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Antibiotics (Basel, Switzerland) May 2024Periprosthetic shoulder infection (PSI) remains a challenging complication after shoulder arthroplasty. Therapeutic options include one- or two-stage revision,... (Review)
Review
Periprosthetic shoulder infection (PSI) remains a challenging complication after shoulder arthroplasty. Therapeutic options include one- or two-stage revision, irrigation and debridement, and resection arthroplasty. With our systematic review and meta-analysis, we aimed to compare one- and two-stage revisions for periprosthetic shoulder joint infections and determine the most appropriate therapeutic procedure. We performed an extensive literature search in PubMed, Ovid Medline, Cochrane Library, Web of Science, and CINAHL and filtered out all relevant studies. The meta-analysis was performed using the random-effects model, heterogeneity was analyzed using I, and publication bias was assessed using the Egger's test. A total of 8 studies with one-stage revisions, 36 studies with two-stage revisions, and 12 studies with both one-stage and two-stage revisions were included. According to the random-effects model, the reinfection rate for the entirety of the studies was 12.3% (95% Cl: 9.6-15.3), with a low-to-moderate heterogeneity of I = 47.72%. The reinfection rate of the one-stage revisions was 10.9%, which was significantly lower than the reinfection rate of the two-stage revisions, which was 12.93% ( = 0.0062). The one-stage revision rate was significantly lower with 1.16 vs. 2.25 revisions in the two-stage revision group ( < 0.0001). The postoperative functional outcome in one-stage-revised patients was comparable but not statistically significant ( = 0.1523). In one- and two-stage revisions, most infections were caused by . In summary, our systematic review and meta-analysis show the superiority of single-stage revision regarding reinfection and revision rates in periprosthetic shoulder joint infection.
PubMed: 38786168
DOI: 10.3390/antibiotics13050440 -
Journal of Oral Biology and... 2023This systematic review and meta-analysis aimed to assess individually the regenerative potential of PRF (Platelet-rich Fibrin), PRP (Platelet-rich Plasma), and PRGF... (Review)
Review
AIM
This systematic review and meta-analysis aimed to assess individually the regenerative potential of PRF (Platelet-rich Fibrin), PRP (Platelet-rich Plasma), and PRGF (Plasma Rich in Growth Factors) in comparison to OFD (Open Flap Debridement) alone for treating Intrabony defects, by calculating pooled effect sizes.
BACKGROUND
Relevant randomized controlled trials on humans were searched in PUBMED, COCHRANE CENTRAL, and GOOGLE SCHOLAR. Mean differences (MD) of Clinical Attachment level (CAL), Probing Pocket depth (PPD), and Defect Depth Reduction (DDR) between the Experimental and Control groups were used for calculating pooled effect sizes. Risk of bias was assessed using Cochrane's tool, and publication bias was evaluated through Funnel plots, Trim & Fill Method, and Rosenthal's Fail-Safe N Test.
REVIEW RESULT
A total of 23 studies were identified for qualitative and quantitative analysis. These studies were categorized into PRF, PRP, and PRGF groups based on the type of APC used. PRF showed the highest CAL gain (1.60 mm, 95% CI = 0.963-2.232 mm, P < 0.001, I2 = 93.83%) and PPD reduction (1.76 mm, 95% CI = 1.056 to 2.446, P < 0.001, I2 = 96.05%). However, PRP exhibited the greatest DDR (3.42 mm, 95% CI = -13.67 to -20.50, P = 0.011, I2 = 87.27%). PRF and PRP demonstrated large effect sizes, while PRGF showed a small effect size.
CONCLUSION
The use of PRF, PRP, and PRGF showed advantages in treating intrabony defects. However, caution is advised when interpreting the results due to heterogeneity and publication bias among the studies.
PubMed: 37711544
DOI: 10.1016/j.jobcr.2023.08.007 -
Journal of Bone and Joint Infection 2023: The aim of this systematic review was to assess the existing published data on the diagnosis and management of tuberculosis (TB) arthritis involving native joints in...
: The aim of this systematic review was to assess the existing published data on the diagnosis and management of tuberculosis (TB) arthritis involving native joints in adults aged 18 years and older. : This study was performed in accordance with the guidelines provided in the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). : The systematic review of the literature yielded 20 data sources involving 573 patients from nine countries. There was considerable variation amongst the studies in terms of the approach to diagnosis and management. The diagnosis was mostly made by microbiological tissue culture. Medical management involved a median of 12 months of anti-tubercular treatment (interquartile range, IQR, of 8-16; range of 4-18 months). The duration of preoperative treatment ranged from 2 to 12 weeks. Surgery was performed on 87 % of patients and varied from arthroscopic debridement to complete synovectomies combined with total joint arthroplasty. The mean follow-up time of all studies was 26 months (range of 3-112 months). Recurrence rates were reported in most studies, with an overall average recurrence rate of approximately 7.4 % (35 of 475 cases). : The current literature on TB arthritis highlights the need for the establishment of standardized guidelines for the confirmation of the diagnosis. Further research is needed to define the optimal approach to medical and surgical treatment. The role of early debridement in active TB arthritis needs to be explored further. Specifically, comparative studies are required to address questions around the use of medical treatment alone vs. in combination with surgical intervention.
PubMed: 37780528
DOI: 10.5194/jbji-8-189-2023 -
International Wound Journal Aug 2023Negative pressure wound therapy (NPWT) is a wound-dressing system that applies sub-atmospheric pressure on the surface of a wound to promote healing. An evolution of... (Meta-Analysis)
Meta-Analysis Review
Effects of negative pressure wound therapy with instillation and dwell time (NPWTi-d) versus NPWT or standard of care in orthoplastic surgery: A systematic review and meta-analysis.
Negative pressure wound therapy (NPWT) is a wound-dressing system that applies sub-atmospheric pressure on the surface of a wound to promote healing. An evolution of this technology, NPWT with solution instillation and dwell time (NPWTi-d), is increasingly being used to maximise wound closure and reduce failure rates. However, there is still a lack of evidence concerning its use in orthoplastic surgery. Therefore, the aim of this study is to compare NPWTi-d with NPWT and standard of care for wound management in orthoplastic surgery. A comprehensive literature search using PubMed, Web of Science, and Cochrane databases up to 15 March 2022 was performed, including studies describing the outcomes of NPWTi-d for traumatic/orthopaedic injuries. A meta-analysis on the number of surgical debridements, as well as the rate of complete wound closure and complications was carried out, although for other outcomes, a descriptive statistic was applied. Risk of bias and quality of evidence were assessed using the Downs& Black's Checklist for Measuring Quality. Thirteen studies with a total number of 871 patients were included, in which NPWTi-d demonstrated significantly higher primary wound closure and lower complication rates (P < .05). No difference in the number of surgical procedures required for final wound healing was observed. Moreover, five out of six studies showed better results for NPWTi-d when the change of the bioburden and bacterial count of the wound were analysed. A singular study investigating the length of the hospital stay of patients treated with NPWTi-d showed a reduction in the latter. The present meta-analysis proves that NPWTi-d is superior to NPTW or conventional dressings in orthoplastic wound care management, in terms of complete wound closure rate and the reduced number of complications. Still, the limited quality of the studies analysed shows that future randomised studies are needed to confirm the benefits and to identify the most appropriate recommendations for using NPWTi-d in orthoplastic surgery, as well as to investigate the cost-effectiveness of this wound-dressing system.
Topics: Humans; Negative-Pressure Wound Therapy; Standard of Care; Wound Healing; Plastic Surgery Procedures; Bandages; Therapeutic Irrigation
PubMed: 36594491
DOI: 10.1111/iwj.14072 -
Journal of Clinical Medicine Apr 2024: to evaluate the effectiveness of different topical agents in biofilm disaggregation during non-surgical periodontal therapy. : the search strategy was conducted... (Review)
Review
: to evaluate the effectiveness of different topical agents in biofilm disaggregation during non-surgical periodontal therapy. : the search strategy was conducted according to the PRISMA 2020 on Pubmed, Cochrane Library, Scopus, and Web of Science, and it was registered in PROSPERO, ID: CRD42023474232. It included studies comparing non-surgical periodontal therapy (NSPT) with and without the application of topical agents for biofilm disruption. A risk of bias analysis, a qualitative analysis, and a quantitative analysis were performed. : out of 1583 records, 11 articles were included: 10 randomized clinical trials and one retrospective analysis. The total number of participants considered in the 11 articles included in the study was 386. The primary outcomes were probing pocket depth (PPD), clinical attachment level (CAL), and bleeding indices. The secondary outcomes were plaque indices, gingival recessions, and microbiological parameters. The meta-analysis revealed the following: [Weighted mean difference (WMD): -0.37; 95% confidence interval (CI) (-0.62, -0.12), heterogeneity I: 79%, statistical significance = 0.004]. : the meta-analysis of probing pocket depth reduction (PPD) between baseline and follow-up at 3-6 months showed a statistically significant result in favor of sulfonated phenolics gel. The scientific evidence is still limited and heterogeneous; further randomized clinical trials are required.
PubMed: 38673451
DOI: 10.3390/jcm13082179 -
European Journal of Orthopaedic Surgery... Oct 2023Periprosthetic joint infection (PJI) of the knee represents a severe complication after 1.5% to 2% of primary total knee replacement. Although two-stage revision was... (Review)
Review
BACKGROUND
Periprosthetic joint infection (PJI) of the knee represents a severe complication after 1.5% to 2% of primary total knee replacement. Although two-stage revision was considered the gold-standard treatment for PJI of the knee, in the last decades, more studies reported the outcomes of one-stage revisions. This systematic review aims to assess reinfection rate, infection-free survival after reoperation for recurrent infection, and the microorganisms involved in both primary and recurrent infection.
MATERIAL AND METHODS
A systematic review of all studies reporting the outcome of one-stage revision for PJI of the knee up to September 2022, according to PRISMA criteria and AMSTAR2 guidelines, was performed. Patient demographics, clinical, surgical, and postoperative data were recorded.
PROSPERO ID
CRD42022362767.
RESULTS
Eighteen studies with a total of 881 one-stage revisions for PJI of the knee were analyzed. A reinfection rate of 12.2% after an average follow-up of 57.6 months was reported. The most frequent causative microorganism were gram-positive bacteria (71.1%), gram-negative bacteria (7.1%), and polymicrobial infections (8%). The average postoperative knee society score was 81.5, and the average postoperative knee function score was 74.2. The infection-free survival after treatment for recurrent infection was 92.1%. The causative microorganisms at reinfections differed significantly from the primary infection (gram-positive 44.4%, gram-negative 11.1%).
CONCLUSION
Patients who underwent a one-stage revision for PJI of the knee showed a reinfection rate lower or comparable to other surgical treatments as two-stage or DAIR (debridement, antibiotics, and implant retention). Reoperation for reinfection demonstrates a lower success compared to one-stage revision. Moreover, microbiology differs between primary infection and recurrent infection. Level of evidence Level IV.
Topics: Humans; Reinfection; Prosthesis-Related Infections; Treatment Outcome; Debridement; Knee Joint; Anti-Bacterial Agents; Reoperation; Arthritis, Infectious; Retrospective Studies
PubMed: 36867259
DOI: 10.1007/s00590-023-03480-7 -
The Saudi Dental Journal Dec 2023The presence of middle mesial canals in mandibular molars are not commonly encountered in daily practice. However, locating and debriding such anatomical variation... (Review)
Review
BACKGROUND
The presence of middle mesial canals in mandibular molars are not commonly encountered in daily practice. However, locating and debriding such anatomical variation during the endodontic therapy is essential to avoid endodontic failure. The aim of this systematic review was to identify the overall prevalence of middle mesial canals (MMC) in mandibular molars using cone-beam computed tomography (CBCT), to assess the influence of different gender on the prevalence of MMCs in mandibular molars and to describe the MMC configurations.
METHODS
The review protocol was registered in the PROSPERO database (CRD42021238523). The main electronic databases were searched until February 2022 for prevalence studies on root/canal anatomy in mandibular molars using CBCT imaging, in addition to hand-searched scientific articles in peer-reviewed journals and grey literature. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tool. Egger's and Begg's tests and Pearson's chi-square test were used for statistical analysis.
RESULTS
From 523 records, 488 studies were excluded after screening the title and abstract. 35 relevant studies were included for full-text assessment and 28 studies were included in the meta-analysis. The overall prevalence of MMC out of the 19,256 teeth was 5.09% (95% CI: 2.894 to 7.784). The prevalence of MMC was 9.79% (95% CI: 4.296 to 17.224) in males and 13.96% (95% CI: 0.541 to 40.737) in females with a statistically significant difference of 4.16% (95% CI: 2.29 to 6.01). The most MMC configuration found in this review to be confluent with the mesiobuccal canal.
CONCLUSION
The results showed an overall 5.09% prevalence of MMC in mandibular molars, with a significantly high prevalence in female subjects. Additionally, this canal was found to be confluent with the mesiobuccal canal.
PubMed: 38107038
DOI: 10.1016/j.sdentj.2023.08.009 -
Photodiagnosis and Photodynamic Therapy Apr 2024This study aimed to assess the influence of methylene blue (MB)-mediated adjunctive antimicrobial photodynamic therapy (aPDT) when compared to conventional mechanical... (Meta-Analysis)
Meta-Analysis Review
Efficacy of methylene blue-mediated antimicrobial photodynamic therapy on clinical and radiographic outcomes among patients with periodontal diseases: A systematic review and meta-analysis of randomized controlled trials.
OBJECTIVE
This study aimed to assess the influence of methylene blue (MB)-mediated adjunctive antimicrobial photodynamic therapy (aPDT) when compared to conventional mechanical debridement (MD) alone on periodontal clinical and radiographic outcomes among periodontitis patients.
METHODS
Randomized clinical trials (RCTs) were incorporated by conducting an electronic search in Web of Science, Scopus, and PubMed for articles published in English up to August 2023 to address the following focused question based on the PICO format: "Whether the application of MB-mediated aPDT as an adjunctive to MD (Intervention) leads to improved periodontal clinical and/or radiographic outcomes (Outcome) among participants with and without periodontal diseases (Population) as compared to MD alone (Conparison)". The risk of bias (RoB) of the included studies was assessed using the modified Jadad scale. A meta-analysis was conducted, and it included the presentation of the standard mean difference (SMD) along with a 95 % confidence interval (CI).
RESULTS
In total, 11 studies were included in this systematic review and meta-analysis. The meta-analysis demonstrated statistically significant improvements in periodontal plaque index (SMD: -0.72 % [95 % CI: -0.99 % to -0.45 %]; p<0.00001), probing depth (SMD: -0.38 % [95 % CI: -0.57 % to -0.19 %; p<0.00001), and bleeding on probing (SMD: -0.44 % [95 % CI: -0.68 % to -0.20 %]; p = 0.0003) scores at the final follow-up visit after the application of MB-mediated aPDT in comparison with MD alone. Nevertheless, there was no statistically significant difference was observed in periodontal clinical attachment level values (SMD: -0.01 % [95 % CI: -0.21 % to 0.19 %]; p = 0.95) between the control group and the experimental group. Six studies achieved a low RoB, five were rated as having medium RoB, while no study received a high RoB.
CONCLUSION
MB-mediated aPDT, when used as an adjunct to conventional MD contributes to the improvement of periodontal clinical outcomes including PI, PD, and BOP in patients with periodontitis.
Topics: Methylene Blue; Humans; Photochemotherapy; Photosensitizing Agents; Randomized Controlled Trials as Topic; Periodontal Diseases
PubMed: 38316339
DOI: 10.1016/j.pdpdt.2024.104000 -
Archives of Orthopaedic and Trauma... Nov 2023Most adult cases of bacterial-septic-arthritis of a native joint are effectively managed with a single surgical debridement, but some cases may require more than one... (Review)
Review
INTRODUCTION
Most adult cases of bacterial-septic-arthritis of a native joint are effectively managed with a single surgical debridement, but some cases may require more than one debridement to control the infection. Consequently, this study assessed the failure rate of a single surgical debridement in adults with bacterial arthritis of a native joint. Additionally, risk factors for failure were assessed.
MATERIALS AND METHODS
The review protocol was registered on PROSPERO (CRD42021243460) before data collection and conducted in line with the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) guidelines. Multiple libraries were systematically searched to identify articles including patients reporting on the incidence of failure (i.e. persistence of infection requiring reoperation) of the treatment of bacterial arthritis. The quality of individual evidence were assessed using the Quality in Prognosis Studies (QUIPS) tool. Failure rates were extracted from included studies and pooled. Risk factors for failure were extracted and grouped. Moreover, we evaluated which risk factors were significantly associated with failure.
RESULTS
Thirty studies (8,586 native joints) were included in the final analysis. The overall pooled failure rate was 26% (95% CI 20 to 32%). The failure rate of arthroscopy and arthrotomy was 26% (95% CI 19 to 34%) and 24% (95% CI 17 to 33%), respectively. Seventy-nine potential risk factors were extracted and grouped. Moderate evidence was found for one risk factor (synovial white blood cell count), and limited evidence was found for five risk factors (i.e. sepsis, large joint infection, the volume of irrigation, blood urea nitrogen-test, and blood urea nitrogen/creatinine ratio).
CONCLUSION
A single surgical debridement fails to control bacterial arthritis of a native joint in approximately a quarter of all adult cases. Limited to moderate evidence exists that risk factors associated with failure are: synovial white blood cell count, sepsis, large joint infection, and the volume of irrigation. These factors should urge physicians to be especially receptive to signs of an adverse clinical course.
Topics: Humans; Adult; Debridement; Reoperation; Arthroscopy; Prognosis; Arthritis, Infectious; Retrospective Studies
PubMed: 37395855
DOI: 10.1007/s00402-023-04958-z -
Cartilage Mar 2024In contrast to osteochondral lesion (OCL) of the ankle, OCLs in other joints of the foot, such as subtalar joint, talonavicular joint, calcaneocuboid joint, and the...
Current Lack of Evidence on Treatment Strategies and Clinical Outcomes for Osteochondral Lesions of the Subtalar, Talonavicular, and Calcaneocuboid Joints: A Systematic Review.
OBJECTIVE
In contrast to osteochondral lesion (OCL) of the ankle, OCLs in other joints of the foot, such as subtalar joint, talonavicular joint, calcaneocuboid joint, and the midfoot, are rare conditions, but they can also lead to significant morbidity. The objective of this systematic review was to summarize the clinical evidence for the treatment of OCLs of the subtalar, talonavicular, calcaneocuboid, and the other midfoot joints.
DESIGN
A systematic search of the MEDLINE, EMBASE, and Cochrane Library databases was performed in January 2021 based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by 2 independent reviewers. Included studies were evaluated with regard to LOE (level of evidence) and QOE (quality of evidence). Variable reporting outcome data, clinical outcomes, and complications were evaluated.
RESULTS
Seventeen studies with 21 patients were included, all of which were case reports (level 5) without any case series reporting greater than 3 patients. There were 5 patients with OCL in the subtalar joint, 15 patients in the talonavicular joint, and 1 patient in the calcaneocuboid joint. Thirteen case reports (4 subtalar joint, 8 talonavicular joint, and 1 calcaneocuboid joint) reported surgical treatment. Surgical procedures mainly included debridement, bone marrow stimulation, fixation, and bone grafting, through open or arthroscopy, all of which resulted in successful outcomes. Four case reports (1 subtalar joint, 3 talonavicular joint) reported successful conservative treatment. Other 13 case reports reported successful surgery after failed conservative treatment. No complications and reoperations were reported.
CONCLUSIONS
The current systematic review revealed that there is no available evidence to ascertain clinical outcomes of both conservative and surgical treatments for cartilage lesions in the talonavicular joint, subtalar joint, and the midfoot joints, owing to the extreme paucity of literature. Both nonoperative and operative treatments can be considered, but no treatment strategies have been established.
Topics: Humans; Tarsal Joints; Subtalar Joint; Ankle Joint; Research Design
PubMed: 38032011
DOI: 10.1177/19476035231216182