-
JSES International Sep 2023Periprosthetic joint infection of the shoulder (PJI) is a devastating complication with a reported incidence of 1%-15.4% and is often difficult to diagnose with current... (Review)
Review
BACKGROUND
Periprosthetic joint infection of the shoulder (PJI) is a devastating complication with a reported incidence of 1%-15.4% and is often difficult to diagnose with current diagnostic tools including serologic tests and arthrocentesis. This systematic review evaluates the reliability and validity of arthroscopic biopsy in the current literature for the diagnosis of shoulder PJI.
METHODS
MEDLINE, Scopus, Web of Sciences, Google Scholar, and Cochrane databases were queried electronically from inception to June 2022 for publications reporting diagnostic accuracy of shoulder arthroscopic biopsy for detecting infection after anatomic total shoulder arthroplasty, shoulder hemiarthroplasty, or reverse total shoulder arthroplasty. This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
After exclusion, our meta-analysis consisted of 7 articles with a total of 112 patients. The estimated pooled sensitivity and specificity of arthroscopic biopsy for confirmation of shoulder periprosthetic infection were 0.87 (95% confidence interval [CI]: 0.73-0.95) and 0.79 (95% CI: 0.67-0.88), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 4.15 (95% CI: 2.57, 6.70) and 0.17 (95% CI: 0.08, 0.36), respectively. The aggregate positive predictive value was 73.58% (95% CI: 63.29%-81.82%), and aggregate negative predictive value was 89.83% (95% CI: 80.59%-94.95%). The diagnostic odds ratio of arthroscopic biopsy was 19.92 (95% CI: 4.96-79.99).
CONCLUSION
Arthroscopic biopsy in patients suspected of shoulder PJI has good diagnostic accuracy, with high sensitivity and specificity. Given the various biopsy protocols (such as devices, numbers, locations, etc.), further prospective studies are necessary to define the future role of arthroscopic biopsy in diagnosis and treatment.
PubMed: 37719814
DOI: 10.1016/j.jseint.2023.05.004 -
Journal of Oral & Facial Pain and...To review randomized clinical trials on arthrocentesis for managing temporomandibular disorders (TMD) and to discuss the clinical implications.
AIMS
To review randomized clinical trials on arthrocentesis for managing temporomandibular disorders (TMD) and to discuss the clinical implications.
METHODS
On March 10, 2019, a systematic search of relevant articles published over the last 20 years was performed in PubMed, as well as in Scopus, the authors' personal libraries, and the reference lists of included articles. The focus question was: In patients with TMD (P), does TMJ arthrocentesis (I), compared to any control treatment (C), provide positive outcomes (O)?
RESULTS/CONCLUSION
Thirty papers were included comparing TMJ arthrocentesis to other treatment protocols in patients with disc displacement without reduction and/or closed lock (n = 11), TMJ arthralgia and/or unspecific internal derangements (n = 8), or TMJ osteoarthritis (n = 11). In general, the consistency of the findings was poor because of the heterogenous study designs, and so caution is required when interpreting the meta-analyses. In summary, it can be suggested that TMJ arthrocentesis improves jaw function and reduces pain levels, and the execution of multiple sessions (three to five) is superior to a single session (effect size = 1.82). Comparison studies offer inconsistent findings, with the possible exception of the finding that splints are superior in managing TMJ pain (effect size = 1.36) compared to arthrocentesis, although this conclusion is drawn from very heterogenous studies (I = 94%). The additional use of cortisone is not effective for improving outcomes, while hyaluronic acid or platelet-rich plasma positioning may have additional value according to some studies. The type of intervention, the baseline presence of MRI effusion, and the specific Axis I diagnosis do not seem to be important predictors of effectiveness, suggesting that, as in many pain medicine fields, efforts to identify predictors of treatment outcome should focus more on the patient (eg, age, psychosocial impairment) than the disease.
Topics: Arthrocentesis; Humans; Osteoarthritis; Range of Motion, Articular; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 33730123
DOI: 10.11607/ofph.2606 -
Journal of Maxillofacial and Oral... Mar 2023Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of... (Review)
Review
Efficacy of Arthrocentesis and Stabilization Splints in Treatment of Temporomandibular Joint Disc Displacement Disorder Without Reduction: A Systematic Review and Meta-analysis.
BACKGROUND
Temporomandibular joint disc displacement disorders are a group of temporomandibular disorders beside from other inflammatory disorders and growth related disorders of joint. The purpose of this analysis was to evaluate the efficacy of arthrocentesis procedure in comparison with stabilization splints used for disc displacement disorders without reduction.
MATERIALS AND METHODS
A systematic search was done in electronic databases (PubMed, Cochrane Central, Web of Science). In addition to this hand search of references and grey literatures was done. Qualities of randomized controlled clinical trials were assessed by Cochrane's tool for Systematic Reviews of Interventions and the Newcastle-Ottawa Scale was followed to assess the prospective and retrospective studies. Outcome variables pain (VAS) and maximum mouth opening were assessed by the software review manager 5.03.
RESULTS
A total of five studies were included in the review. Three studies showed greater improvement of symptoms in patients of arthrocentesis group in terms of maximum mouth opening, pain (VAS) value. Two other studies found no significant advantage of arthrocentesis over the other treatment protocol. The meta-analysis resulted in statistically significant difference between outcome variables favouring arthrocentesis group (VAS 1-10) (Mean Difference: 3.10; 95% CI 1.74, 4.45; ≤ .00001, Mean difference: 2.00; 95% CI 0.29, 3.71; = 0.02).
CONCLUSION
Arthrocentesis showed effective result in terms of increase in mouth opening and reduction of pain level compared to stabilization splint and other non-invasive approaches in patients with disc displacement disorders without reduction. Overall, results supported the rationale of using arthrocentesis in patients with disc displacement disorders without reduction.
PubMed: 36703686
DOI: 10.1007/s12663-021-01675-1 -
Journal of Oral Rehabilitation Sep 2021To compare intra-operative and postoperative outcomes between the single-puncture and the standard double-puncture techniques of arthrocentesis. (Meta-Analysis)
Meta-Analysis Review
Comparison of outcomes with the single-puncture and double-puncture techniques of arthrocentesis of the temporomandibular joint: An updated systematic review and meta-analysis.
OBJECTIVE
To compare intra-operative and postoperative outcomes between the single-puncture and the standard double-puncture techniques of arthrocentesis.
METHODS
PubMed, Embase, ScienceDirect and CENTRAL databases were searched from inception up to 31 August 2020. Randomised controlled trials (RCTs), prospective and retrospective studies conducted on patients with temporomandibular joint disorders comparing any type of single-puncture arthrocentesis with standard double-puncture arthrocentesis and reporting intra-operative/postoperative outcomes were included. Assessment of the risk of bias was done with the Cochrane Collaboration risk assessment tool.
RESULTS
Thirteen studies were included (12 were RCTs). Analysis of a limited number of studies indicated no difference in pain or maximal mouth opening (MMO) between the single-puncture type-1 or type-2 and the double-puncture technique at various follow-up intervals. Pooled analysis (four studies) demonstrated that the single-puncture type-2 technique requires significantly less operating time as compared to the double-puncture method. No such difference was noted between single-puncture type-1 and double-puncture techniques. Analysis of two studies indicated significantly reduced intra-operative needle relocations with the single-puncture techniques. Studies were not of high quality with concerns of bias in randomisation, allocation concealment and blinding.
CONCLUSIONS
Limited data indicate no difference in pain or MMO with single- or double-puncture techniques of arthrocentesis. Amongst the three techniques, the single-puncture type-2 technique has the advantages of significantly lower operating time and reduced intra-operative needle relocations and it may be the preferred method of TMJ arthrocentesis in clinical practice.
Topics: Arthrocentesis; Humans; Punctures; Range of Motion, Articular; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 34273184
DOI: 10.1111/joor.13228 -
Cureus Sep 2021Novel oral anticoagulants (NOACs) are increasingly prescribed blood-thinning medication. Surpassing Warfarin, NOACs are more favored and extensively used in paroxysmal... (Review)
Review
Novel oral anticoagulants (NOACs) are increasingly prescribed blood-thinning medication. Surpassing Warfarin, NOACs are more favored and extensively used in paroxysmal atrial fibrillation, acute coronary syndrome, and in elderly patients. Well-known benefits of novel oral anticoagulants include predictable pharmacokinetics, pharmacodynamics, and shorter half-life. However, as with any anticoagulant, there are bleeding risks with NOACs. There is a lack of evidence and consensus on the management of novel anticoagulants for intraarticular injections and arthrocentesis. This systematic review aims to analyze the risk of bleeding complications in patients on novel oral anticoagulants who underwent joint injections and arthrocentesis to help physicians in the decision-making and consenting process. A literature search of three online databases was completed using the Cochrane methodology for systematic reviews. Eligibility criteria included any study that reported bleeding complication rates in adult patients on novel oral anticoagulants that had a joint injection or aspiration whilst continuing their regular oral anticoagulation. All studies with any number of patients and published in any language were included. Review articles and systematic reviews were excluded. The search of databases resulted in a total of 310 articles. After screening, a total of four articles were deemed suitable to be included in the analysis. These described a total of 668 patients undergoing injections/aspiration procedures with patients on three different novel oral anticoagulants namely Rivaroxaban, Apixaban, and Dabigatran. Only one patient joint had a bleeding complication and the patient was on Dabigatran. The results of this systematic review show that it is relatively safe to perform joint injections and arthrocentesis whilst continuing on Novel oral anticoagulation.
PubMed: 34659968
DOI: 10.7759/cureus.17755 -
Cureus Mar 2024Temporomandibular disorder (TMD) is a multifaceted disorder impacting the temporomandibular joint (TMJ), causing substantial discomfort and functional limitations. This... (Review)
Review
Temporomandibular disorder (TMD) is a multifaceted disorder impacting the temporomandibular joint (TMJ), causing substantial discomfort and functional limitations. This systematic review aims to comprehensively assess the effectiveness of non-invasive treatment modalities for TMJ dysfunction, prioritizing a definitive protocol to ensure patient safety and enhance quality of life. Employing the PRISMA guidelines, we meticulously analyzed 20 studies from a pool of 1,417 articles sourced from databases such as PubMed, Google Scholar, ScienceDirect, and Medline. These studies underscore the multifarious nature of TMD and the varied responses to treatments such as physical therapy, laser therapy, ultrasound and electrical stimulation, splint therapy, injections, and arthrocentesis. Notably, the review highlights the paramount importance of precise diagnosis, often through surface electromyography, followed by a tailored treatment approach integrating manual therapy, counseling, and splint therapy. The systematic analysis revealed that while certain treatments such as transcutaneous electrical nerve stimulation and low-level laser therapy showed limited efficacy, combination therapies, especially those involving manual therapy, counseling, and splint therapy, demonstrated substantial improvement in reducing pain, depression, and anxiety. The findings advocate for a non-invasive, patient-centric approach, emphasizing education and symptom management before considering more invasive procedures such as injections and arthrocentesis. The review identifies the need for more comprehensive, longitudinal studies to establish a standardized, evidence-based treatment protocol for TMJ dysfunction, aiming to improve patient outcomes holistically.
PubMed: 38646388
DOI: 10.7759/cureus.56713 -
Clinical Oral Investigations Apr 2022This systematic review compared minimally and invasive surgical procedures to manage arthrogenous temporomandibular joint (TMJ). (Meta-Analysis)
Meta-Analysis Review
Invasive surgical procedures for the management of internal derangement of the temporomandibular joint: a systematic review and meta-analysis regarding the effects on pain and jaw mobility.
OBJECTIVES
This systematic review compared minimally and invasive surgical procedures to manage arthrogenous temporomandibular joint (TMJ).
MATERIALS AND METHODS
The review included clinical trials assessing surgical procedures of arthrogenous temporomandibular disorder (TMD) management by carrying out comparisons within the same surgical procedure (pre- and post-treatment) as well as between different surgical procedures. Meta-analyses were conducted only for similar comparison reporting the same outcome measures, visual analog scale (VAS) values to evaluate pain and maximum incisal opening (MIO) values.
RESULTS
Of the 1,015 studies identified by the search strategy, 26 were selected for full-text reading, and 19 were included in the review. Of these, 16 studies were included in the meta-analysis and 3 in the qualitative analysis. The VAS scores showed significantly lower values after discectomies (p < 0.001) and discoplasties (p < 0.001) in the within-group comparison. Moreover, significantly lower VAS scores and higher MIO values were observed after discectomy compared to arthroscopy, eminectomy, and discoplasty (p < 0.05).
CONCLUSION
The findings of this systematic review suggest that although significantly lower VAS scores and higher MIO values were observed after discectomy, the currently available scientific evidence is unclear, and the use of invasive surgical procedures should not be implemented as an efficient first-line treatment option for arthrogenous TMD management.
CLINICAL SIGNIFICANCE
VAS and MIO outcomes could be insufficient to describe the success or failure of open surgical procedures like discectomy and discoplasty.
Topics: Arthroscopy; Humans; Pain; Range of Motion, Articular; Retrospective Studies; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 35291030
DOI: 10.1007/s00784-022-04428-7 -
International Journal of Oral and... Jan 2015The aim of this study was to assess whether arthroscopy or arthrocentesis is most effective and feasible in the management of internal derangement of the... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to assess whether arthroscopy or arthrocentesis is most effective and feasible in the management of internal derangement of the temporomandibular joint (TMJ), specifically in relation to joint movement and pain. A comprehensive electronic search without date or language restrictions was performed in January 2014. Inclusion criteria were the following: study in humans; randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies; comparison of arthrocentesis and arthroscopy in the treatment of internal derangement. Six publications were included in the review, two RCTs, two CCTs, and two retrospective studies. Two studies showed a low risk of bias and four studies showed a moderate risk of bias. There were statistically significant differences between arthrocentesis and arthroscopy with regard to maximal inter-incisal opening and pain reduction, but no difference between the two groups for postoperative complications. The results of this meta-analysis on the management of internal derangement of the TMJ revealed arthroscopy to have superior efficacy to arthrocentesis in increasing joint movement and decreasing pain. Both arthroscopy and arthrocentesis have comparable postoperative complication rates. However, the current meta-analysis is incomplete due to the paucity of good quality studies in the high-impact, peer-reviewed literature; therefore, further better-designed studies are required to address this important question before final conclusions can be drawn as to the true comparative outcomes of TMJ arthrocentesis versus TMJ arthroscopy.
Topics: Arthroscopy; Facial Pain; Humans; Paracentesis; Range of Motion, Articular; Temporomandibular Joint Disorders
PubMed: 25123511
DOI: 10.1016/j.ijom.2014.07.008 -
International Journal of Environmental... Feb 2022Learning modifications particularly increased due to the SARS-CoV-2 pandemic, which made it necessary to offer distance health education for many months. Social media... (Review)
Review
Learning modifications particularly increased due to the SARS-CoV-2 pandemic, which made it necessary to offer distance health education for many months. Social media allows students to have interactive activities such as discussing specific subjects or sharing data with each other, and also to have interactions with their teachers and tutors. So, we aimed to compare the effects of the use of social media on knowledge, skills and perceptions in health students compared to other methods. We performed a systematic review on PubMed, ScienceDirect and Embase about comparative learning methods using social media. The search followed PRISMA guidelines, and the quality assessment of the studies was performed using the Medical Education Research Quality instrument (MERSQI). Eight studies were analyzed including 1014 participants. Mean age ranged from 19.9 to 23.4 years, and 70% were females. About 54.4% of the participants were medical students and 20.9% were dental students. The mean MERSQI was 11.7 ± 2.6. Various subjects were included-anatomy, cultural competences, sterile surgical techniques, radiology, arthrocentesis, medical pathologies and cariology. As far as knowledge evaluation was concerned, we found that the use of social media may have had a positive effect from a short-term point of view but results concerning skills were less consistent across studies. Students usually had a positive perception of the use of social media as a complementary method but not as a complete alternative so it is not excluded that this effect might result from an increase in working time. The impact on patient care should also be assessed in future studies.
Topics: Adult; COVID-19; Education, Medical; Female; Humans; SARS-CoV-2; Social Media; Students, Medical; Young Adult
PubMed: 35206401
DOI: 10.3390/ijerph19042205 -
The British Journal of Oral &... Dec 2021The objective of this study was to compare, through a systematic review with a meta-analysis, the relative risks of arthroscopy and arthrocentesis in the... (Meta-Analysis)
Meta-Analysis Review
The objective of this study was to compare, through a systematic review with a meta-analysis, the relative risks of arthroscopy and arthrocentesis in the temporomandibular joint. MEDLINE/PUBMED, EMBASE, Cochrane Library (CENTRAL), Web of Science, SCOPUS were the researched databases, as well as grey literature and manual searches. The search results showed 656 studies, but only five met the eligibility criteria. The evaluation included 194 joints (104 patients): 101 were arthroscopy and 93 arthrocentesis. Complications were observed in four patients undergoing arthroscopy (two with temporary facial paralysis and two with prolonged cervical oedema) and in three patients undergoing arthrocentesis (two with severe bradycardia and one with prolonged cervical oedema). The meta-analysis demonstrated a relative risk of 0.99 for complications after arthroscopy compared with arthrocentesis, but the results showed no statistical differences. In conclusion, this systematic review suggests that there is no increased risk of complications with arthroscopy than arthrocentesis. When complications were present, they were temporary.
Topics: Arthrocentesis; Arthroscopy; Edema; Humans; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 34274169
DOI: 10.1016/j.bjoms.2021.05.007