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Clinical Immunology (Orlando, Fla.) Jan 2023Osteoarthritis (OA) patients demonstrated higher Osteopontin (OPN) plasma, serum, and synovial fluid concentrations than healthy individuals. In the present study, we... (Meta-Analysis)
Meta-Analysis
PURPOSE
Osteoarthritis (OA) patients demonstrated higher Osteopontin (OPN) plasma, serum, and synovial fluid concentrations than healthy individuals. In the present study, we aimed to investigate whether OPN could be used as a diagnostic or prognostic marker for OA symptom/disease severity.
METHODS
Using Web of Science, PubMed, Scopus, and Embase, we conducted a systematic review and meta-analysis of studies that measured OPN levels in OA patients' plasma, serum, or synovial fluid. After setting the eligibility criteria, data extraction, and quality assessment of the identified studies, we performed statistical analysis using Revman 5.4 and Open Meta analyst.
RESULTS
OPN has been found to be associated with advanced knee joint damage in OA patients. In addition, higher expression of OPN is thought to be associated with disease progression. Nevertheless, further studies should examine the role of other markers of chronic bone damage, such as leptin and sclerostin. This systematic review and meta-analysis included 14 studies with a total of 776 cases and 530 controls. OPN was significantly elevated in osteoarthritis patients' plasma, serum, and synovial fluid samples, with significant heterogeneity between studies.
CONCLUSION
We recommend that OPN plasma and synovial fluid levels be measured as a diagnostic and prognostic marker to determine the severity of OA symptoms.
Topics: Humans; Osteopontin; Osteoarthritis; Synovial Fluid; Biomarkers; Bone and Bones
PubMed: 36403917
DOI: 10.1016/j.clim.2022.109187 -
Orthopaedic Journal of Sports Medicine Jan 2022Various methods exist for managing the joint capsule during the Latarjet procedure. Repairing the capsule to the native glenoid rim results in an extra-articular bone... (Review)
Review
BACKGROUND
Various methods exist for managing the joint capsule during the Latarjet procedure. Repairing the capsule to the native glenoid rim results in an extra-articular bone block, while repairing it to the remnant coracoacromial ligament stump of the coracoid graft renders it intra-articular. The technique that optimizes patient outcomes is not well defined.
PURPOSE
To compare the outcomes of intra-articular and extra-articular bone block techniques for the Latarjet procedure.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
Using PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, we queried the PubMed, EMBASE, and the Cochrane Library for all studies reporting outcomes of the Latarjet procedure with a clearly defined method of capsular repair that rendered the coracoid graft intra-articular or extra-articular. The included levels of evidence and degree of heterogeneity in this study precluded meta-analysis. Outcomes of interest included preoperative variables, surgical technique, rehabilitation protocols, functional outcome assessments, recurrent instability, range of motion, and radiographic findings.
RESULTS
A total of 16 studies including 816 patients were included. A total of 8 studies employed an intra-articular bone block in 338 patients, while the other 8 employed an extra-articular technique in 478 patients. There was variation among studies in reference to baseline patient characteristics, surgical techniques, rehabilitation, methods for assessing patient outcomes, and follow-up times. Rates of postoperative instability were reported in 8 intra-articular (0%, 0%, 2.1%, 2.7%, 3.2%, 5%, 5.4%, 5.9%) and 7 extra-articular (0%, 0%, 1.2%, 2%, 3.9%, 6.3%, 14%) bone block studies. Postoperative osteoarthritis or progression of preoperative osteoarthritis was reported in 5 intra-articular bone block studies (0%, 5.6%, 23.5%, 23.5%, 25%) and 4 extra-articular bone block studies (0%, 1.9%, 5.2%, 8.6%).
CONCLUSION
Varying capsular repair methods appeared to provide similar outcomes regarding stability. There was an apparent trend toward higher rates of post-traumatic arthritis among studies in which an intra-articular bone block technique was employed; however, it is possible that this was influenced by substantially different follow-up times between groups and other various sources of heterogeneity among the included studies. There were no studies in the literature directly comparing intra-articular and extra-articular bone block techniques. Large-scale randomized controlled trials or comparative studies are needed to draw stronger conclusions comparing the 2 techniques.
PubMed: 35097145
DOI: 10.1177/23259671211068371 -
Arthroscopy : the Journal of... Aug 2019To evaluate the preliminary clinical outcomes and complications of superior capsule reconstruction (SCR) for irreparable rotator cuff tears.
PURPOSE
To evaluate the preliminary clinical outcomes and complications of superior capsule reconstruction (SCR) for irreparable rotator cuff tears.
METHODS
A systematic review of PubMed, MEDLINE, EMBASE, and Cochrane databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical outcomes of irreparable rotator cuff tears managed by SCR were included. Clinical outcome analyses of pre- and postoperative range of motion, American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, and acromiohumeral intervals (AHIs) were performed and reported as range or frequency.
RESULTS
Five studies (285 patients, 291 shoulders) of level III-IV evidence were included, with a weighted mean (± standard deviation) follow-up of 27.7 ± 17.3 months. Forward flexion improved from 91°-130° preoperatively to 147°-160° postoperatively, external rotation from 26°-41° to 41°-45°, and internal rotation from L4-L1 to L1. American Shoulder and Elbow Surgeons scores increased from 36-52.2 to 77.5-92, and visual analog scale pain scores decreased from 4.0-6.3 to 0.4-1.7. Radiographically, AHIs with acellular dermal allograft ranged from 4.5 to 7.1 mm preoperatively, improving to 7.6-10.8 mm immediately postoperation before decreasing to 6.7-9.7 mm by final follow-up. Complication and graft failure rates were 17.2% and 11.7%, respectively.
CONCLUSIONS
Preliminary results of SCR show consistent improvement in shoulder functionality and pain reduction. However, a decrease in postoperative AHIs indicates dermal allograft elongation and persistent superior migration of the humerus, potentially contributing to later graft failure. Studies with longer follow-up will be essential to evaluate the long-term utility of SCR in the treatment of irreparable rotator cuff tears.
LEVEL OF EVIDENCE
Level IV, systematic review of level III-IV studies.
Topics: Arthroscopy; Humans; Joint Capsule; Range of Motion, Articular; Plastic Surgery Procedures; Rotator Cuff Injuries; Shoulder Joint
PubMed: 31395196
DOI: 10.1016/j.arthro.2019.02.053 -
Arthroscopy : the Journal of... Aug 2023To perform a systematic review of studies reporting on minimum 5-year outcomes of patients undergoing primary hip arthroscopy (HA) for femoroacetabular impingement... (Review)
Review
PURPOSE
To perform a systematic review of studies reporting on minimum 5-year outcomes of patients undergoing primary hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) to determine whether capsular management influences patient-reported outcomes (PROs), rates of clinically significant outcome, and rates of revision surgery or conversion to total hip arthroplasty (THA).
METHODS
PubMed, Scopus, and Google Scholar were searched around the terms hip arthroscopy, FAIS, five-year follow-up, and capsule management. Articles available in English, presenting original data, and reporting minimum 5-year follow-up after HA using either PROs or conversion to THA or revision surgery were included. Quality assessment was completed using MINORS assessment. Articles were stratified into unrepaired and repaired capsule cohorts (excluding periportal capsulotomy techniques).
RESULTS
Eight articles were included. MINORS assessment ranged from 11-22, with excellent (k = 0.842) inter-rater reliability. Populations without capsular repair were identified in 4 studies including a total of 387 patients, at an age of 33.1 to 38.0 years and follow-up range of 60.0 to 77 months. Populations with capsular repair were identified in 5 studies including a total of 835 patients, at an age range of 33.6 to 43.1 years and follow-up range of 60.0 to 78.0 months. All studies included PROs and all reported significant improvement (P < .05) at the 5-year timepoint, with modified Harris Hip Score (mHHS) being the most frequent (n = 6). No differences were noted between groups regarding any of the measured PROs. Average rates of achieving MCID and PASS for mHHS were similar between patients without capsular repair (MCID 71.1%, PASS 73.7%, n = 1) and with capsular repair (MCID 66.0%-90.6%, PASS 55.3%-87.4%, n = 4). Conversion to THA occurred in 12.8% to 18.5% and 0.0% to 29.0% for patients with an unrepaired and repaired capsule, respectively. Revision HA occurred in 15.4% to 25.5% and 3.1% to 15.4% in unrepaired and repaired capsular patients, respectively.
CONCLUSIONS
Patients undergoing hip arthroscopy for FAI had significant improvement in PRO scores at minimum 5-year follow-up, and scores did not differ between patients who underwent capsular repair and those who did not. Similar rates of markers of clinical benefit and THA conversion were achieved by both groups; however, lower rates of revision hip arthroscopy were demonstrated in the capsular repair cohort.
LEVEL OF EVIDENCE
Level IV; systematic review of Level II-IV studies.
Topics: Humans; Child, Preschool; Child; Hip Joint; Treatment Outcome; Retrospective Studies; Arthroscopy; Reproducibility of Results; Femoracetabular Impingement; Arthroplasty, Replacement, Hip; Patient Reported Outcome Measures; Follow-Up Studies; Activities of Daily Living
PubMed: 37146665
DOI: 10.1016/j.arthro.2023.04.016 -
PloS One 2020The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty...
Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty.
The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty (THA). Increasing incidence of osteoarthritis is accompanied by a dramatic rise in THAs over the last few decades. Consequently, to improve this treatment, THA with capsular repair has evolved. This partial restoration of physiological hip stability has resulted in a substantial reduction in post-operative dislocation rates compared to conventional THA without capsular repair. A further reason for the success of this procedure is thought to be the preservation of the innervation of the capsule. A systematic review of studies investigating the innervation of the hip joint capsular complex and pseudocapsule with histological techniques was performed, as this is not well established. The literature was sought from databases Amed, Embase and Medline via OVID, PubMed, ScienceDirect, Scopus and Web of Science; excluding articles without a histological component and those involving animals. A total of 21 articles on the topic were identified. The literature indicates two primary outcomes and potential clinical implications of the innervation of the capsule. Firstly, a role in the mechanics of the hip joint, as mechanoreceptors may be present in the capsule. However, the nomenclature used to describe the distribution of the innervation is inconsistent. Furthermore, the current literature is unable to reliably confirm the proprioceptive role of the capsule, as no immunohistochemical study to date has reported type I-III mechanoreceptors in the capsule. Secondly, the capsule may play a role in pain perception, as the density of innervation appears to be altered in painful individuals. Also, increasing age may indicate requirements for different strategies to surgically manage the hip capsule. However, this requires further study, as well as the role of innervation according to sex, specific pathology and other morphometric variables. Increased understanding may highlight the requirement for capsular repair following THA, how this technique may be developed and the contribution of the capsule to joint function and stability.
Topics: Arthroplasty, Replacement, Hip; Hip Joint; Humans; Joint Capsule; Joint Instability; Postoperative Complications
PubMed: 32101545
DOI: 10.1371/journal.pone.0229128 -
Evidence-based Complementary and... 2021Compound capsule (CTCC), an antitumor Chinese patent medicine, has been commonly prescribed as an adjunctive agent to chemotherapy for the management of non-small-cell...
BACKGROUND
Compound capsule (CTCC), an antitumor Chinese patent medicine, has been commonly prescribed as an adjunctive agent to chemotherapy for the management of non-small-cell lung cancer (NSCLC); however, the effects of CTCC added to chemotherapy for NSCLC patients have never been comprehensively evaluated or summarized.
PURPOSE
To assess the synergistic effects of CTCC and chemotherapy on NSCLC. . Evidence-based study, systematic review, and quantitative meta-analysis.
METHODS
This systematic review and meta-analysis was implemented in accordance with the PRISMA (Preferred Reported Items for Systematic Review and Meta-Analysis) guidelines. Eight databases including China National Knowledge Infrastructure, SINOMED, China Biomedical Literature Database, Wanfang Database, VIP, PubMed, Cochrane Library, and EMBASE were searched for relevant RCTs from their inception until May 24, 2021, and hand-searching was also carried out to identify additional studies. All randomized controlled trials (RCTs) that compared CTCC combined with chemotherapy versus chemotherapy alone were included in our study. The Cochrane Risk-of-Bias tool was used to determine the risk of bias and methodological quality of the included RCTs. Review Manager 5.3 software was used for comprehensive analysis. The primary outcome measure for this study was the disease control rate (DCR), and the secondary outcomes included the objective response rate (ORR), adverse reactions, and quality of life (QOL).
RESULTS
Six RCTs with a total sample size of 410 were finally included. The pooled data showed that, compared with chemotherapy alone, CTCC combined with chemotherapy significantly improved DCR (RR = 1.15, 95% CI: 1.06-1.25, = 0.006), ORR (RR = 1.38, 95% CI: 1.18-1.63, 0.00001), and QOL (MD = 8.69, 95% CI: 7.26-10.13, < 0.006) and reduced the incidence of total adverse reactions (RR = 0.48, 95% CI: 0.38-0.60, < 0.00001). The subgroup analyses indicated that CTCC plus chemotherapy significantly improved gastrointestinal reactions ( = 0.004), leukopenia ( = 0.0009), thrombocytopenia ( = 0.01), rash ( = 0.002), and fever ( = 0.007).
CONCLUSION
Based on the available evidence, compared with chemotherapy alone, CTCC used as an adjunctive agent to chemotherapy for NSCLC can improve the clinical efficacy and quality of life and decrease the likelihood of adverse reactions, suggesting that CTCC might be an effective and safe adjunctive medicine to chemotherapy for NSCLC. However, considering the relatively small sample size and the inherent imperfections of the included randomized controlled trials, more high-quality clinical trials with longer follow-up time are needed to further assess the efficacy and safety of this combined treatment regimen.
PubMed: 34956388
DOI: 10.1155/2021/9535061 -
Seminars in Arthritis and Rheumatism Apr 2023Osteoarthritis (OA) is a joint disease that is clinically diagnosed using components of history, physical exam, and characteristic radiographic findings, such as joint... (Review)
Review
PURPOSE
Osteoarthritis (OA) is a joint disease that is clinically diagnosed using components of history, physical exam, and characteristic radiographic findings, such as joint space narrowing. Currently, there are no laboratory findings that are specific to a diagnosis of OA. The purpose of this systematic review is to evaluate the state of current studies of metabolomic biomarkers that can aid in the diagnosis and treatment of OA.
METHODS
Articles were gathered from PubMed and Web of Science using the search terms "osteoarthritis" and "biomarkers" and "metabolomics". Last search of databases took place December 3rd, 2022. Duplicates were manually screened, along with any other results that were not original journal articles. Only original reports involving populations with diagnosed primary or secondary OA (human participants) or surgically induced OA (animal participants) and a healthy control group for comparison were considered for inclusion. Metabolites and metabolic pathways reported in included articles were then manually extracted and evaluated for importance based on reported a priori p-values and/or area under the receiver-operator curve (AUC).
RESULTS
Of the 161 results that were returned in the database searches, 43 unique articles met the inclusion criteria. Articles were categorized based on body fluid analyzed: 6 studies on urine samples, 13 studies on plasma samples, 11 studies on synovial fluid (SF) samples, 11 studies on serum samples, 1 study on both synovial fluid and serum, and 1 study that involved both plasma and synovial fluid. To synthesize results, individual metabolites, as well as metabolic pathways that involve frequently reported metabolites, are presented for each study. Indications as to whether metabolite levels were increased or decreased are also included if this data was included in the original articles.
CONCLUSIONS
These studies clearly show that there are a wide range of metabolic pathways perturbed in OA. For this period, there was no consensus on a single metabolite, or panel of metabolites, that would be clinically useful in early diagnosis of OA or distinguishing OA from a healthy control. However, many common metabolic pathways were identified in the studies, including TCA cycle, fatty acid metabolism, amino acid metabolism (notably BCAA metabolism and tryptophan metabolism via kynurenine pathway), nucleotide metabolism, urea cycle, cartilage matrix components, and phospholipid metabolism. Future research is needed to define effective clinical biomarkers of osteoarthritis from metabolomic and other data.
Topics: Animals; Humans; Osteoarthritis; Metabolomics; Biomarkers; Synovial Fluid; Metabolic Networks and Pathways
PubMed: 36736024
DOI: 10.1016/j.semarthrit.2023.152163 -
The American Journal of Sports Medicine Sep 2020Graft bridging (GB) and superior capsule reconstruction (SCR) were developed to treat large to massive rotator cuff tears (RCTs); however, the outcome differences...
BACKGROUND
Graft bridging (GB) and superior capsule reconstruction (SCR) were developed to treat large to massive rotator cuff tears (RCTs); however, the outcome differences between GB and SCR remain unclear.
PURPOSE
To systematically review and compare the outcomes of GB and SCR for large to massive RCT.
STUDY DESIGN
Systematic review.
METHODS
A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of GB or SCR were included according to the inclusion and exclusion criteria. The primary outcome was Constant-Murley score at the final follow-up. Secondary outcomes included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, active shoulder range of motion, and graft healing rate. Complication rate was the safety outcome measure. Outcomes were summarized into group SCR and group GB, and the results were compared statistically ( < .05).
RESULTS
A total of 23 studies were included in this review: 238 repairs from the 5 studies in group SCR and 593 repairs from the 18 studies in group GB. For group SCR and group GB, the mean age was 61.6 and 63.3 years, and the mean follow-up was 18.0 and 40.1 months, respectively. Overall, both procedures demonstrated improvement of clinical outcomes. When compared with group SCR, group GB had significantly higher mean differences of the Constant-Murley score (41.9 vs 19.8), American Shoulder and Elbow Surgeons score (39.3 vs 33.8), visual analog scale score for pain (4.4 vs 3.4), and active external rotation at side (15.3 vs 9.3). No statistically significant difference was detected in the mean difference of active forward flexion, internal rotation, abduction, and graft healing rate between the groups. The complication rates were 0.84% (2 of 238) in group SCR and 0.67% (4 of 593) in group GB.
CONCLUSION
In general, GB showed significantly better clinical and functional outcomes postoperatively than SCR, with a similar complication rate. The available fair-quality evidence suggested that GB might be a better choice for large to massive RCT. More high-quality randomized controlled studies are required to further evaluate the relative benefits of the 2 procedures.
Topics: Arthroscopy; Humans; Joint Capsule; Middle Aged; Range of Motion, Articular; Rotator Cuff; Rotator Cuff Injuries; Tendon Transfer; Treatment Outcome
PubMed: 31766858
DOI: 10.1177/0363546519889040 -
The American Journal of Sports Medicine Jun 2022In hip arthroscopic surgery, capsulotomy is performed to improve visualization and allow instrumentation of the joint. Traditionally, the defect has been left... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In hip arthroscopic surgery, capsulotomy is performed to improve visualization and allow instrumentation of the joint. Traditionally, the defect has been left unrepaired; however, increasing evidence suggests that this may contribute to persistent pain and iatrogenic capsular instability. Nevertheless, the clinical benefit of performing routine capsular repair remains controversial.
PURPOSE/HYPOTHESIS
We conducted a systematic review and meta-analysis to investigate the effects of routine capsular closure on patient-reported outcomes (PROs), hypothesizing that superior PROs would be observed with routine capsular closure.
STUDY DESIGN
Meta-analysis and systematic review; Level of evidence, 4.
METHODS
A systematic review and meta-analysis was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The terms "hip,""arthroscopy,""capsule,""capsular,""repair," and "closure" were used to query Ovid MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), CINAHL (Cumulative Index to Nursing and Allied Health Literature), SPORTDiscus, and PubMed. Articles with PROs stratified by capsular management were included. Multivariate mixed-effects metaregression models were implemented with study-level random-effects and fixed-effects moderators for capsular closure versus no repair and after controlling for surgical indication and preoperative PROs. The effect of repair on both the postoperative score and the change in scores was evaluated via the Harris Hip Score (HHS)/modified HHS (mHHS), Hip Outcome Score (HOS)-Activities of Daily Living (ADL), and HOS-Sport Specific Subscale (SSS), with a supplemental analysis of additional outcomes.
RESULTS
Of 432 initial articles, 36 were eligible for analysis, with results for 5132 hip arthroscopic procedures. The capsule was repaired in 3427 arthroscopic procedures and unrepaired in 1705. Capsular repair was associated with significantly higher postoperative HHS/mHHS (2.011; SE, 0.743 [95% CI, 0.554-3.467]; = .007), HOS-ADL (3.635; SE, 0.873 [95% CI, 1.923-5.346]; < .001), and HOS-SSS (4.137; SE, 1.205 [95% CI, 1.775-6.499]; < .001) scores as well as significantly superior improvement on the HHS/mHHS (2.571; SE, 0.878 [95% CI, 0.849-4.292]; = .003), HOS-ADL (3.315; SE, 1.131 [95% CI, 1.099-5.531]; = .003), and HOS-SSS (3.605; SE, 1.689 [95% CI, 0.295-6.915]; = .033).
CONCLUSION
This meta-analysis is the largest to date evaluating the effect of capsular closure on PROs and demonstrates significantly higher mean postoperative scores and significantly superior improvement with repair, while controlling for the effects of preoperative score and surgical indication. The true magnitude of the benefit of capsular repair may be clarified by large prospective randomized studies using PRO measures specifically targeted and validated for hip arthroscopic surgery/preservation.
Topics: Activities of Daily Living; Arthroscopy; Femoracetabular Impingement; Follow-Up Studies; Hip Joint; Humans; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 34403279
DOI: 10.1177/03635465211023508 -
The Bone & Joint Journal Mar 2022The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated... (Comparative Study)
Comparative Study Meta-Analysis
Synovial fluid calprotectin performs better than synovial fluid polymerase chain reaction and interleukin-6 in the diagnosis of periprosthetic joint infection : a systematic review and meta-analysis.
AIMS
The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated the performance characteristics of polymerase chain reaction (PCR), interleukin-6 (IL6), and calprotectin of synovial fluid in the diagnosis of PJI.
METHODS
We performed systematic search of PubMed, Embase, The Cochrane Library, Web of Science, and Science Direct from the date of inception of each database through to 31 May 2021. Studies which described the diagnostic accuracy of synovial fluid PCR, IL6, and calprotectin using the Musculoskeletal Infection Society criteria as the reference standard were identified.
RESULTS
Overall, 31 studies were identified: 20 described PCR, six described IL6, and five calprotectin. The sensitivity and specificity were 0.78 (95% confidence interval (CI) 0.67 to 0.86) and 0.97 (95% CI 0.94 to 0.99), respectively, for synovial PCR;, 0.86 (95% CI 0.74 to 0.92), and 0.94 (95% CI 0.90 to 0.96), respectively, for synovial IL6; and 0.94 (95% CI 0.82 to 0.98) and 0.93 (95% CI 0.85 to 0.97), respectively, for synovial calprotectin. Likelihood ratio scattergram analyses recommended clinical utility of synovial fluid PCR and IL6 as a confirmatory test only. Synovial calprotectin had utility in the exclusion and confirmation of PJI.
CONCLUSION
Synovial fluid PCR and IL6 had low sensitivity and high specificity in the diagnosis of PJI, and is recommended to be used as confirmatory test. In contrast, synovial fluid calprotectin had both high sensitivity and specificity with utility in both the exclusion and confirmation of PJI. We recommend use of synovial fluid calprotectin studies in the preoperative workup of PJI. Cite this article: 2022;104-B(3):311-320.
Topics: Humans; Interleukin-6; Joint Prosthesis; Leukocyte L1 Antigen Complex; Polymerase Chain Reaction; Prosthesis-Related Infections; Sensitivity and Specificity; Synovial Fluid
PubMed: 35227091
DOI: 10.1302/0301-620X.104B3.BJJ-2021-1320.R1