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Hip & Pelvis Jun 2023The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic... (Review)
Review
The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic arthritis of the hip in children. A search of literature in PubMed, Embase, and Google Scholar was conducted for identification of studies reporting on the outcomes of intervention for septic arthritis of the hip in children. Of the 17 articles selected, four were comparative studies; two of these were randomized controlled trials while the rest were single arm studies. Statistical difference was observed between the proportion of excellent clinical and radiological outcomes in arthrotomy (90%, 95% confidence interval [CI] 81-98%; 89%, 95% CI 80-98%), arthroscopy (95%, 95% CI 91-100%; 95%, 95% CI 90-99%), and arthrocentesis (98%, 95% CI 97-100%; 99%, 95% CI 97-100%), respectively. The highest overall rate of additional unplanned procedures was observed in the arthrocentesis group (24/207, 11.6%). Patients who underwent arthrocentesis had a statistically greater chance of excellent clinical and radiological outcomes, although the highest level of need for additional unplanned surgical intervention was observed in the arthrocentesis group, followed by the arthroscopy group and the arthrotomy group. Future conduct of a prospective multicentric study focusing on the developed and developing world, along with acquisition of data. such as delay of treatment and severity of disease will enable assessment of the efficacy of one technique over the other by surgeons worldwide.
PubMed: 37323550
DOI: 10.5371/hp.2023.35.2.73 -
Journal of Oral Rehabilitation Jul 2023Over the past few years, researchers have investigated whether varying menstrual statuses and oestrogen levels could affect the likelihood of temporomandibular disorders... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Over the past few years, researchers have investigated whether varying menstrual statuses and oestrogen levels could affect the likelihood of temporomandibular disorders (TMDs), with conflicting results. While some studies suggest a potential link between increased oestrogen levels and higher TMD risk, others have found no correlation. It is worth noting that oestrogen levels can impact the structure and function of the temporomandibular joint (TMJ). In the light of these findings, our study seeks to investigate the prevalence of TMDs among pregnant women.
METHODS
We searched in PubMed, Web of Science and Lilacs for articles published from the inception until 20 January 2023. We applied the Population, Exposure, Comparator and Outcomes (PECO) model to assess the document eligibility: (P) Participants: female human subjects. (E) Exposure: pregnancy. (C) Comparison: pregnant women compared to non-pregnant women in the childbearing age. (O) Outcome: TMDs diagnosis. Only study providing data about the prevalence in both group (pregnant and non-pregnant) were included. We set the following exclusion criteria: (1) diagnosis of rheumatic diseases or chronic inflammatory disorders (e.g. rheumatoid arthritis, juvenile, idiopathic arthritis, psoriatic arthritis); (2) diagnosis of fibromyalgia; (3) congenital abnormality or neoplastic conditions in the TMJ region; (4) studies including subjects undergoing arthrocentesis or intra-articular infiltrations; (5) studies including local pressure pain assessment; (6) studies including women in menopause in the control group (7) cross-over study design; (8) language different from English; (9) full- text unavailability (i.e. posters and conference abstracts); (10) studies involving animals; (11) review (topical or systematic) article; (12) case reports/series; (13) studies evaluating TMDs prevalence in subjects not pregnant. The software Review Manager version 5.2.8 (Cochrane Collaboration) was used to perform the pooled analysis. We measured the risk ratio (RR) between the two groups (pregnant and non-pregnant).
RESULTS
The included subjects in this review were 440. Among them, 244 were pregnant while the remaining 196 were age matched non-pregnant women. Among those pregnant 102 presented sign/symptoms of TMD or TMD diagnosis (41.8%) whereas 80 of those not pregnant were diagnosed with (40.8%). The overall effect showed that there was no difference in TMD prevalence between pregnant and non-pregnant women in childbearing age (RR 1.12; 95% CI: 0.65-1.93), suggesting that pregnant is neither a risk factor nor a protective factor for TMD.
CONCLUSIONS
Overall, we did not find an association between TMD and pregnancy, neither positive nor negative. Further studies on larger samples are needed to clarify our results.
Topics: Humans; Female; Pregnancy; Prevalence; Cross-Over Studies; Temporomandibular Joint Disorders; Temporomandibular Joint; Estrogens
PubMed: 37021601
DOI: 10.1111/joor.13458 -
Bioengineering (Basel, Switzerland) Mar 2024Temporomandibular joint disorders (TMDs) are prevalent musculoskeletal conditions involving pain and dysfunction of jaw mobility and function, which have proven... (Review)
Review
Does Liquid/Injectable Platelet-Rich Fibrin Help in the Arthrocentesis Treatment of Temporomandibular Joint Disorder Compared to Other Infusion Options? A Systematic Review of Randomized Clinical Trials.
Temporomandibular joint disorders (TMDs) are prevalent musculoskeletal conditions involving pain and dysfunction of jaw mobility and function, which have proven difficult to treat satisfactorily. The present study aimed to assess the effectiveness of a liquid platelet-rich fibrin (i-PRF) infusion during arthrocentesis versus other options using coadjuvant materials to reduce TMD symptoms. A literature search was conducted using PubMed, EMBASE, Web of Science, Scopus, and ClinicalTrials.gov for RCTs published before January 2024, comparing i-PRF to any other TMD treatment. This systematic review was registered on PROSPERO (CRD42023495364). The searches generated several recent RCTs that compared i-PRF injection combined with arthrocentesis (AC) to AC-only or AC with platelet-rich plasma (PRP). The outcomes analyzed included measures of pain (visual analog scale, VAS), maximum mouth opening, joint sounds, and MRI-verified changes in joint structure. Across the RCTs, the addition of i-PRF injection to AC resulted in significant improvements in pain relief, joint function, mouth opening, and structural changes compared to AC-only or with PRP over follow-up periods ranging from 6 to 12 months. Current clinical evidence favors using i-PRF as an adjunct to AC rather than AC-only or AC with PRP for the treatment of TMDs. The improvements in subjective and objective outcome measures are clinically meaningful. Still, additional high-quality RCTs with larger sample sizes and longer follow-ups are required to strengthen the evidence base and better define the role of i-PRF in TMD management guidelines.
PubMed: 38534521
DOI: 10.3390/bioengineering11030247 -
Journal of Clinical Medicine Apr 2022Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular... (Review)
Review
INTRODUCTION
Hyaluronic acid, steroids and blood products are popularly injected into the temporomandibular joint (TMJs) to relieve pain and increase the extent of mandibular abduction. The purpose of this review is to identify other injectable substances and to evaluate them in the above-mentioned domains.
MATERIAL AND METHODS
The review included articles describing clinical trials of patients treated with intra-articular injections with or without arthrocentesis.
RESULTS
The following emerging substances were initially evaluated to be effective in treating TMJ pain and increasing the amplitude of mandibular abduction: analgesics, dextrose with lidocaine, adipose tissue, nucleated bone marrow cells and ozone gas.
DISCUSSION
Better effects of intra-articular administration are achieved by preceding the injection with arthrocentesis.
CONCLUSIONS
The most promising substances appear to be bone marrow and adipose tissue.
PubMed: 35566431
DOI: 10.3390/jcm11092305 -
Journal of Clinical Medicine Feb 2023This systematic review and meta-analysis aimed to validate the hypothesis that intra-articular injections into the inferior temporomandibular joint compartment are more... (Review)
Review
This systematic review and meta-analysis aimed to validate the hypothesis that intra-articular injections into the inferior temporomandibular joint compartment are more efficient than analogous superior compartment interventions. Publications reporting differences between the above-mentioned techniques in the domains of revealing articular pain, decreasing the Helkimo index, and abolishing mandibular mobility limitation were included. Medical databases covered by the Bielefeld Academic Search Engine, Google Scholar, PubMed, ResearchGate, and Scopus engines were searched. The risk of bias was assessed using dedicated Cochrane tools (RoB2, ROBINS-I). The results were visualized with tables, charts, and a funnel plot. Six reports describing five studies with a total of 342 patients were identified. Of these, four trials on a total of 337 patients were qualified for quantitative synthesis. Each eligible report was at moderate risk of bias. From 19% to 51% improvement in articular pain, 12-20% lower Helkimo index, and 5-17% higher maximum mouth opening were observed. The evidence was limited by the small number of eligible studies, discrepancies regarding the substances used, possible biases, and the differences in observation times and scheduled follow-up visits. Despite the above, the advantage of inferior over superior compartment temporomandibular joint intra-articular injections is unequivocal and encourages further research in this direction.
PubMed: 36836198
DOI: 10.3390/jcm12041664 -
Journal of Oral Rehabilitation Jun 2024Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform... (Review)
Review
BACKGROUND
Surgical treatment of temporomandibular joint (TMJ) disc displacement (DD) has been established in different forms since over a century. Ther is a consensus to perform minimal invasive interventions as first-line surgical treatment since there are no evidence on best surgical practice yet.
OBJECTIVE
The aim was to perform a complex systematic review (SR) on the topic-is there evidence for surgical treatment of TMJ DD?
METHODS
The PICO was defined as DD patients (population), treated with different surgical interventions including arthrocentesis (intervention), compared with other or no treatment (control) regarding the outcome variables mandibular function, mouth opening capacity, TMJ pain, etcetera (outcome). For identification of prospective controlled trials and SRs, a search strategy was developed for application in three databases.
RESULTS
The search yielded 4931 studies of which 56 fulfilled the stipulated PICO. Studies with low or moderate risk of bias were possible to include in meta-analyses. There were evidence suggesting arthrocentesis being more effective compared to conservative management (maximum interincisal opening (MIO): p < .0001, I = 22%; TMJ pain: p = .0003, I = 84%) and arthrocentesis being slightly more effective than arthrocentesis with an adjunctive hyaluronic acid injection (MIO: p = .04, I = 0%; TMJ pain: p = .28, I = 0%). Other treatment comparisons showed nonsignificant differences. The performed meta-analyses only included 2-4 studies each, which might indicate a low grade of evidence.
CONCLUSION
Although arthrocentesis performed better than conservative management the findings should be interpreted cautiously, and non-invasive management considered as primary measure. Still, several knowledge gaps concerning surgical methods of choice remains.
Topics: Humans; Temporomandibular Joint Disorders; Minimally Invasive Surgical Procedures; Joint Dislocations; Temporomandibular Joint Disc; Treatment Outcome; Arthrocentesis; Range of Motion, Articular; Hyaluronic Acid; Injections, Intra-Articular
PubMed: 38400536
DOI: 10.1111/joor.13661 -
International Journal of Oral and... Dec 2016This systematic review aimed to investigate whether intra-articular injections of hyaluronic acid (HA) are better than other drugs used in temporomandibular joint... (Review)
Review
This systematic review aimed to investigate whether intra-articular injections of hyaluronic acid (HA) are better than other drugs used in temporomandibular joint arthrocentesis, for the improvement of temporomandibular disorder (TMD) symptoms. Two independent reviewers performed an electronic search of the MEDLINE and Web of Science databases for relevant studies published in English up to March 2016. The key words used included a combination of 'hyaluronic acid', 'viscosupplementation', 'intra-articular injections', 'corticosteroids', or 'non steroidal anti inflammatory agents' with 'temporomandibular disorder'. Selected studies were randomized clinical trials and prospective or retrospective studies that primarily investigated the application of HA injections compared to other intra-articular medications for the treatment of TMD. The initial screening yielded 523 articles. After evaluation of the titles and abstracts, eight were selected. Full texts of these articles were accessed and all fulfilled the inclusion criteria. Intra-articular injections of HA are beneficial in improving the pain and/or functional symptoms of TMDs. However, other drug therapies, such as corticosteroid and non-steroidal anti-inflammatory drug injections, can be used with satisfactory results. Well-designed clinical studies are necessary to identify an adequate protocol, the number of sessions needed, and the appropriate molecular weight of HA for use.
Topics: Humans; Hyaluronic Acid; Injections, Intra-Articular; Randomized Controlled Trials as Topic; Retrospective Studies; Temporomandibular Joint Disorders; Viscosupplements
PubMed: 27374020
DOI: 10.1016/j.ijom.2016.06.004 -
Journal of Stomatology, Oral and... Apr 2024We aimed to find out if there is any difference in outcomes with the use of platelet-rich plasma (PRP) or hyaluronic acid (HA) intra-articular injections after... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We aimed to find out if there is any difference in outcomes with the use of platelet-rich plasma (PRP) or hyaluronic acid (HA) intra-articular injections after temporomandibular joint arthrocentesis.
METHODS
A systematic search of the electronic databases of PubMed, Embase, and Scopus was undertaken up to 5th May 2023. Randomized controlled trials (RCTs) comparing PRP with HA after TMJ arthrocentesis were included.
RESULTS
Seven RCTs were eligible. Pooled analysis failed to demonstrate any significant difference in MMO between PRP and HA groups at 1 month (MD: 0.21 95 % CI: -1.29, 1.70), 3 months (MD: 0.92 95 % CI: -2.96, 4.80), and 6 months (MD: -0.05 95 % CI: -2.08, 1.97). The inter-study heterogeneity was high with I values of 85 %, 98 %, and 81 % respectively. Similarly, there was no statistically significant difference in pain scores between the PRP and HA groups at 1 month (MD: 0.42 95 % CI: -2.25, 3.10), 3 months (MD: 0.90 95 % CI: -1.60, 3.41), and 6 months (MD: 0.06 95 % CI: -0.92, 1.04) with inter-study heterogeneity of 99 %, 99 %, and 92 % respectively.
CONCLUSION
Intra-articular use of PRP or HA after TMJ arthrocentesis may lead to comparable clinical outcomes. The current evidence is low-quality and fraught with high heterogeneity.
Topics: Humans; Hyaluronic Acid; Arthrocentesis; Treatment Outcome; Injections, Intra-Articular; Platelet-Rich Plasma
PubMed: 37923134
DOI: 10.1016/j.jormas.2023.101676 -
The Orthopedic Clinics of North America Apr 2024Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are... (Review)
Review
Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.
Topics: Humans; Arthritis, Infectious; Debridement; Risk Factors; Wrist; Wrist Joint
PubMed: 38403373
DOI: 10.1016/j.ocl.2023.11.002 -
International Journal of Oral and... Sep 2021A systematic review based on the PRISMA guidelines was conducted to investigate and compare treatment with hyaluronic acid (HA), corticosteroids, and blood products in... (Review)
Review
Is there a difference in treatment effect of different intra-articular drugs for temporomandibular joint osteoarthritis? A systematic review of randomized controlled trials.
A systematic review based on the PRISMA guidelines was conducted to investigate and compare treatment with hyaluronic acid (HA), corticosteroids, and blood products in patients with temporomandibular joint osteoarthritis (TMJOA). The MEDLINE/PubMed, Embase, and Cochrane Library databases were searched for articles published until September 25, 2019. Articles met the inclusion criteria if they reported patients with TMJOA, a comparison group, and a follow-up period of at least 6 months. The mean and standard deviation for TMJ pain and maximum mouth opening (MMO) were reported. Nine studies involving 443 patients were included. Injectables and Ringer's lactate solution or normal saline were reported to significantly improve TMJ pain and MMO. Regarding TMJ pain, two studies showed a significant superiority of plasma rich in growth factors (PRGF)/platelet-rich plasma (PRP) injections with or without arthrocentesis over HA, but HA showed a significant improvement compared to corticosteroids. For MMO, no injectable was found to be superior to Ringer's lactate or a normal saline control, but arthrocentesis + PRP resulted in MMO improvement compared to arthrocentesis + HA. Overall, all injectables in conjunction with arthrocentesis were efficient in alleviating pain and improving MMO in TMJOA patients; however, a meta-analysis was not possible due to heterogeneity across studies.
Topics: Humans; Hyaluronic Acid; Injections, Intra-Articular; Osteoarthritis; Platelet-Rich Plasma; Randomized Controlled Trials as Topic; Ringer's Lactate; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 33642154
DOI: 10.1016/j.ijom.2021.01.019