bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Risk of Stiffness following Total Knee Arthroplasty with Direct Oral Anticoagulants and Avoidance of Selective COX-2 Inhibitors
Authors: Frederick Jeremy S , Weiner Travis R , Neuwirth Alexander L , Shah Roshan P , Geller Jeffrey A , Cooper H. John 
Published: August 2023

Background Database studies demonstrate a strong association between use of direct oral anticoagulant (DOAC) medications and stiffness following total knee arthroplasty (TKA). The goal of this study was to evaluate whether the risk of stiffness in patients receiving a DOAC was affected by concomitant use or avoidance of a selective COX-2 inhibitor, when compared to a control group of patients receiving aspirin. Methods Consecutive primary TKA’s performed at a single institution between January 2014 - September 2019 were retrospectively reviewed. During this period, a risk-stratification algorithm for prophylaxis against venous thromboembolism (VTE) was used, with DOACs selected for patients at elevated VTE risk and aspirin for the remainder. Patients who required manipulation under anesthesia (MUA) within six months of index TKA were identified. Arc of motion (AOM) data at 6-weeks, 3-months, and 1-year was collected. Patients were divided into 3 groups based on postoperative medications prescribed: (a) Aspirin, (b) DOAC alone, and (c) DOAC + NSAID. Categorical variables were analyzed using Fisher’s Exact Tests and Pearson’s Chi-Square, while continuous variables were analyzed using Student’s T-test. Multivariate logistic regression was used to assess MUA risk while controlling for demographic differences. Results Forty patients underwent MUA from a population of 1,358 TKAs (2.9%). There was a significantly increased risk of MUA in patients where DOACs were used and concomitant NSAIDs were avoided when compared to the control group of patients receiving aspirin (5.4% vs 2.7%, OR 3.17; p = 0.029). This increased risk was not present when DOACs were used concomitantly with NSAIDs (3.1% vs 2.7%, OR 1.30; p = 0.573). In addition, less consistent AOM was achieved at 1-year postoperatively in the DOAC alone group compared to the control group of patients receiving aspirin (p=0.034). Conclusions Compared to aspirin anticoagulation, patients receiving DOACs without concomitant NSAIDs were more likely to develop postoperative stiffness requiring MUA and achieved less predictable AOM. The addition of selective COX-2 inhibitors may mitigate some risk of stiffness following primary TKA when anticoagulation with DOACs is necessary.
The Cost-Effectiveness of Wound Dressings for Infection Prophylaxis in Total Joint Arthroplasty: An Economic Evaluation
Authors: Kirchner Gregory , Kim Andrew , Dunleavy Mark , Webb Matthew , Kerbel Yehuda , Moretti Vincent 
Published: August 2023

Background Periprosthetic joint infection (PJI) is a medical and economical challenge. Specific post-operative wound dressings have been developed to mitigate risk of PJI following total hip arthroplasty (THA) and total knee arthroplasty (TKA), but these come with added cost and unknown benefit. The purpose of this study was to determine which dressings may be economically justifiable. Methods The average added cost of Xeroform with gauze (Xeroform+gauze), Mepilex Border, Aquacel Ag, and Dermabond Prineo dressings compared to standard dressing (Xeroform+gauze) only were obtained from institutional records and contemporary literature. Baseline infection rates following THA and TKA and average costs of PJI treatment were obtained from the literature. A break-even analysis was utilized to determine the absolute risk reduction (ARR) needed in infection rate to make each dressing cost-effective. Results At $3.00, a single Xeroform+gauze is economically justified if the initial infection rate for TKA (1.10%) and THA (1.62%) are reduced by an ARR of 0.01% and 0.009%, respectively. Two to three additional post-operative dressing changes increases the cost of Xeroform+gauze to $9.00-12.00 and increases the required ARR for TKA to 0.04-0.05% and for THA to 0.028-0.038%. Mepilex Border costs $29.00 and requires an ARR of 0.11% for TKA and 0.09% for THA. Aquacel Ag costs $40.00 and requires an ARR of 0.16% for TKA and 0.13% for THA. Dermabond Prineo costs $79.00 and requires an ARR of 0.31% for TKA and 0.25% for THA. Variations in estimation of initial infection rate did not impact ARR for any dressing type. Conclusions Orthopaedic surgeons have multiple options for surgical dressings following total joint replacement. With respect to infection prophylaxis, Xeroform+gauze is the most cost-effective. Other specialized dressings such as Mepilex Border, Aquacel Ag, or Dermabond Prineo, require significantly higher reductions in infection rate to be economically justifiable.
The Lateral Femoral Condyle is not Hypoplastic Relative to the Medial Condyle in 6829 Magnetic Resonance Images Irrespective of Gender, Age, or Extent of Arthritis
Authors: Shah Romil , Vail Thomas , Bini Stefano 
Published: August 2023

Background Understanding the relationship between the radii of the medial/lateral femoral condyles (MFC/LFC respectively) is important for restoring kinematics in knee arthroplasty. The objective of this study is to use a large cohort of patient magnetic resonance Images (MRIs) to investigate whether asymmetry exists between the radii of the medial/lateral femoral condyles. Methods Patients recruited into the Osteoarthritis Initiative (OAI) with knee MRIs were included. Using a validated machine learning algorithm, the radii of each condyle was calculated. The study sample was split into cohorts depending on medial and lateral compartment wear patterns of each knee in addition to their KL classification. The radii of each condyle in each cohort were compared using paired t-tests. Finally, a multivariable regression was run to evaluate factors that could impact differences between medial/lateral condylar size. Results 6,829 MRIs were included in this study of which 89% were classified as varus knees. The average best fit radius of the MFC was significantly smaller than that of the LFC (15.3mm vs. 16.8mm, p<0.001) in general and in patient knees with medial wear with KL 0, 1, 2, 3 and 4 and patient knees with lateral wear with KL 0, 2, 3, and 4. After adjusting for age, BMI, and Gender, patients with lateral wear patterns and patients with increasing KL score had a statistically significant larger lateral condylar size. Conclusion ML was effectively used to automate the measurement of femoral condyle size suggesting that the LCF has a slightly larger radius than the MFC and is not hypoplastic.
Total Joint Arthroplasty Time-of-Day Start Time Has Minimal Effect on Intraoperative Efficiency
Authors: Hammoor Bradley T. , Kaidi Austin C , Hickernell Thomas R. , Cooper H. John 
Published: August 2023

Introduction Total hip (THA) and knee arthroplasties (TKA) are common elective procedures, and dedicated arthroplasty teams perform multiple procedures per day. Little is documented about how time-of-day scheduling affects the intraoperative efficiency of total joint arthroplasties (TJA). In this study, we analyzed the effects of surgical start time on TJA operative lengths. Methods A retrospective study was performed for primary TJA patients done within a four-year period at a single academic medical center. Surgical start time, operative duration, and patient demographics were collected. Based on a 12-hour operative day, surgical start times were categorized as early (7AM to 11AM), mid-day (11AM to 3PM), or late (after 3PM). A chi-squared test was performed to examine for associations between patient demographics and surgical start time. A multivariate linear regression (MLR) was performed to determine the effect of surgical start time on operative duration. P-values less than 0.05 were considered significant. Results This study identified 1663 TJAs – 869 total knee (TKA) and 791 total hip arthroplasties (THA) who met inclusion criteria. Among TKAs, we identified 319 (36.7%) early, 437 (50.3%) mid-day, and 113 (13.0%) late operations. Among THAs, we identified 407 (51.4%) early, 297 (37.5%) mid-day, and 87 (11.0%) late operations. MLR demonstrated that for TKA there was a 4.9 (p =0.018) and 7.3 (p=0.013) minute increase for mid-day and late cases, respectively. For THAs, a non-early start time was associated with an increased operative duration of 9.1 to 12 minutes (p<0.001). Discussion Surgical start time has a statistically significant, but minimal, effect on operative length for TJAs, with later cases being slightly longer than first-start cases.
Reverse Total Shoulder Arthroplasty in Proximal Humerus Fractures with Concomitant Nerve Injury
Authors: Katanbaf Reza , Greiwe R. Michael 
Published: August 2023

Background Axillary nerve dysfunction has been a relative contraindication for reverse total shoulder arthroplasty (RTSA) as it implies deltoid dysfunction which is necessary for a successful outcome and to maintain stability. However, most axillary nerve injuries or brachial plexus injuries in the setting of acute fracture or fracture dislocation are temporary neuropraxias. Therefore, RTSA may be a feasible option in the acute setting in patients with associated axillary/brachial plexus injury. The objective of this study is to compare results of RTSA patients with preoperative nerve injuries to patients without nerve injuries at a minimum of 2 years. Methods A retrospective case series of all proximal humerus fractures treated with rTSA from 2010 to 2018 by a single surgeon was performed. Inclusion criteria were patients with a diagnosis of fracture-dislocation of the proximal humerus. American Shoulder and Elbow Surgeon (ASES) scores, Simple Shoulder Test (SST) scores, range of motion (ROM) as well as complications were obtained at final follow up. Results A total 29 patients treated with RTSA for fracture-dislocation were identified. Five patients declined to participate in the study, 4 patients died prior to final follow-up, leaving 20 patients in the study group. Two patients were lost to follow-up leaving 18 of 20 patients (90%) with final follow up data. Seven (35%) patients presented with a brachial plexus/axillary nerve injury associated with their fracture. Average follow-up was 5.83 years (range 2-8 years). There were no differences between the two groups regarding age or body mass index (BMI). The American Society of Anesthesiologists (ASA) was higher in the group without nerve injury 2.92 +/- 0.28 vs 2.43 +/- 0.53 (P=0.0130). There was no difference in time to surgery after fracture between the 2 groups. At final follow-up, there was no difference between the 2 groups regarding shoulder ROM, ASES or SST scores. No patients experienced surgical complications, however, two patients were still reporting nerve related symptoms at final follow up. Conclusion Reverse total shoulder arthroplasty for fracture-dislocation in the acute setting may be a feasible option in patients with concomitant brachial plexus injury.
Managing Recurrent Clavicle Nonunion and Construct Failure: A Case Report
Authors: Jenkins Skyler , Daji Akshay , Fomunung Clyde , Grunhut Joel , Sabesan Vani 
Published: August 2023

Case A 36-year-old male who suffered a left midshaft clavicle fracture, following a fall from a mountain bike, was treated unsuccessfully with two ORIF surgeries. Smoking cessation and management of hypovitaminosis was addressed preoperatively before final revision with a dual plate construct and tibial autologous bone graft. Follow-up radiographs taken at 12 months from the initial surgery showed intact hardware and full bone healing. Conclusion Successful management of clavicle nonunions can be optimized through optimal plate selection, plate positioning, number of plates, construct biomechanics, biologic augmentation, and preoperative risk optimization. Efforts to minimize controllable risk factors for nonunion, such as smoking cessation or vitamin D supplementation, should be utilized both preoperatively and postoperatively.
Cost-Effectiveness of Bone Cement With and Without Antibiotics: A Broader Perspective
Authors: Sogard Oliver , Brown Gregory A. 
Published: August 2023

Background Periprosthetic joint infections (PJIs) and periprosthetic femur fractures (PFFs) increase total costs of care. Retrospective registry/institutional studies with selection bias and underpowered meta-analyses have corrupted the evidence base regarding antibiotic-laden bone cement (ALBC) use in total knee arthroplasties (TKAs). Clinical practice guidelines (CPGs) recommend using cement fixation of femoral components in hip fracture patients to prevent PFFs, but have no recommendations regarding ALBC. Hip osteoarthritis CPGs have no bone cement recommendations regarding prevention of PJIs or PFFs. ALBC is potentially cost-effective by reducing PJIs, PFFs, and reducing implant costs. Methods A systematic review was conducted to identify randomized controlled trials (RCTs), meta-analyses, and registry reports related to the efficacy of ALBC in reducing PJIs and cemented femoral fixation in reducing PFFs. Numbers needed to treat (NNT) are calculated. Cost-effectiveness margins per case are calculated. Results A pooled analysis of four TKA RCTs found ALBC reduces PJI by 0.94% (p=0.027), NNT 106. A total hip arthroplasty (THA) meta-analysis found ALBC reduces PJI by 0.58% (p<0.0001), NNT 172. A hip hemiarthroplasty (HH) RCT found high-dose dual-antibiotic ALBC reduces PJI by 2.35% (p=0.0474), NNT 43. A THA registry report found that cemented fixation compared to ingrowth fixation reduced PFFs by 0.44% (p<0.0001), NNT 229. A pooled analysis of three HH RCTs found that cemented femoral stem fixation reduced PFFs by 5.09% (p-0.0099), NNT 20. Mean PJI treatment costs are $80,000. Mean PFF treatment costs are $27,596. Mean HH cemented femoral stem cost reduction: $685. Using ALBC: TKA margin/case is $755; THA margin/case is $586; and HH margin/case is $3,925. Using plain bone cement: TKA margin/case is $0; THA margin/case is $121; and HH margin/case is $2,065. Conclusions A broader perspective demonstrates that ALBC provides significant financial margins in TKAs, THAs, and hip hemiarthroplasties. ALBC is cost-effective when including the additional costs of using ALBC in TKAs, THAs, and hip hemiarthroplasties. Hand-mixed ALBC is more cost-effective than pre-mixed ALBC in all scenarios.
Paradox in Melanie Martinez’s Song Lyrics, “Lunchbox Friends and Fire Drill”
Authors: Rita Napitupulu  , Stefany Kangginata  
Published: August 2023

This research, done is to explore about the paradox used in the song lyrics, and through the exploration will be known how and why it is used there. The research conducted by using the method of qualitative research, which does not use statistical data; it is collected in the form of written, spoken, or observed behavior. The researcher also uses the library research in the collecting data.
Findings of this research are paradox is used by bringing order to the ambiguous shared meanings that are provided by perceptions of reality, constructing a draft to use as a guide for their future research, reformulating element of modern, industrial society, understanding the start or result of research, supporting the suitability of the goal of the research, giving space to have critical quality, amplify contrast between elements of the lyrics.
Through this research is hoped that it can inspire the readers to deeper into the subject of paradox, spark the discussion of the paradox sentences or ideas in Martinez’s lyrics, so that the readers can have a better understanding about the paradox itself.
FAKTOR YANG MEMENGARUHI PEMAHAMAN PASIEN TERHADAP PENJELASAN INFORMED CONSENT PASIEN OPERASI DI RUMAH SAKIT KHUSUS MATA MEDAN BARU
Authors: Delfi Delfi , Asriwati Asriwati , Fitriani Arifah Devi , Theo Deli , Harahap Juliandi 
Published: August 2023

Informed consent atau persetujuan tindakan medis merupakan salah satu hal yang sangat penting sebelum dilakukan tindakan operasi. Dalam pelaksanaannya setiap rumah sakit harus memliki prosedur tetap sebagai acuan. Dari survei awal pada bulan September 2021 terhadap pasien dan keluarga pasien yang sudah dilakukan tindakan operasi, pemberian informed consent masih belum sesuai dengan prosedur yang berlaku. Dari 15 orang terdapat 6 orang (40%) belum paham dengan isi dari informasi medis yang disampaikan dokter berupa risiko, komplikasi dan tindakan bedah.Desain penelitian ini menggunakan rancangan penelitian Survey Analitik pada pasien dan keluarga yang mewakili pasien yang telah dilakukan tindakan operasi di Rumah Sakit Khusus Mata Medan Baru. Populasinya adalah pasien dan keluarga yang mewakili pasien yang telah dilakukan tindakan operasi di Instalasi Bedah mata RSK Mata Medan Baru. Pengambilan sampel dengan metode Accidental sampling yaitu 96 orang. Pengumpulan data menggunakan kuesioner. Analisa data menggunakan univariat, bivariat dengan uji chi-square dan multivariat dengan uji Normaltas, Multiolinearitas, Heteroskedastisitas, Koefisien Determinasi (Adjusted R2), Signifikansi Nilai F dan Uji Signifikan Nilai t. Hasil penelitian menunjukan bahwa tingkat pemahaman pasien terhadap penjelasan informed consent operasi dalam kategori paham (83,4%) dan kategori sangat paham (15,6%). Hasil dari uji chi-square berdasarkan beberapa karakteristik (pasien, akses informasi, Bahasa Penyampaian, dan Faktor Psikologi) terdapat hubungan antara informed consent terhadap Pemahaman pasien yang akan dioperasi, kecuali berdasarkan karakteristik pasien.Hasil dari analisis multivariat dikatakan bahwa penelitian ini terdistribusi Normal dan Baik, diterima, dan cukup ketepatannya.Kesimpulannya adalah sebagian besar tingkat pemahaman pasien terhadap penjelasan informed consent operasi dalam kategori paham dan faktor yang secara signifikan memengaruhi pemahaman pasien adalah faktor akses informasi berupa waktu penyampaian informasi dan Psikologi Pasien. Saran yang diberikan adalah waktu penyampaian informasi sebaiknya 1 hari sebelum tindakan operasi dilakukan dan Menertibkan pelaksanaan penjelasan informed consent operasi sesuai dengan peraturan yang berlaku
EFEKTIFITAS PENGENCANGAN MUSCULUS TRANVERSUS ABDOMONIS TERHADAP KECEPATAN PENGELUARAN URINE PADA IBU POST PARTUM DI PMB SENANG AM.KEB KABUPATEN BANYUASIN
Authors: Solekah Umi , Mariyam Mariyam , Nabila Putri 
Published: August 2023

Pengencangan Musculus Tranversus Abdominis merupakan latihan yang dilakukan oleh ibu post partum untuk menjaga otot abdominal agar menjadi lebih kuat setelah melewati proses persalinan. Penelitian ini bertujuan untuk mengetahui Efektifitas Pengencangan Musculus Tranversus Abdominis Terhadap Kecepatan Pengeluaran Urine Pada Ibu Post Partum Di PMB Senang AM.Keb Kabupaten Banyuasin. Penelitian ini bersifat Survey Analitik dengan menggunakan metode Case Control. Populasi penelitian ini adalah seluruh ibu post partum dengan total jumlah sampel 6 Responden. Jenis Tekhnik pengambilan data dalam penelitian ini yaitu menggunakan Accidental Sampling. Ibu post partum yang dilakukan Pengencangan Musculus Tranversus Abdominis sebanyak 3 responden (50,0%), yang tidak dilakukan sebanyak 3 responden (50,0%). Dengan menggunanakn Uji T-Independent didapatkan p_value = 0,002 < ? (0,05) yang berarti Ada Perbedaan Rata-Rata Pengencangan Musculus Tranversus Abdominis Terhadap Kecepatan Pengeluaran Urine Pada Ibu Post Partum Di PMB Senang AM.Keb Kabupaten Banyuasin. Disarankan untuk petugas kesehatan yang melakukan pelayanan kesehatan di PMD Senang AM.Keb Kabupaten Banyuasin agar dapat memperhatikan Kecepatan Pengeluaran Urine Pada Ibu Post partum.
PENGARUH HIPERTENSI DAN ANEMIA PADA KEHAMILAN TERHADAP PENINGKATAN KEJADIAN BERAT BAYI LAHIR RENDAH: STUDI CASE CONTROL
Authors: Annisa Dinda Mega , Riyanto Riyanto , Islamiyati Islamiyati 
Published: August 2023

Berat bayi lahir rendah masih mendominasi penyebab morbiditas dan mortalitas perinatal. Ibu hamil dengan hipertensi dan anemia cenderung melahirkan BBLR. Penelitian ini bertujuan menganalisis pengaruh hipertensi dan anemia pada ibu hamil dengan kejadian BBLR di Rumah Sakit Mardi Waluyo Metro. Studi case control dengan pendekatan retrospective merupakan desain penelitian yang dipilih. Sampel penelitian ini terdiri atas kelompok kasus adalah bayi lahir dengan berat bayi lahir rendah dan kelompok kasus adalah baru lahir dengan berat bayi lahir normal. Perbandingan kelompok kasus dan kelompok adalah 1 : 2 atau 29 kasus dan 58 kontrol yang diambil dengan teknik consecutive sampling. Sumber data bersumber dari catatan medik rumah sakit yang memenuhi kriteria penelitian. Pengumpulan data meliputi BBLR atau tidak (variabel dependen) serta hipertensi dan anemia pada kehamilan atau tidak (variabel independen). Data dianalisis menggunakan uji chi square dengan tingkat tingkat kemaknaan (?) 0,05. Ditemukan hasil penelitian secara statistik ada hubungan hipertensi dengan kejadian BBLR (p = 0,02; OR = 3,367; CI 95% 1,309-8,660) dan ada hubungan anemia dalam kehamilan dengan kejadian BBLR (p = 0,012; OR = 3,610 95%; CI 1,413-9,221). Kesimpulan penelitian menemukan bahwa faktor hipertensi dan anemia pada ibu hamil menjadi faktor yang meningkatkan kejadian BBLR. Perlu mengatasi anemia pada ibu hamil dan mengontrol tekanan darah pada ibu hamil untuk menurunkan kejadian BBLR.
Low birth weight babies still dominate the causes of perinatal morbidity and mortality. Pregnant women with hypertension and anemia tend to deliver LBW. This study aims to analyze the effect of hypertension and anemia on pregnant women with LBW events at Mardi Waluyo Metro Hospital in 2018. A case-control study with a retrospective approach is the chosen research design. The sample of this study consisted of the case group which were babies born with low birth weight and the case group were newborns with normal birth weight. Comparison of the case and group is 1: 2 or 29 cases and 58 controls taken by consecutive sampling technique. The data source comes from hospital medical records that meet the research criteria. Data collection included LBW or not (the dependent variable) and hypertension and anemia during pregnancy or not (the independent variable). Data were analyzed using the chi-square test with a significance level (?) of 0.05. The research results found that statistically there was a relationship between hypertension and the incidence of LBW (p = 0.02; OR = 3.367; 95% CI 1.309-8.660) and there was a relationship between anemia in pregnancy and the incidence of LBW (p = 0.012; OR = 3.610 95%; CI 1.413-9.221). The conclusion of the study found that hypertension and anemia in pregnant women were factors that increased the incidence of LBW. Need to overcome anemia in pregnant women and control blood pressure in pregnant women to reduce the incidence of LBW.