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
The degenerative cuff tear still unresolved. The image is CC by Brian
I’ve previously reported on Kukkonen et al’s excellent three-armed rotator cuff surgery RCT. They’ve now just published the 2-year follow-up where they still don’t see any difference in outcomes. Interestingly, they’ve added an MRI and noted that the cuff tear remains smaller among those that had surgery. This indicates that the intended surgery works but still too early to see any actual results. Continue reading
Gout onset is sudden and be intensely painful. The image is CC by Mike
Gout can be incredibly painful where the main treatment option are nonsteroidal anti-inflammatory drugs (NSAID). Unfortunately NSAIDs are not the best alternative for elderly patients as it may induce heart & kidney failure. I was therefore thrilled to see that canakinumab recently was approved by Läkemedelsverket as a treatment alternative. Continue reading
Time to give up on the proximal humerus fracture? The image is CC by Crouchy99.
Most orthopaedic surgeons have met patients with poor shoulder function after a proximal humerus fracture, and many of us have thought: if I’ve only done the other thing I was thinking of…. Unfortunately the outcome seems to be independent of what we do, at least according to Launonen et al’s meta-analysis and Rangan et al’s recent RCT on 250 patients. Continue reading
Is the evidence on blood transfusions going down the drain? The image is CC by
Steve Koukoulas.
In a recent RCT by Gregersen et al. they manage to complicate blood transfusions in orthopaedic patients even further. They suggest that orthopaedic patients from nursing homes fare better with liberal blood transfusions (> 113 g/L compared to >97 g/L). The concept is interesting, although the paper has some issues. Continue reading
Jailbreaking spine fracture braces. The image is CC by Parée.
Continuing on the theme of #2MuchMed (see BMJ’s campaign) I figured it may be worth highlighting two recent studies on stable compression fractures of the spine. Both failed to show any benefit with standard bracing treatment. As some patients experience the brace as claustrophobic and uncomfortable (from my own patients’ experience), I’m thrilled to have this option available. Continue reading
Will Carson et al.’s study be the garlic that deters the most blood thirsty colleagues? The image is CC by Gaviota Paseandera.
As I have a weakness for studies that challenge the dogma, I was ecstatic when I stumbled upon Carson et al.’s bold study on blood transfusions. In their study they selected 2000 patients with cardiovascular disease that were undergoing surgery due to hip fracture. Interestingly, there was no difference in 3-year mortality when randomizing between transfusion Hemoglobin thresholds of 100 g/L or 80 g/L! Continue reading
Shinier is not always better. The image is CC by Dennis Skley.
Costa et. al. performed recently a multi-center study including 18 trauma centers throughout the United Kingdom. They randomized patients with distal radius fractures to volar locking plates or Kirschner wires. They managed to randomize 461 patients and follow-up 90% after 1 year using self-reported scores. They could not find any difference after 1 year regarding their primary outcome, PRWE-score (−1.3 points, 95% CI -4.5 to 1.8). This was well below their stipulated minimally clinically important difference of 6 points. Could this be the end of the volar locking plate era? Continue reading