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Archives of Orthopaedic and Trauma... Aug 2023Muscular strength loss and atrophy are postoperative complications. This systematic review with meta-analysis investigated the course of on knee extensor mass and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Muscular strength loss and atrophy are postoperative complications. This systematic review with meta-analysis investigated the course of on knee extensor mass and strength from pre-surgery over total knee arthroplasty to rehabilitation and recovery.
METHODS
A systematic literature search was conducted in PubMed (Medline), Cochrane Library (CINAHL, Embase) and Web of Science (until 29th of June 2022). Main inclusion criteria were ≥ 1 preoperative and ≥ 1 measurement ≥ 3-months post-operation and ≥ 1 objective assessment of quadriceps strength, muscle mass or neuromuscular activity, measured at both legs. Studies were excluded if they met the following criteria: further impairment of treated extremity or of the contralateral extremity; further muscle affecting disease, or muscle- or rehabilitation-specific intervention. The Robins-I tool for non-randomized studies, and the Cochrane Rob 2 tool for randomized controlled studies were used for risk of bias rating. Pre-surgery, 3 months, 6 months and 1 year after surgery data were pooled using random effects meta-analyses (standardized mean differences, SMD, Hedge's g) in contrast to the pre-injury values.
RESULTS
1417 studies were screened, 21 studies on 647 participants were included. Thereof, 13 were non-randomized controlled trails (moderate overall risk of bias in most studies) and 7 were randomized controlled trials (high risk of bias in at least one domain in most studies). Three (k = 12 studies; SMD = - 0.21 [95% confidence interval = - 0.36 to - 0.05], I = 4.75%) and six (k = 9; SMD = - 0.10 [- 0.28 to - 0.08]; I = 0%) months after total knee arthroplasty, a deterioration in the strength of the operated leg compared with the strength of the non-operated leg was observed. One year after surgery, the operated leg was stronger in all studies compared to the preoperative values. However, this increase in strength was not significant compared to the non-operated leg (k = 6, SMD = 0.18 [- 0.18 to 0.54], I = 77.56%).
CONCLUSION
We found moderate certainty evidence that deficits in muscle strength of the knee extensors persist and progress until 3 months post-total knee arthroplasty in patients with end-stage knee osteoarthritis. Very low certainty evidence exists that preoperatively existing imbalance of muscle strength and mass in favor of the leg not undergoing surgery is not recovered within 1 year after surgery.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Joint; Lower Extremity; Quadriceps Muscle; Leg; Muscle Strength
PubMed: 36637491
DOI: 10.1007/s00402-022-04750-5 -
International Orthopaedics Nov 2022Interposition arthroplasty for the post-traumatic osteoarthritic elbow is a salvage procedure used in young and active patients and remains a rare and unexplored...
PURPOSE
Interposition arthroplasty for the post-traumatic osteoarthritic elbow is a salvage procedure used in young and active patients and remains a rare and unexplored therapeutic option.
METHODS
We systematically reviewed the available literature searching electronic databases, MEDLINE using the PubMed interface and EMBASE. The primary objective was to synthesize functional outcomes and to investigate revision frequencies, but also complication and subsequent surgery rates among patients with surviving grafts. The preferred reporting guidelines for systematic reviews and meta-analyses guidelines were applied.
RESULTS
Five studies were left for inclusion, all retrospective in design, comprising 67 patients. The mean age was 40 years, the mean follow-up period was 61 months, and 68.2% of the patients treated were male. Eleven patients (16.4%) were treated with fascia lata autografts, and 56 patients (83.6%) were treated with Achilles tendon allografts. The graft survived in 53 patients (79.1%); the post-operative Mayo Elbow Performance Score averaged 69 points. Fourteen patients (20.9%) required revision surgery. In the setting of graft survival, 39.1% of patients had complications not requiring further surgical treatment and 5.7% of patients with surviving grafts needed subsequent operative treatment within the follow-up period.
CONCLUSION
Given graft survival, this systematic review demonstrated satisfactory functional outcomes following interposition arthroplasty of the post-traumatic osteoarthritic elbow, however, associated with a cumulative complication and subsequent operative treatment rate of 44.8%. In addition, a revision rate of 20.9% needs to be expected. Varus-valgus instability in the pre-operative clinical assessment seems to be associated with unsatisfactory post-operative elbow function. The superiority of either of the two main reported graft methods (fascia lata autograft and Achilles tendon allograft) remains pending, and the role of an external fixator in preventing post-operative instability remains unresolved.
Topics: Adult; Arthroplasty; Elbow; Elbow Joint; Female; Humans; Male; Osteoarthritis; Retrospective Studies; Treatment Outcome
PubMed: 36042057
DOI: 10.1007/s00264-022-05562-3 -
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 -
The Bone & Joint Journal Aug 2016There is uncertainty regarding the optimal means of thromboprophylaxis following total hip and knee arthroplasty (THA, TKA). This systematic review presents the evidence... (Meta-Analysis)
Meta-Analysis Review
AIMS
There is uncertainty regarding the optimal means of thromboprophylaxis following total hip and knee arthroplasty (THA, TKA). This systematic review presents the evidence for acetylsalicylic acid (aspirin) as a thromboprophylactic agent in THA and TKA and compares it with other chemoprophylactic agents.
MATERIALS AND METHODS
A search of literature published between 2004 and 2014 was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 13 studies were eligible for inclusion.
RESULTS
Evidence from one good quality randomised controlled trial (RCT) showed no difference in rates of venous thrombo-embolism (VTE) in patients given aspirin or low molecular weight heparin (LMWH) following TKA. There was insufficient evidence from trials with moderate to severe risk of bias being present to suggest aspirin is more or less effective than LMWH, warfarin or dabigatran for the prevention of VTE in TKA or THA. Compared with aspirin, rates of asymptomatic deep vein thrombosis (DVT) in TKA may be reduced with rivaroxaban but insufficient evidence exists to demonstrate an effect on incidence of symptomatic DVT. Compared with aspirin there is evidence of more wound complications following THA and TKA with dabigatran and in TKA with rivaroxaban. Some studies highlighted concerns over bleeding complications and efficacy of aspirin.
CONCLUSION
The results suggest aspirin may be considered a suitable alternative to other thromboprophylactic agents following THA and TKA. Further investigation is required to fully evaluate the safety and efficacy of aspirin. Cite this article: Bone Joint J 2016;98-B:1056-61.
Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Aspirin; Clinical Protocols; Fibrinolytic Agents; Heparin, Low-Molecular-Weight; Humans; Intraoperative Care; Randomized Controlled Trials as Topic; Registries; Venous Thromboembolism; Warfarin
PubMed: 27482017
DOI: 10.1302/0301-620X.98B8.36957 -
Danish Medical Journal Dec 2015Patient blood management strategies for total hip and knee arthroplasty are controversial. They range from pre-operative haemoglobin optimisation to intra- and... (Review)
Review
INTRODUCTION
Patient blood management strategies for total hip and knee arthroplasty are controversial. They range from pre-operative haemoglobin optimisation to intra- and post-operative interventions. The aim of this study was to assess the various treatment modalities with respect to blood loss, haemoglobin levels and blood transfusions.
METHODS
The analysis was based on the principles of a systematic review. The literature was searched in PubMed for the period from 2004 to November 2014. The articles were reviewed with respect to blood loss, post-operative haemoglobin drop, blood transfusions and length of hospital stay. The papers were evidence-graded. Non-randomised clinical studies and papers not concerning total hip or knee arthroplasty were excluded as were studies lacking a control group. Subanalyses were performed for tranexamic acid, tourniquet and fibrin use.
RESULTS
A total of 49 studies were found eligible which is equivalent to a total of 4,752 patients. Tranexamic acid administered either orally, topically, intravenously or in combination decreased blood loss, increased the post-operative haemoglobin level, decreased the number of patients receiving blood transfusions and minimised the length of stay. A similar result was found for fibrin spray in total hip arthroplasty. However, for total knee arthroplasty, the outcome was blurred. Tourniquet use was uniformly not significant in the measured parameters.
CONCLUSIONS
Tranexamic acid is useful in managing anaemia and blood loss. Fibrin sealant also has this potential, but is not more potent than tranexamic acid. Tourniquet use is not advantageous.
Topics: Adult; Anemia; Antifibrinolytic Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Blood Loss, Surgical; Blood Transfusion; Female; Fibrin; Hemoglobins; Humans; Length of Stay; Male; Postoperative Period; Tourniquets; Tranexamic Acid
PubMed: 26621400
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Aug 2023Our aim was to determine the best operative procedure in human participants with a displaced or non-displaced femoral neck fracture comparing cannulated screw (CS)... (Meta-Analysis)
Meta-Analysis
Cannulated screws versus dynamic hip screw versus hemiarthroplasty versus total hip arthroplasty in patients with displaced and non-displaced femoral neck fractures: a systematic review and frequentist network meta-analysis of 5703 patients.
BACKGROUND
Our aim was to determine the best operative procedure in human participants with a displaced or non-displaced femoral neck fracture comparing cannulated screw (CS) fixation, dynamic hip screw (DHS) fixation, hemiarthroplasty (HA), and total hip arthroplasty (THA) in terms of surgical and functional outcomes, reoperation and postoperative complications.
METHODS
We searched PubMed, The Cochrane Library, Clinical trials, CINAHL, and Embase for randomized controlled trials (RCTs) or quasi-RCTs up to 31 July 2022. A frequentist network meta-analysis was performed to assess the comparative effects of the four operative procedures, using fixed-effects and random-effects models. Mean differences (MDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables.
RESULTS
A total of 33 RCTs with 5703 patients were included in our network meta-analysis. CS fixation was best in terms of operation time (CS: MD = - 57.70, 95% CI - 72.78; - 42.62; DHS: MD = - 53.56, 95% CI - 76.17; - 30.95; HA: MD = - 20.90, 95% CI - 30.65; - 11.15; THA: MD = 1.00 reference) and intraoperative blood loss (CS: MD = - 3.67, 95% CI - 4.44; - 2.90; DHS: MD = - 3.20, 95% CI - 4.97; - 1.43; HA: MD = - 1.20, 95% CI - 1.73; - 0.67; THA: MD = 1.00 reference). In life quality and functional outcome, measured at different time points with EQ-5D and the Harris Hip Score (HHS), THA ranked first and HA second (e.g. EQ-5D 2 years postoperatively: CS: MD = - 0.20, 95% CI - 0.29; - 0.11; HA: MD = - 0.09, 95% CI - 0.17; - 0.02; THA: MD = 1.00 reference; HHS 2 years postoperatively: CS: MD = - 5.50, 95% CI - 9.98; - 1.03; DHS: MD = - 8.93, 95% CI - 15.08; - 2.78; HA: MD = - 3.65, 95% CI - 6.74; - 0.57; THA: MD = 1.00 reference). CS fixation had the highest reoperation risk, followed by DHS fixation, HA, and THA (CS: OR = 9.98, 95% CI 4.60; 21.63; DHS: OR = 5.07, 95% CI 2.15; 11.96; HA: OR = 1.60, 95% CI 0.89; 2.89; THA: OR = 1.00 reference).
CONCLUSION
In our cohort of patients with displaced and non-displaced femoral neck fractures, HHS, EQ-5D, and reoperation risk showed an advantage of THA and HA compared with CS and DHS fixation. Based on these findings, we recommend that hip arthroplasty should be preferred and internal fixation of femoral neck fractures should only be considered in individual cases.
LEVEL OF EVIDENCE I
a systematic review of randomized controlled trials.
TRIAL REGISTRATION
PROSPERO on 10 August 2022 (CRD42022350293).
Topics: Humans; Arthroplasty, Replacement, Hip; Hemiarthroplasty; Network Meta-Analysis; Femoral Neck Fractures; Bone Screws; Fracture Fixation, Internal
PubMed: 37626370
DOI: 10.1186/s13018-023-04114-8 -
Clinics in Orthopedic Surgery Sep 2016Different implant designs are utilized in reverse shoulder arthroplasty. The purpose of this systematic review was to evaluate the results of reverse shoulder... (Review)
Review
BACKGROUND
Different implant designs are utilized in reverse shoulder arthroplasty. The purpose of this systematic review was to evaluate the results of reverse shoulder arthroplasty using a traditional (Grammont) prosthesis and a lateralized prosthesis for the treatment of cuff tear arthropathy and massive irreparable rotator cuff tears.
METHODS
A systematic review of the literature was performed via a search of two electronic databases. Two reviewers evaluated the quality of methodology and retrieved data from each included study. In cases where the outcomes data were similar between studies, the data were pooled using frequency-weighted mean values to generate summary outcomes.
RESULTS
Thirteen studies met the inclusion and exclusion criteria. Demographics were similar between treatment groups. The frequency-weighted mean active external rotation was 24° in the traditional group and 46° in the lateralized group (p = 0.0001). Scapular notching was noted in 44.9% of patients in the traditional group compared to 5.4% of patients in the lateralized group (p = 0.0001). The rate of clinically significant glenoid loosening was 1.8% in the traditional group and 8.8% in the lateralized group (p = 0.003).
CONCLUSIONS
Both the traditional Grammont and the lateralized offset reverse arthroplasty designs can improve pain and function in patients with diagnoses of cuff tear arthropathy and irreparable rotator cuff tear. While a lateralized design can result in increased active external rotation and decreased rates of scapular notching, there may be a higher rate of glenoid baseplate loosening.
Topics: Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement; Female; Humans; Male; Middle Aged; Postoperative Complications; Prosthesis Design; Rotator Cuff; Shoulder Prosthesis; Treatment Outcome
PubMed: 27583112
DOI: 10.4055/cios.2016.8.3.288 -
The Bone & Joint Journal Jan 2018Patients with neuromuscular imbalance who require total hip arthroplasty (THA) present particular technical problems due to altered anatomy, abnormal bone stock,... (Review)
Review
Patients with neuromuscular imbalance who require total hip arthroplasty (THA) present particular technical problems due to altered anatomy, abnormal bone stock, muscular imbalance and problems of rehabilitation. In this systematic review, we studied articles dealing with THA in patients with neuromuscular imbalance, published before April 2017. We recorded the demographics of the patients and the type of neuromuscular pathology, the indication for surgery, surgical approach, concomitant soft-tissue releases, the type of implant and bearing, pain and functional outcome as well as complications and survival. Recent advances in THA technology allow for successful outcomes in these patients. Our review suggests excellent benefits for pain relief and good functional outcome might be expected with a modest risk of complication. Cite this article: 2018;100-B(1 Supple A):17-21.
Topics: Arthroplasty, Replacement, Hip; Humans; Neuromuscular Diseases; Osteoarthritis, Hip; Postoperative Complications; Postural Balance; Treatment Outcome
PubMed: 29292335
DOI: 10.1302/0301-620X.100B1.BJJ-2017-0571.R1 -
Archives of Orthopaedic and Trauma... Oct 2021Osteoarthritis is the single most common cause of pain and disability in older adults. This review addresses the question of the clinical effectiveness and... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Osteoarthritis is the single most common cause of pain and disability in older adults. This review addresses the question of the clinical effectiveness and cost-effectiveness of physiotherapy interventions following total knee replacement (TKR).
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. MEDLINE, CINAHL, AMED, DARE, HTA and NHS EED databases were searched from inception to 02 May 2020. Search terms related to the clinical and cost-effectiveness of physiotherapy interventions were used. Studies meeting the inclusion criteria were identified and key data were extracted. Random effect meta-analysis was conducted for pain, physical function and range of motion (ROM).
RESULTS
In total, 1467 studies were identified. Of these, 26 studies were included; methodological quality of most studies was adequate. Physiotherapy interventions were more effective than control for function, SMD - 0.166 [95% Confidence Interval (CI) - 0.420 to 0.088.] and ROM, SMD - 0.219 [95% CI - 0.465 to 0.028] for a follow-up of 2 or 3 months. Patients in the intervention group showed improvement in pain at 12-13 weeks, SMD - 0.175 [95% CI - 0.416 to 0.067]. No evidence on the pooled estimate of cost-effectiveness of physiotherapy interventions was found.
CONCLUSIONS
This is the first systematic review and meta-analysis that has examined the clinical and cost-effectiveness of physiotherapy interventions following TKR. The findings of this review suggest that physiotherapy interventions were effective for improving physical function, ROM and pain in a short-term follow-up following TKR. Insufficient evidence exists to establish the benefit of physiotherapy in the long term for patient with TKR. Further study should examine the long-term effectiveness and cost-effectiveness of physiotherapy interventions.
Topics: Aged; Arthroplasty, Replacement, Knee; Cost-Benefit Analysis; Humans; Physical Therapy Modalities; Range of Motion, Articular; Treatment Outcome
PubMed: 33554305
DOI: 10.1007/s00402-021-03784-5 -
Journal of Orthopaedic Surgery and... Aug 2022Total hip arthroplasty is a common orthopedic surgery for treating primary or secondary hip osteoarthritis. Bilateral total hip replacement could be performed in a... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Total hip arthroplasty is a common orthopedic surgery for treating primary or secondary hip osteoarthritis. Bilateral total hip replacement could be performed in a single stage or two separate stages. Each surgical procedure's reliability, safety, and complications have been reported controversially. This study aimed to review the current evidence regarding the outcomes of simultaneous and staged bilateral total hip arthroplasty.
METHODS
We conducted a meta-analysis using MEDLINE, EMBASE, Web of Science, and Scopus databases. Eligible studies compared complications and related outcomes between simultaneous and staged bilateral THA. Two reviewers independently screened initial search results, assessed methodological quality, and extracted data. We used the Mantel-Haenszel method to perform the meta-analysis.
RESULTS
In our study, we included 29,551 patients undergoing simBTHA and 74,600 patients undergoing stgBTHA. In favor of the simBTHA, a significant reduction in deep vein thrombosis (DVT) and systemic, local, and pulmonary complications was documented. However, we evidenced an increased pulmonary embolism (PE) and periprosthetic fracture risk in simBTHA. In the simBTHA, total blood loss, length of hospital stay, and total cost were lower.
CONCLUSION
This meta-analysis shows that simultaneous bilateral THA accompanies fewer complications and lower total cost. Well-designed randomized controlled trials are needed to provide robust evidence.
Topics: Arthroplasty, Replacement, Hip; Humans; Length of Stay; Postoperative Complications; Pulmonary Embolism; Reproducibility of Results
PubMed: 35964047
DOI: 10.1186/s13018-022-03281-4