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Orthopedics

Choice of implant combinations in total hip replacement: systematic review and network meta-analysis – The BMJ (free)

Commentary: What is the most effective type of hip implant combination for patients undergoing a hip replacement? – University of Bristol (free)

“…there is no evidence that any of the newer hip implant combinations, such as ceramic or uncemented, are better than the widely used small head metal-on-plastic cemented hip combination, which has been commonly used since the 1960s”.

 


Local nerve blocks can improve outcomes for people with hip fracture – NIHR Signal (free)

Original article: Peripheral nerve blocks for hip fractures – Cochrane Library (link to abstract – $ for full-text)

“One case of pneumonia prevented for every 7 hip fracture patients given pain relief with nerve block” (RT @NIHR_DC see Tweet)

 


Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

Original article: Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials – Journal of The American Geriatrics society (link to abstract – $ for full-text)

“Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hip fracture surgery” (RT @NIHR_DC see Tweet)

 


Osteoarthritis of the Knee Clical Care Standard – Australian Commission on Safety and Quality in Health Care (PDF Guideline and other resources)

Source: Research Review Australia (free resource to find articles of interest)

 


Low molecular weight heparin for prevention of venous thromboembolism in patients with lower-limb immobilization – Cochrane Library (link to abstract – $ for full-text)

“Moderate-quality evidence showed that the use of LMWH in outpatients reduced DVT when immobilization of the lower limb was required, when compared with no prophylaxis or placebo”.

 


Long-Term Effects of Repeated Injections of Local Anesthetic With or Without Corticosteroid for Lumbar Spinal Stenosis: A Randomized Trial – Archives of Physical Medicine and Rehabilitation (free)

Source: ACP Journal Wise ($)

“Epidural injections of corticosteroid plus lidocaine offered no benefits from 6 weeks to 12 months beyond that of injections of lidocaine alone”

 


When surgery is just a stitch-up – The Guardian (RT @Onisillos  see Tweet)

Related article: Use of placebo controls in the evaluation of surgery: systematic review – The BMJ (free)

“With evidence mounting that many minor operations owe their success to the placebo effect, is it time to call a halt to some routine procedures?”

 


A comprehensive guide to the new science of treating lower back pain – VOX (free)

“Mainstream medicine has failed people with chronic back pain”

 


New National Guideline Clearinghouse (NGC) Summaries in Low back, Cervical and Thoracic Spine Disorders with focus on occupational health.

Low Back Disorders – American College of Occupational and Environmental Medicine (free summary from NGC – $ see original guideline in ACOEM website)

Cervical and thoracic spine disorders – American College of Occupational and Environmental Medicine (free summary from NGC – $ see original guideline in ACOEM website)

 


Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis – The Lancet (link to abstract – $ for full-text)

Diclofenac 150 mg/day is the most effective NSAID available at present (are the cardiac and renal risks worth it?) and Paracetamol does not seem to work for this condition.

 


Is cyclobenzaprine useful for pain? – Therapeutics Initiative (free)

“…cyclobenzaprine is a long-acting sedative, not a muscle relaxant, and questioning whether any potential benefits are worth the side effects”. (from TI Newsletter). “If prescribed, a dose of 5 mg at bedtime should be tried first.  Evidence suggests titration based on response and tolerability to a maximum dose of 15 mg/day, for no longer than one week”.

 


Viewpoint: The Evolving Story of Overlapping Surgery – JAMA (free) (RT @pash22 see Tweet)

Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)

This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.

 


Implant Survival After Minimally Invasive Anterior or Anterolateral Vs. Conventional Posterior or Direct Lateral Approach: An Analysis of 21,860 Total Hip Arthroplasties from the Norwegian Arthroplasty Register (2008 to 2013) – The Journal of Bone and Joint Surgery (link to abstract – $ for full-text)

Commentary: Implant survival for minimally invasive vs. open hip surgery: 4 key notes – Spine Review (free)

Source: EvidenceAlerts (free resource to find articles of interest in all specialties)

“There were no significant differences among the surgical approaches with regard to the 2 and 5-year survival rates or RR of revision due to any cause”

 


Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update. Comparative Effectiveness Review – Agency for Healthcare Research and Quality (free report and summary)

See also: Executive summary (free PDF)

Source: ACP Journal Wise ($ resource to find articles of interest)

Comprehensive review on the evidence regarding thromboembolism prophylaxis in major orthopedic surgery.

 


What I Wish I’d Known About My Knees – The New York Times (10 articles per month are free)

Related guideline: Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline – The BMJ (free)

“There’s little evidence to support many of the procedures people undergo in the hopes of avoiding a knee replacement”. (RT @NYTHealth see Tweet)

 



A Meta-analysis of the Impact of Aspirin, Clopidogrel, and Dual Antiplatelet Therapy on Bleeding Complications in Noncardiac Surgery – Annals of Surgery (link to abstract – $ for full-text)

Source: EvidenceAlerts (free resource to find articles of interest)

“Antiplatelet therapy at the time of noncardiac surgery confers minimal bleeding risk with no difference in thrombotic complications. In many cases, it is safe to continue antiplatelet therapy in patients with important indications for their use”

 


After Knee or Hip Replacement, No Place Like Home – The New York Times (10 articles per month are free)

See also: Time to Rethink Inpatient Rehab After Knee Replacement? – The Rheumatologist (free)

Original article abstract ($ for full-text): Effect of Inpatient Rehabilitation vs a Monitored Home-Based Program on Mobility in Patients With Total Knee Arthroplasty: The HIHO Randomized Clinical Trial – JAMA (free)

The NYT commentary talks about the futility of some interventions currently used to postpone surgery and about the benefits of outpatient rehabilitation.

 


Preventing Sports Injury and Illness: Key Resources for Family Physicians – American Family Physician (free)

Selection of resources for primary care providers to improve their ability to prevent and treat injuries from sports and physical activity.

 


ACR Appropriateness Criteria Adds Topics, Covers More Clinical Variants Than Ever Before (free)

Browse Appropriateness Criteria Topics (free)

Source: Newswise

This comprehensive guide from American College of Radiology (ACR) covers 230 topics with more than 1,100 clinical indications and has just been updated. It is a very useful resource for doctors in all specialties to guide which exam is most appropriate in each clinical situation.

 


Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative – The BMJ (free)

See also: Knee Replacement Should Be Reserved for More Severe Osteoarthritis, Study Suggests – Physician’s First Watch (free)

Total knee replacement for patients with osteoarthritis had minimal effects on quality of life in this study. Severely affected patients seem to benefit the most from the procedure.

 


Going Under the Knife, With Eyes and Ears Wide Open – New York Times (free access to 10 articles per month)

“More and more surgeries are being performed with the patient awake and looking on, for financial and medical reasons”.

 


Trial of Pregabalin for Acute and Chronic Sciatica – New England Journal of Medicine (link to abstract – $ required for full-text)

Pregabalin did not reduce pain and was associated with higher incidence of adverse events.

 


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