noncardiac medical complications. ⋯ There were 623 patients in the study cohort and 493 patients in the control population. There was a statistically significant decrease in the incidence of delirium (control, 10.4% vs study, 0.8%; P = .0001), renal (4.9% vs 0.6%, P = .0001), cardiac (16.3% vs 2.1%, P = .0001), and pulmonary complications (5.7% vs 0.8%, P = .0001) in the screened patients vs control. Preoperative screening and management for medical complications resulted in a significant decrease in renal, pulmonary, delirium, and cardiac complications.
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Comparative Study
Comparison of arthroplasty trial publications after registration in ClinicalTrials.gov.
In 2005, the International Committee of Medical Journal Editors established a mandatory trial registration before study enrollment for publication in member journals. Our primary objective was to evaluate the publication rates of arthroplasty trials registered with ClinicalTrials.gov (CTG). We further aimed to examine the consistency of registration summaries with that of final publications. ⋯ Of 101 closed and completed trials, we found 23 publications, for an overall publication rate of 22.8%. Registration of arthroplasty trials in CTG does not consistently result in publication or disclosure of results. In addition, changes are frequently made to the final presentation of the data that are not reflected in the trial registry.