A nice surprise article from JBJS on low back pain. The image is CC by Wanderer99.
Low back pain has a history of failed trials supporting surgery (see Brox et al. and Fairbank et al.) and I was therefore thrilled when I encountered Dengler et al.’s randomized controlled trial (RCT) on sacroiliac joint dysfunction. They showed that arthrodesis outperformed conservative management both early and up to two years after surgery. Continue reading
Bridging the knowledge gap in how to operate femoral neck fractures. The image is CC by Nick Mealey.
One of the first surgeries young orthopaedic surgeons learn is the femoral neck fracture fixation with collum screws. A common theme is how to position the screws and as a young surgeon one often believe that everything depends on the screw position, especially if they’re parallel or not. It was therefore quite fun and liberating to read Nyholm et al’s study with the subtitle: “Minimal Effect of Implant Position on Risk of Reoperation” Continue reading
Bicycle injuries are by far the most common mechanism of injury for clavicle injuries. The image is CC by Hiroyuki Takeda.
So… just a few days after my previous clavicle post, Ahrens et al released their multi-center study on 300 patients randomized to surgery. They found that operated clavicles have less pain early on, but that after 9 months they perform the same. The study was excellently performed with 20 centers, adequate patient selection, random block permutation for treatment allocation, and reasonable treatment options. Continue reading
Finding the right path can be harder than we want to think . The image is CC by Gwenole Camus.
In the early 2000s Nowak et al. [1] shattered the belief that mid-shaft clavicle fractures always healed fine; even after 10 years almost half of the patients had remaining symptoms*. This common injury had also by in others [2] (with shorter follow-ups) been hinted as problematic, and within short we were showered with fancy new implants. After ≥ 7 RCTs [3], [4] on the subjects it seems that these new implants failed do deliver. Can we finally start questioning if surgery is the solution? Continue reading
The first step in orthopedic deep learning. The image is CC from Pixabay.
We finally published our first article on deep learning (a form of artificial intelligence, AI) in orthopedics! We got standard off-the-shelf neural networks to perform equally well as senior orthopedic surgeons for identifying fractures. This was under the premise that both the network and the surgeons reviewed the same down-scaled images. Nevertheless, this was better than we expected and verifies my belief that deep learning is suitable for analyzing orthopedic radiographs. Continue reading
Keeping the blood flowing is part of core medical knowledge – then why the controversy? The image is CC by Andi Campbell-Jones
In a recent post I noted that there was a dissonance between what I’ve been taught in school and what is actually the case regarding thrombosis prophylaxis after orthopaedic surgery. A new study by Parvizi et. al. looks into different dosages of ASA as a thromboprophylaxis after joint arthroplasties. Coming from a country that has fully embraced LMWH this feels alien… regardless, there seems to be increasing evidence that challenges my point of view. Continue reading
Will Cochrane break through to the blood thirsty colleagues? The image is CC by Gaviota Paseandera.
I’ve previously written a two posts on blood transfusions from a surgeons perspective (End of the blood reign and A bloody mess) and I was therefore thrilled when I stumbled upon this [Cochrane review](https://www.ncbi.nlm.nih.gov/pubmed/27731885) that concludes:
The findings provide good evidence that transfusions with allogeneic RBCs can be avoided in most patients with haemoglobin thresholds above 7 g/dL to 8 g/dL.
Sad to see when new methods fail to improve outcomes. The image is CC by Karly Crystal
I’ve previously [written](http://gforge.se/2012/07/cartilage-defects-part-iv/) about some interesting studies on treatment of cartilage defects. I was therefore thrilled to see Knutsen et al’s 15 year follow-up study. Unfortunately the results were rather disappointing; autologous chondorcyte implantation failed at a higher rate than microfractures, 40% vs 30%. Continue reading
As things change over time so should our statistical models. The image is CC by Prad Prathivi
Since I’m frequently working with large datasets and survival data I often find that the proportional hazards assumption for the Cox regressions doesn’t hold. In my most recent study on cardiovascular deaths after total hip arthroplasty the coefficient was close to zero when looking at the period between 5 and 21 years after surgery. Grambsch and Thernau’s test for non-proportionality hinted though of a problem and as I explored it there was a clear correlation between mortality and hip arthroplasty surgery. The effect increased over time, just as we had originally thought, see below figure. In this post I’ll try to show how I handle with non-proportional hazards in R. Continue reading
Tales of Big Pharma Horror. The image is CC from Mike Licht.
Thromboprophylaxis is a given for patients operated due to lower limb injuries, at least if we believe Big Pharma-studies. This dogma is now challenged by a double-blind, multi-center, RCT by Selby et al. They found that the DVT rate was much lower than expected and had to pull the plug on the study as it would be practically impossible to show a difference between placebo and LMWH. Continue reading