Randomised comparative effectiveness trial of Pulmonary Embolism Prevention after hiP and kneE Replacement (PEPPER): the PEPPER trial protocol.

Introduction: More than 1 million elective total hip and knee replacements are performed annually in the USA with 2% risk of clinical pulmonary embolism (PE), 0.1%-0.5% fatal PE, and over 1000 deaths.

Governance of Academic Health Centers and Systems: A Conceptual Framework for Analysis.

Health care has evolved from a cottage industry to a very complex one constituting nearly one-fifth of the U.S. economy.

The Mark Coventry Award: Prevention of readmission for venous thromboembolism after total knee arthroplasty.

Venous thromboembolism is the most common reason for readmission after total knee arthroplasty. Prospective contrast venography was conducted from 1984 to 2003 in 1321 patients undergoing total knee arthroplasty. Patients with deep venous thrombosis or pulmonary embolism were treated with warfarin; those with negative venograms received no further anticoagulation.

Resident selection: a key to the future of orthopaedics.

Recognizing the challenges presented in the process of resident selection, in 1981 the American Orthopaedic Association formed a Steering Committee on Resident Selection. This Committee was charged with studying the processes involved in the selection of orthopaedic residents and developing guidelines and making suggestions to program directors. The activities of the Committee focused on five areas: (1) the mechanics of resident selection; (2) the assessment of cognitive skills; (3) the assessment of motor ability; (4) the assessment of noncognitive factors (the affective domain); (5) the assessment of "dropouts.

The John Charnley Award: prevention of readmission for venous thromboembolic disease after total hip arthroplasty.

Unlabelled: Venous thromboembolic disease remains the most common reason for readmission after total hip arthroplasty. Prospective analysis of screening contrast venography was done from 1984 to 2003 in 1972 patients having elective total hip arthroplasty. Patients with deep venous thrombosis or pulmonary embolism received warfarin therapy; those with negative venograms received no further anticoagulation.

The John Charnley Award. Natural history of thromboembolic disease after total hip arthroplasty.

In 1079 consecutive patients undergoing total hip arthroplasty between 1984 and 1992, complications of thromboembolic disease and related anticoagulation were reviewed for 6 months after hospital discharge, including cost data. Of 347 patients having venograms, 78 (22.5%) had positive results and 269 (77.

Strategic planning for academic health centers.

The mission, indeed the very existence, of the traditional academic health center is under siege. Changes in the financing and delivery of health care threaten the clinical revenue used to subsidize the tripartite mission of education, research, and patient care. Market practices, driven by the growth of managed care, will intensify the impact of declining revenue to threaten the actual patient base necessary to sustain these endeavors.

Core values in health care reform: a communitarian approach.

Controlling health care costs should allow the nation to provide more health services and higher quality care to more people. The authors are concerned, however, that many of the reform efforts will unwittingly undermine the culture of care in their pursuit of savings and access. This article is a plea to maintain the core moral values and the social and institutional commitments that are essential in the delivery of care, so that the health care community is not turned into a health industry.

A collarless cobalt-chrome femoral component in uncemented total hip arthroplasty. Five- to eight-year follow-up.

We implanted 57 uncemented cobalt-chrome porous-coated collarless femoral components into 51 patients (mean age 49 years). At review, five to eight years postoperatively, good or excellent results were recorded in 70% by the Mayo Clinic hip evaluation and in 84% by the Harris hip score. Revision for aseptic loosening of the femoral stem was necessary in only one hip.

Radiation prophylaxis of heterotopic bone formation following total hip arthroplasty: current status.

Differentiation of pluripotential stem cells into osteogenic precursors is exquisitely sensitive to ionizing radiation. Radiation prophylaxis effectively prevents ectopic ossification if delivered to the operative site within 5 days following total hip arthroplasty. Continued efforts at dose reduction over the last decade have demonstrated efficacy with as little as 6,000 to 8,000 rad; no soft tissue sarcomas have been reported in this low dose range following treatment of malignant disease.

Prevention of heterotopic ossification with irradiation after total hip arthroplasty. Radiation therapy with a single dose of eight hundred centigray administered to a limited field.

Sixty-two hips in fifty-five patients who were considered to be at risk for postoperative heterotopic ossification were randomly divided into two groups: one received a single 800-centigray dose of limited-field radiation and the other, 1000 centigray of limited-field radiation in divided doses. The risk for heterotopic-bone formation was identified on the basis of previously described criteria, which included previous heterotopic ossification after an operation about the hip, hypertrophic osteoarthritis or post-traumatic osteoarthrosis characterized by formation of extensive osteophytes, radiographic evidence of diffuse idiopathic skeletal hyperostosis, ankylosing spondylitis, and male sex. The treatment portals excluded prosthetic surfaces that were intended for biological fixation by ingrowth of bone.

Prevention of heterotopic ossification in high-risk patients by radiation therapy.

Heterotopic ossification (HO) is a frequent occurrence after cemented and cementless total hip arthroplasty (THA). Patients at risk for this complication include those with preexisting ipsilateral or contralateral HO, diffuse idiopathic skeletal hyperostosis, hypertrophic osteoarthrosis, posttraumatic arthritis, and ankylosing spondylitis. Low-dose radiation therapy effectively prevents HO in this high-risk group when treatment is begun early in the postoperative period.

Randomized trial comparing single dose versus fractionated irradiation for prevention of heterotopic bone: a preliminary report.

Radiation therapy has been shown to prevent heterotopic bone formation in high risk patients undergoing total hip replacement. A number of doses have been used without a randomized trial comparing one dose regimen against another. A prospective randomized trial was undertaken comparing 10 Gy in 5 fractions versus 8 Gy in 1 fraction.

The use of postoperative irradiation for the prevention of heterotopic bone after total hip replacement with biologic fixation (porous coated) prosthesis: an animal model.

Radiation has been shown to be effective in the prevention of heterotopic bone. The exact etiology of heterotopic bone is unknown. Total Hip prosthetic devices that do not depend upon bone cement for fixation have become increasingly popular.

The relationship of physician assistants to an orthopedic residency program.

In 1979, coincident with a planned decrease in the size of the general surgery training program, the orthopedic department of the senior author's university-affiliated teaching hospital began to employ physician assistants. The intent of using physician assistants was to relieve the two orthopedic residents assigned to the hospital of many service responsibilities and patient care that previously had been rendered by the general surgical residents and interns. The non-M.

Long-term clinical observations and venous functional abnormalities after asymptomatic venous thrombosis following total hip or knee arthroplasty.

The long-term clinical and physiological sequelae of venographically diagnosed, asymptomatic postoperative venous thrombosis were studied in a group of 51 patients following total hip or total knee arthroplasty. After a mean follow-up period of 49.7 months, the patients were recalled for interview, physical examination, air plethysmography (APG), and photoplethysmography (PPG).

Prevention of venous thromboembolism.

Pulmonary embolism is still the largest single cause of postoperative mortality (1%-3%) from major reconstructive lower extremity joint surgery. It is imperative that the surgeon who deals with trauma and musculoskeletal disorders be informed about the prevention of venous thromboembolic disease, recognize the magnitude of the problem, and then take effective steps. Attention must be given to the use of physical methods and the administration of effective antithrombotic agents, including anticoagulants and antiplatelet agents as well as combination agents, to prevent thromboembolic disease.

Prevention of heterotopic bone formation with early post operative irradiation in high risk patients undergoing total hip arthroplasty: comparison of 10.00 Gy vs 20.00 Gy schedules.

Prior studies have demonstrated the effectiveness of postoperative radiation therapy (RT) to the hip area following total hip replacement (THR) surgery in preventing the development of heterotopic bone formation in patients considered to be at high risk for development of this complication. Previously, patients received 20.00 Gy in 10 fractions (fx) over 2 weeks, beginning as soon postop as medically feasible (usually post-op day 2).

The prevention of heterotopic ossification in high-risk patients by low-dose radiation therapy after total hip arthroplasty.

A prospective study was done to evaluate the efficacy of treatment with 1,000 rads of radiation in the prevention of heterotopic ossification after total hip arthroplasty in patients who are at high risk. In a previous prospective study, patients who were at high risk for heterotopic ossification after total hip arthroplasty were identified and an effective regimen for its prevention was established. It was demonstrated that treatment with 2,000 rads of radiation that was initiated within four days after the total hip arthroplasty was highly effective in the prevention of heterotopic ossification and in the prevention of recurrence after resection of existing ossification.