Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · May 2015
Short-term complications have more effect on cost-effectiveness of THA than implant longevity.
Outcomes research in THA has focused largely on long-term implant survivorship as a primary outcome and emphasized the development of new implant technologies. In contrast, strategies to improve short-term outcomes, such as the frequencies of periprosthetic joint infections and unplanned readmissions, have received less attention. ⋯ Level II, economic and decision analysis.
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Clin. Orthop. Relat. Res. · May 2015
Surgeons' attitudes are associated with reoperation and readmission rates.
Attitudes influence how people make decisions. In an effort to decrease pilot judgment-related accidents, the Federal Aviation Administration teaches new pilots about hazardous attitudes that are believed to be incompatible with safe flight: macho, impulsive, worry, resignation, self-confidence, and antiauthority. If these attitudes are hazardous for pilots and their passengers, they may also be incompatible with the reliable and safe delivery of surgical care. ⋯ Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · May 2015
Do glycemic markers predict occurrence of complications after total knee arthroplasty in patients with diabetes?
Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated. ⋯ Level III, prognostic study.
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Clin. Orthop. Relat. Res. · May 2015
Do claims-based comorbidities adequately capture case mix for surgical site infections?
There is increasing interest in using administrative claims data for surveillance of surgical site infections in THAs and TKAs, but the performance of claims-based models for case-mix adjustment has not been well studied. Performance of claims-based models can be improved with the addition of clinical risk factors for surgical site infections. ⋯ Claims-based risk-adjustment models for surgical site infections in THA and TKA appear to be adequately calibrated but lack predictive discrimination, particularly with TKAs. The addition of clinical risk factors improves the discriminative ability of the models to a moderate degree; however, addition of clinical factors did not change calibrations, as the models showed reasonable degrees of calibration. When used in the clinical setting, the predictive performance of claims-based risk-adjustment models may be improved further with inclusion of additional clinical data elements.
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Clin. Orthop. Relat. Res. · May 2015
Platelet-rich plasma in meniscal repair: does augmentation improve surgical outcomes?
Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair. ⋯ Level III, therapeutic study.