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Orthopaedic Journal of Sports Medicine Jan 2022Reverse total shoulder arthroplasty (rTSA) is an established procedure for cuff tear arthropathy. More lateralized prostheses have been designed to overcome the reported... (Review)
Review
BACKGROUND
Reverse total shoulder arthroplasty (rTSA) is an established procedure for cuff tear arthropathy. More lateralized prostheses have been designed to overcome the reported adverse outcomes of Grammont-style rTSA.
PURPOSE
To compare the clinical and radiological outcomes of medialized and lateralized center of rotation (COR) in rTSA.
STUDY DESIGN
Systematic review; Level of evidence, 3.
METHODS
This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were studies with a level of evidence ≥3 that compared medialized and lateralized rTSA with a minimum follow-up of 12 months. Functional scores including the American Shoulder and Elbow Surgeons (ASES) score and Constant score (CSS), range of motion at final follow-up, gain of external rotation (ER), visual analog scale (VAS) pain score, scapular notching, and heterotopic ossification (HO) were compared. Data were analyzed using random-effects or fixed-effects models in accordance with heterogeneity.
RESULTS
Five retrospective cohort studies and 1 randomized controlled study (n = 594 patients) were included. Lateralized rTSA resulted in greater improvement in ER degree ( < .001), a lower VAS pain score (standardized mean difference [SMD], -0.39; = .002), and a lower rate of scapular notching (risk ratio [RR], 0.40; < .001) and HO (RR, 0.52; < .001). Final forward flexion (SMD, -0.14; = .629) and ER (SMD, 0.21; = .238) did not differ significantly between the 2 groups. Overall functional scores, including ASES score (SMD, 0.22; = .310) and CSS (SMD, 0.37; = .077), also did not differ significantly (SMD, 0.28; = .062). The overall complication rate did not differ significantly between the 2 groups (RR, 0.71; = .339).
CONCLUSION
Compared with medialized rTSA, lateralized COR rTSA results in greater improvement in ER and the VAS pain score, decreased rates of scapular notching and HO, and no significant changes in functional outcome scores or the complication rate.
PubMed: 35005051
DOI: 10.1177/23259671211063922 -
Clinical Oral Investigations Feb 2022To determine the prevalence of the elongated styloid process (ESP) and its characteristics, such as sex and age of the patient, unilateral and bilateral incidence,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the prevalence of the elongated styloid process (ESP) and its characteristics, such as sex and age of the patient, unilateral and bilateral incidence, besides variations between different populations and panoramic and CBCT examinations.
MATERIALS AND METHODS
A search was performed in six databases (PubMed, Web of Science, Scopus, Cochrane, Lilacs, and Embase) to identify observational studies that used imaging exams and assessed ESP prevalence among panoramic radiograph CBCT examinations, whose transversal prevalence studies were included. Furthermore, studies with a specific group of patients or symptomatic patients were excluded. Additionally, Joanna Briggs Institute checklist was used to evaluate the quality of the studies. A meta-analysis was conducted, then subgroup analyses were performed by grouping studies according to the secondary outcomes, with a significance level set at 5%. The Grading of Recommendations Assessment, Development, and Evaluation system was used to rate the certainty in the evidence.
RESULTS
The initial search resulted in 1635 studies, from which 39 articles met the inclusion criteria, encompassing 50,655 participants. The sample size varied between 82 and 5,000 participants. The prevalence of the ESP ranged from 1.3 to 94.8%, with an overall prevalence of 30.2%. The bilateral occurrence was higher than the unilateral one, but no significant predilection was observed according to sex, age, or population. The type of imaging examination also showed no difference in its detection.
CONCLUSION
The overall prevalence of ESP was 30.2%, with a propensity for bilaterality, but not for any sex, age, or population geographic location. The imaging examination modality did not influence the diagnosis of ESP. However, the quality level of the studies evaluated was very low, demonstrating the need for more homogeneous primary studies on the prevalence of the ESP with a more standardized methodology.
CLINICAL RELEVANCE
There is no consensus in the literature regarding the prevalence of the ESP and the characteristics of the affected patients that can cause chronic and debilitating discomfort in the head and neck region. Therefore, knowledge about the prevalence and characteristics of this condition would help dental clinicians reach the correct diagnosis.
Topics: Humans; Ossification, Heterotopic; Prevalence; Radiography, Panoramic; Temporal Bone
PubMed: 34800204
DOI: 10.1007/s00784-021-04285-w -
Archives of Orthopaedic and Trauma... May 2022The pelvic INFIX technique has been proposed as a useful alternative to symphyseal plating for management of unstable pelvic ring injuries. The minimally invasive nature... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The pelvic INFIX technique has been proposed as a useful alternative to symphyseal plating for management of unstable pelvic ring injuries. The minimally invasive nature of the procedure, shorter operative time and less perioperative blood loss have been purported as potential advantages.
QUESTIONS/PURPOSES
This systematic review and meta-analysis were conducted to determine the outcomes and complications of the INFIX technique for unstable pelvic ring injuries.
METHODS
A systematic review of literature was performed on the PubMed, EMBASE and Scopus databases. Prospective and retrospective studies in all languages, whether comparative or non-comparative, pertaining to the use of INFIX in pelvic fractures were included. Studies which did not evaluate INFIX, case reports, conference abstracts and those with less than 10 cases were excluded. Cadaveric studies, technique papers and studies that did not describe the prespecified outcome measures were also excluded. Meta-analysis consisted of two different arms: a comparative arm, to compare INFIX to symphyseal plating, and a non-comparative meta-analysis arm, to determine pooled rates of outcomes and complications. Risk of bias was determined by the Methodological Index for Non-Randomised Studies (MINORS) tool.
RESULTS
A total of 22 studies were included in the systematic review, of which 7 were comparative and 15 were non-comparative. 746 patients were included for qualitative analysis and pooled analysis done for 589 patients. The average follow-up of these studies ranged from a minimum of 5.4 months to a maximum of 54 months. Comparative meta-analysis (n = 3 studies) of plating and INFIX showed significantly lesser blood loss (mean difference = 176.46 mL; 95% CI - 207.54 to - 145.38) and shorter operative time (mean difference = 26.43 min, 95% CI - 31.79 to - 21.07) with INFIX, but no significant difference in the overall complication rates (OR 1.59, 95% CI 0.83-3.05) and functional outcome scores (mean difference = - 2.51, 95% CI - 5.73 to 0.71). Pooled analysis showed overall good radiological (mean percentage of excellent to good reduction = 91.4%, 95% CI 0.860-0.969) and functional outcomes (mean Majeed score = 86.48, 95% CI 83.34-89.61) with INFIX. The most common complications were lateral femoral cutaneous nerve (LFCN) injury (overall rate 28%, 95% CI 15.1-41%) and heterotopic ossification (HO) (overall rate 9.4%, 95% CI 5.5-13.3%); rates of other complications were low. Significant heterogeneity was noted in the pooled analysis of blood loss, operative time, functional outcome, HO and LFCN injury. The overall strength of evidence was found to be weak.
CONCLUSION
The INFIX technique can be considered as a viable alternative to symphyseal plating for unstable pelvic ring injuries. It has the advantages of shorter operative times and less blood loss, along with comparable functional outcomes, when compared to plating. Overall, good functional outcomes can be expected. However, well-designed, multi-center randomized controlled trials are needed to conclusively prove the benefit of this technique.
Topics: Fracture Fixation, Internal; Fractures, Bone; Humans; Pelvic Bones; Prospective Studies; Retrospective Studies
PubMed: 33426606
DOI: 10.1007/s00402-020-03742-7 -
Arthroscopy : the Journal of... Apr 2016This systematic review examines outcomes and risk profiles of the hip arthroscopy in the supine versus lateral decubitus positions to elucidate any superiority of one... (Review)
Review
PURPOSE
This systematic review examines outcomes and risk profiles of the hip arthroscopy in the supine versus lateral decubitus positions to elucidate any superiority of one approach over the other.
METHODS
Three databases (Embase, PubMed, and Medline) were searched for studies that addressed hip arthroscopy performed in either position, and were subsequently screened by two reviewers with data abstracted in duplicate.
RESULTS
Similar outcomes were observed. Supine studies showed a greater mean postoperative improvement for modified Harris hip score (33.74), visual analog scale (-3.99), nonarthritic hip score (29.61), Harris hip score (35.73), and hip outcome score (31.4). Lateral decubitus studies showed greater improvement using the Western Ontario and McMaster University Osteoarthritis (14.76) score. Supine studies reported more neuropraxic injuries (2.06% v 0.47%), labral penetration (0.65% v 0%), and heterotopic ossification (0.21% v 0%). Lateral decubitus studies reported more fluid extravasation (0.21% v 0.05%) and missed loose bodies (0.08% v 0.01%). Similar rates of revision (1.8% lateral, 1.4% supine) and conversion to open procedures (2.6% in lateral, 2.0% in supine) were also identified.
CONCLUSIONS
Because of quality of evidence, direct comparisons are currently limited; however, the supine position is associated with more neuropraxic injuries, labral penetration, and heterotopic ossification, whereas lateral decubitus has increased risk of fluid extravasation and missed loose bodies. At this time, no evidence exists to establish superiority of one position.
LEVEL OF EVIDENCE
Level IV, systematic review of Level II, III, and IV studies.
Topics: Arthroscopy; Humans; Patient Positioning; Postoperative Complications; Treatment Outcome
PubMed: 26947742
DOI: 10.1016/j.arthro.2015.12.028 -
Spine Jul 2023Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
This study aimed to assess the incidence of heterotopic ossification (HO) 10 years after cervical disk replacement (CDR).
SUMMARY OF BACKGROUND DATA
HO is a common complication after CDR and may limit the range of motion of the artificial disk. As HO usually progresses slowly, a long-term follow-up is required to better understand its incidence. In recent years, the increasing number of original articles reporting 10-year outcomes gives us the opportunity to better understand the long-term incidence of HO.
MATERIALS AND METHODS
We searched PubMed, Medline, Embase, and Cochrane Library databases to identify eligible studies. The incidence of HO was pooled, and subgroup analysis was performed. Meta-regression analyses were conducted to identify factors contributing to heterogeneity.
RESULTS
Eleven studies with at least 10 years of follow-up comprising 1140 patients who underwent CDR were included. The pooled incidence of overall HO was 70% (95% CI, 60%-81%) at 10 years postoperatively, 60% (95% CI, 44%-75%) at five or six years postoperatively, and 50% (95% CI, 27%-72%) at one or two years postoperatively. The pooled incidence of severe HO (grade 3 or 4) was 37% (95% CI, 29%-45%), and mild HO (grade 1 to 2) was 30% (95% CI, 17%-44%) at 10 years of follow-up. Pooled range of motion decreased from 8.59° before surgery to 7.40° 10 years after surgery. Subgroup analysis showed that HO incidence differed according to the prosthesis type. The earlier publication was associated with a higher pooled incidence of severe HO in the meta-regression analysis.
CONCLUSIONS
This is the first meta-analysis providing detailed information on the pooled 10-year incidence of HO after CDR. The incidence of HO seems to increase with the length of follow-up.
LEVEL OF EVIDENCE
3.
Topics: Humans; Cervical Vertebrae; Incidence; Neck; Ossification, Heterotopic; Range of Motion, Articular; Retrospective Studies; Total Disc Replacement; Treatment Outcome
PubMed: 37036304
DOI: 10.1097/BRS.0000000000004674 -
International Journal of Surgery... Mar 2016The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of anterior and posterior approaches for the treatment of... (Meta-Analysis)
Meta-Analysis Review
Anterior versus posterior approach for the treatment of cervical compressive myelopathy due to ossification of the posterior longitudinal ligament: A systematic review and meta-analysis.
PURPOSE
The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of anterior and posterior approaches for the treatment of cervical compressive myelopathy due to cervical ossification of the posterior longitudinal ligament (OPLL).
METHODS
Randomized controlled trials or non-randomized controlled trials published since January 1995 to October 2015 that compared the clinical effectiveness of anterior and posterior surgical approaches for the treatment of cervical OPLL were acquired by a comprehensive search in three electronic databases (PubMed, EMBASE, Cochrane library). A total of 13 studies (1050 patients) were included in this systematic review and meta-analysis.
RESULT
The results indicated that no statistically significant differences between the anterior group and posterior group in terms of preoperative JOA score [P = 0.16, SMD = 0.1 (-0.04, 0.23)] and recovery rate of patients with canal-occupying ratio < 50%-60% [p = 0.89, SMD = 0.03 (-0.35, 0.41)]. The anterior group showed higher postoperative JOA score [P < 0.05, SMD = 0.23 (0.05, 0.41)], overall recovery rate (regardless of canal-occupying ratio) [P < 0.01, SMD = 0.79 (0.31, 1.27)], especially a significant higher recovery rate of patients with canal-occupying ratio > 50%-60% [P < 0.01, SMD = 1.50 (0.52, 2.47)]. However, it also revealed that the postoperative complication rate [P < 0.05, OR = 1.90 (1.08, 3.36)], blood loss [P < 0.01, SMD = 0.63 (0.34, 0.93)] and operative time [P < 0.01, SMD = 1.86 (1.07, 2.65)] were significantly higher.
CONCLUSION
Based on the results above, anterior approach surgery was associated with better overall (regardless of the canal-occupying ratio) postoperative neural function than posterior approach in the treatment of cervical compressive myelopathy due to OPLL. We thought anterior approach especially preferable to patients with canal-occupying ratio > 50%-60%, although it leads to a higher surgical trauma and incidence of surgery-related complications. Posterior approach surgery was relatively safer with lower surgical trauma and incidence of complications. We also suggest posterior approach for patients with canal-occupying ratio < 50%-60%, since the postoperative neural function was similar between the two groups for this part of patients.
Topics: Cervical Vertebrae; Decompression, Surgical; Humans; Non-Randomized Controlled Trials as Topic; Operative Time; Ossification of Posterior Longitudinal Ligament; Postoperative Complications; Postoperative Period; Randomized Controlled Trials as Topic; Spinal Cord Compression; Spinal Fusion; Treatment Outcome
PubMed: 26804354
DOI: 10.1016/j.ijsu.2016.01.038 -
JSES International Jan 2021Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused,... (Review)
Review
BACKGROUND
Globally, reverse shoulder arthroplasty (RSA) has moved away from the Grammont design to modern prosthesis designs. The purpose of this study was to provide a focused, updated systematic review for each of the most common complications of RSA by limiting each search to publications after 2010. In this part II, the following were examined: (1) instability, (2) humerus/glenoid fracture, (3) acromial/scapular spine fractures (AF/SSF), and (4) problems/miscellaneous.
METHODS
Four separate PubMed database searches were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Overall, 137 studies for instability, 94 for humerus/glenoid fracture, 120 for AF/SSF, and 74 for problems/miscellaneous were included in each review, respectively. Univariate analysis was performed with chi-square and Fisher exact tests.
RESULTS
The Grammont design had a higher instability rate vs. all other designs combined (4.0%, 1.3%; < .001), and the onlay humerus design had a lower rate than the lateralized glenoid design (0.9%, 2.0%; = .02). The rate for intraoperative humerus fracture was 1.8%; intraoperative glenoid fracture, 0.3%; postoperative humerus fracture, 1.2%; and postoperative glenoid fracture, 0.1%. The rate of AF/SSF was 2.6% (371/14235). The rate for complex regional pain syndrome was 0.4%; deltoid injury, 0.1%; hematoma, 0.3%; and heterotopic ossification, 0.8%.
CONCLUSIONS
Focused systematic reviews of recent literature with a large volume of shoulders demonstrate that using non-Grammont modern prosthesis designs, complications including instability, intraoperative humerus and glenoid fractures, and hematoma are significantly reduced compared with previous studies. As the indications continue to expand for RSA, it is imperative to accurately track the rate and types of complications in order to justify its cost and increased indications.
PubMed: 33554177
DOI: 10.1016/j.jseint.2020.07.018 -
Journal of Hand and Microsurgery Jul 2021Heterotopic ossification (HO) can be a potentially serious and devastating complication following traumatic injury to the elbow. HO prophylaxis options include...
Heterotopic ossification (HO) can be a potentially serious and devastating complication following traumatic injury to the elbow. HO prophylaxis options include nonsteroidal anti-inflammatory drugs (NSAIDs) and radiation therapy (RT) but neither has been proven more effective. The purpose of this review is to compare effectiveness and outcomes between NSAID and RT prophylaxis for HO about the elbow following a traumatic injury. We performed a systematic review of PubMed and Cochrane Library for cases of HO prophylaxis following elbow trauma utilizing PRISMA guidelines to determine the most effective form of prophylaxis. Outcomes of interest included recurrence of HO, range of motion (ROM), and Mayo elbow performance index (MEPI). A total of 36 articles and 826 elbows of which 203 received RT and 623 received NSAID were identified and included in the final analysis. Rates of HO formation or recurrence following elbow trauma were similar between radiation and NSAID prophylaxis (15.6% vs. 22.2%, respectively = 0.457). ROM was similar in flexion and extension arc (109.0 degrees in radiation vs. 112.8 in NSAIDs, = 0.459) and in pronation and supination arc (118.9 degrees radiation vs. 134.7 degrees NSAIDs, = 0.322). MEPI scores were 79.19 in the radiation group and 88.82 in the NSAIDs group at the final follow-up. There is no statistical difference in HO development, recurrence, or final ROM between NSAIDs and RT prophylaxis following trauma to the elbow. We recommend the choice of modality based on patient characteristics, cost, and surgeon preference. Level III.
PubMed: 34511838
DOI: 10.1055/s-0040-1721880 -
Medicine Jun 2017Prevalence estimates of heterotopic ossification (HO) following cervical artificial disc replacement (ADR) varied widely in previous studies. We conducted a systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Prevalence estimates of heterotopic ossification (HO) following cervical artificial disc replacement (ADR) varied widely in previous studies. We conducted a systematic review and meta-analysis to summarize its point prevalence.
METHODS
Electronic searches of PubMed, Web of Science, Embase, and Cochrane Library databases were conducted to identify studies that reported prevalence of HO. Definitions of HO and severe HO were based on McAfee grading system. Random-effects model was used to estimate the pooled prevalence. We conducted subgroup analyses according to the different length of follow-up time, and performed univariate metaregression analyses to explore the effects of potential variables on the overall prevalence.
RESULTS
A total of 38 studies were included in this study. The pooled data showed that the prevalence of HO after cervical ADR within the 1 to 2 years, 2 to 5 years, and 5 to10 years of follow-up was 38.0% (95% confidence interval [CI], 30.2%-46.5%), 52.6% (95% CI, 43.1%-61.9%), and 53.6% (95% CI, 40.0%-66.7%), respectively, while the prevalence of severe HO was 10.9% (95% CI, 9.0%-13.2%), 22.2% (95% CI, 15.5%-30.7%), and 47.5% (95% CI, 30.0%-65.8%), respectively. Follow-up time was positively associated with the prevalence of severe HO (P < .01), and the 1-month growth of mean follow-up went with 0.63% increase of severe HO.
CONCLUSION
This meta-analysis reported data on the prevalence of HO and severe HO after cervical ADR, and provided information on its process of development. These should be useful to enable surgeons and patients to gain a better understanding of HO after cervical ADR.
Topics: Cervical Vertebrae; Humans; Ossification, Heterotopic; Postoperative Complications; Prevalence; Total Disc Replacement
PubMed: 28614250
DOI: 10.1097/MD.0000000000007163 -
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