Spine fellowships.
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Education, Medical, Graduate↗
Biomedical subjects
Kevin J McGuire
Publications and source records attributed to Kevin J McGuire.
Lateral retinacular release as a function of femoral component rotation in total knee arthroplasty.
A consensus exists in the orthopaedic community that proper rotational placement of components may reduce the need for lateral release. This study compares the rates and results of lateral release before and after femoral component placement was defined by the transepicondylar axis (TEA). Between 1990 and 1991, 104 primary total knee arthroplasties (TKA) were reviewed during which equal amounts of bone from the posterior femoral condyles were removed. In this group, the lateral release incidence was 24% for varus deformities and 33% for valgus deformities. When the femoral component was externally rotated approximating the TEA, a review of 246 primary TKAs performed between 1998 and 1999 showed lateral release rates of 7% in varus deformities and 29% in valgus deformities. This study documents the statistically significant decline in the lateral release rate with external rotation of the femoral component during TKA in varus deformities (P<.0001), and a decreasing trend in valgus knees (P =.09).
Adult↗
The digital divide phenomenon in a hand surgery outpatient clinic.
The Internet has become an important source of medical information for patients. However, the availability of this resource for individuals in the lower socioeconomic groups is limited, a concept termed the digital divide. To evaluate this phenomenon, we conducted a survey study to quantify the accessibility and use of the Internet for obtaining medical information in an outpatient hand surgery clinic population. A 28-question survey was distributed to 207 patients concerning computer accessibility, Internet use for medical and nonmedical information, Internet trust and security, and patient economic demographics. After analysis of the data, we found individuals in households with higher incomes had a greater likelihood of owning computers than those in lower income brackets. As income increases, the time spent on the Internet also increases. Another statistically significant trend was that higher income patient households thought that Internet information was trustworthy, secure, and private compared with the lower income brackets. We concluded that clinical settings where the predominant patient population earns less than $18,000 may not benefit or use physician Internet-based services or information. The concept of the digital divide seems to be a real phenomenon in the clinical practice of orthopaedics.
Attitude to Computers↗
The 2004 Marshall Urist award: delays until surgery after hip fracture increases mortality.
The objective of this study was to analyze whether a delay in time from admission until surgical treatment increased the mortality rate for patients with a closed hip fracture. We used the day of the week of admission as an instrumental variable to pseudorandomize patients. We analyzed 18,209 Medicare recipients who were 65 years of age or older and had surgical treatment for a closed hip fracture. Patients for whom the delay between admission and surgery was 2 days or more had a 17% higher chance of dying by Day 30. Using instrumental variables analysis, we found a similar 15% increased risk of mortality in patients with delays until surgery of 2 or more days. Based on these results, we found that a delay of 2 or more days significantly increased the mortality rate. This suggests that delay to surgery independently affects mortality, therefore additional study on the effect of smaller delays on outcome is needed.
Aged↗
Torticollis in children: can dynamic computed tomography help determine severity and treatment.
For children with torticollis, dynamic computed tomography scanning (DCTS) is the imaging modality of choice in diagnosing atlantoaxial rotatory subluxation (AARS). At present, there is no grouping system based on DCTS to determine severity and direct treatment. Fifty children with torticollis underwent DCTS in the workup for AARS. The relative rotation of C1 versus C2 was compared for left and right rotation views. Each DCTS was classified: stage 0, torticollis but normal DCTS; stage 1, limitation of motion (<15 degrees difference between C1 and C2, but C1 crosses midline of C2); and stage 2, fixed (C1 does not cross midline of C2). Duration of symptoms and treatment were compared. There were 27 girls and 23 boys with a mean age of 8.2 years. There were 8 stage 0, 30 stage 1, and 12 stage 2 DCTS. Average onset of symptoms to diagnosis was 6.7 days for stage 0, 8.6 days for stage 1, and 20 days for stage 2. A significant trend was found between increasing intensity of treatment and stage. Using this grouping system, the authors found that patients with a higher stage had an increase in the mean duration of symptoms and intensity of treatment.
Atlanto-Axial Joint↗
Assessment of the test characteristics of C-reactive protein for septic arthritis in children.
The purpose of this study was to determine the test characteristics of C-reactive protein (CRP) in the diagnosis of septic arthritis in children and to compare with erythrocyte sedimentation rate (ESR). The authors reviewed patients with synovial fluid aspiration sent for culture and Gram stain for whom a CRP was drawn within 24 hours of presentation. Descriptive statistics and univariate analyses were performed. Results for CRP were compared with ESR. Thirty-nine of 133 patients had septic arthritis. Sensitivity of CRP ranged from 41% to 90%, specificity from 29% to 85%. Positive predictive values ranged from 34% to 53%, negative predictive values from 78% to 87%. In comparison to ESR, CRP is a better independent predictor of disease. CRP is a better negative predictor than a positive predictor of disease. Indeed, if the CRP is <1.0 mg/dL, the probability that the patient does not have septic arthritis is 87%.
Arthritis, Infectious↗