Keeping the cast dry

The image is CC by  Mattieu Guionnet.

The image is CC by Mattieu Guionnet.

I love the study from McDowell et al. where they tested different methods for keeping casts dry. It is simple but takes up a both common and important issue that we doctors frequently forget about. They compare six different methods and it seems that double plastic bags secured with duct tape provide the best protection for the money. Continue reading

Does age matter for THR-outcomes?

Age is perhaps one of the most important confounder that none of us can escape. The image is CC by Sara.

Age is perhaps one of the most important confounder that none of us can escape. The image is CC by Sara.

Age is an important confounder in studying most health related outcomes [1, s 5], and perhaps the most commonly adjusted variable. In this and next post I will go into (1) what we know about the age effect in relation to total hip replacements (THR) re-operations and mortality, (2) what I found in my study on age and health-related quality of life (HRQoL) using splines, and (3) how I implemented and evaluated different splines using R for this study. Continue reading

My thesis: patient-related factors & hip arthroplasty outcomes

Title: Evaluation of patient related factors influencing outcomes after total hip replacement

Title: Evaluation of patient related factors influencing outcomes after total hip replacement

On May 29:th I successfully defended my thesis at the Karolinska Institute and I’m now a “Doctor of Philosophy“, i.e. PhD. It has been a fun and rewarding project that spurred me into starting this blog and diving into R. Below you can find the thesis abstract and my reflections on the subject. Continue reading

Drawing a directed acyclic graph (DAG) for blood transfusions after surgery

A directed acyclic graph (DAG) can help you take the right path. The image is CC by Ian Sane

A DAG can help you take the right path. The image is CC by Ian Sane

I recently wrote about blood transfusions and their inherent risk of postoperative infections. This post is a tutorial on some of the basics of drawing a directed acyclic graph (DAG). Blood transfusions and infections is a great topic as most are familiar with risk factors for infections. Continue reading

The final nail in the coffin for the degenerative meniscus?

Some studies give time for pause. The image is CC by Matt Katzenberger.

Some studies give time for pause. The image is CC by Matt Katzenberger.

I have my doubts when it comes to operating a degenerative meniscus (see my previous post) and in an amazing Finnish multicenter RCT it seems that my doubts have been confirmed. Sihvonen et al. managed to randomize 146 patients to arthroscopic meniscal or sham surgery where none of the outcomes differed between the groups. Continue reading

A bloody mess?

Do blood transfusions cause infections? The image is CC by Peter Almay.

Do blood transfusions cause infections? The image is CC by Peter Almay.

Blood transfusions lower the immune response – a known fact although not all doctors are aware of it. It is therefore nice to see that two new articles in JBJS that focus on the subject. Both focus on arthroplasties where the impact of an infection due to a lowered immune response can be catastrophic to the individual. Continue reading

The rotator cuff dilemma – revisited

A black-shouldered kite with prey. The image is CC by Tariq Sani.

A black-shouldered kite with prey. The image is CC by Tariq Sani.

Is Kukkonen et. al.’s RCT the end of our love for the rotator cuff tear? The industry surrounding rotator cuff tears costs in the US alone about $3 billion every year, earning a top position among common orthopaedic procedures. I have previously written about my doubts concerning this procedure and it is with some satisfaction that I dive in to this recent study by Kukkonen et. al.

It is better to have loved and lost, than never to have loved at all.

Alfred Lord Tennyson

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Pills instead of surgery?

It is not every day you find something as beautiful as research that can change your perception of the world. The image is CC from photophilde.

It is not common to find something as research that can change your perception of the world – it’s a beauty. The image is CC from photophilde.

I recently stumbled upon one of the most interesting articles in a while. Albert et al. questioned the long-standing theory behind low back pain by doing a double-blind randomized clinical controlled trial. They randomized patients to antibiotics or placebo for 100 days and found an impressive effect on pain and other outcomes in the treatment group. Continue reading

In sickness and in health

Pubmed trends showing how the popularity of analyzing comorbidities have increased over time. The search query is "Arthroplasty[MeSH Major Topic] AND (comorbidity OR co-morbidity)",  for the blue bar I also added "AND (Charlson OR Elixhauser)" to indicate that the popularity of using scores that summarize the comorbidities also are increasing.

Pubmed trends showing how the popularity of analyzing comorbidities have increased over time. The search query is “Arthroplasty[MeSH Major Topic] AND (comorbidity OR co-morbidity)”, for the blue bar I also added “AND (Charlson OR Elixhauser)” to indicate that the popularity of using scores that summarize the comorbidities also are increasing.

When I started my PhD-studies I had this idea that if we know the exact medical status of the patients and implant characteristics we will be able to explain why and when people are re-operated after total hip replacements (THR). Three years later I have just published an article in the Bone and Joint Journal about how wrong I was. In this post I’ll try to give some personal reflections on the article. Continue reading