Level IV, prospective study of case series.

Lateral parapatellar approach combined with TTO may prove highly beneficial in significant valgus deformities, as the anatomical axis is restored accurately and soft tissue release of the lateral contracted structures facilitated to an important extent.

The purpose of our study was to determine the effectiveness of a postoperative autologous blood reinfusion system as an alternative to homologous, banked blood transfusions in total knee arthroplasty. We carried out a prospective randomised controlled study on 60 patients having unilateral total knee replacements. In all these patients, the same surgical team applied the same surgical technique, and all patients followed the same rehabilitation program. In 30 of these patients (group A), a reinfusion system of unwashed salvaged blood was applied, and they were supplemented postoperatively with banked blood transfusions when required. A control group of 30 patients (group B), in whom standard suction drains were used, received one unit of homologous banked blood transfusion intraoperatively and additional blood transfusions postoperatively when required. The administration of banked blood transfusion was determined by the haemoglobin value (<9 mg/dl) and/or clinical signs (blood pressure, pulse, etc.). The values of haemoglobin, haematocrit and platelets were recorded preoperatively and the first, fifth and 15th postoperative days, respectively. Five patients of group A required nine units of homologous blood (0.3 units/patient) postoperatively. Ten patients of group B required an additional 15 banked blood units postoperatively (in total 45 banked blood units for group B; 1.5 units/ patient). In the study group, the total homologous blood requirements were reduced by 80%, while the postoperative blood requirements were reduced by 50%. There was no significant difference in the postoperative haematocrit and haemoglobin values between the two groups. The cost of the blood management in the study group was reduced by 36%. The use of an autologous blood reinfusion system reduces highly effectively the demands of homologous banked blood transfusion in total knee arthroplasty.

PurposeThe aim of this study is to determine the perceived familiarity of medical residents with statistical concepts, assess their ability to integrate these concepts in clinical scenarios, and investigate their susceptibility to the gambler’s fallacy and the conjunction fallacy.MethodsA multi-institutional, cross-sectional survey of Greek medical residents was performed. Participants were asked to indicate their familiarity with basic statistical concepts and answer clinically oriented questions designed to assess their biostatistics knowledge and cognitive biases. Univariate, bivariate, and multivariate statistical models were used for the evaluation of data.ResultsOut of 153 respondents (76.5% response rate), only two participants (1.3%) were able to answer all seven biostatistics knowledge questions correctly while 29 residents (19%) gave incorrect answers to all questions. The proportion of correct answers to each biostatistics knowledge question ranged from 15 to 51.6%. Residents with greater self-reported familiarity were more likely to perform better on the respective knowledge question (all p<0.01). Multivariate analysis of the effect of individual resident characteristics on questionnaire performance showed that previous education outside Greece, primarily during medical school, was associated with lower biostatistics knowledge scores (p<0.001). A little more than half of the respondents (54.2%) answered the gambler’s fallacy quiz correctly. Residents with higher performance on the biostatistics knowledge questions were less prone to the gambler’s fallacy (odds ratio 1.38, 95% confidence intervals 1.12–1.70, p=0.003). Only 48 residents (31.4%) did not violate the conjunction rule.ConclusionsA large number of medical residents are unable to correctly interpret crucial statistical concepts that are commonly found in the medical literature. They are also especially prone to the gambler’s fallacy bias, which may undermine clinical judgment and medical decision making. Formalized systematic teaching of biostatistics during residency will be required to de-bias residents and ensure that they are proficient in understanding and communicating statistical information.

Arthroscopic implantation of a subacromial spacer for irreparable rotator cuff tear resulted in a noticeable improvement in pain relief and shoulder function at a mean 12.6 months follow up. It is a quick, safe and a minimally invasive procedure that is suitable for elderly patients with irreparable cuff tears and medical co-morbidities.