Increase in quality and quantity of orthopaedic studies from 2002 to 2012.

PURPOSE: To compare the level of evidence of orthopaedic studies published in 2002 and 2012 to determine whether the quality and quantity of studies have increased. METHODS: The top 10 orthopaedic journals in 2002 and 2012 were identified, according to the Thomson Reuters impact factor. The level of evidence of each clinical article between January and June in 2002 and 2012 were determined by 2 senior orthopaedic trainees, according to the Oxford Centre for Evidence-based Medicine 2011 Levels of Evidence. Basic science articles, case reports, and non-systematic reviews were excluded. The proportions of papers designated to each level of evidence in 2002 and 2012 were compared, as was the mean level of evidence of studies in 2002 and 2012. RESULTS: In 2002, 379 clinical articles were identified and their level of evidence was level 1 (n=3), level 2 (n=67), level 3 (n=71), and level 4 (n=238). In 2012, 642 clinical articles were identified and their level of evidence was level 1 (n=26), level 2 (n=113), level 3 (n=167), and level 4 (n=336). The proportion of level 4 articles decreased from 62.8% in 2002 to 52.3% in 2012 (p=0.001), whereas the proportion of level 1 articles increased from 0.8% to 4.1% (p=0.002) and level 3 articles increased from 18.7% to 26.0% (p=0.008). The mean level of evidence improved from 3.44 in 2002 to 3.27 in 2012 (p=0.002). CONCLUSION: The quality and quantity of orthopaedic studies have increased from 2002 to 2012, but most studies remained of a low level of evidence.

Causes of a painful total knee arthroplasty. Are patients still receiving total knee arthroplasty for extrinsic pathologies?

PURPOSE: Whilst patients undergoing total knee replacements generally have good relief of their symptoms, up to 20% complain of persisting pain. Revision rates have therefore been rising, particularly so for unexplained pain. We reviewed the causes of painful total knee replacements including extrinsic causes. METHODS: Forty-five consecutive patients referred to our department with painful total knee replacement were reviewed with our standard protocol, including history and examination, inflammatory markers and radiological studies including radiographs of the hip and knee and computed tomography scan of the knee joint. RESULTS: Of the 45 patients, 15 patients had degenerative hip and lumbar spine disease which resolved after injections of the relevant joints. Nine patients had unexplained pain. CONCLUSIONS: Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis. We suggest heightened awareness at pre- and post-operative assessment and thorough history and examination with the use of diagnostic injections to identify the cause of pain if there is doubt.

A prospective study comparing attempted weight bearing in fiberglass below-knee casts and prefabricated pneumatic braces.

Partial weight bearing is commonly advised after fracture of the lower extremity. Research has determined this to be inaccurate both in its instruction and its reproducibility. Many trauma departments are commonly using alternatives to plaster in the splintage of fractures, such as fiberglass and the prefabricated pneumatic braces. This study's null hypothesis is that there is no difference between partial weight bearing through a fiberglass cast as compared with a pneumatic walker. A prospective study was conducted in our department including all patients who had metatarsal or ankle fractures and could partially weight bear. Patients were excluded if they were not allowed to bear weight, had received operative fixation of their fracture, or were younger than age 16 years. The patients' total weight was measured first, and then they were trained to place 50% of their weight through the splinted limb. Three measurements were taken of their attempted weight bearing at 50%, and they were blinded to the results. Over a 16-month period, 117 patients were enrolled for this study: 72 in the pneumatic walker group and 45 in the fiberglass group. There was no significant difference in sex, age, or fracture type. There was a significant difference in percentage of weight placed through the splinted limb, with the pneumatic brace group placing much greater force than the fiberglass group. This may have been caused by altered proprioception from the walker. It is important to realize this when prescribing partial weight bearing in a particular splint as this may result in avoidable complications.

Azoospermia in testicular sarcoidosis is an indication for corticosteroid therapy.

OBJECTIVE: To report improvement of azoospermia and hypogonadism after high-dose corticosteroid therapy in a patient with testicular sarcoidosis. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 27-year-old man with testicular sarcoidosis and azoospermia. INTERVENTION(S): High-dose corticosteroid therapy was commenced in an attempt to improve sperm count and restore gonadal function. MAIN OUTCOME MEASURE(S): Analysis of sperm count, T, and gonadotropin response to steroid therapy. RESULT(S): FSH and LH concentrations decreased and T levels increased in parallel with control of disease activity with steroid therapy. Repeat semen analysis demonstrated a significant increase in sperm count, allowing sperm banking to take place. CONCLUSION(S): High-dose corticosteroid therapy may be indicated in testicular sarcoidosis, not only for control of systemic disease activity but also for recovery of gonadal function and spermatogenesis.