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Evidence Based Medicine in Orthopedic Surgery, An Issue of Orthopedic Clinics - E-Book

Evidence Based Medicine in Orthopedic Surgery, An Issue of Orthopedic Clinics - E-Book

Safdar N. Khan | Mark A. Lee | Munish C. Gupta

(2010)

Additional Information

Book Details

Abstract

Articles include: Definition and Principles, Evidence-Based Orthopaedics: Is it possible? Conflict of Interest and Orthopaedic Publications, SPRINT Trial, Clavicle fractures, Intracapsular femur neck fractures, SPORT trial: Spinal stenosis, Cervical spondylotic myelopathy – anterior vs posterior approaches, Total disc replacement vs Fusion, Flexible constructs for spinal fusion, DVT prophylaxis in adult reconstruction, Hip resurfacing – what is the evidence, Graft selection/type in ACL surgery, LEAP Trial, BESTT Trial, SPORT trial: Lumbar disc herniations,

SPORT trial: Degenerative spondylolisthesis.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Contributors iii
Contents vii
Orthopedic Clinics of North America xii
Preface: Evidence–Based Medicine in Orthopedic Surgery xiii
Chapter 1. Principles of Evidence-Based Medicine 131
EVIDENCE-BASED ORTHOPEDICS 131
GRADING OF EVIDENCE 132
CHALLENGES OF CONDUCTING RCTS IN SURGERY 132
THE VALUE OF OBSERVATIONAL STUDIES WHEN NO RCTS EXIST 132
LEARNING THE ‘‘NEW’’ LANGUAGE OF EBM 132
PRACTICING EBM 135
WHY BOTHER WITH EBM? 137
REFERENCES 137
Chapter 2. Evidence-Based Orthopedic Surgery: Is It Possible? 139
MEASURING OUTCOMES 140
CLINICIAN-BASED OUTCOMES 140
PATIENT-REPORTED OUTCOMES 140
EVALUATING EXISTING OUTCOMES MEASURES 141
EVIDENCE-BASED ORTHOPEDICS: IS IT POSSIBLE? 141
REFERENCES 142
Chapter 3. Challenges of Randomized Controlled Surgical Trials 145
RCTS AND EVIDENCE-BASED MEDICINE 146
BARRIERS TO PERFORMING AND PUBLISHING RCTS 146
QUALITY OF PUBLISHED RCTS 148
POTENTIAL SUBJECTS’ LACK OF COMPREHENSION AND SUPPORT OF RANDOMIZATION AS A BARRIER TO RECRUITMENT 149
OTHER BARRIERS TO SUBJECT RECRUITMENT AND RETENTION 150
ALTERNATIVES TO SURGICAL RCTS 150
ETHICAL CONCERNS REGARDING SURGICAL RCTS 151
CASE STUDY 153
SUMMARY 153
REFERENCES 154
Chapter 4. Optimal Treatment of Femoral Neck Fractures According to Patient’s Physiologic Age: An Evidence- Based Review 157
FEMORAL NECK FRACTURES IN YOUNG PATIENTS 157
SHOULD THE INTRACAPSULAR PRESSURE/ HEMATOMA BE DECOMPRESSED? 158
WHICH IMPLANT IS BEST FOR FEMORAL NECK FRACTURES IN YOUNG PATIENTS? 158
SUMMARY OF THE EVIDENCE: PHYSIOLOGICALLY YOUNG PATIENTS 159
EXPERT OPINION 159
FEMORAL NECK FRACTURES IN OLD PATIENTS 160
IS THERE A ROLE FOR NONOPERATIVE MANAGEMENT IN THE ELDERLY WITH FEMORAL NECK FRACTURES? 160
WHAT IS THE BEST IMPLANT FOR INTERNAL FIXATION IN THE ELDERLY PATIENT POPULATION? 162
WHAT TYPE OF ACUTE ARTHROPLASTY IS THE BEST FOR FEMORAL NECK FRACTURES? 163
SUMMARY OF THE EVIDENCE: PHYSIOLOGICALLY OLDER PATIENTS 163
REFERENCES 165
Chapter 5. Fusion Versus Disk Replacement for Degenerative Conditions of the Lumbar and Cervical Spine: Quid Est Testimonium? 167
LUMBAR FUSION 167
CERVICAL SPINE 176
THE PHILOSOPHY 178
SUMMARY 178
REFERENCES 178
Chapter 6. Contemporary Management of Symptomatic Lumbar Spinal Stenosis 183
PATHOPHYSIOLOGY AND CLINICAL PRESENTATION 183
NONSURGICAL TREATMENT 184
SURGICAL TREATMENT 185
EVIDENCE FOR SURGICAL TREATMENT OF SPINAL STENOSIS 185
THE SPORT STUDY 188
SUMMARY 189
REFERENCES 190
Chapter 7. Cervical Spondylotic Myelopathy: A Review of the Evidence 193
GOALS 193
NATURAL HISTORY 193
SURGICAL APPROACH 195
LAMINOPLASTY, LAMINECTOMY, AND LAMINECTOMY AND FUSION 198
CERVICAL ARTHROPLASTY 200
SUMMARY 201
REFERENCES 201
Chapter 8. Dynamic Constructs for Spinal Fusion: An Evidence-Based Review 203
CERVICAL SPINE 204
LUMBAR SPINE 206
TRAUMA 210
SUMMARY 212
REFERENCES 213
Chapter 9. Contemporary Management of Symptomatic Lumbar Disc Herniations 217
LUMBAR DISCECTOMY 217
SPORT TRIAL 218
SPORT STUDY HYPOTHESIS 219
SPORT STUDY POPULATION 219
HIGH CROSSOVER RATE 222
NO STRATIFICATION OF KNOWN PROGNOSTIC FACTORS 222
DISCUSSION 222
REFERENCES 223
Chapter 10. Clavicle Fractures in 2010: Sling/Swathe or Open Reduction and Internal Fixation? 225
TREATMENT OPTIONS 226
COMPARATIVE STUDIES 227
SUMMARY 230
REFERENCES 231
Chapter 11. Lower Extremity Assessment Project (LEAP) – The Best Available Evidence on Limb-Threatening Lower Extremity Trauma 233
REFERENCES 238
Chapter 12. A Critical Appraisal of the SPRINT Trial 241
OVERVIEW OF THE METHODOLOGY USED IN THE SPRINT TRIAL 241
THE RESULTS OF THE SPRINT TRIAL 242
CRITICAL APPRAISAL OF THE SPRINT TRIAL METHODOLOGY 242
SUMMARY 245
REFERENCES 245
Chapter 13. Graft Selection for Anterior Cruciate Ligament Reconstruction: A Level I Systematic Review Comparing Failure Rates and Functional Outcomes 249
METHODS 253
RESULTS 253
OUTCOMES 254
DISCUSSION 255
SUMMARY 260
REFERENCES 260
Chapter 14. Hip Resurfacing Arthroplasty: A Review of the Evidence for Surgical Technique, Outcome, and Complications 263
MODERN IMPLANT DESIGN 263
SURGICAL TECHNIQUE 264
MODERN HIP RESURFACING ARTHROPLASTY OUTCOMES 266
COMPLICATIONS AND CONCERNS 267
SUMMARY 268
REFERENCES 269
Chapter 15. DVT Prophylaxis in Total Joint Reconstruction 273
AMERICAN COLLEGE OF CHEST PHYSICIANS GUIDELINES 274
AMERICAN ACADEMY OF ORTHOPEDIC SURGEONS GUIDELINES 274
LOW MOLECULAR WEIGHT HEPARINS 275
FONDAPARINUX 275
WARFARIN 276
ASPIRIN 277
MECHANICAL PROPHYLAXIS (PNEUMATIC COMPRESSION BOOTS AND INTERMITTENT PLANTAR COMPRESSION DEVICES) 278
AUTHORS’ COMMENTARY ON CURRENT GUIDELINES 278
REFERENCES 278
Index 281