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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 -
Advanced Biomedical Research 2023A case with an inflamed or damaged nerve root in the cervical spine is defined as cervical radiculopathy.The purpose of the current study is to recognize the most... (Review)
Review
A case with an inflamed or damaged nerve root in the cervical spine is defined as cervical radiculopathy.The purpose of the current study is to recognize the most effective surgical procedures in cervical radiculopathy subjects. All related studies were taken using PubMed searching international databases, Scopus, ISI Web of Science (WoS), and Science direct with no limit of until November 20, 2021. Finally, based on the inclusion and exclusion criteria, after reviewing all randomized controlled trial studies which had the related data the researchers were looking for, they conducted meta-analysis with the seven remaining studies including eight different treatments. Heterogeneity was evaluated by Cochran's Q and Higgins I using R software for the network. In the results presented in this study, the neck disability index (NDI) changes as a result of taking cervical anterior discectomy without (ACD) and with fusion (ACDF) and ACD arthroplasty were -0.003, -1.659, and -1.656, respectively. According to the final diagram of the network, 11 comparisons were made in pairs. When each treatment group is compared with ACDF, it is shown that there was a significant mean effect among the patients who receive Mobi-C, Kineflx|C, and ADR, with mean differences of - 8.60 [CI 95% (- 12.75, - 4.45)], - 1.10 [CI 95% (- 5.22, 3.02)], and - 1.00 [CI 95% (- 7.18, 5.18)], respectively. The most effective surgical treatments for cervical radiculopathy were Mobi-c, Kineflx|C, and artificial disc replacement compared to ACDF treatment, respectively.
PubMed: 37694261
DOI: 10.4103/abr.abr_251_22 -
Shoulder & Elbow Sep 2023Increasing numbers of young patients receive shoulder replacements. Greater information on outcomes is needed to inform implant choice. The aim of this study was to... (Review)
Review
INTRODUCTION
Increasing numbers of young patients receive shoulder replacements. Greater information on outcomes is needed to inform implant choice. The aim of this study was to investigate the survivorship and clinical effectiveness of hemiarthroplasty and anatomical total shoulder arthroplasty (TSA) in patients younger than 65 years.
METHOD
A systematic review was performed of MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports. The primary outcomes were implant survival and change in perioperative shoulder scores.
RESULTS
Meta-analysis of implant survivorship was performed of six studies reporting on 416 patients. Implant survival was 86.1% (72.1,100) at 10 years for hemiarthroplasty and 82.3% (64.6,100) for TSA. 20 year survival was 80.0% for hemiarthroplasty (72.5,87.4) and 75.0% (56.9,93.1) for TSA. Ten studies were included in the meta-analysis of shoulder scores, multiple instruments were used. The standardised mean difference between pre-operative and post-operative shoulder scores was 2.15 (1.95, 2.35) for TSA at 4.2-4.9 years, and 2.72 (1.98,3.47) for hemiarthroplasty at 3.8-6 years.
CONCLUSION
Over 80% of shoulder replacements last more than 10 years, and 75% last more than 20 years. Significant improvements in shoulder scores are shown at all time points.
PubMed: 37692879
DOI: 10.1177/17585732221075037 -
International Orthopaedics Dec 2023This systematic review and meta-analysis aimed to identify risk factors of dislocation after total hip arthroplasty (THA) in patients with developmental dysplasia of the... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review and meta-analysis aimed to identify risk factors of dislocation after total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH).
METHODS
A systematic literature review was performed on 18th August 2022 using Medline, Embase, Scopus, Web of Science electronic databases, and a manual search. The study was conducted according to the PRISMA guidelines and registered with PROSPERO. Statistical analysis includes assessment of heterogeneity and data synthesis using RevMan 5.4.
RESULTS
Review of five studies including 2865 patients and 116 dislocated hips found that lower body mass index (BMI) (SMD = 0.22, p = 0.04, I = 0%), Crowe classification type IV versus I, II, and III (OR = 2.70, p = 0.004, I = 51%), higher cup inclination (SMD = 0.39 p = 0.0007, I = 0%), femoral head size < 28 mm (OR = 5.07, p = 0.003, I = 71%), lateral surgical approach (OR = 1.96, p = 0.02, I = 0%), and postoperative infection (OR = 6.26, p < 0.0001, I = 0%) were significant risk factors. However, age, gender, cup anteversion, femoral osteotomy, vertical (V-COR) centre of rotation, intraoperative fracture, preoperative and postoperative leg length discrepancy (LLD) and previous hip surgery were not found to be significant risk factors.
CONCLUSION
This study underscores importance of these risk factors in THA planning for DDH patients to reduce dislocation risk. Further research needed to understand mechanisms.
Topics: Humans; Arthroplasty, Replacement, Hip; Developmental Dysplasia of the Hip; Hip Dislocation, Congenital; Joint Dislocations; Risk Factors; Retrospective Studies
PubMed: 37688602
DOI: 10.1007/s00264-023-05949-w -
Archives of Orthopaedic and Trauma... Nov 2023The incidence of acetabular fractures has increased significantly in recent years due to demographic change. It can be divided into high-energy acetabular fractures... (Review)
Review
INTRODUCTION
The incidence of acetabular fractures has increased significantly in recent years due to demographic change. It can be divided into high-energy acetabular fractures primarily seen in adult patients versus geriatric patients mostly suffering from low-energy trauma. Historically, acetabular fractures have been treated either non-operatively or surgically following open reduction and internal fixation (ORIF), whereas nowadays total hip arthroplasty (THA) provides a true alternative. Aim of this study was to perform a systematic review on the outcome following THA in acute acetabulum fractures.
METHODS
PubMed/MEDLINE, Cochrane and Google databases were systematically searched on December 9, 2021. The key terms were [acetabular fracture] AND [[arthroplasty] OR [fixation]]. All retrospective and prospective original studies in English and German were analyzed the outcome following THA in acute acetabulum fractures were included.
RESULTS
A total of 2459 studies were screened, which includes 15 studies that met the inclusion criteria with a total of 590 patients at a mean age of 61.3 years (SD 11.48). Most studies described good to excellent results. Especially, THA allows elderly patients quicker mobilization and rehabilitation as well as symptomatic relief, as compared to ORIF or non-operative treatment. Patients who underwent non-operative treatment showed better results compared to those who underwent ORIF initially.
CONCLUSION
In acetabulum fractures, THA provides a good alternative with very good results when patients are carefully selected. Good to excellent outcomes are reported for both acute and delayed use of THA in elderly patients.
LEVEL OF EVIDENCE
Level 2, systematic review.
Topics: Adult; Humans; Aged; Middle Aged; Fractures, Bone; Arthroplasty, Replacement, Hip; Acetabulum; Retrospective Studies; Fracture Fixation, Internal; Prospective Studies; Hip Fractures; Spinal Fractures; Treatment Outcome
PubMed: 37543998
DOI: 10.1007/s00402-023-05007-5 -
Journal of Shoulder and Elbow Surgery Aug 2023Reverse shoulder arthroplasty (RSA) has become an increasingly popular treatment option for proximal humerus fractures in the elderly. There is however contradictory... (Meta-Analysis)
Meta-Analysis Review
HYPOTHESIS
Reverse shoulder arthroplasty (RSA) has become an increasingly popular treatment option for proximal humerus fractures in the elderly. There is however contradictory evidence on the impact of timing of RSA on patient outcomes. It remains unclear if poor results after initial nonsurgical or surgical management can be improved with delayed RSA. The aim of this systematic review and meta-analysis is to compare the outcomes of acute RSA and delayed RSA for the treatment of proximal humerus fractures in the elderly.
MATERIALS AND METHODS
A systematic search was performed on 4 databases for studies that compared acute RSA with RSA used after prior nonoperative or operative treatment. Studies with a mean cohort age of <65 years were excluded. Demographical data, clinical outcome scores, range of motion measurements, and postoperative complications were collected from the included studies.
RESULTS
Sixteen studies were included for data analysis. Compared with delayed RSA cohorts, acute RSA cohorts had higher forward flexion (124.3° vs. 114.9°; P = .019), external rotation (24.7° vs. 20.2°; P = .041), and abduction (113.2° vs. 99.8°; P = .03). Compared with RSA after conservative management, acute RSA had greater external rotation (29.9° vs. 21.4°; P = .043). The acute RSA cohort had significantly higher American Shoulder and Elbow Surgeons (76.4 vs. 68.2; P = .025) and Constant-Murley scores (65.6 vs. 57.3; P = .002) compared with the delayed RSA cohort. Subgroup analyses showed significantly greater Constant-Murley (64.9 vs. 56.9; P = .020) and Simple Shoulder Test scores (8.8 vs. 6.8; P = .031) with acute RSA compared with RSA after conservative treatment. The American Shoulder and Elbow Surgeons score was higher in the acute RSA cohort compared with RSA after open reduction internal fixation (77.9 vs. 63.5; P = .008). The overall complication rate per 100 patient-years was 11.7 for the acute RSA cohort and 18.5 for the delayed RSA cohort (risk ratio: 0.55; P = .015).
CONCLUSION
Based on the current evidence, acute RSA presents better clinical outcome measures and range of motion measurements, with decreased complication rates than RSA performed after prior nonoperative or operative treatment.
Topics: Humans; Aged; Arthroplasty, Replacement, Shoulder; Shoulder; Shoulder Joint; Shoulder Fractures; Treatment Outcome; Range of Motion, Articular; Humeral Fractures; Retrospective Studies
PubMed: 37024039
DOI: 10.1016/j.jse.2023.03.006 -
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 -
Cureus Oct 2023This systematic review aims to assess the contemporary literature on the incidence rate, functional scores, and clinical outcomes of heterotopic ossification (HO)... (Review)
Review
This systematic review aims to assess the contemporary literature on the incidence rate, functional scores, and clinical outcomes of heterotopic ossification (HO) following shoulder arthroplasty. We conducted a thorough literature search on EMBASE, MEDLINE, and Ortho Search to identify studies that directly compared patients with and without HO following hemiarthroplasty, anatomic total shoulder arthroplasty (aTSA), or reverse total shoulder arthroplasty (rTSA). We included studies with a minimum follow-up period of one year published from January 2000 to March 2023. We excluded case reports, editorials, and reviews. We performed the systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of the 297 studies initially identified, seven met our inclusion criteria. These studies evaluated a total of 1,134 arthroplasties (212 hemiarthroplasties, 376 aTSAs, and 546 rTSAs). The mean follow-up period was 30.52 (12-120) months and the mean age was 68.69 (20-92). The overall incidence rate of HO was 26.8% (304/1,134). Male gender was associated with a higher incidence rate of HO in three studies. No statistically significant difference was noted in symptoms at follow-up or in Constant-Murley score at two years of follow-up (HO vs. non-HO: 70 vs. 75, p = 0.081). Only one study reported a significant difference in the post-arthroplasty range of motion, specifically in forward elevation (121° vs. 133°, p = 0.0087) and external rotation (19° vs. 25°, p-value = 0.0266). We conclude that HO after shoulder arthroplasty does not display a significant impact on postoperative symptoms or functional outcomes in the majority of patients. To fully comprehend its effect, further research and consensus among experts is necessary.
PubMed: 38021631
DOI: 10.7759/cureus.47374 -
Journal of Orthopaedic Science :... Jan 2024Focus on reviewing a vigorous research effort to improve the safety profile of vancomycin powder (VP) and its optimal dose in reducing periprosthetic joint infection... (Meta-Analysis)
Meta-Analysis
A systematic review and meta-analysis comparing intrawound vancomycin powder and povidone iodine lavage in the prevention of periprosthetic joint infection of hip and knee arthroplasties.
BACKGROUND
Focus on reviewing a vigorous research effort to improve the safety profile of vancomycin powder (VP) and its optimal dose in reducing periprosthetic joint infection (PJI) is the need of the hour. This systematic review and meta-analysis attempt to explore the ongoing use of VP and VP + povidone iodine (PI) lavage to prevent PJI of hip/knee arthroplasties and highlights its challenges among the orthopedic community about the existence of the major organism and its frequency in total joint arthroplasty (TJA) patients.
METHODS
We searched PubMed/MEDLINE, EMBASE databases regarding the outcomes of vancomycin powder (VP) and VP + povidone iodine (PI) combination in preventing periprosthetic joint infection of hip and knee arthroplasties.
RESULTS
In 5 of 7 studies, the combination of vancomycin powder (VP) and povidone iodine (PI) lavage have shown a lower risk of periprosthetic joint infection (PJI) in acute and high-risk hip and knee arthroplasties patients, with less or without serious adverse events and readmissions; while four of seven studies using VP-only found increasing rates of PJI in primary total knee arthroplasty and partial hip replacement in elderly patients with comorbidities, and significantly causes aseptic wound complications compared to the control group.
CONCLUSIONS
Intra-articular vancomycin powder (VP) and povidone iodine (PI) lavage showed a significant reduction of periprosthetic joint infection in primary and revision total joint arthroplasty. Before its widespread use in clinical settings, prospective randomized studies and, most importantly, its long-term efficacy and safety are recommended.
Topics: Humans; Aged; Vancomycin; Arthroplasty, Replacement, Knee; Anti-Bacterial Agents; Povidone-Iodine; Powders; Therapeutic Irrigation; Prosthesis-Related Infections; Prospective Studies; Arthroplasty, Replacement, Hip; Arthritis, Infectious; Retrospective Studies
PubMed: 36470703
DOI: 10.1016/j.jos.2022.11.013 -
Hand Surgery & Rehabilitation Apr 2024Thumb osteoarthritis is a frequent pathology, mainly affecting the elderly. The surgical treatment initially described and having proved its worth is total... (Review)
Review
OBJECTIVE
Thumb osteoarthritis is a frequent pathology, mainly affecting the elderly. The surgical treatment initially described and having proved its worth is total trapeziectomy. Since the advent of trapeziometacarpal prostheses, several studies showed the non-inferiority of this technique on clinical criteria, with superiority in bone sparing, although neither technique demonstrated overall superiority. We therefore examined the specific complications of each surgical technique by analyzing their nature and prevalence through a review of the literature to compare them on these new parameters.
METHODS
Seventy-four of the 320 articles reviewed were included, 38 of which concerned trapeziectomy, and 36 concerned prostheses, for a total of 4,865 patients. They were original studies, involving adults undergoing trapeziometacarpal arthroplasty or trapeziectomy, published after 2015, reporting at least one well-described complication.
RESULTS
6.13% of trapeziectomies presented severe complications (in particular thumb collapse and metacarpophalangeal hyperextension), 3.31% moderate complications and 1.90% minor complications, leading to a 2.0% revision rate. 23.88% of prostheses had severe complications (loosening, dislocation and wear), 5.06% moderate complications and 1.36% minor complications, leading to a 12.8% revision rate. In addition, we analyzed more recent prosthesis designs separately, and found lower prevalence of severe complications (16.56%) and revision surgery (4.3%).
CONCLUSION
Revision surgery for trapeziometacarpal prostheses is usually only a standard trapeziectomy with the same follow-up as first-line trapeziectomy, whereas revision surgery for trapeziectomies is much more complex and the results are uncertain. For this reason, we would reserve total trapeziectomy for revision surgeries and patients with low functional demand for whom a second surgery is not desirable. Further studies could confirm this attitude, especially focusing on the latest generation of dual mobility implants.
Topics: Humans; Trapezium Bone; Osteoarthritis; Joint Prosthesis; Carpometacarpal Joints; Postoperative Complications; Thumb; Arthroplasty, Replacement; Prosthesis Failure; Reoperation
PubMed: 38408727
DOI: 10.1016/j.hansur.2024.101672