Asunto(s)

RESUMEN

BACKGROUND: Hospital revenues for orthopaedic operations are not keeping pace with inflation or with rising hospital expenses. In an attempt to reduce the hospital cost of orthopaedic operations by reducing the cost of operating-room supplies, we developed a Single Price/Case Price Purchasing Program for implants used in total hip arthroplasty, total knee arthroplasty, and total shoulder arthroplasty as well as for arthroscopic shavers and burrs, interference screws, and bone-suture anchors. METHODS: The Lahey Clinic asked orthopaedic vendors to supply all instruments, implants, and disposable items related to these selected products for one single price per unit or case. For example, a single price for total hip arthroplasty implants included instruments, acetabular cups, acetabular liners, acetabular screws, femoral stems, femoral heads, and stem centralizers, if required. The hospital implemented the Single Price/ Case Price Purchasing Program with a competitive-bid request for proposal. Surgeons evaluated the responses to the bidding process, and they made final decisions on product selection. RESULTS: The Single Price/Case Price Purchasing Program at the Lahey Clinic was successful in reducing the cost of orthopaedic implants and supplies. In the present article, we could not disclose the specific prices that we agreed to pay our vendors. The specific cost reductions were 32 percent for hip implants with a change of vendor, 23 percent for knee implants without a change of vendor, 25 percent for shoulder implants with a change of vendor, 45 percent for arthroscopic shavers and burrs without a change of vendor, 45 percent for interference screws without a change of vendor, and 23 percent for bone-suture anchors without a change of vendor. CONCLUSIONS: The Single Price/Case Price Purchasing Program at the Lahey Clinic allowed the hospital to reduce its cost of orthopaedic operations by lowering the cost of operating-room supplies. This cost reduction is important in a health-care economy in which hospital revenues per unit of service or care are decreasing.

Asunto(s)

RESUMEN

We report the 5-year follow-up results of a prospective, multicenter study evaluating the use of a Dacron prosthetic ligament in reconstruction of anterior cruciate-deficient knees. The study group consisted of 84 patients, followed for at least 5 years. The patients were divided into 2 groups: 50 patients with isolated anterior cruciate ligament laxity (Group 1) and 34 patients with a failed previous anterior cruciate ligament surgery or combined laxities (Group 2). Two surgical techniques were employed: reconstruction through drill holes in the tibia and femur (30 patients) and reconstruction using the over-the-top position with the Dacron ligament wrapped in a strip of iliotibial band (54 patients). The overall failure rate was 35.7% at 5 years. The failure rate at 2 years was 20%, illustrating a significant deterioration of results between the two follow-up intervals. Evaluation of subjective criteria using the Lysholm score showed an improvement from preoperative status at the 2-year followup; however, there was a slight decline when 5-year results were evaluated. Tegner activity levels increased from a mean of 2.9 +/- 2.1 at the preoperative visit, to a mean of 4.9 +/- 2.0 at the 2-year followup and a mean of 5.0 +/- 2.0 at the 5-year visit. These results show that the Dacron ligament prosthesis achieves the short-term goal of restoring stability and improving function and may be sufficient to provide long-term stability for the anterior cruciate-deficient knee.

Asunto(s)

RESUMEN

Thirteen posterior Monteggia fracture-dislocations in adults were treated surgically at the Massachusetts General Hospital from 1980 to 1988. A characteristic lesion was observed, consisting of a proximal ulna fracture with a triangular or quandrangular fracture at or near the level of the coronoid, a posterior or posterolateral radiocapitellar dislocation, and, in 10 cases, a radial head fracture. Nine patients were women and four were men, with an average age of 56 years. Following reduction of the radiocapitellar dislocation, the ulnar fractures were treated with plates in each case. Seven fractured radial heads were excised, one replaced with a silicone prosthesis, and three treated by open reduction and internal fixation. The 11 surviving patients were observed using the performance index of Broberg and Morrey at an average follow-up time of 38.4 months. The conditions of three were rated excellent, three good, four fair, and one poor. Incomplete reduction of the ulnar fracture with residual posterior radiocapitellar subluxation was observed in four cases, all leading to loss of forearm supination. We believe this lesion to be more common than previously reported. Recognition of its specific anatomic features is essential to achieve a functional outcome.

Asunto(s)

RESUMEN

High-resolution three-dimensional Fourier transformation (3DFT) multislab acquisitions and a specially designed counter-rotating loop surface coil were used to increase the quality and clinical efficacy of imaging of the temporomandibular joint. The results were compared with those of 2D multisection imaging. Multislab 3DFT magnetic resonance imaging combines the advantages of volume imaging for viewing small structures and the clinical efficiency of 2DFT multisection acquisitions. A 3DFT multislab acquisition, coupled with a specially designed coil, yields two slabs of 16 sections each. The thin-section 3D imaging method facilitates the diagnosis of medially and laterally displaced disks and allows a bilateral examination.

Asunto(s)

RESUMEN

With the development of high resolution techniques, magnetic resonance imaging has become a valuable diagnostic tool for evaluating temporomandibular joint disorders.

Asunto(s)

RESUMEN

Magnetic resonance imaging (MRI) was done in 454 temporomandibular joints of 240 patients and the images produced were correlated with arthrographic, tomographic, and, in the 85 patients who were operated on, surgical findings. The MRI was found to be more accurate than arthrography in demonstrating soft tissue changes. In addition, the technique does not expose the patient to ionizing radiation and has no known biological hazard.

Asunto(s)

Asunto(s)

RESUMEN

A total of 115 temporomandibular joints (TMJ) in 67 patients were examined by high resolution magnetic resonance (MR) using a surface coil. Five millimeter sections were imaged using a two-dimensional multisection acquisition. Findings of MR examinations were correlated with findings of conventional radiographic and clinical examinations. Surgical confirmation was available in 15 patients. MR definition of soft-tissue structures including the meniscus is superior to that of conventional imaging methods. Bony detail is comparable. MR is an excellent method for the primary diagnostic evaluation of TMJ abnormalities.

Asunto(s)