Survey of Preferences in Patients Scheduled for Carpal Tunnel Release Using Conjoint Analysis

BACKGROUND: This study aimed to investigate the preferences of patients scheduled for carpal tunnel release using conjoint analysis and also introduce an example of how to apply a conjoint analysis to the medical field. The use of conjoint analysis in this study is new to the field of orthopedic surgery. METHODS: A total of 97 patients scheduled for carpal tunnel release completed the survey. The following four attributes were predefined: board certification status, distance from the patient's residency, medical costs, and waiting time for surgery. Two plausible levels for each attribute were assigned. Based on these attributes and levels, 16 scenarios were generated (2 × 2 × 2 × 2). We employed 8 scenarios using a fractional factorial design (orthogonal plan). Preferences for scenarios were then evaluated by ranking: patients were asked to list the 8 scenarios in their order of preference. Outcomes consisted of two results: the average importance of each attribute and the utility score. RESULTS: The most important attribute was the physician's board certificate, followed by distance from the patient's residency to the hospital, waiting time, and costs. Utility estimate findings revealed that patients had a greater preference for a hand specialist than a general orthopedic surgeon. CONCLUSIONS: Patients considered the physician's expertise as the most important factor when choosing a hospital for carpal tunnel release. This suggests that patients are increasingly seeking safety without complications as interest in medical malpractice has increased.

Surgical Approach to the Hip: Direct Lateral Approach

The direct lateral approach was first described and named the transgluteal approach by Bauer in 1979 and was popularized by Hardinge K in 1982. In total hip arthroplasty, the direct lateral approach offers distinct advantages for the orientation of implants, access to both the acetabulum and proximal femur, and the preservation of soft tissue continuity between the gluteus medius and vastus lateralis muscle group. It can also be quite versatile, even in cases requiring extensive exposure, such as revision arthroplasty. The disadvantages include a risk of superior gluteal nerve injury, disruption of the repaired abductor mechanism, and postoperative heterotopic ossification. This review describes the surgical exposure of the direct lateral approach as well as the advantages and potential complications of the direct lateral approach.

The Relationship of Osteoporosis and Hip Fractures in Elderly Patients

PURPOSE: We measured the BMD (bone mineral density) of elderly patients with hip fracture in order to understand the relationship between osteoporosis and hip fracture, and also to suggest a reference point for starting an osteoporosis treatment program. MATERIALS AND METHODS: From February 2004 to April 2007, we investigated 172 elderly hip fracture patients. Their BMD was checked by DEXA (Hologic QDR-4500w, S/N 49492) at the proximal femur and at the 1st to 4th lumbar vertebrae. The average T-score of the hip fracture patients and the fracture threshold was calculated. RESULTS: The average BMD of the patients with hip fracture was -2.63 of the T-score in the proximal femur and - 2.95 of that in the lumbar vertebrae. The BMD in the patients with intertrochanteric fracture was significantly decreased compared to that of femur neck fracture (p=0.04, 0.19). For the femur neck fracture patients, the BMD of the displaced group was decreased compared to that of the undisplaced group (p=0.04, 0.01). The fracture threshold was -1.29 of the T-score in lumbar vertebrae, and the fracture threshold was -1.15 in the proximal femur. CONCLUSION: The BMD in elderly patients with hip fracture was significantly decreased compared that of normal people. For the prevention of hip fracture in elderly patients, we propose that the aggressive treatment of osteoporosis should be started for patients with a T-score less than -1.5.

Comparative Analysis of Primary Total Hip Arthroplasty (THA) Performed with Conventional or Single-incision, Minimally Invasive (MIS) Direct Lateral Approach

PURPOSE: We compared the outcomes of primary consecutive THAs performed via the direct lateral approach through minimally invasive incisions (<8 cm) and through standard incisions (15~20 cm). MATERIALS AND METHODS: Eighty primary consecutive THAs were performed via direct lateral approach through minimally invasive incisions or through standard size incisions. The standard incision is Hardinge's direct lateral approach. For the MIS group, an approximately 8 cm long oblique skin incision was made centered at the tip of the greater trochanter and running anterosuperiorly to posteroinferiorly. RESULTS: The surgical time was shorter (p=0.03) and the average amount of Hemovac drainage was smaller (p=0.02) in the MIS group. Alignment of the femoral stem and acetabular cup, post-operative pain and limping, HHS, and infection rate were no different between the two groups. In the MIS group, two complications (5.0%) occurred (one lateral positioning of the acetabular cup, one intra-operative acetabular fracture), and one varus stem insertion occurred. CONCLUSION: Minimization of the skin incision length for primary THAs performed via the direct lateral approach appears to have benefits with regard to shortening the wound closing time and decreasing the amount of postoperative Hemovac suction drainage. However, the minimally exposed operative field raises technical problems, so sufficient surgical experience and training are required.