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The Journal of Hand Surgery, European... Oct 2017The use of implant arthroplasty in the hand and wrist is increasing, often with little evidence of outcomes in the literature. We therefore undertook a systematic review... (Review)
Review
UNLABELLED
The use of implant arthroplasty in the hand and wrist is increasing, often with little evidence of outcomes in the literature. We therefore undertook a systematic review of the outcomes of distal radio-ulnar joint arthroplasties following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Papers were assessed for outcomes, implant survival and methodological quality. Fourteen papers assessed ulna head replacements. The implant survival rate was 93% at a mean follow-up of 45 months. One paper assessed a partial ulna head replacement. Fourteen papers assessed total distal radio-ulnar joint replacements; all but two used the Aptis prosthesis. These implants had a survival rate of 97% at a mean of 56 months. Complications rates were 28% in both groups, and many were major. Although these data are impressive, worldwide there are many more implants placed and not followed up. All studies were level IV and V studies with low Coleman scores. This systematic review demonstrates that implant arthroplasty for the distal radio-ulnar joint has produced acceptable results in small numbers of patients. Whilst these short term outcomes are encouraging, the indications should be carefully considered and there should be proper consideration of the potential for later failure.
LEVEL OF EVIDENCE
III.
Topics: Arthroplasty, Replacement; Humans; Joint Diseases; Joint Prosthesis; Treatment Outcome; Wrist Injuries; Wrist Joint
PubMed: 28196431
DOI: 10.1177/1753193417692506 -
JBJS Reviews Jul 2017Most total elbow arthroplasty (TEA) designs aim to replicate anatomy and provide stability in the treatment of the degenerative elbow joint. Given the promising results... (Review)
Review
BACKGROUND
Most total elbow arthroplasty (TEA) designs aim to replicate anatomy and provide stability in the treatment of the degenerative elbow joint. Given the promising results that have been reported following the use of TEA for the treatment of complex fractures, the indications for this procedure are growing. The objective of the present study was to review the most recent literature on the results of the most commonly performed TEAs.
METHODS
A comprehensive literature search was conducted. All relevant studies were reviewed according to a set of predefined inclusion and exclusion criteria. After the initial assessment, 2 authors extracted data from the included articles. Groups were created on the basis of the design of TEA implant, the type of implant (linked or unlinked), and the indication for treatment. Outcome parameters were survival rate, pain, range of motion, complications, and specific elbow outcome scores.
RESULTS
Seventy-three articles involving a total of 9,379 TEAs were included. The level of evidence was primarily Level IV. Nineteen specific designs of TEA implants were described, including the Souter-Strathclyde (n = 2,387), Coonrad-Morrey (n = 1,586), Kudo (n = 560), and GSB III (n = 498). The most common indication for TEA was rheumatoid arthritis (70%). The weighted mean survival rate for the linked and unlinked prostheses was 85.5% at 7.8 years and 74% at 12.3 years, respectively. For the Coonrad-Morrey, Souter-Strathclyde, and GSB III, the weighted mean survival rate was 87.2% at 7.2 years, 70.6% at 14.2 years, and 81.7% at 9.5 years, respectively. The range of motion after TEA was good overall, with a mean flexion angle of 129° and a mean extension lag angle of 30°. The complication rates ranged from 11% to 38%, with clinical loosening being the most frequently reported complication (7%).
CONCLUSIONS
The results of TEA are respectable overall. It appears that there are small differences between designs. However, despite the fairly good functional results and elbow scores, the survival and complication rates are still not as favorable as those following arthroplasties in other joints.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Arthroplasty, Replacement, Elbow; Elbow Prosthesis; Humans; Postoperative Complications
PubMed: 28696952
DOI: 10.2106/JBJS.RVW.16.00089 -
Foot and Ankle Surgery : Official... Dec 2022Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and subsequent re-operations compared to ankle arthrodesis. The aim of this systematic review and meta-analysis is to generate an overview of complications of TAA surgery.
METHODS
PubMed, EMBASE and the Cochrane library were searched between 2000 and 2020 to identify all papers reporting on complications in TAA surgery. Meta-analysis was conducted based on type of complication in TAA surgery. Pooled estimates of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates was rated and described according to the recommendations of the GRADE working group.
RESULTS
One hundred twenty-seven studies were included in this systematic review. All combined, they reported on 16.964 TAAs with an average follow-up of 47.99 ± 29.18 months. Complications with highest reported pooled incidence were intra-operative fracture 0.06 (95 %CI 0.04-0.08) (GRADE Very low) and impingement 0.06 (95 %CI 0.04-0.08) (GRADE low) respectively.
CONCLUSION
Reported complication incidence of TAA surgery is still high and remains a significant clinical problem that can be severely hampering long-term clinical survival of the prosthesis. The results of this systematic review and meta-analysis can help guide surgeons in informing their patient about complication risks. Implementation of more stringent patient selection criteria might contribute to diminishing TAA complication rates.
Topics: Humans; Retrospective Studies; Arthroplasty, Replacement, Ankle; Arthrodesis; Ankle Joint; Reoperation; Treatment Outcome
PubMed: 35872118
DOI: 10.1016/j.fas.2022.07.004 -
Orthopaedics & Traumatology, Surgery &... Jun 2023Planned overlapping surgery can improve efficiency, reduce costs and help manage long waiting lists; yet, this practice has been questioned due to patient safety... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Planned overlapping surgery can improve efficiency, reduce costs and help manage long waiting lists; yet, this practice has been questioned due to patient safety concerns. A systematic review and meta-analysis were performed to answer the question: (1) are there any differences in the risk of postoperative adverse outcomes; and (2) are there any differences in length of stay or length of surgery, in elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed either as non-overlapping surgery (NOS) or overlapping surgery (OS).
PATIENTS AND METHODS
A systematic search of literature in the databases of MEDLINE, PubMed, Embase and Cochrane from dates of inception was performed. All studies published in English were included. Risk of Bias in Non-randomised Studies-of Interventions (ROBINS-I) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were utilised. Relative risk (RR) was used for dichotomous outcomes, while mean difference (MD) was used for continuous variables, with 95% confidence intervals. Alpha was set at 0.05.
RESULTS
A total of nine studies with 120,625 patients were included for analyses. There were no statistically significant differences for overall rates of postoperative complications, dislocations, fractures, infections, readmissions or revision surgery nor with length of stay or length of surgery (p>0.05). Patient characteristics between groups were similar (p>0.05).
DISCUSSION
There were no differences in postoperative adverse outcomes for elective orthopaedic THA and TKA performed as NOS when compared to OS. Operating schedules for OS in elective lower limb arthroplasty appear to be safe, given appropriate patient selection processes and may be a useful method to improve hospital efficiency. Informed consent and preoperative patient education should remain paramount.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Arthroplasty, Replacement, Knee; Postoperative Complications; Arthroplasty, Replacement, Hip; Reoperation; Preoperative Care; Length of Stay
PubMed: 35472455
DOI: 10.1016/j.otsr.2022.103299 -
The Knee Jan 2023It is unclear whether a difference in functional outcome exists between kinematically aligned (KA) and mechanically aligned (MA) knee replacements. The aim of this study... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
It is unclear whether a difference in functional outcome exists between kinematically aligned (KA) and mechanically aligned (MA) knee replacements. The aim of this study is to perform a comprehensive systematic review and meta-analysis of the available level I-IV evidence.
METHODS
A meta-analysis of randomised controlled trials and observational studies comparing patient reported outcome measures (PROMs), range of motion (ROM), gait analysis and complications in TKA with KA and MA was performed. Quality assessment was performed for each study using the Joanna Briggs Institute (JBI) critical appraisal tools.
RESULTS
Twelve randomised controlled trials and fourteen observational studies published between 2014 and 2022 were included in the final analysis. Meta-analysis revealed KA to have significantly better Oxford Knee Score (OKS) (p = 0.02), Forgotten Joint Score (FJS) (p = 0.006), Knee Society Score (KSS) Objective Knee (p = 0.03) and KSS Functional Activity (p = 0.008) scores. However, these improvements did not exceed the minimum clinically important difference (MCID) values reported in the literature. Subgroup analysis showed robotic assisted KA-TKA to have a clinically superior FJS (p = 0.0002) and trend towards KSS Objective Knee score (p = 0.10), compared to PSI. Gait and plantar pressure distribution of KA cohorts more closely represented healthy cohorts, and KA showed a weak association of a decreased knee adduction moment (KAM) compared to MA. Differences in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), range of motion and complications were not significant between groups.
CONCLUSION
Although KA results in several improved functional outcomes, these do not reach clinical significance. Further standardised large-scale randomised studies are required to improve the quality of evidence. As it stands, it is difficult to recommend one philosophy over the other.
Topics: Humans; Knee Prosthesis; Osteoarthritis, Knee; Biomechanical Phenomena; Knee Joint; Arthroplasty, Replacement, Knee; Range of Motion, Articular
PubMed: 36403396
DOI: 10.1016/j.knee.2022.11.001 -
JBJS Reviews Sep 2017Modern management of human immunodeficiency virus (HIV) infection has afforded patients longevity while increasing the burden of arthroplasty procedures because of the... (Review)
Review
BACKGROUND
Modern management of human immunodeficiency virus (HIV) infection has afforded patients longevity while increasing the burden of arthroplasty procedures because of the increased risk of osteonecrosis, fragility fractures, and degenerative joint disease. Early publications on hip and knee arthroplasty in HIV-positive patients reported a high risk of complications, although some more recent publications demonstrated acceptable outcomes. Despite the widespread nature of the HIV pandemic, there is a paucity of literature addressing outcomes following joint arthroplasty in infected patients. We pooled available studies to obtain the best evidence regarding the safety of total hip and knee arthroplasty procedures in HIV-positive patients. The studies identified were heterogeneous, precluding a meta-analysis. However, we performed a review of the literature focusing on complications and outcomes.
METHODS
Twenty-one published English-language articles involving 6,516,186 joints were identified by a systematic review as suitable for inclusion in the study. The articles were analyzed for complication and prosthesis survivorship rates and relative risks.
RESULTS
An overall complication rate of 3.3% was found across the 19 articles that provided such data. HIV-positive patients had a significantly elevated risk of periprosthetic joint infection, at 7.6%, compared with HIV-negative patients, at 3.3% (relative risk = 2.28, 95% confidence interval = 2.14 to 2.43). Eleven articles were suitable for analysis of prosthesis survivorship, and survivorship rates did not differ significantly between HIV-positive and negative patients.
CONCLUSIONS
Total hip and total knee arthroplasty appear to be safe procedures with acceptable outcomes in HIV-positive patients.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Clostridioides difficile; HIV; HIV Infections; HIV Seropositivity; Humans; Interleukin-1; Joint Prosthesis; Male; Meta-Analysis as Topic; Osteonecrosis; Postoperative Complications; Prevalence; Reoperation; Risk Factors; Staphylococcus aureus; Survivorship; Tumor Necrosis Factor-alpha
PubMed: 28953137
DOI: 10.2106/JBJS.RVW.17.00029 -
The Journal of Hand Surgery Jan 2018We conducted a meta-analysis and systematic review with the primary objective to determine the overall incidence of radial head prosthesis removal or revision. Our... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We conducted a meta-analysis and systematic review with the primary objective to determine the overall incidence of radial head prosthesis removal or revision. Our secondary objectives addressed the incidence of removal or revision based on the type of prosthesis fixation (cemented, uncemented smooth stem, uncemented press-fit), material (metal, Vitallium, titanium, pyrocarbon), and design (short vs long stem and monopolar vs bipolar), and the reasons for prosthetic removal or revision.
METHODS
We included 30 studies with a total of 1,017 patients out of whom 77 prostheses were removed and 45 prostheses were revised.
RESULTS
The pooled rate of radial head prosthesis removal or revision was 10.0% (95% confidence interval, 7.3%-13.6%) with a mean follow-up of 38 months. Subgroup analysis showed that the incidence of removal/revision was lowest with the cemented fixation, longer-stem, Vitallium material, and bipolar prosthesis. More than half of the prostheses were removed/revised for excision of the heterotopic ossification (47%) and for the treatment of stiffness and limitation of motion (42%). Other reasons recorded were pain (19%), loosening (16%), overstuffing (13%), instability (12%), infection (8%), and prosthesis disassembly (4%).
CONCLUSIONS
The current data show that the highest incidence of removal/revision occurred within 2 years after implantation. There was no major difference in the incidence of removal/revision among different designs and materials. Implant removal was often performed as part of a procedure to manage elbow stiffness and heterotopic ossification at the surgeon's preference, not necessarily because the implant was malfunctioning. It appears that most radial head arthroplasties have an acceptable and comparable mid-term longevity; however, it is unclear whether long-term longevity will differ between devices.
TYPE OF STUDY/LEVEL OF EVIDENCE
Prognostic II.
Topics: Arthroplasty, Replacement, Elbow; Device Removal; Elbow Joint; Elbow Prosthesis; Humans; Joint Instability; Ossification, Heterotopic; Postoperative Complications; Radius Fractures; Reoperation
PubMed: 29054353
DOI: 10.1016/j.jhsa.2017.08.031 -
Acta Orthopaedica Jun 2017Background and purpose - Radiostereometric analysis (RSA) is an accurate method for measurement of early migration of implants. Since a relation has been shown between... (Review)
Review
Background and purpose - Radiostereometric analysis (RSA) is an accurate method for measurement of early migration of implants. Since a relation has been shown between early migration and future loosening of total knee and hip prostheses, RSA plays an important role in the development and evaluation of prostheses. However, there have been few RSA studies of the upper limb, and the value of RSA of the upper limb is not yet clear. We therefore performed a systematic review to investigate the accuracy and precision of RSA of the upper limb. Patients and methods - PRISMA guidelines were followed and the protocol for this review was published online at PROSPERO under registration number CRD42016042014. A systematic search of the literature was performed in the databases Embase, Medline, Cochrane, Web of Science, Scopus, Cinahl, and Google Scholar on April 25, 2015 based on the keywords radiostereometric analysis, shoulder prosthesis, elbow prosthesis, wrist prosthesis, trapeziometacarpal joint prosthesis, humerus, ulna, radius, carpus. Articles concerning RSA for the analysis of early migration of prostheses of the upper limb were included. Quality assessment was performed using the MINORS score, Downs and Black checklist, and the ISO RSA Results - 23 studies were included. Precision values were in the 0.06-0.88 mm and 0.05-10.7° range for the shoulder, the 0.05-0.34 mm and 0.16-0.76° range for the elbow, and the 0.16-1.83 mm and 11-124° range for the TMC joint. Accuracy data from marker- and model-based RSA were not reported in the studies included. Interpretation - RSA is a highly precise method for measurement of early migration of orthopedic implants in the upper limb. However, the precision of rotation measurement is poor in some components. Challenges with RSA in the upper limb include the symmetrical shape of prostheses and the limited size of surrounding bone, leading to over-projection of the markers by the prosthesis. We recommend higher adherence to RSA guidelines and encourage investigators to publish long-term follow-up RSA studies.
Topics: Arthroplasty, Replacement; Elbow Joint; Hand Joints; Humans; Joint Prosthesis; Postoperative Care; Prosthesis Design; Prosthesis Failure; Radiostereometric Analysis; Shoulder Joint; Upper Extremity
PubMed: 28464752
DOI: 10.1080/17453674.2017.1291872 -
The Bone & Joint Journal Jun 2023This systematic review and meta-analysis aimed to compare the influence of patellar resurfacing following cruciate-retaining (CR) and posterior-stabilized (PS) total... (Meta-Analysis)
Meta-Analysis
AIMS
This systematic review and meta-analysis aimed to compare the influence of patellar resurfacing following cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) on the incidence of anterior knee pain, knee-specific patient-reported outcome measures, complication rates, and reoperation rates.
METHODS
A systematic review of MEDLINE, PubMed, and Google Scholar was performed to identify randomized controlled trials (RCTs) according to search criteria. Search terms used included: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, and patellar retaining. RCTs that compared patellar resurfacing versus unresurfaced in primary TKA were included for further analysis. Studies were evaluated using the Scottish Intercollegiate Guidelines Network assessment tool for quality and minimization of bias. Data were synthesized and meta-analysis performed.
RESULTS
There were 4,135 TKAs (2,068 resurfaced and 2,027 unresurfaced) identified in 35 separate cohorts from 33 peer-reviewed studies. Anterior knee pain rates were significantly higher in unresurfaced knees overall (odds ratio (OR) 1.84; 95% confidence interval (CI) 1.20 to 2.83; p = 0.006) but more specifically associated with CR implants (OR 1.95; 95% CI 1.0 to 3.52; p = 0.030). There was a significantly better Knee Society function score (mean difference (MD) -1.98; 95% CI -1.1 to -2.84; p < 0.001) and Oxford Knee Score (MD -2.24; 95% CI -0.07 to -4.41; p = 0.040) for PS implants when patellar resurfacing was performed, but these differences did not exceed the minimal clinically important difference for these scores. There were no significant differences in complication rates or infection rates according to implant design. There was an overall significantly higher reoperation rate for unresurfaced TKA (OR 1.46 (95% CI 1.04 to 2.06); p = 0.030) but there was no difference between PS or CR TKA.
CONCLUSION
Patellar resurfacing, when performed with CR implants, resulted in lower rates of anterior knee pain and, when used with a PS implant, yielded better knee-specific functional outcomes. Patellar resurfacing was associated with a lower risk of reoperation overall, but implant type did not influence this.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Knee Joint; Knee; Osteoarthritis, Knee; Knee Prosthesis; Pain; Treatment Outcome
PubMed: 37257851
DOI: 10.1302/0301-620X.105B6.BJJ-2022-0970.R2 -
Journal of Shoulder and Elbow Surgery May 2022The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral... (Review)
Review
BACKGROUND
The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral components in reverse total shoulder arthroplasty are only approved for clinical trials in the United States with an investigational device exception with limited data.
METHODS
A systematic review on stemless reverse total shoulder arthroplasty was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted on November 25, 2020, using the MEDLINE/PubMed, Cochrane, and Embase databases. All articles were reviewed by 2 independent evaluators, with any conflicts or issues resolved by consensus or a final decision by the senior author. The primary outcomes extracted were complications, radiographic results, and outcome scores.
RESULTS
We evaluated 10 studies that used either the Total Evolutive Shoulder System (TESS) or Verso implant. There were 430 total patients and 437 total procedures; 266 patients in the TESS group underwent a total of 272 procedures, and 164 patients in the Verso group underwent a total of 165 procedures. The mean age at the time of surgery was 73.8 years (range, 38-93 years). The mean follow-up period ranged from 6.4 to 101.6 months per study. There was an overall trend of improved clinical outcome scores, a 0.2% humeral component loosening rate, and an 11.2% complication rate.
CONCLUSIONS
This review shows that the clinical and functional outcomes following stemless or metaphyseal reverse total shoulder arthroplasty are quite promising, especially with the low rate of humeral-sided complications. There continues to be a need for additional long-term studies and randomized clinical trials.
Topics: Arthroplasty, Replacement, Shoulder; Humans; Prosthesis Design; Shoulder Joint; Shoulder Prosthesis; Treatment Outcome
PubMed: 35051541
DOI: 10.1016/j.jse.2021.12.017