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In the multivariate analysis, patients with a prior revision (hazard ratio [HR]= 2.78, P= .02), an isolated polyethylene exchange (HR= 3.0, P= .004), and a hinged prosthesis (HR= 3.47, P= .05) were significant risk factors for lower revision-free survival. Forty-two patients (21%) underwent re-revision, most commonly for periprosthetic joint infection (7%), instability (6%), and aseptic loosening (5%). Re-revision occurred in 18/68 (26%) patients undergoing an isolated polyethylene exchange.
Patients less than 55 years undergoing revision TKA have a modest 5-year revision-free survival of 80%. Levofloxacin purchase Patients with prior revision TKAs (HR= 2.78), hinge type prostheses (HR= 3.47), and polyethylene-only revisions (HR= 3.0) had higher revision rates.
Patients less than 55 years undergoing revision TKA have a modest 5-year revision-free survival of 80%. Patients with prior revision TKAs (HR = 2.78), hinge type prostheses (HR = 3.47), and polyethylene-only revisions (HR = 3.0) had higher revision rates.
Revision total knee arthroplasty (TKA) involves varying levels of case complexity and costs depending on the following (1) number of components revised, (2) duration of operating room time, and (3) length of hospital stay. However, the cost associated with different types of aseptic TKA revisions, based on number and type of components revised, is not well described. We sought to determine differences in cost associated with different revision types, and to correlate this with average national hospital and surgeon reimbursement based on current Centers for Medicare and Medicaid Services data.
This is a retrospective review of aseptic revision TKAs performed at a single tertiary referral center from 2015 to 2018. Patient demographic data, operating room time, and direct surgery and total hospital costs obtained from an internal accounting database (Enterprise Performance Systems, Inc) were collected. Patients were stratified by the components revised (polyethylene liner only, tibia only, femur only, or botent revision.
There are significant differences in cost associated with aseptic TKA revisions based on number and type of components revised. These differences may not be accurately reflected in reimbursement, and often represent a burden to those who treat complex revisions.
There are significant differences in cost associated with aseptic TKA revisions based on number and type of components revised. These differences may not be accurately reflected in reimbursement, and often represent a burden to those who treat complex revisions.
The Fragility Index (FI) is a method for evaluating the robustness of statistically significant findings from randomized controlled trials (RCTs) beyond the P value in trials with dichotomous outcomes. The FI is defined as the number of patients in one arm of a trial that would have to have a different outcome to change the results of the trial from statistically significant to nonsignificant. This review assessed the FI in arthroplasty RCTs.
A systematic search was conducted in MEDLINE, Embase, and Web of Science for RCTs related to primary total joint arthroplasty (TJA) from 2010 to 2020. Trials with a statistically significant dichotomous primary outcome were included. The FI was calculated using Fisher's exact test to determine how many events would need to be reversed to change a study from statistically significant to nonsignificant.
A total of 34 RCTs were included. The median sample size was 103 patients (range 24-791). The median FI was 1 (range 0-45), meaning that reversing the outcome of just one patient in either treatment group of each trial would change it from a significant to a nonsignificant result.
Hip and knee arthroplasty RCTs with statistically significant dichotomous outcomes in TJA are fragile. The median FI in TJA is lower than the FI in any of the other previously reported orthopedic subspecialties. Fragility is another reason to be cautious when conducting or interpreting small trials, and to continue to strive toward large trials to answer important questions in TJA.
Level I.
Level I.
A chief complaint of men with stuttering priapism (SP) and sleep-related painful erections (SRPE) is bothersome nocturnal erections that wake them up and result in poor sleep and daytime tiredness. SP and SRPE are rare entities that have similarities in their clinical features, but that require different treatment approaches.
The aim of this study was to describe the clinical features, investigations, and effective management options for men with SP and SRPE.
Retrospective cohort study of 133 men with bothersome nocturnal painful erections that attended a tertiary andrology unit between 2004 and 2018. These men were divided into 3 groups. Group 1 (n=62) contains men with sickle cell SP; group 2 (n=40) has men with non-sickle cell SP and group 3 (n=31) contains men with SRPE.
To determine the effectiveness of medical and surgical treatments for men with SP and SRPE.
Hydroxyurea and automated exchange transfusion were the most effective treatment options in the sickle cell SP group. Hormonal manipulating Priapism and Sleep-Related Painful Erection. J Sex Med 2021;18376-384.
Managing men in these 3 groups differently and in accordance with the proposed treatment pathway provides a more structured approach to the management of these rare conditions. Johnson M, McNeillis S, Chiriaco G, et al. Rare Disorders of Painful Erection A Cohort Study of the Investigation and Management of Stuttering Priapism and Sleep-Related Painful Erection. J Sex Med 2021;18376-384.
We used bibliometric techniques to analyze the participation of Spanish institutions in research on major cardiovascular topics during the last 4 decades.
Bibliometric indicators of production, collaboration and impact were obtained from the Science Citation Index Expanded (SCIE) database. Search strategies were used in major topics and institutional collaboration networks were identified, represented using the Kamada-Kawai algorithm.
Global cardiovascular publications doubled from 2000 to 2018. In 2018, those by Spanish authors represented 2.33%, with a participation of between 7% and 1.84%, depending on the topics analyzed. The offset with respect to global production was between 0 and 7 years. Annual growth rates were higher in more recent topics. Revista Española de Cardiología published the largest number of articles from Spanish institutions. The journals generating the highest number of citations in the chosen topics were the Journal of the American College of Cardiology, Europace, and the European Heart Journal.
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