Medical Team Training Improves Team Performance: AOA Critical Issues.

Effective teamwork and communication can decrease medical errors in environments where the culture of safety is enhanced. Health care can benefit from programs that are based on teamwork, as in other high-stress industries (e.g., aviation), with crew resource management programs, simulator use, and utilization of checklists. Medical team training (MTT) with a strong leadership commitment was used at our institution to focus specifically on creating open, yet structured, communication in operating rooms. Training included the 3 phases of the World Health Organization protocol to organize communication and briefings: preoperative verification, preincision briefing, and debriefing at or near the end of the surgical case. This training program led to measured improvements in job satisfaction and compliance with checklist tasks, and identified opportunities to improve training sessions. MTT provides the potential for sustainable change and a positive impact on the environment of the operating room.

Use of Continuous Passive Motion in the Postoperative Treatment of Intra-Articular Knee Fractures.

BACKGROUND: The use of continuous passive motion in the postoperative treatment of intra-articular fractures around the knee is increasing. The purpose of this study was to determine the effects of a continuous passive motion device on knee range of motion after operative treatment of intra-articular fractures around the knee. METHODS: Forty patients with intra-articular fractures of either the proximal part of the tibia or the distal end of the femur were prospectively randomized to the use of continuous passive motion or standardized physical therapy in the immediate postoperative period for forty-eight hours. The primary outcome was knee range of motion. Secondary outcome measures included pain scores, Lower Limb Outcomes Questionnaire scores, and Short Musculoskeletal Function Assessment scores. Evaluations were conducted at forty-eight hours, two weeks, six weeks, three months, and six months postoperatively. RESULTS: There was no significant difference in knee extension between the groups at any time point measured. Knee flexion was significantly greater at forty-eight hours in the group managed with the continuous passive motion device than in the group managed without the continuous passive motion device (p < 0.005). However, there was no significant difference in knee flexion at any other time point. There was no significant difference in knee pain at forty-eight hours between groups. Six (30%) of twenty patients were unable to tolerate the use of the continuous passive motion device. There were no significant differences in overall complications. CONCLUSIONS: The results of this study suggest that the use of continuous passive motion in the immediate postoperative period following the treatment of intra-articular fractures offers no benefit with regard to knee motion at six months and is not tolerated by all patients. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Metal-on-Metal Hip Retrieval Analysis: A Case Report.

This is a case report involving a single case with severe bone and soft tissue destruction in a young male patient with a 10-year-metal on-metal total hip arthroplasty. Following complete aseptic erosion of the affected hip greater trochanter and abductor muscles, the hip was revised for recurrent instability. Histological examination of the patient's periprosthetic tissues, serological studies, and review of recent medical reports of similar cases were used to support an explanation of the destructive process and better contribute to our understanding of human reaction to metal debris in some patients following metal-on-metal hip arthroplasty.

Comparison of conventional polyethylene wear and signs of cup failure in two similar total hip designs.

Multiple factors have been identified as contributing to polyethylene wear and debris generation of the acetabular lining. Polyethylene wear is the primary limiting factor in the functional behavior and consequent longevity of a total hip arthroplasty (THA). This retrospective study reviewed the clinical and radiographic data of 77 consecutive THAs comparing in vivo polyethylene wear of two similar acetabular cup liners. Minimum follow-up was 7 years (range 7-15). The incidence of measurable wear in a group of machined liners sterilized with ethylene oxide and composed of GUR 1050 stock resin was significantly higher (61%) than the compression-molded, GUR 1020, O2-free gamma irradiation sterilized group (24%) (P = 0.0004). Clinically, at a 9-year average followup, both groups had comparable HHS scores and incidence of thigh or groin pain, though the machined group had an increased incidence of osteolysis and annual linear wear rate.

Intraoperative platelet rich plasma usage in total knee arthroplasty: does it help?

Autologous platelet rich plasma preparations, commonly referred to as platelet gel, have been reported to have benefits when used in total knee replacement of less blood loss and better motion, with few reported complications. This retrospective review of 268 consecutive primary total knee arthroplasty cases compares postsurgical range of motion at 2, 8, and 12 weeks, knee manipulation rates, change in hemoglobin, and complications between one group receiving a platelet gel preparation (135 cases), and an equivalent group receiving no platelet gel preparation (133 control cases). No difference was found between groups in manipulation rates, knee range of motion, or changes in hemoglobin (P > 0.05). The use of platelet gel in this study did not have a significant effect on hemoglobin at 72 hours postoperatively, knee range of motion, or manipulation rates up to 3 months post-op in this patient cohort.