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Knee Surgery, Sports Traumatology,... Jun 2015To compare clinical outcomes after high-flex versus conventional total knee arthroplasty (TKA). (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To compare clinical outcomes after high-flex versus conventional total knee arthroplasty (TKA).
METHODS
A systematic review and meta-regression were performed to compare post-operative outcomes between the two types of prostheses. Relevant randomized controlled trials were identified from MEDLINE and Scopus up to November, 2014.
RESULTS
Fourteen of 369 studies were eligible; 14, 7, 6, 5, 3, 12 and 7 studies were included in the pooling of maximum knee flexion, Knee Society Knee Score (KS), Knee Society Function Score (FS), Hospital for Special Surgery score (HSS), short-form (SF) physical activity score, post-operative complications (DVT, fractures, infection) and revision TKA, respectively. The high-flex TKA had 1.97° [95% confidence interval (CI) 0.37, 3.57], -0.86 (95% CI -1.65, 0.07) and -1.34 (-2.57, -0.11) higher mean maximum knee flexion, KS and FS when compared to conventional TKA. However, there were non-significant differences in HSS, SF-36 (physical), complications and revision TKA.
CONCLUSION
This study suggests that there are improvements in post-operative knee range of motion and knee scores in high-flex TKA implants when compared to conventional TKA implants; however, the difference was very small and therefore might not have any clinical impact. Therefore, conventional TKA can be used as a substitute. However, cost-effective analysis should be performed to make appropriate selections in the future. There are no statistically significant differences in terms of HSS, quality of life, complications and revisions between the groups.
LEVEL OF EVIDENCE
I.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Prosthesis; Prosthesis Design; Range of Motion, Articular
PubMed: 25786819
DOI: 10.1007/s00167-015-3557-0 -
The Bone & Joint Journal Apr 2017The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which... (Meta-Analysis)
Meta-Analysis Review
AIMS
The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported.
MATERIALS AND METHODS
A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database.
RESULTS
A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months. Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation. Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation.
CONCLUSION
A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures. Cite this article: 2017;99-B(4 Supple B):17-25.
Topics: Arthroplasty, Replacement, Hip; Femoral Fractures; Fracture Fixation, Internal; Hip Prosthesis; Humans; Periprosthetic Fractures; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 28363890
DOI: 10.1302/0301-620X.99B4.BJJ-2016-1311.R1 -
Journal of Orthopaedic Surgery and... Dec 2023Extended reality (XR), including virtual reality, augmented reality (AR), and mixed reality, has been used to help achieve accurate acetabular cup placement in total hip... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Extended reality (XR), including virtual reality, augmented reality (AR), and mixed reality, has been used to help achieve accurate acetabular cup placement in total hip arthroplasty (THA). This study aimed to compare the differences between XR-assisted and conventional THA.
METHODS
In this systematic review and meta-analysis, electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to September 10, 2023. The outcomes were accuracy of inclination and anteversion, duration of surgery, and intraoperative blood loss. Meta-analysis was performed using Review Manager 5.4 software.
RESULTS
A total of five studies with 396 patients were included in our study. The pooled results indicated AR-assisted THA had better accuracy of inclination and anteversion than conventional THA (SMD = - 0.51, 95% CI [- 0.96 to - 0.07], P = 0.02; SMD = - 0.96, 95% CI [- 1.19 to - 0.72], P < 0.00001), but duration of surgery and intraoperative blood loss were similar in the two groups.
CONCLUSION
This systematic review and meta-analysis found that AR-assisted THA had better accuracy of inclination and anteversion than conventional THA, but the duration of surgery and intraoperative blood loss were similar in the two groups. Based on the pooled results, we suggested that AR can provide more precise acetabular cup placement than conventional methods in THA.
Topics: Humans; Arthroplasty, Replacement, Hip; Augmented Reality; Blood Loss, Surgical; Acetabulum; Surgery, Computer-Assisted; Hip Prosthesis
PubMed: 38042852
DOI: 10.1186/s13018-023-04421-0 -
Documenta Ophthalmologica. Advances in... Feb 2015The effect of elevated serum cobalt on the human visual system has not yet been established. In light of recent reports of visual problems with elevated cobalt in... (Review)
Review
PURPOSE
The effect of elevated serum cobalt on the human visual system has not yet been established. In light of recent reports of visual problems with elevated cobalt in association with hip prostheses, this review examines the literature for evidence regarding the effects of cobalt on human visual function.
METHODS
A systematic literature review was undertaken in July 2013. The electronic databases of PubMed (1955 to July week 1 2013), Cochrane Library and EMBASE were searched. Only human studies or case reports written in English were included.
RESULTS
Eight case reports were identified. Five case reports involved patients with metal hip arthroplasties, two cases involved patients exposed to environmental cobalt, and one case involved a patient treated medically for anaemia with cobalt chloride. No human prospective studies were identified.
CONCLUSIONS
Several case reports showed that high serum cobalt may be associated with both irreversible and reversible visual loss, optic neuropathy and atrophy, electrophysiological evidence of abnormal retinal and retinal pigment epithelium function and fluorescein angiographic evidence of abnormal choroidal perfusion.
Topics: Arthroplasty, Replacement, Hip; Cobalt; Environmental Exposure; Female; Humans; Male; Metal-on-Metal Joint Prostheses; Optic Nerve Diseases; Retinal Diseases; Vision Disorders
PubMed: 25380579
DOI: 10.1007/s10633-014-9469-3 -
Acta Orthopaedica Et Traumatologica... Mar 2018The aim of this systematic review was to analyze the results of published treatment options in Brucella infection following total joint arthroplasty (TJA). (Review)
Review
INTRODUCTION
The aim of this systematic review was to analyze the results of published treatment options in Brucella infection following total joint arthroplasty (TJA).
METHODS
We performed a systematic review of the literature regarding outcomes of Brucella infection after TJA (hip and knee). We searched multiple databases for articles in the area published from 1950 to 2016.
RESULTS
A total of 18 patients (12 male and 6 female; mean age 59 years) from 14 published studies were identified. The minimum follow-up time was 6 months (range, 6-120 months). Seven patients were treated with debridement or antibrucella treatment only. Eleven patients (61%) underwent removal of the prosthesis and were treated with one or two-stage exchange arthroplasty. The mean duration of antibiotic therapy was 5.8 months. There was no relapse of infection.
CONCLUSIONS
In the absence of loosening of the components of the prosthesis, an attempt to treat Brucella infection medically might be a reasonable choice. One or two-stage exchange arthroplasty could provide successful results without relapse of infection when combined with appropriate antibiotherapy.
LEVEL OF EVIDENCE
Level III, therapeutic study.
Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Clinical Decision-Making; Female; Humans; Male; Middle Aged; Prosthesis-Related Infections; Reoperation
PubMed: 29223445
DOI: 10.1016/j.aott.2017.11.003 -
Joint Diseases and Related Surgery Jan 2024This study overviewed the current database of studies on periprosthetic joint infections (PJIs) to compare outcomes and antibiotic side effects in culture-negative or... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study overviewed the current database of studies on periprosthetic joint infections (PJIs) to compare outcomes and antibiotic side effects in culture-negative or culture-positive PJIs and assess treatment options for culture-negative PJIs.
PATIENTS AND METHODS
A systematic review and meta-analysis was undertaken using studies published before July 2022 in MEDLINE, EMBASE, and Cochrane Library. All studies comparing treatment of culture-negative or -positive PJIs were included. Afterward, the infection control rate, periprosthetic or spacer fracture, hip joint or spacer dislocation, and antibiotic side effects in different treatment methods of PJI were analyzed.
RESULTS
Eleven studies involving 1,747 patients were included. Most studies clearly defined the infection control criteria: no pain or swelling, no wound drainage, normal serology, and normal radiographic findings. Patients were followed until treatment failure, death, or until the last clinical visit without evidence of treatment failure. The two types of PJIs did not differ significantly in infection control rates (culture-negative PJI 79.2% vs. culture-positive PJI 76.6%; odds ratio [OR]=1.20, 95% confidence interval [CI]: 0.84 to 1.70), either after all types of surgical treatment or after two-stage revision arthroplasty (OR=1.12, 95% CI: 0.72 to 1.75), single-stage revision arthroplasty (OR=0.51, 95% CI: 0.19 to 1.37), or debridement, antibiotics, and implant retention (OR=0.88, 95% CI: 0.50 to 1.54). Similarly, we did not find differences in periprosthetic or spacer fracture and hip joint or spacer dislocation. For culture-negative PJIs, the infection control rate was 85.2% after two-stage revision arthroplasty, 90.6% after single-stage revision arthroplasty, and 69.7% after debridement, antibiotics, and implant retention. Data pooled from three studies showed higher incidence of antibiotic side effects for culture-negative PJIs.
CONCLUSION
The clinical outcomes of one-stage revision and two-stage revision are comparable. Therefore, both of them can be considered in surgical treatment for culture-negative PJIs. In addition, limited data showed a higher incidence of antibiotic side effects in culture-negative PJIs.
Topics: Humans; Arthroplasty, Replacement, Hip; Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Hip Joint; Prostheses and Implants; Prosthesis-Related Infections
PubMed: 38108185
DOI: 10.52312/jdrs.2023.1437 -
Knee Surgery, Sports Traumatology,... Sep 2018Patient-specific instruments (PSIs) are already in relatively common use, and their post-operative radiographic results are equal to those for total knee arthroplasty... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Patient-specific instruments (PSIs) are already in relatively common use, and their post-operative radiographic results are equal to those for total knee arthroplasty (TKA) with conventional instrumentation. PSI use requires a preoperative MRI scan, CT scan, or a combination of MRI and a long-leg standing radiograph. However, there is no consensus as to which of these modalities, MRI or CT, is the preferred imaging modality when performing TKA with PSIs.
METHODS
This systematic literature review and meta-analysis studied the differences in alignment outliers between CT- and MRI-based PSI for TKA. A search of the Cochrane Database of Systematic Reviews, MEDLINE/PubMed and Embase was conducted, without restriction on date of publication. Only level I evidence studies written in English that included TKA with the use of MRI- and CT-based PSI were selected. A meta-analysis was then performed of the rate of outliers in the biomechanical axis and individual femoral and tibial component alignment. Where considerable heterogeneity among studies was present or the data did not provide sufficient information for performing the meta-analysis, a qualitative synthesis was undertaken.
RESULTS
Twelve randomized controlled trials, studying 841 knees, were eligible for data extraction and meta-analysis. MRI-based PSI resulted in a significantly lower proportion of coronal plane outliers with regard to the lateral femoral component (OR 0.52, 95% CI 0.30-0.89, P = 0.02), without significant heterogeneity (n.s.). There were no significant differences regarding the biomechanical axis or frontal femoral and individual tibial component alignment.
CONCLUSION
This systematic review and meta-analysis demonstrate that alignment with MRI-based PSI is at least as good as, if not better than, that with CT-based PSI. To prevent for malalignment, MRI should be the imaging modality of choice when performing TKA surgery with PSI.
LEVEL OF EVIDENCE
I.
Topics: Arthroplasty, Replacement, Knee; Bone Malalignment; Femur; Humans; Knee Joint; Knee Prosthesis; Magnetic Resonance Imaging; Osteoarthritis, Knee; Surgery, Computer-Assisted; Tibia; Treatment Outcome
PubMed: 28698929
DOI: 10.1007/s00167-017-4637-0 -
International Journal of Oral and... Jun 2018This systematic review provides an overview of the historical evolution of the prosthetic temporomandibular joint and addresses the challenges and complications faced by... (Review)
Review
This systematic review provides an overview of the historical evolution of the prosthetic temporomandibular joint and addresses the challenges and complications faced by engineers and surgeons, in an effort to shed light on why only a few systems remain available. A better understanding of the history of temporomandibular joint prostheses might also provide insights into the origin of the negative public opinion of the prosthesis, which is based on outdated information. A computerized search using the PubMed Central, ScienceDirect, Wiley Online, Ovid, and Cochrane Library databases was performed following the PRISMA guidelines. Out of 7122 articles identified, 41 met the inclusion criteria for this systematic review. Although several historical reviews have been published previously, none has covered such an extensive time period or has described all designs. Furthermore, besides providing a historical overview, this review discusses the rationale behind the evolution in design and biomaterials, which have largely contributed to the outcomes of the prosthetic systems.
Topics: Arthroplasty, Replacement; Humans; Mandibular Prosthesis; Prosthesis Design; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 29433767
DOI: 10.1016/j.ijom.2018.01.014 -
Surgical Infections Sep 2022To evaluate systematically the failure rate of short versus long courses of antibiotic agents for prosthetic joint infections (PJIs). PubMed, Embase, and Cochrane... (Meta-Analysis)
Meta-Analysis Review
To evaluate systematically the failure rate of short versus long courses of antibiotic agents for prosthetic joint infections (PJIs). PubMed, Embase, and Cochrane Library databases were searched for controlled studies of short- and long-course antibiotic agents for joint prosthesis infections, all from the time of database creation to April 2022. Literature search, quality evaluation, and data extraction were performed independently by two researchers, and the primary outcome was the rate of surgical failure after antibiotic treatment. Stata 11.0 software was then applied for meta-analysis. Publication bias was assessed using Begg test. Heterogeneity was assessed using the test, and fixed or random effects models were used accordingly. Meta-regression was used to determine the causes of heterogeneity. A total of 14 articles involving 1,971 participants met the inclusion criteria, including 12 observational studies and two randomized controlled trials. Meta-analysis showed no difference between short and long courses of antibiotic agents (relative risk, 1.08; 95% confidence interval [CI], 0.89-1.32). The results of the subgroup analysis showed no differences between the failure rates of patients with PJI treated with short and long courses of antibiotic agents in studies with different study areas, different treatment modalities, and different locations of the artificial joints. Patients with PJIs may not require long-term or lifelong antibiotic agents after surgical treatment, and short-term (four to six weeks) antibiotic therapy is usually safe.
Topics: Anti-Bacterial Agents; Arthritis, Infectious; Arthroplasty, Replacement; Humans; Joint Prosthesis
PubMed: 35950957
DOI: 10.1089/sur.2022.157 -
Musculoskeletal Surgery Jun 2022Hofmann et al., in 1995, first described an articulating spacer made by cleaning and autoclaving the original femoral component, which is then re-implanted with a new... (Review)
Review
BACKGROUND
Hofmann et al., in 1995, first described an articulating spacer made by cleaning and autoclaving the original femoral component, which is then re-implanted with a new tibial polyethylene. This systematic review aims to assess the state of existing evidence on the intraoperative autoclaving and re-use of an infected prosthesis, as a spacer, during a two-stage revision following Periprosthetic Joint Infections (PJI).
METHODS
A systematic review was conducted with methods described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. OVID-MEDLINE, EMBASE, Cochrane Library, SCOPUS, Web of Science, Google Scholar and PubMed were searched from 1995 to April 2020 to identify relevant studies.
RESULTS
Fourteen studies were included in this systematic review: two prospective case series; six retrospective comparative studies and six retrospective case series. The reviewed studies included 567 patients (571 knees): 394 patients treated with autoclaved components and 173 with a spacer made of new components. The cumulative re-infection rate in patients treated with re-used autoclaved components was 13.7% (54 re-infections in 394 patients), whereas in control patients the re-infection rate was 13.3% (23 re-infections in 173 patients). The final Range of Movement in patients treated using the autoclaved components as a spacer, compared with patients receiving static spacers, was significantly higher in three out of four comparative studies.
CONCLUSION
There is a moderate level of evidence that the intraoperative autoclaving and re-use of an infected prosthesis as a spacer, during a knee resection arthroplasty, is an effective procedure in the management of knee PJI.
Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Knee; Humans; Knee Prosthesis; Prosthesis-Related Infections; Reinfection; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 34322843
DOI: 10.1007/s12306-021-00722-x