Posts by Aleksi R:

Core elements in shared decision making process

Shared decision making is becoming a fundamental part of clinical practice also in orthopaedics. This should not be a problem in our field because many different questionnaires are used in SDM and our field have decades of experience in patient rated outcome measures (PROM). Valintine et al. investigated how a certain SDM questionnaire “Shared Decision […]

Implications of binomial distribution in the daily orthopaedic practice

Deep infection is a devastating complication in the orthopaedic surgery. It usually requires a revision surgery and a risk for further complications increases greatly. Functional outcome is usually much worse after deep infection compared to uneventful primary surgery especially if removal of implants is required to eridicate the infection. Deep infection are often systematically recorded […]

Arthroscopy 15 weeks before TKR surgery?

This post could be also titled “Why we dichotomize: Part XXIXCM”, but I´ll focus on the subject matter. Gu et al. investigated how prior knee arthroscopy affects the subsequent total knee replacement surgery. They concluded: This study suggests that an interval of at least 36 weeks should be maintained between the 2 procedures to minimize […]

How to investigate “novel techniques”?

I liked the study by Lapner et al. very much. Their study was titled “Preoperative bone marrow stimulation does not improve functional outcomes in arthroscopic cuff repair: a prospective randomized controlled trial”. They proposed a new concept to improve healing of rotator cuff repair. Authors hypothesized that preoperative ultrasound-guided bone channeling in the footprint 5-7 […]

Mesenchymal stem cells outperforming total knee replacement

Tan et al. published a meta-analysis about mesencymal stem cells in the tretment of osteoarhritis. They reported pooled estimates as follows: The standardized mean differences (SMDs) for the visual analog scale (VAS) for pain at rest and upon exertion were –1.48 (95% CI, –1.85 to –1.11) and –2.25 (95% CI, –2.64 to –1.85), respectively. This […]

Continues discourse about “level V evidence”

In my recent post I discussed about “Level V Guideline” for subacromial decompression. I naturally participated to the discussion Drs Poolman and van den Bekerom had started. We wrote in our letter: ‘Optimal patient selection’ can be considered a myth until evidence of effect modifiers arises. We argue that if there were subpopulations that benefit […]

Nth conclusion about hip resurfacings

It can´t be argued that the theoretical premises of hip resurfacing arthroplasty would not have been truly great. What could sound any better than “restoring native anatomy and hip biomechanics”? As we know, everything went a different road. Clough & Clough outlined quite accurate statement about hip resurfacings: Whilst MoM HRA can, in very limited […]

Crusade against low value care continues

Hohmann et al. published a truly exceptional “Level V Guideline” in the Arthroscopy Journal. They conclude: However, when indicated, SAD has stood the test of time and long-term studies have clearly demonstrated good and excellent outcomes. So, two recent high-quality sham-controlled studies clearly demonstrate that arthroscopic subacromial decompression offers no relevant benefit over sham-surgery. Apparently […]

What sort of improvement we need in our research?

This is not a new study but I came across to this study by Brophy et al. titled “Update on the Methodological Quality of Research Published in The American Journal of Sports Medicine“. They concluded: Despite a dramatic increase in the number of published articles, the research published in AJSM shifted toward more prospective, randomized, […]