Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Sep 2012
Randomized Controlled Trial Comparative StudyBlood loss in cemented THA is not reduced with postoperative versus preoperative start of thromboprophylaxis.
Thrombin formation commences perioperatively in orthopaedic surgery and therefore some surgeons prefer preoperative initiation of pharmacologic thromboprophylaxis. However, because of the potential for increased surgical bleeding, the postoperative initiation of thromboprophylaxis has been advocated to reduce blood loss, need for transfusion, and bleeding complications. Trials on timing of thromboprophylaxis have been designed primarily to detect thrombotic events, and it has been difficult to interpret the magnitude of blood loss and bleeding events owing to lack of information for bleeding volume and underpowered bleeding end points. ⋯ Our data suggest blood loss is similar with preoperative and postoperative initiation of dalteparin thromboprophylaxis, but indicate a trend toward fewer transfusion requirements which might favor postoperative start of thromboprophylaxis.
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Clin. Orthop. Relat. Res. · Sep 2012
Randomized Controlled Trial Comparative StudyMost effective regimen of tranexamic acid in knee arthroplasty: a prospective randomized controlled study in 240 patients.
The antifibrinolytic tranexamic acid reduces surgical blood loss, but studies have not identified an optimal regimen. ⋯ Single-dose tranexamic acid did not give effective results. The two-dose regimen of POIO was the least amount necessary for effective results. When compared against the control, this regimen produced reduction of drain loss and total blood loss, whereas the IOPO regimen did not. The three-dose regimen of POIOPO produced maximum effective reduction of drain loss and total blood loss.
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Clin. Orthop. Relat. Res. · Sep 2012
Editorial ReviewReviewing for clinical orthopaedics and related research.
Peer review in science was established in the 17th Century and while not without detractors and some controversy, has been a mainstay of high-quality scientific publications ever since. Most believe peer review adds substantially to the value of papers that achieve publication. However, in practice, peer review can be practiced with varying degrees of rigor and the value of the review depends on rigor. ⋯ In this brief review I outline such key questions. An invitation to review is an honor and reflects the confidence of the editor in the reviewer's expertise and accomplishments. Given proper reviews and recommendations, the majority of authors believe peer review adds great value to their papers and the reviewer makes contributions to the community and their own knowledge.
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Clin. Orthop. Relat. Res. · Sep 2012
Neer modification of open Bankart procedure: what are the rates of recurrent instability, functional outcome, and arthritis?
Neer modified the Bankart procedure by combining a superoinferior capsular shift with the labral reattachment. The theoretical advantages of the modification were that such a procedure would restore the patient's anatomy and also treat the repeated capsular stretching encountered in anteroinferior instability without limiting external rotation and, thereby reducing the risk of arthritis. ⋯ The open Bankart procedure modified by Neer provided high function scores but a relatively low rate of return to sport and high rate of recurrent instability. Our rate of recurrent instability, similar to that obtained with arthroscopic Bankart procedures, has prompted us to abandon the open procedure.
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Clin. Orthop. Relat. Res. · Sep 2012
Triple innominate osteotomy for Legg-Calvé-Perthes disease in children: does the lateral coverage change with time?
Triple innominate osteotomy (TIO) is one of the modalities of surgical containment in Legg-Calvé-Perthes disease (LCPD). However, overcoverage with TIO can lead to pincer impingement. ⋯ TIO resulted in femoral head containment in all cases. Lateral acetabular coverage changed during the growing years in all patients. Surgical correction beyond 44° of CE angle and -6° of ARA should be avoided to prevent pincer morphology later.