Abstract:
BACKGROUND:Bisphosphonates reduce the risk of fractures associated with osteoporosis but increase the risk of atypical subtrochanteric femur fractures. After unilateral atypical femur fracture, there is risk of contralateral fracture, but the indications for prophylactic fixation are controversial. QUESTIONS/PURPOSES:The purpose of this study is to use Markov modeling to determine whether contralateral prophylactic femur fracture fixation is cost-effective after a bisphosphonate-associated atypical femur fracture and, if so, what patient-related factors may influence that determination. METHODS:Markov modeling was used to determine the cost-effectiveness of contralateral prophylactic fixation after an initial atypical femur fracture. Simulated patients aged 60 to 90 years were included and separated into standard and high fracture risk cohorts. Patients with standard fracture risk were defined as those presenting with one atypical femur fracture but without symptoms or findings in the contralateral femur, whereas patients with high fracture risk were typified as those with more than one risk factor, including Asian ethnicity, prodromal pain, femoral geometry changes, or radiographic findings in the contralateral femur. Outcome probabilities and utilities were derived from studies matching to patient characteristics, and fragility fracture literature was used when atypical femur fracture data were not available. Associated costs were largely derived from Medicare 2015 reimbursement rates. Sensitivity analysis was performed on all model parameters within defined ranges. RESULTS:Prophylactic fixation for a 70-year-old patient with standard risk for fracture costs USD 131,300/quality-adjusted life-year (QALY) and for high-risk patients costs USD 22,400/QALY. Sensitivity analysis revealed that prophylaxis for high-risk patients is cost-effective at USD 100,000/QALY when the cost of prophylaxis was less than USD 29,400, the probability of prophylaxis complications was less than 21%, or if the patient was younger than 89 years old. The parameters to which the model was most sensitive were the cost of prophylaxis, patient age, and probability of prophylaxis-related complications. CONCLUSIONS:Prophylactic fixation of the contralateral side after unilateral atypical femur fracture is not cost-effective for standard-risk patients but is cost-effective among high-risk patients between 60 and 89 years of age with a high risk for an atypical femur fracture defined by patients with more than one risk factor such as Asian ethnicity, prodromal pain, varus proximal femur geometry, femoral bowing, or radiographic changes such as periosteal beaking and a transverse radiolucent line. However, our findings are based on several key assumptions for modeling such as the probability of fractures and complications, the costs associated for each health state, and the risks of surgical treatment. Future research should prospectively evaluate the degree of risk contributed by known radiographic and demographic parameters to guide management of the contralateral femur after a patient presents with an atypical femur fracture. LEVEL OF EVIDENCE:Level III, economic and decision analyses.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Jiang SY,Kaufman DJ,Chien BY,Longoria M,Shachter R,Bishop JAdoi
10.1097/CORR.0000000000000545subject
Has Abstractpub_date
2019-03-01 00:00:00pages
480-490issue
3eissn
0009-921Xissn
1528-1132journal_volume
477pub_type
杂志文章abstract::Hematomas in the lumbar ligamentum flavum are rare and may generate signs and symptoms of lumbar nerve root compression or neurogenic claudication similar to the far more common degenerative diseases. The pathogenesis of these hematomas is unclear. Ruptured irregular vessels of the degenerated and hypertrophic ligamen...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000195412.21988.41
更新日期:2006-02-01 00:00:00
abstract::Two hundred thirty-four primary total knee prostheses were evaluated with a 45 degrees merchant view to examine patellar position and fixation. Despite a standardized technique for obtaining roentgenographs, patellar position varied with leg position. Overall, 54.7% tracked centrally, 31.2% tilted, and 14.5% displaced...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-01-01 00:00:00
abstract::In adult rabbits, a unilateral subcapital osteotomy of the femoral neck was performed to induce avascularity. One half of the osteotomy sites were fixed with a magnetic resonance imaging (MRI) compatible absorbable pin and the other osteotomies had no fixation. The femoral heads were studied at three, five, and 12 day...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1992-12-01 00:00:00
abstract::During the working years, rheumatic conditions are the foremost cause of disability in the United States. Disability evaluation for Social Security applicants and Workers' Compensation patients is commonplace in orthopedic practices. Yet, formal education in this aspect of patient care is rare both during and after re...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-08-01 00:00:00
abstract::Osteochondritis dissecans of the capitellum produces an area of focal necrosis that may result in a potentially unstable relationship between the capitellum and the radial head. Seven patients with developmental instability of the radial head secondary to osteochondritis dissecans of the capitellum treated between 198...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199705000-00006
更新日期:1997-05-01 00:00:00
abstract:BACKGROUND:Prophylactic surgical treatment of the femur is commonly offered to patients with metastatic disease who have a high risk of impending pathologic fracture. Prophylactic fixation is associated with improved functional outcomes in appropriate patients selected based on established criteria, but the perioperati...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000000489
更新日期:2018-12-01 00:00:00
abstract::Because there is no consensus regarding the factors predicting femoral head collapse in asymptomatic osteonecrosis of the hip, we studied the risk factors for collapse. Between 1990 and 2000, we used MRI to confirm asymptomatic osteonecrosis of the femoral head in 81 patients (81 hips) whose other hip had nontraumatic...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-008-0191-x
更新日期:2008-05-01 00:00:00
abstract::Median nerve compression may occur acutely, subacutely, or late following fractures of the distal radius. Hematoma and swelling at the mouth of the carpal tunnel are the likely cause in acute cases. A contributing factor generally not recognized initially is a volarly displaced fragment of distal radius compressing th...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1987-02-01 00:00:00
abstract:BACKGROUND:The National Inpatient Sample (NIS) database is accessible, inexpensive, and increasingly used in orthopaedic research, but it has complex design features that require nuanced methodological considerations for appropriate use and interpretation. A recent study showed poor adherence to recommended research pr...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000001355
更新日期:2020-12-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/CORR.0000000000001082
更新日期:2020-03-01 00:00:00
abstract::Allograft struts are used to reinforce the deficient proximal femur in hip arthroplasty or for fixation of a periprosthetic fracture. Although the use of strut grafts wired or cabled to the proximal femur generally has been successful, the time for healing is slow. The purpose of the current study was to determine whe...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200012000-00006
更新日期:2000-12-01 00:00:00
abstract::Supracondylar osteotomy is an alternative to other procedures for realignment of the rheumatoid hindfoot. Of 64 hindfoot operations performed since 1964, 12 were supracondylar osteotomies. The specific indication for this procedure was an ankylosed rheumatoid foot with equinovarus deformity and limited range of tarsal...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-07-01 00:00:00
abstract::An unusual case of wringer injury in a 29-month-old child demonstrates extensive loss of the diaphysis of both the radius and ulna. Reconstruction consisted of cortico-cancellous autogenous tibial bone grafting of the radius and ulna in two stages. Follow-up of 24 years showed remodeling and good alignment of the enti...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1976-05-01 00:00:00
abstract::The natural history of degenerative lumbar spinal stenosis is documented poorly. Little is known about the efficacy of nonoperative treatments. An aggressive nonoperative treatment consisting of therapeutic exercise, analgesics, and epidural steroid injections is proposed. The clinical evaluation of the patients is re...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-200103000-00018
更新日期:2001-03-01 00:00:00
abstract::This study examines effects of acute stretch on electrophysiologic properties of rabbit tibial nerve. Compound motor action potentials (CMAP) were measured in 30 rabbits, during and after two hours of acute, graded strain. The rabbits were assigned to one of three groups defined by the degree of stretch (0%, 8%, or 15...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-11-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s11999-012-2326-3
更新日期:2012-09-01 00:00:00
abstract::The use of a peritoneal catheter enhances diagnosis using arthroscopy by affording a clear visibility of the knee joint. The accuracy in diagnosis is significantly enhanced using this method of irrigation. No better method of irrigation is available for cases of acute knee joint injuries. ...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1977-10-01 00:00:00
abstract::Three patients had distraction osteogenesis as a salvage method for infected endoprostheses. At the first operation, the infected prosthesis was removed and stabilization was achieved with an external fixator to preserve limb length. An additional external fixator was applied later for distraction osteogenesis after e...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/01.blo.0000128215.33603.4c
更新日期:2004-07-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-10-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199608000-00022
更新日期:1996-08-01 00:00:00
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journal_title:Clinical orthopaedics and related research
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doi:10.1097/00003086-199809000-00014
更新日期:1998-09-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1985-03-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1993-05-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1097/00003086-199602000-00018
更新日期:1996-02-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1991-04-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-015-4218-9
更新日期:2015-05-01 00:00:00
abstract::Lead markers were placed on various osseous structures of the talus and calcaneus in fresh amputation specimens to analyze the radiographic anatomy of the hindfoot. Analysis of the talocalcaneal articulations revealed that only the central one-third of the posterior subtalar joint can be visualized on the lateral proj...
journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1983-07-01 00:00:00
abstract::To define radiographic criteria, the radiographs of all patients diagnosed with coxarthrosis during the year 1951 were reviewed. Structural or joint space changes, evident radiographically in one of every seven cases in 1951, persisted at the time of the review in 1962. In the remaining cases, the diagnosis had been b...
journal_title:Clinical orthopaedics and related research
pub_type: 传,古典文章,历史文章,杂志文章
doi:
更新日期:1993-02-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:10.1007/s11999-012-2719-3
更新日期:2013-06-01 00:00:00
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journal_title:Clinical orthopaedics and related research
pub_type: 杂志文章
doi:
更新日期:1994-04-01 00:00:00