Pulmonary Vein Isolation in Obese Compared to Non-Obese Patients: Real-Life Experience from a Large Tertiary Center.

1. Introduction: Pulmonary vein isolation (PVI) is an established procedure used to achieve rhythm control in atrial fibrillation (AF). In obese patients (pts), in whom AF occurs more frequently, a reduced effectiveness of PVI has been observed.

Non-invasive assessment of fibrosis regression and portal hypertension in patients with advanced chronic hepatitis C virus (HCV)-associated liver disease and sustained virologic response (SVR): 3 years follow-up of a prospective longitudinal study.

Long-term effects on cirrhosis and portal hypertension of direct antiviral agent (DAA)-based eradication of hepatitis C virus (HCV) are still under debate. We analysed dynamics of liver and spleen elastography to assess potential regression of cirrhosis and portal hypertension 3 years post-treatment. Fifty-four patients with HCV-associated cirrhosis and DAA-induced SVR were included.

Can the FEAR Index Be Used to Predict Microinstability in Patients Undergoing Hip Arthroscopic Surgery?

Background: Atraumatic hip instability, or microinstability, is a challenging diagnosis for clinicians to make. Several radiographic parameters have been proposed to help identify patients with instability as a means to direct treatment. The Femoro-epiphyseal Acetabular Roof (FEAR) index was recently offered as a parameter to predict instability in a borderline dysplastic population.

Healing, Pain and Function after Midshaft Clavicular Fractures: A Systematic Review of Treatment with Immobilization and Rehabilitation.

Objective: To systematically evaluate the scientific literature examining the efficacy of nonoperative management for midshaft clavicular fractures, specifically looking at the effect of immobilization and/or functional rehabilitation. TYPE: Systematic review.

Literature Survey: MEDLINE (PubMed), EMBASE, CINAHL databases were searched.

Diagnostic Accuracy of 3 Physical Examination Tests in the Assessment of Hip Microinstability.

Background: Hip microinstability is a diagnosis gaining increasing interest. Physical examination tests to identify microinstability have not been objectively investigated using intraoperative confirmation of instability as a reference standard.

Purpose: To determine the test characteristics and diagnostic accuracy of 3 physical examination maneuvers in the detection of hip microinstability.

Hip arthroscopy in the United States: an update following coding changes in 2011.

The purpose of this study is to define the incidence of hip arthroscopy-related procedures in the United States prior to and following 2011 and to determine if the rise in incidence has coincided with an increase in the complexity and diversity of procedures performed. Patients who underwent hip arthroscopy were identified from a publicly available US database. A distinction was made between 'traditional' and 'extended' codes.

Humeral Avulsion of the Glenohumeral Ligament: Indications for Surgical Treatment and Outcomes-A Systematic Review.

Background: The inferior glenohumeral ligament, the most important static anterior stabilizer of the shoulder, becomes disrupted in humeral avulsion of the glenohumeral ligament (HAGL) lesions. Unfortunately, HAGL lesions commonly go unrecognized. A missed HAGL during an index operation to treat anterior shoulder instability may lead to persistent instability.

Cholesterol Granuloma of the Abdominal Wall: An Unusual Finding in the Setting of Renal Cell Carcinoma.

Cholesterol granulomas are composed of a distinct type of granulation tissue that contains lipids and cholesterol crystals. They are not believed to be a pathological entity, but rather an inflammatory tissue reaction to the presence of trapped blood secondary to localized hemorrhage. Cholesterol granulomas can be identified histologically by the presence of multi-nucleated giant cells, hemosiderin, and red blood cells along with their associated break-down products.

Complication Rates for Hip Arthroscopy Are Underestimated: A Population-Based Study.

Purpose: To identify major and minor complication rates associated with hip arthroscopy from a payer-based national database and compare with the rates reported in the existing literature.

Methods: Patients who underwent hip arthroscopy between 2007 and 2014 were identified using PearlDiver, a publicly available database. Rates of major and minor complications, as well as conversion to total hip arthroscopy (THA), were determined by using Current Procedural Terminology (CPT) and International Classification of Diseases, Ninth Revision (ICD-9), codes.

Odds ratios deconstructed: A new way to understand and explain odds ratios as conditional risk ratios.

Objectives: The aim of this analysis was to provide an alternative derivation of the odds ratio (OR) to provide an intuitive meaning, freeing it from any mention of odds, which may make it a more useful concept for clinicians to use when describing treatment effect.

Study Design And Setting: By examining the four possible combinations of treatment/control and corresponding outcomes, we considered the conditional risk ratio (RR, also known as relative risk) of an event with the treatment compared with an event with the control for pairs of patients for whom treatment and control would yield different results. Both matched and unmatched studies are considered.

Bilateral Osteonecrosis of the Femoral Head During Pregnancy Following Two Corticosteroid Injections: A Case Report and Review of the Literature.

Osteonecrosis of the femoral head during pregnancy, or shortly thereafter, is a rare clinical problem. Little is known about pregnancy as an etiological factor for femoral head osteonecrosis with only 40 reported cases in the literature. Furthermore, single or dual dose steroid-induced multifocal osteonecrosis is a controversial topic with only a handful of published cases.

YouTube as an information source for femoroacetabular impingement: a systematic review of video content.

Purpose: This study was carried out to assess the quality of information available on YouTube regarding femoroacetabular impingement (FAI).

Methods: YouTube was searched on September 7, 2013 using the search terms FAI, femoroacetabular impingement, and hip impingement. Analysis was restricted to the first 3 pages of results for each search term.

Delayed versus early motion after arthroscopic rotator cuff repair: a meta-analysis.

Background: We conducted a meta-analysis of randomized trials to compare delayed vs early motion therapy on function after arthroscopic rotator cuff repair.

Methods: We searched 4 electronic databases (Medline, Embase, Cochrane, and Physiotherapy Evidence Database [PEDro]). The methodologic quality of the included studies was assessed, and the relevant data were extracted.

The learning curve for hip arthroscopy: a systematic review.

Purpose: The learning curve for hip arthroscopy is consistently characterized as "steep." The purpose of this systematic review was to (1) identify the various learning curves reported in the literature, (2) examine the evidence supporting these curves, and (3) determine whether this evidence supports an accepted number of cases needed to achieve proficiency.

Methods: The electronic databases Embase and Medline were screened for any clinical studies reporting learning curves in hip arthroscopy.

The use of video before arthroscopic shoulder surgery to enhance patient recall and satisfaction: a randomized-controlled study.

Background: Historically, the preoperative consultation has consisted of a discussion between patient and surgeon. There is a growing literature describing efforts to integrate multimedia into surgical patient education. This study aimed to assess the efficacy of an educational video tutorial on early learning of information specific to patients undergoing shoulder arthroscopy when it was used as an adjunct to the standard preoperative consultation.

Hierarchy of evidence: where observational studies fit in and why we need them.

Although randomized controlled designs are considered the so-called gold standard in medical trials and sit atop the hierarchy of evidence in evidence-based medicine, there are situations in which they are impractical or unethical to undertake, especially in surgical trials. Then, observational studies often provide the best source of information. In this paper, we use examples from the literature to explain the importance of observational studies in furthering the boundaries of orthopaedic surgery and knowledge of musculoskeletal disorders.

Making decisions about prognosis in evidence-based practice.

Prognostic studies are designed to investigate factors that impact the outcome of a disease or its treatment. These factors include, but are not limited to, inherent patient characteristics, the state of the disease, and severity of symptoms. The results of prognostic studies can be used to guide the treatment of patients with similar conditions and overall characteristics.

User's guide to a prognostic study on an orthopaedic implant.

A prognostic study about an orthopaedic implant is an investigation that studies both the short-and long-term success rates of a specific procedure and identifies factors that contribute to the longevity of the implant. This article identifies the steps a surgeon needs to take when critically evaluating literature on the prognosis of an implant they are intending to use. It is not only important to consider whether the study design is scientifically valid, whether the follow-up was long enough to justify accurate survival rates, and whether the estimates of survival were precise, but also whether the results of the study are applicable to the patient being treated by the surgeon.

Evidence-based orthopaedics: a brief history.

Evidence-based medicine was recently noted as one of the top 15 most important medical discoveries over the past 160 years. Since the term was coined in 1990, EBM has seen unparalleled adoption in medicine and surgery. We discuss the early origins of EBM and its dissemination in medicine, especially orthopaedic surgery.