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1.
Introduction
Rib fractures after blunt trauma contribute substantially to morbidity and mortality in the elderly.Methods
Retrospective review of 255 patients ≥65 years old at a level 2 trauma center over 6 years, who sustained blunt trauma resulting in rib fractures. Outcomes measured include mortality, hospital length of stay(LOS), intensive care unit(ICU) admission, ICU LOS, need for MV, and MV days.Results
There were 24 deaths (9.4%), of which 7 were early (<24?h). 130 patients (51%) were admitted to ICU, and 49 (19.2%) required MV. Mean ICU and MV days were 5.9 and 6.3, respectively. ICU admission was predicted by a base deficit <-2.0, ISS>15, bilateral rib fractures, pneumothorax or hemothorax on chest x-ray (All p?<?0.001), as well as hypotension, GCS<15, and 1st rib fractures (All p?<?0.05). Mortality was predicted by a base deficit?<?-5.0, GCS score of 3(Both p?<?0.001), as well as hypotension, ISS≥25, RTS <7.0, bilateral pneumothoraces, 1st rib fractures, and >5 rib fractures (All p?<?0.05).Conclusion
Rib fractures in elderly blunt trauma patients are associated with significant mortality and morbidity, but outcomes can be predicted to improve care. 相似文献2.
John Kuckelman Mike Derickson Cody Phillips Morgan Barron Shannon Marko Matthew Eckert Matthew Martin 《American journal of surgery》2018,215(5):832-835
Introduction
Tension pneumothorax (tPTX) remains a major cause of preventable death in trauma. Needle decompression (ND) has up to a 60% failure rate.Methods
Post-mortem swine used. Interventions were randomized to 14G-needle decompression (ND, n?=?25), bladed trocar with 36Fr cannula (BTW, n?=?16), bladed trocar alone (BTWO, n?=?16) and surgical thoracostomy (ST?=?11). Simulated tPTX was created to a pressure(p) of 20?mmHg.Results
Success (p?<?5?mmHg by 120?s) was seen in 41 of 68 (60%) interventions. BTW and BTWO were consistently more successful than ND with success rates of 88% versus 48% in ND (p?<?.001). In successful deployments, ND was slower to reach p?<?5?mmHg, average of 82s versus 26s and 28s for BTW and BTWO respectively (p?<?.001). Time to implement procedure was faster for ND with an average of 3.6s versus 16.9s and 15.3s in the BTW and BTWO (p?<?.001). Final pressure was significantly less in BTW and BTWO at 1.7?mmHg versus 7?mmHg in ND animals (p?<?.001).Conclusion
Bladed trocars can safely and effectively tPTX with a significantly higher success rates than needle decompression. 相似文献3.
4.
Emrah Kovalak Hanife Özdemir Cenk Ermutlu Abdullah Obut 《Acta orthopaedica et traumatologica turcica》2018,52(3):196-200
Objectives
The aim of this study was to evaluate how fatty atrophy (FA) of the hip abductors in operated and non-operated hips affected the functional outcome following arthroplasty.Methods
Forty-four hips of 22 patients (8 males and 14 females; mean age: 60?±?14.4 (range: 24–84)) who matched the inclusion criteria and willing to participate in the study were retrospectively evaluated. The mean follow-up was 13.8?±?2.3 (range: 10–18) months Magnetic resonance imaging (MRI) and Harris Hip Score (HHS) were used to evaluate muscle degeneration and functional outcome after unilateral THA through a posterolateral approach. The FA grade was evaluated using Goutallier grading system. Non-operated hips of subjects were used as the control. Age, duration after the operation, gluteal muscle FA, and the relationships with HHS were evaluated.Results
FA was more evident in the operated hip (p?<?0.05), and was more in the gluteus minimus than in the gluteus medius in both hips (p?<?0.05). Patients' age was not correlated with gluteal muscle FA in the operated hip (p?>?0.05), whereas there was a positive correlation with the contra-lateral hip (p?<?0.05). Duration after surgery did not affect gluteal muscle FA in the operated hip. Older age and FA of either the operated or healthy hip resulted in poorer HHS (p?<?0.05). HHS had the strongest correlations with patient age (p?<?0.001) and FA (p?=?0.026) of the gluteus minimus of contralateral hip.Conclusion
Following THA, there was marked FA in the operated hip compared to that in the contralateral hip. In these cases, degree of FA in the replaced hip did not correlate with patients' age. Fatty atrophy of the gluteus minimus precedes that of gluteus medius. FA of the contralateral gluteus minimus and patient age are strongly correlated with lower HHS. Level of evidence: Level IV, diagnostic study.Level of evidence
Level IV, diagnostic study. 相似文献5.
Cassie A. Barton Marissa Hom Nathan B. Johnson Jon Case Ran Ran Martin Schreiber 《American journal of surgery》2018,215(5):775-779
Introduction
Life-threatening bleeding can complicate warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin-K dependent clotting factors is essential for hemostasis. We compare two methods of rapid factor replacement for warfarin reversal.Methods
A retrospective cohort study of warfarin-treated patients experiencing life-threatening bleeding who received a reversal protocol comprised of 4F PCC or 3F PCC and rFVIIa was performed. Demographic, clinical and anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded.Results
195 patients were included in final analysis. While baseline demographics were similar between groups, the 3F-PCC group had a longer ICU LOS and higher in-hospital mortality (p?<?.01, .01).Pre-reversal INR was similar between both groups, but post-reversal INR was significantly lower in the 3F-PCC group, 0.8 versus 1.3 (p?<?.01). Significantly more patients experienced thromboembolic complications in the 3F-PCC group than the 4F-PCC group (p?<?.01). Receipt of rFVIIa was significantly associated with thromboembolic complications.Discussion
A 4F PCC reversal strategy is efficacious in INR reversal and provides lower thromboembolic risk as compared to 3F PCC with rFVIIa. 相似文献6.
Jeffrey D. Howard Mickey S. Ising Megan E. Delisle Robert C.G. Martin 《American journal of surgery》2019,217(1):156-162
Background
Appropriate postoperative readmission rates and modifiable risk factors for readmission have yet to be defined for many operations. This systematic review and meta-analysis attempt to define these parameters for pancreaticoduodenectomy.Materials and methods
The main outcomes were readmission rate, risk factors, and reasons for readmission. Meta-analyses were performed when data was homogeneous, otherwise, a qualitative review was performed.Results
The 30-day, 90-day, and overall readmission rates were 17.63%, 26.14%, and 27.18%, respectively. In the meta-analysis, chronic pancreatitis (OR, 1.44, p?=?0.04), operative length (MD, 26.1; p?<?0.01), wound infection (OR, 1.9, p?<?0.01), intra-abdominal abscess (OR, 3.79, p?<?0.01), VTE (OR, 2.27, p?=?0.01), and LOS (MD, 1.66, p?<?0.01) where associated with readmission.Conclusion
Hospital readmission will continue to be a quality metric and will influence reimbursement models. Thirty and 60-day readmission data underestimate the true readmission rate. Chronic pancreatitis, operative length, and several post-operative complications were associated with greater readmission. More uniform reporting is necessary to identify modifiable risk factors associated with readmission. 相似文献7.
Heather E. Hoops Caleb Haley Laszlo N. Kiraly Elena An Karen J. Brasel Donn Spight 《American journal of surgery》2018,215(5):880-885
Background
Although expert proficiency times for Fundamentals of Laparoscopic Surgery (FLS) tasks exist, these times are not always attainable for junior residents. We hypothesize that post-graduate year (PGY)-specific benchmarks will improve resident performance of FLS tasks.Methods
In 2014, PGY-specific benchmarks were developed for FLS tasks for PGY1-PGY4 general surgery residents by averaging completion times for each task from 2007 to 2013. Resident performance on each FLS task and overall performance was compared for PGY1-PGY4 residents in the 2007–2013 group and the 2014–2016 group, before and after implementation of PGY-specific benchmarks.Results
There was a significant improvement in FLS performance in the 2014–2016 group at the PGY1 (p?=?0.01), PGY2 (p?<?0.01), and PGY3 (p?=?0.01) levels, but no difference at the PGY4 level (p?=?0.71).Conclusions
PGY-specific benchmarks may improve efficacy of laparoscopic skills training for junior residents, increasing the efficiency of skill development. 相似文献8.
James W. Davis Rachel C. Dirks Krista L. Kaups Phu Tran 《American journal of surgery》2018,215(4):682-685
Background
Base Deficit (BD) and lactate have been used as indicators of shock and resuscitation. This study was done to determine the association of BD and lactate and to determine if one is superior.Methods
A retrospective review from 3/2014–12/2016 was performed. Data included demographics, systolic BP, ISS, BD, lactate, blood transfusion, and outcomes. BD and lactate were modeled continuously and categorically and compared.Results
1191 patients were included. BD and lactate correlated strongly (r?=?-0.76 p?<?0.001). Higher lactate and more negative BD were associated with transfusion and mortality. On multivariate regression, only BD was associated with transfusion (OR?=?0.8, p?<?0.001). As a categorical variable, worsening BD was associated with decreased BP, higher ISS, increased transfusions and worse outcomes.Conclusions
BD and lactate are strongly related. BD was superior to lactate in assessing the need for transfusion. The BD categories discriminate high risk trauma patients better than lactate. 相似文献9.
Emily Kobayashi Bennett Johnson Kathleen Goetz James Scanlan Robert Weinsheimer 《American journal of surgery》2018,215(5):917-920
Background
Efficacy of care pathways for pediatric appendicitis is well established in children's hospitals, but not in community Emergency Departments (EDs). Methods: A diagnostic pathway combining the Pediatric Appendicitis Score (PAS) with selective ultrasound was implemented. The charts of 2201 pediatric patients seen at four general EDs before and after implementation were retrospectively reviewed, identifying 611 children seriously considered for appendicitis.Results
There were no cases of missed appendicitis within the pathway cohort (0/72). Low-PAS children on pathway had fewer computed tomography (CT) scans (0% vs. 21%; p?<?0.02). Moderate-PAS patients also had a reduced CT-first rate (2.4% vs. 23%; p?<?0.01). However, pathway adoption in 2016 was only 24%. Correct pathway application would have avoided 58 ultrasounds and 17 CTs over three months (annual savings $281,276).Conclusion
A pediatric appendicitis pathway is safe, rules out low suspicion patients without imaging, and is cost effective in a general hospital setting. 相似文献10.
Sook C. Hoang Adam A. Klipfel Leslie A. Roth Mathew Vrees Steven Schechter Nishit Shah 《American journal of surgery》2019,217(1):40-45
Background
Despite the introduction of the Surgical Care Improvement Project, surgical site infections remain a source of morbidity. The aim of this study was to determine the value of implementing a colorectal bundle on SSI rates.Methods
Between 2011 and 2016 a total of 1351 patients underwent colorectal operations. Patients were grouped into pre-implementation (Group A, January 1, 2011–December 31, 2012), implementation (Group B, January 1, 2013–December 31, 2014) and post-implementation (Group C, January 1, 2015–December 31, 2016). Primary endpoints were superficial SSI, deep SSI, wound separation and total SSI.Results
After the bundle was implemented, there was a significant reduction in superficial (6.6%–4%, p?<?0.05), deep (3.7%–1.1%, p?<?0.05), and total SSI rates (10.9%–4.7%, p?<?0.05). Comparing Group A to Group C there was a decrease in total SSI (9.4%–4.7%, p?<?0.05).Conclusion
Implementation of the bundle resulted in a reduction in overall SSI rates particularly as compliance increased. This study offers evidence that small changes can lead to significant decreases in surgical site infections. 相似文献11.
P. Nadziakiewicz T. Niklewski B. Szyguła-Jurkiewicz J. Pacholewicz M. Zakliczyński P. Przybyłowski A. Krauchuk M. Zembala 《Transplantation proceedings》2018,50(7):2080-2084
Background
Left ventricular assist devices (LVADs) are used for treatment of end-stage heart failure. Outcomes are dependent on right ventricle (RV) function. Prediction of RV function after LVAD implantation is crucial for device selection and patient outcome.The aim of our study was to compare early LVAD course in patients with optimal and borderline echocardiographic parameters of RV function.Material and methods
We retrospectively reviewed 24 male patients with LVAD implantation. The following echocardiographic data of RV function were collected: FAC (fractional area change) with optimal value?>?20%, tricuspid annulus plane systolic excursion?>15 mm, RV diameter?<?50mm, and right-to-left ventricle ratio?<?0.57 (RV/LV). Patients were divided into group 1 (12 patients) with transthoracic echocardiography parameters in optimal ranges and group 2 (12 patients) with suboptimal transthoracic echocardiography findings. Study endpoints were mortality, discharge from the intensive care unit, and RV dysfunction. Demographics, postoperative clinical outcomes, comorbidities, complications, and results in a 30-day period were analyzed between groups.Results
Echocardiography parameters differed significantly between groups 1 and 2 according to FAC (31.8% vs 24.08%; P?=?.005), RV4 (45.08 mm vs 51.69 mm; P?=?.02), and RV/LV ratio (0.6 vs 0.7; P?=?.009).Patients did not differ according to course of disease, comorbidities before implantation, or complications. One patient from each group died. Patients in group 2 experienced more pulmonary hypertension, required increased doses of catecholamines, and stayed in the intensive care unit longer. No RV dysfunction was noted.Conclusions
Borderline FAC, tricuspid annulus plane systolic excursion, and RV4 add RV/LV ratio prolonged recovery after LVAD implantation even with no RV failure. Parameters chosen for qualification are in safe ranges. 相似文献12.
Samuel R. Montgomery Paris D. Butler Chris J. Wirtalla Karole T. Collier Rebecca L. Hoffman Cary B. Aarons Scott M. Damrauer Rachel R. Kelz 《American journal of surgery》2018,215(6):1046-1050
Background
Inflammatory Bowel Disease (IBD) has not historically been a focus of racial health disparities research. IBD has been increasing in the black community. We hypothesized that outcomes following surgery would be worse for black patients.Methods
A retrospective cohort study of death and serious morbidity (DSM) of patients undergoing surgery for IBD was performed using data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP 2011–2014). Multivariable logistic regression modeling was performed to evaluate associations between race and outcomes.Results
Among 14,679 IBD patients, the overall rate of DSM was 20.3% (white: 19.3%, black 27.0%, other 23.8%, p?<?0.001). After adjustment, black patients remained at increased risk of DSM compared white patients (OR: 1.37; 95% CI 1.14–1.64).Conclusions
Black patients are at increased risk of post-operative DSM following surgery for IBD. The elevated rates of DSM are not explained by traditional risk factors like obesity, ASA class, emergent surgery, or stoma creation. 相似文献13.
Gregory J. Landry Alla Yarmosh Timothy K. Liem Enjae Jung Amir F. Azarbal Cherrie Z. Abraham Erica L. Mitchell Gregory L. Moneta 《American journal of surgery》2018,215(5):838-841
Background
To examine the epidemiology, treatments, and outcomes of acute symptomatic non-atherosclerotic mesenteric vascular disease.Methods
Subjects were reviewed over a six year period. Categories included embolism (EM), dissection (DI), and aneurysm (AN). Presentation, demographics, treatment and outcomes were compared.Results
46 patients were identified (EM:20, AN:15, DI:11). Age at presentation differed (EM: 66.3, AN 62.4, DI 54.6, p?<?.05). EM more likely affected the superior mesenteric artery (EM80%, AN20%, DI45%, p?=?.002), DI hepatic artery (EM20%, AN13%, DI55%, p?<?.05), and AN mesenteric branches (EM5%, AN47%, DI0%; p?=?.001). EM more likely had history of arrhythmia (EM40%, AN7%, DI0%, p,0.05) and diarrhea (EM30%, AN7%, DI0%, p?<?.05). Treatment was most often surgical in EM (EM85%, AN33%, DI9%, p?<?.001), endovascular in AN (EM5%, AN40%, DI 9%, p?<?.02), and conservative in DI (EM15%, AN 33%, DI82%, p?<?.05). In hospital mortality was infrequent (EM10%, AN7%, DI0%, p?=?ns). Mean hospital length of stay differed by mechanism (EM13.6days, AN9.2, DI2.3, p?=?.005). Median follow up was 61 months. Survival at 1, 3 and 5 years for emboli was 75%, 70% and 59%, for aneurysms 93%, 86%, and 77%, and for dissections 100% at all time points (p?=?.043 log rank).Conclusions
Patients with EM, AN, and DI differ in age, anatomic distribution and method of treatment. The etiology significantly affects long term survival. 相似文献14.
Rachel Van Dusen 《American journal of surgery》2018,215(5):780-781
Introduction
Life-threatening bleeding is the most feared complication of warfarin therapy. Rapid anticoagulant reversal via replacement of vitamin K dependent clotting factors is essential for hemostasis.Methods
A retrospective cohort study of warfarin-treated patients experiencing a life-threatening bleed treated with a warfarin reversal protocol comprised of 4F PCC (post-implementation group) and those who received the prior reversal protocol of 3F PCC and rFVIIa (pre-implementation group) was performed. Demographic and clinical information, anticoagulant reversal information, and all adverse events attributed to warfarin reversal were recorded.Results
195 patients were included in final analysis; 118 in the pre-implementation group, 77 in the post-implementation group. While baseline SOFA and GCS scores were similar between groups, the pre-implementation group had a longer ICU LOS and higher in-hospital mortality (p?<?.01, .01 respectively). The most common indication for anticoagulation reversal was intracranial hemorrhage in both groups.Pre-reversal INR was similar between both groups, but post-reversal INR was significantly lower in the pre-implementation group, 0.8 versus 1.3 (p?<?.01). Significantly more patients experienced thromboembolic complications (TEC) in the pre-implementation group than the post-implementation group, 27.9% versus 6.5% of patients (p?<?.01).The leading TEC in both groups was deep venous thrombosis. Differences in baseline characteristics (p?≤?.2) were entered into a Poisson log-linear regression model for association with TECs. Receipt of rFVIIa was the only characteristic significantly associated with TECs.Discussion
A 4F PCC warfarin reversal strategy is efficacious at reversing INR while providing significantly lower thromboembolic risk as compared to 3F PCC with rVIIa. 相似文献15.
Joshua Lyons Lauren McCaulley Nicole Maronian Jeffrey M. Hardacre 《American journal of surgery》2019,217(3):419-422
Background
The timing of inpatient discharges can impact hospital throughput with later discharges leading to decreased patient satisfaction, increased length of stay (LOS), and longer boarding times.Methods
A 12-month targeted intervention that included both pre-operative and inpatient components was implemented across all surgical inpatient services to increase the proportion of patients discharged by noon.Results
Discharge by noon rates increased from 14.3% to 21.5% during the 12-month initiative (p?<?0.01). The case mix index adjusted LOS (aLOS) decreased from 2.17 to 2.02 days (p?<?0.01). ED, PACU, and ICU boarding times were all significantly lower during the initiative (p?<?0.01, p?<?0.01, p?=?0.03 respectively).Conclusions
A targeted initiative to discharge surgical patients earlier resulted in a 50% increase in the proportion of patients discharged by noon. Associated with this finding were improvements in hospital throughput as measured by aLOS and boarding times in the ED, ICUs, and PACU. 相似文献16.
Dong-Yeong Lee Young-Jin Park Hyun-Jung Kim Hyeong-Sik Ahn Sun-Chul Hwang Dong-Hee Kim 《Acta orthopaedica et traumatologica turcica》2018,52(2):101-108
Introduction
The aim of this study is to evaluate whether early (<8 h) surgical decompression is better in improving neurologic outcomes than late (≥8 h) surgical decompression for traumatic spinal cord injury (tSCI).Methods
The various electronic databases were used to detect relevant articles published up until May 2016 that compared the outcomes of early versus late surgery for tSCI. Data searching, extraction, analysis, and quality assessment were performed according to Cochrane Collaboration guidelines. The results are presented as relative ratio (RR) for binary outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CIs).Results
Seven studies were finally included in this meta-analysis. There were significant differences between the 2 groups in neurologic improvement (MD = 0.54, 95% CI = ?18.52 to ?7.02, P < 0.0001) and length of hospital stay (MD = ?12.77, 95% CI = 0.34–0.74, P < 0.00001). However, no significant differences were found between the 2 groups in perioperative complications (OR = 0.95, 95% CI = 0.35–2.61, P = 0.92).Conclusions
Early surgical decompression within 8 h after tSCI was beneficial in terms of neurologic improvement compared with late surgery. Early surgical decompression (within 8 h) is recommended for patients with tSCI.Level of evidence
Level III, therapeutic study. 相似文献17.
Effect of a hospital-associated urinary tract infection reduction policy on general surgery patients
Sheena K. Harris Erica L. Mitchell Michael R. Lasarev Fouad Attia John G. Hunter Brett C. Sheppard 《American journal of surgery》2018,215(4):658-662
Background
Hospital-associated UTI rates in surgery patients have not improved despite recommendations for reducing indwelling catheter days.Methods
We performed a retrospective review of institutional NSQIP general surgery patient data, 2006–2015. During this time, a UTI-reduction policy was implemented. Demographics, HA-UTI incidence, CA-UTI incidence, indwelling catheter days, straight catheterization rates, and mortality were examined.Results
Females had significantly higher risk of HA-UTI. There was no significant change in HA-UTI (X12?=?0.02, p?=?.878) or indwelling catheter days (5.18?±?1.12 days v 3.73?±?0.39 days, p?=?.23). Straight catheterizations among those with HA-UTI increased (0.04?±?0.04 v 0.32?±?0.12, p?=?.029). There was no change in CA-UTI (1.38 v 1.11 CAUTI/1000 patient hospital-days P?=?.555) or in initial indwelling catheter days of patients with CA-UTI (7.2 SD 8.89 v 47.0 SD 7.04 days P?=?.961) after policy implementation.Conclusions
The reduction policy increased the number of straight catheterizations for patients developing HA-UTI, but did not reduce the number of initial indwelling catheter days, HA-UTI rates, or CA-UTI rates. 相似文献18.
Nikolaus Johannes Wachter Martin Mentzel Gert D. Krischak Joachim Gülke 《Journal of hand therapy》2018,31(4):524-529
Introduction
In the assessment of hand and upper limb function, grip strength is of the major importance. The measurement by dynamometers has been established.Purpose of the Study
In this study, the effect of a simulated ulnar nerve lesion on different grip force measurements was evaluated.Methods
In 25 healthy volunteers, grip force measurement was done by the JAMAR dynamometer (Fabrication Enterprises Inc, Irvington, NY) for power grip and by a pinch strength dynamometer for tip pinch strength, tripod grip, and key pinch strength.Study Design
A within-subject research design was used in this prospective study. Each subject served as the control by preinjection measurements of grip and pinch strength. Subsequent measurements after ulnar nerve block were used to examine within-subject change.Results
In power grip, there was a significant reduction of maximum grip force of 26.9% with ulnar nerve block compared with grip force without block (P < .0001). Larger reductions in pinch strength were observed with block: 57.5% in tip pinch strength (P < .0001), 61.0% in tripod grip (P < .0001), and 58.3% in key pinch strength (P < .0001).Discussion
The effect of the distal ulnar nerve block on grip and pinch force could be confirmed. However, the assessment of other dimensions of hand strength as tip pinch, tripod pinch and key pinch had more relevance in demonstrating hand strength changes resulting from an distal ulnar nerve lesion.Conclusions
The measurement of tip pinch, tripod grip and key pinch can improve the follow-up in hand rehabilitation.Level of Evidence
II. 相似文献19.
Darryl Schuitevoerder Irvan Bubic Jeanine Fortino Kristen P. Massimino John T. Vetto 《American journal of surgery》2018,215(5):868-872
Introduction
Completion lymph node dissection (CLND) for melanoma after positive sentinel lymph node biopsy (SLNB) was recently shown to improve regional but not overall survival, likely due to the majority of patients harboring no further nodal disease. We sought to determine predictors of non-sentinel node (NSN) positivity.Methods
Retrospective review of prospectively collected data on melanoma patients undergoing SLNB.Results
116 patients underwent 119 CLNDs. The incidence of NSN positivity was 17.6%; the average number of positive NSNs in those cases was 1.5. Cervical and inguinofemoral location were most likely to yield positive NSN(s) (40% each). Conversely, the axilla was least likely at 18% (p?<?0.001). The average number of nodes harvested was 13 for NSN negative cases and 20 for NSN positive cases (p?=?0.005). Tumor thickness increased the probability of positive NSN(s) (OR 1.2, p?=?0.02).Conclusions
Tumor thickness and nodal basin were predictors of NSN metastasis, factors that could help determine which patients may benefit from CLND. Further, CLNDs with fewer nodes may inadequately clear residual nodal disease. 相似文献20.
William G. Hamilton Deborah J. Ammeen Nancy L. Parks Nitin Goyal Gerard A. Engh C. Anderson Engh 《The Journal of arthroplasty》2017,32(6):1803-1807