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July 14, 1993


Author Affiliations

Mayo Clinic, Rochester, Minn

JAMA. 1993;270(2):240-242. doi:10.1001/jama.1993.03510020108037

The greatest energy in orthopedics overall is directed at assessing the risks, complications, and value of elective surgical procedures, particularly those that involve artificial implants. Mechanisms of evaluating the effectiveness of surgical procedures have appeared in increasing numbers in the orthopedic literature, as they have in other medical specialties. Anatomically, the spine remains a second focus of basic and clinical research. While procedures are rapidly evolving on the one hand, increased questioning of the merits of these procedures and emphasis on patient selection and the value of nonoperative treatment are being investigated on the other.

Issues relating to joint replacement arthroplasty continue to dominate the orthopedic literature. Basic research to better understand the ideal fixation of joint replacement devices has focused on interface enhancement, such as coating the implant with hydroxyapatite. In an experiment using a dog model, Soballe et al1 demonstrated that hydroxyapatite improved the radiographic and biomechanical