-
The Journal of Arthroplasty Mar 2022Patients with hemophilia (PWHs) may experience spontaneous or traumatic bleeding episodes. Recurrent bleeding can lead to end-stage hemophilic arthropathy and total knee... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Patients with hemophilia (PWHs) may experience spontaneous or traumatic bleeding episodes. Recurrent bleeding can lead to end-stage hemophilic arthropathy and total knee replacement (TKR) provides an effective treatment. The aim of this study is to investigate outcomes in PWHs who undergo TKR.
METHODS
A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study outcomes included patient-reported functional outcomes, implant survivorship, and complications. Subgroup analysis was performed assessing the effect of recombinant prophylaxis medication by comparing studies that included only TKRs performed after the year 2000 (period A), to those that included TKRs before 2000 (period B).
RESULTS
Twenty-eight studies were included, with a total of 1210 TKRs performed in 917 PWHs. The mean age of patients was 38.5 years (standard deviation 5.1) with a mean length of follow-up of 7.1 years (standard deviation 2.9). The total complication rate was 28.7%, with 19.3% requiring a further procedure. Hospital for Special Surgery Knee Score improved by 44.6 points (confidence interval 38.9-50.4) and Knee Society Score function improved by 35.9 points (confidence interval 30.1-41.8). Total range of motion improved by 22.3°. The most common complication was post-operative hemarthrosis (7.6%, 92 TKRs). Deep infection (6.2% vs 3.9%) and aseptic loosening (3.8% vs 2.1%) rates fell between period B and period A.
CONCLUSION
TKR in PWHs is a successful procedure improving function, reducing pain, and improving range of motion. PWHs undergo TKR at a younger age and have a higher risk of complications, though contemporary treatment has reduced these risks. PWHs can expect similar survivorship to the general population.
Topics: Adult; Arthroplasty, Replacement, Knee; Hemarthrosis; Hemophilia A; Humans; Knee Joint; Knee Prosthesis; Survivorship; Treatment Outcome
PubMed: 34756977
DOI: 10.1016/j.arth.2021.10.015 -
Knee Surgery, Sports Traumatology,... Mar 2022The purpose of this systematic review and meta-analysis was to investigate the variability in femoral geometric ratios among knees of different sexes and races, and to... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this systematic review and meta-analysis was to investigate the variability in femoral geometric ratios among knees of different sexes and races, and to appreciate whether the observed variability is accommodated by commonly implanted total knee arthroplasty (TKA) components. The hypothesis was that the anthropometric studies report considerable variability of femoral geometric ratios among sexes and races.
METHODS
This systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE and Embase on 6 July 2020 for clinical studies reporting on femoral geometric ratios among sexes and races. Femoral geometric ratios were graphically represented as means and 2 standard deviations, and compared to those of 13 commonly implanted femoral components.
RESULTS
A total of 15 studies were identified that reported on a combined total of 2627 knees; all reported the aspect ratio, and 2 also reported the asymmetry ratio and trapezoidicity ratio. Men had wider knees than women, and compared to Caucasian knees, Arabian and Indian knees were wider, while East Asian were narrower. There were no differences in asymmetry ratio between men and women, nor among Caucasian and East Asian knees. Men had more trapezoidal knees than women, and East Asian knees were more trapezoidal than Caucasian knees. The commonly implanted femoral components accommodated less than a quarter of the geometric variability observed among sexes and races.
CONCLUSION
Anthropometric studies reported considerable sexual dimorphism and racial diversity of femoral geometric ratios. Since a surgeon generally only uses one or a few TKA brands, bone-implant mismatch remains unavoidable in a large proportion of knees. These findings support the drive towards personalized medicine, and accurate bone-implant fit may only be achievable through customisation of implants, though the clinical benefits of custom TKA remain to be confirmed.
LEVEL OF EVIDENCE
IV.
Topics: Arthroplasty, Replacement, Knee; Female; Femur; Humans; Knee Joint; Knee Prosthesis; Male; Osteoarthritis, Knee; Sex Characteristics
PubMed: 33512544
DOI: 10.1007/s00167-021-06447-5 -
Knee Surgery, Sports Traumatology,... Dec 2023In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
In revision total knee arthroplasty (TKA) ligament instability and bone defects might require more constraint implants such as a condylar constrained knee (CCK) or rotating hinged knee (RHK). When both implants are suitable, the choice remains controversial. The purpose of this systematic review and meta-analysis was to compare the survivorship and clinical outcome between CCK and RHK in revision TKA.
METHODS
Systematic literature research was performed. Studies analysing the clinical outcome and/or survivorship of CCK and/or RHK in revision TKA were included. Clinical outcomes included the Knee Society Score, both clinical (KSCS) and functional (KSFS), range of motion (ROM) and reoperations. Survival was defined as the time free from removal or revision of the femoral and/or tibial component.
RESULTS
A total of 40 articles analysing 4.555 knees were included. Survival did not differ between RHK and CCK implants (p = 0.6058), with, respectively, 91.6% and 89.8% survival after 5 years. Postoperative KSCS and KSFS were, respectively, 79.2 (SD 10.7) and 61.1 (SD 21.8) for the CCK group. Similar scores were noted for the RHK group with a KSCS of 80.2 (SD 14.1) and KSFS of 58.5 (SD 17.3). Postoperative ROM was similar for CCK (105.3°, SD 17.1°) and RHK patients (104.1°, SD 16.9°).
CONCLUSION
This meta-analysis revealed that both survivorship and clinical outcome are similar for CCK and RHK patients for whom both designs are technically suitable and indicated.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Arthroplasty, Replacement, Knee; Survivorship; Prosthesis Design; Knee Prosthesis; Knee Joint; Reoperation; Treatment Outcome; Retrospective Studies; Prosthesis Failure
PubMed: 37747534
DOI: 10.1007/s00167-023-07572-z -
European Journal of Orthopaedic Surgery... Apr 2018Postoperative dislocation is a challenging complication after total hip arthroplasty (THA) that affects patient outcome worldwide. Instability is one of the main... (Meta-Analysis)
Meta-Analysis Review
Postoperative dislocation is a challenging complication after total hip arthroplasty (THA) that affects patient outcome worldwide. Instability is one of the main complications with rates exceeding 20% in some series. Currently, alternative acetabular components are available with dual mobility (DMTHA) bearing surfaces and larger femoral head size that may reduce the risk of dislocation, yet provide the functional benefit of standard single mobility (STHA) bearing surface THA. However, whether STHA, big femoral head (BTHA) and DMTHA should be used is still controversial. This systematic review and meta-analysis aim to compare postoperative dislocation and revision (aseptic loosening and infection) of BTHA, STHA and DMTHA in primary or revision THA. These clinical outcomes consist of postoperative dislocation and revision (aseptic loosening and infection). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies were identified from Medline and Scopus from inception to June 8, 2017, that reported postoperative dislocation and revision (aseptic loosening and infection) of either implant THA. Eleven of 677 studies (nine comparative studies and two RCTs) (N = 4084 patients) were eligible; all 11 studies were included in pooling. Intervention included dual mobility THA (N = 1068 patients), standard THA (N = 2568 patients), big head THA (N = 378 patients) and constrain THA (N = 70 patients). A network meta-analysis showed that risk of revision and dislocation of DMTHA was significantly lower with RR of 2.19 (1.36, 3.53) and 4.19 (2.04, 8.62) when compared to STHA. While there was no statistically significant risk of having revision and dislocation of DMTHA when compared to BTHA and CTHA. The SUCRA probability of DM and BTHA was in the first and second rank with 46.5 and 44.8% in the risk of revision and 46.7 and 45.1% in the risk of dislocations. In short-term outcomes (5 years or less, with follow-up of 0-5 years), the best implant of choice that has lowest risk of revision and dislocation after THA is DMTHA follow by BTHA. We recommend using dual mobility and big head as an implant for safety in THA. However, there were only two studies that reported long-term survivorship (more than 5 years, with follow-up of 5-15 years). Further research that assesses long-term survivorship is necessary to further evaluate which implants are the best for THA.
Topics: Aged; Arthroplasty, Replacement, Hip; Female; Femur Head; Hip Dislocation; Hip Prosthesis; Humans; Male; Middle Aged; Network Meta-Analysis; Postoperative Complications; Prosthesis Failure; Prosthesis-Related Infections; Randomized Controlled Trials as Topic; Reoperation; Risk Factors
PubMed: 29119371
DOI: 10.1007/s00590-017-2073-y -
The Journal of Arthroplasty Oct 2019Knee kinematics is an analysis of motion pattern that is utilized to assess a comparative, biomechanical performance of healthy nonimplanted knees, injured nonimplanted... (Meta-Analysis)
Meta-Analysis
Knee kinematics is an analysis of motion pattern that is utilized to assess a comparative, biomechanical performance of healthy nonimplanted knees, injured nonimplanted knees, and various prosthetic knee designs. Unfortunately, a consensus between implanted knee kinematics and outcomes has not been reached. One might hypothesize that the kinematic variances between the nonimplanted and implanted knee might play a role in patient dissatisfaction following TKA. There is a wide range of TKA designs available today. With such variety, it is important for surgeons and engineers to understand the various geometries and kinematic profiles of available prostheses. The purpose of this review is to provide readers with the pertinent information related to TKA kinematics.
Topics: Aged; Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Computer-Aided Design; Female; Fluoroscopy; Humans; Imaging, Three-Dimensional; Knee; Knee Joint; Knee Prosthesis; Magnetic Resonance Imaging; Male; Polyethylene; Prosthesis Design; Prosthesis Failure; Range of Motion, Articular; Rotation
PubMed: 31229370
DOI: 10.1016/j.arth.2019.05.037 -
The Journal of Knee Surgery Jan 2017Knee arthroplasty is an effective and reproducible way of treating advanced knee arthritis; however, results are not always favorable. Knee arthroscopy has been... (Review)
Review
Knee arthroplasty is an effective and reproducible way of treating advanced knee arthritis; however, results are not always favorable. Knee arthroscopy has been described in symptomatic knee arthroplasty, but opinion is divided over its utility. The purpose of this systematic review is to examine existing evidence supporting knee arthroscopy in the setting of knee arthroplasty. Predetermined inclusion criteria were used to search the databases EMBASE, MEDLINE, and PubMed for articles addressing knee arthroplasty patients who subsequently underwent arthroscopy. Inclusion criteria limited our search to human and English language studies with clearly described surgical indications. Article screening was conducted in duplicate. Before duplicate screening, 2,179 studies were retrieved and 52 ultimately satisfied the inclusion criteria. A total of 609 patients underwent knee arthroscopy of a symptomatic knee arthroplasty and 120 patients went on to require further surgery post-arthroscopy. Peripatellar fibrosis and pain with no clear diagnosis were the most commonly described indications for surgery. Knee arthroscopy is a safe diagnostic and therapeutic tool in symptomatic knee arthroplasty with variable efficacy depending on indication. It has diagnostic utility in painful knee arthroplasty patients and is a reliable therapeutic option for those with post-arthroplasty diagnoses; although 20% of the patients go on to require further surgery. This is a systematic review of level IV studies.
Topics: Adult; Aged; Arthroplasty, Replacement, Knee; Arthroscopy; Female; Humans; Knee Prosthesis; Male; Middle Aged; Patient Selection
PubMed: 26963069
DOI: 10.1055/s-0036-1579669 -
International Journal of Surgery... May 2018The debate over the use of cemented or cementless fixation in total knee arthroplasty (TKA) has never stopped since cementless fixation was introduced. We undertook a... (Meta-Analysis)
Meta-Analysis Review
No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: A systematic review and meta-analysis.
BACKGROUND
The debate over the use of cemented or cementless fixation in total knee arthroplasty (TKA) has never stopped since cementless fixation was introduced. We undertook a systematic review and meta-analysis to evaluate the optimal mode of fixation (full-cementless vs. full-cemented) in TKA.
METHODS
PubMed, Embase, and the Cochrane Library databases up to July 2017 were searched to identify randomised controlled trials (RCTs) and quasi-RCTs comparing full-cementless TKA and full-cemented TKA. The primary outcome was implant survivorship. Secondary outcomes included radiological outcomes (maximum total point-motion [MTPM], radiolucent line, rotation degree) and clinical outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] score, Knee Society Score [KSS] score, postoperative range of movement, blood loss and complications).
RESULTS
Seven studies were included in the systematic review and meta-analysis. The mean follow-up was 7.1 years (range from 2 to 16.6 years). There was no difference in implant survivorship (RR, 0.98; 95% CI, 0.95-1.01; p = 0.25; I = 0%), MTPM (weighted mean difference [WMD], 0.13 mm; 95% CI, -0.69-0.95; p = 0.75; I = 89.3%) and radiolucent line (RR, 1.36; 95% CI, 0.57-3.23; p = 0.48; I = 54%) between the cementless and cemented methods. There was a mean 0.22° more rotation in the full-cementless fixation group (95% CI, 0.13-0.32; p < 0.01; I = 28.5%). There were no significant differences relating to clinical outcomes (WOMAC score, KSS score, postoperative range of movement, blood loss and complications) between the two fixation groups.
CONCLUSIONS
Although more overall component rotation is found in full-cementless fixation, the implant survivorship and clinical efficacy are likely similar between full-cementless and full-cemented fixation. However, future RCTs with similar cementless prosthetic coating and longer-term follow-up are still needed to confirm our findings.
Topics: Arthroplasty, Replacement, Knee; Bone Cements; Humans; Knee Joint; Knee Prosthesis; Prosthesis Design; Prosthesis Failure
PubMed: 29656129
DOI: 10.1016/j.ijsu.2018.04.015 -
Archives of Orthopaedic and Trauma... Sep 2023Implant designs for total knee arthroplasties (TKA) are continuously evolving to improve outcomes and satisfaction rates after TKA. The present systematic review and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Implant designs for total knee arthroplasties (TKA) are continuously evolving to improve outcomes and satisfaction rates after TKA. The present systematic review and meta-analysis aimed to explore the evidence in the literature regarding the outcomes of the Attune knee system over the PFC Sigma knee design and investigate the advantage of one over the other.
METHODS
A systematic review and meta-analysis of published studies till August 2021 was performed using the defined eligibility criteria. This was a systematic review of the literature published in the Cochrane Central Register of Controlled Trials (CENTRAL) Library, PUBMED, and EMBASE. The analysis included prospective and retrospective comparative trials comparing TKA by PFC sigma or Attune posterior stabilized (PS) or cruciate-retaining (CR), fixed bearing, or rotating platform systems. Patient-reported outcome measures (PROM) and postoperative patellar complications were analysed in the studies utilizing attune knee system (modern implants) to its counterpart PFC sigma (traditional implants) for TKA. Quality assessment was conducted using NIH Quality Assessment Tool for controlled intervention studies (RCTs and case-control studies).
RESULTS
This review included 3 RCTs and the rest, 10 of which were non-RCT, including 5852 patients. ATTUNE designs suggested a statistically significant improvement in KSS over PFC Sigma designs. Other PROMs such as OKS and WOMAC scores yielded comparable results between the two groups. ATTUNE knee prosthesis did not result in better knee range of motion, patient satisfaction, or radiological outcomes than the PFC design. Regarding the complications, attune knee prosthesis demonstrated favourable results over PFC Sigma for anterior knee pain and patellofemoral (PF) crepitus.
CONCLUSIONS
The present systematic review highlights better KSS and lesser chances of PF complications favouring a modern implant design over its traditional counterpart. Other patient-reported outcome analyses at a short-term follow-up period were comparable among patients undergoing total knee replacements with two different implant designs. Radiological outcomes for component positioning also suggested similar results among the two groups.
Topics: Humans; Arthroplasty, Replacement, Knee; Patellofemoral Joint; Retrospective Studies; Prospective Studies; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Postoperative Complications; Range of Motion, Articular; Prosthesis Design
PubMed: 36961568
DOI: 10.1007/s00402-023-04832-y -
Postgraduate Medical Journal Sep 2015It has been perceived that people following total hip arthroplasty (THA) or total knee arthroplasty (TKA) have the capability, with reduced pain, to increase their... (Review)
Review
BACKGROUND
It has been perceived that people following total hip arthroplasty (THA) or total knee arthroplasty (TKA) have the capability, with reduced pain, to increase their levels of physical activity.
OBJECTIVES
To determine the attitudes and perceptions of people awaiting or having undergone THA or TKA to physical activity post-arthroplasty and to identify potential facilitators or barriers to engage in active living and physical activity pursuits.
METHODS
Systematic review of published and unpublished databases was undertaken from their inception to November 2014. Studies exploring the attitudes and perceptions of people awaiting or having undergone THA or TKA to physical activity post-arthroplasty were included. Data were analysed through a meta-ethnography approach.
RESULTS
From 528 citations, 13 papers were eligible, sampling 282 people post-THA or TKA. The literature was judged moderate to high quality. Following THA and TKA, people either wished to return to their pre-pathology level of physical activity or simply be able to engage in less physically demanding activities that are meaningful to them and their lifestyles. Barriers to engaging in higher levels of physical activity were largely related to limited information, which culminated in fear surrounding 'doing the right thing' both for individual's recovery and the longevity of the joint replacement.
CONCLUSIONS
While many people post-THA or TKA wish to return to pre-pathological physical activity status, there is limited interest in actually undertaking greater levels of physical activity post-arthroplasty either for pleasure or health gains. Improvement in education and awareness of this may be key drivers to improve habitualisation of physical activity post-arthroplasty.
TRIAL REGISTRATION NUMBER
CRD42014014995.
Topics: Activities of Daily Living; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Motor Activity; Pain Measurement; Patient Satisfaction; Quality of Life; Recovery of Function; Time Factors; Treatment Outcome
PubMed: 26306502
DOI: 10.1136/postgradmedj-2015-133507 -
Journal of Shoulder and Elbow Surgery Nov 2022Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy, irreparable rotator cuff tears, glenoid deformity, and other challenging clinical scenarios, including fracture sequelae and revision shoulder arthroplasty. There has been a wide range of reported outcomes and postoperative complication rates reported in the literature. The purpose of this systematic review and meta-analysis is to provide an updated review of the clinical outcomes and complication rates following primary rTSA.
METHODS
A systematic review and meta-analysis was performed to evaluate outcomes and complications following primary rTSA according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Demographics, range of motion, patient-reported outcome measures (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES] and Constant scores), number of complications, and revisions were extracted, recorded, and analyzed from the included articles.
RESULTS
Of the 1415 studies screened, 52 studies met the inclusion criteria comprising a total of 5824 shoulders. The mean age at the time of surgery was 72 years (range: 34-93), and the mean follow-up was 3.9 years (range: 2-16). Patients demonstrated a mean improvement of 56° in active flexion, 50° in active abduction, and 14° in active external rotation. Regarding functional outcome scores, rTSA patients demonstrated a mean clinically significant improvement of 37 in Constant score (minimal clinically important difference [MCID] = 5.7) and ASES score (42.0; MCID = 13.6). The overall complication rate for rTSA was 9.4% and revision rate of 2.6%. Complications were further subdivided into major medical complications (0.07%), shoulder- or surgical-related complications (5.3%), and infections (1.2%). The most frequently reported shoulder- or surgical-related complications were scapular notching (14.4%), periprosthetic fracture (0.8%), glenoid loosening (0.7%), and prosthetic dislocation (0.7%).
DISCUSSION
Primary rTSA is a safe and reliable procedure with low complication, revision, infection, and scapular notching rates. Additionally, patients demonstrated clinically significant improvements in both range of motion and clinical outcome scores.
Topics: Humans; Adult; Middle Aged; Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Rotator Cuff Injuries; Joint Prosthesis; Range of Motion, Articular; Treatment Outcome; Retrospective Studies
PubMed: 35870805
DOI: 10.1016/j.jse.2022.06.005