Comparison of therapy in severe systemic lupus erythematosus employing stratification techniques

Randomized studies, attempting to clarify the role of combined azathioprine and prednisone therapy versus prednisone alone in severe systemic lupus erythematosus have sustained rather than mollified a clinical controversy. No differences have been detected in some studies, while others have appeared to show benefit with addition of azathioprine. The present study suggests that neither small random trials nor uncorrected clinical experience can be expected to provide truly comparable control groups in conditions as variable as systemic lupus, but that stratification techniques can yield relatively similar groups. Patients meeting different entry characteristics are demonstrated to come to different outcomes. Depending upon the specifications of a subgroup, one therapy or another appears better.     

Periprosthetic femoral condyle fracture after total knee arthroplasty and saline-coupled bipolar sealing technology

Saline-cooled bipolar radiofrequency technology has emerged as an effective method to reduce bleeding during total knee arthroplasty (TKA). No significant osseous complications have been previously reported, and animal studies have revealed no difference in bone healing, strength, or osteonecrosis compared to conventional monopolar electrocautery. This article presents 4 cases of early postoperative periprosthetic femoral condyle fractures after extensive use of saline-cooled bipolar radiofrequency requiring revision TKA. Preoperative, intraoperative, and postoperative details from 4 patients who underwent early TKA revision for periprosthetic femoral condyle fractures were retrospectively reviewed. The senior author (M.M.) had not experienced similar condyle fractures postoperatively in over 2,500 primary TKAs performed over 2 decades. The cases described here were performed between July 2009 and November 2009, shortly after increasing the usage of saline-cooled bipolar radiofrequency on the synovium overlying the femoral condyles for hemostasis. No other change in surgical technique or implant that occurred during this time was observed. The senior author has significantly decreased his use of saline-cooled bipolar radiofrequency and has seen no recurrence of these complications.