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Asian Journal of Surgery Oct 2021Progressive resistance training (PRT) is one of the most commonly used exercise methods after joint replacement, while its effectiveness and safety are still... (Meta-Analysis)
Meta-Analysis Review
Progressive resistance training (PRT) is one of the most commonly used exercise methods after joint replacement, while its effectiveness and safety are still controversial. Therefore, it's vital to investigate the effect of PRT on muscle strength and functional capacity early postoperative total hip arthroplasty (THA) or total knee arthroplasty (TKA). Relevant studies were identified via a search of Medline, Web of science and Cochrane Library from 2002 to 12 May 2020. Fifteen of 704 studies which comprised 6 THAs and 8 TKAs, involving 1021 adult patients were eligible for inclusion in the meta-analysis. There were no significant differences between the two groups after TKA in the 6-min walk test (6-WMT) within 1 month (95% CI = -0.41, 1.53), within 3 months (95% CI = -0.27, 0.76), within 12 months (95% CI = -0.29, 0.66); climb performance in seconds (s) (SCP), leg extension power, timed up and go test in seconds (s) (TUG) within 1 month (95% CI = -1.75, 0.77), within 3 months (95% CI = -0.48, 0.33), within 12 months (95% CI = -0.44, 0.35), sit to stand, number of repetitions in 30s (ST). There was no difference in the incidence of adverse events (95% CI = -0.01, 0.10). Similarly, two groups were also no obvious distinction after THA in the 6-WMT, SCP, Leg extension power, ST. PRT early after THA or TKA did not differ significantly from SR in terms of functional capacity, muscle strength recovery and incidence of adverse events. PRT is one of the options for rapid rehabilitation after joint replacement.
Topics: Adult; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Postural Balance; Resistance Training; Time and Motion Studies
PubMed: 33715964
DOI: 10.1016/j.asjsur.2021.02.007 -
The Bone & Joint Journal May 2021This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified... (Meta-Analysis)
Meta-Analysis
AIMS
This systematic review asked which patterns of complications are associated with the three reverse total shoulder arthroplasty (RTSA) prosthetic designs, as classified by Routman et al, in patients undergoing RTSA for the management of cuff tear arthropathy, massive cuff tear, osteoarthritis, and rheumatoid arthritis. The three implant design philosophies investigated were medial glenoid/medial humerus (MGMH), medial glenoid/lateral humerus (MGLH), and lateral glenoid/medial humerus (LGMH).
METHODS
A systematic review of the literature was performed via a search of MEDLINE and Embase. Two reviewers extracted data on complication occurrence and patient-reported outcome measures (PROMs). Meta-analysis was conducted on the reported proportion of complications, weighted by sample size, and PROMs were pooled using the reported standardized mean difference (SMD). Quality of methodology was assessed using Wylde's non-summative four-point system. The study was registered with PROSPERO (CRD42020193041).
RESULTS
A total of 42 studies met the inclusion and exclusion criteria. Rates of scapular notching were found to be significantly higher in MGMH implants (52% (95% confidence interval (CI) 40 to 63)) compared with MGLH ((18% (95% CI 6 to 34)) and LGMH (12% (95% CI 3 to 26)). Higher rates of glenoid loosening were seen in MGMH implants (6% (95% CI 3 to 10)) than in MGLH implants (0% (95% CI 0 to 2)). However, strength of evidence for this finding was low. No significant differences were identified in any other complication, and there were no significant differences observed in PROMs between implant philosophies.
CONCLUSION
This systematic review has found significant improvement in PROMS and low complication rates across the implant philosophies studied. Scapular notching was the only complication found definitely to have significantly higher prevalence with the MGMH implant design. Cite this article: 2021;103-B(5):813-821.
Topics: Arthroplasty, Replacement, Shoulder; Humans; Patient Reported Outcome Measures; Postoperative Complications; Prosthesis Design; Shoulder Prosthesis
PubMed: 33616421
DOI: 10.1302/0301-620X.103B.BJJ-2020-2101 -
British Journal of Anaesthesia Sep 2019Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes. (Meta-Analysis)
Meta-Analysis
Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) based on a systematic review and meta-analysis.
BACKGROUND
Evidence-based international expert consensus regarding anaesthetic practice in hip/knee arthroplasty surgery is needed for improved healthcare outcomes.
METHODS
The International Consensus on Anaesthesia-Related Outcomes after Surgery group (ICAROS) systematic review, including randomised controlled and observational studies comparing neuraxial to general anaesthesia regarding major complications, including mortality, cardiac, pulmonary, gastrointestinal, renal, genitourinary, thromboembolic, neurological, infectious, and bleeding complications. Medline, PubMed, Embase, and Cochrane Library including Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, from 1946 to May 17, 2018 were queried. Meta-analysis and Grading of Recommendations Assessment, Development and Evaluation approach was utilised to assess evidence quality and to develop recommendations.
RESULTS
The analysis of 94 studies revealed that neuraxial anaesthesia was associated with lower odds or no difference in virtually all reported complications, except for urinary retention. Excerpt of complications for neuraxial vs general anaesthesia in hip/knee arthroplasty, respectively: mortality odds ratio (OR): 0.67, 95% confidence interval (CI): 0.57-0.80/OR: 0.83, 95% CI: 0.60-1.15; pulmonary OR: 0.65, 95% CI: 0.52-0.80/OR: 0.69, 95% CI: 0.58-0.81; acute renal failure OR: 0.69, 95% CI: 0.59-0.81/OR: 0.73, 95% CI: 0.65-0.82; deep venous thrombosis OR: 0.52, 95% CI: 0.42-0.65/OR: 0.77, 95% CI: 0.64-0.93; infections OR: 0.73, 95% CI: 0.67-0.79/OR: 0.80, 95% CI: 0.76-0.85; and blood transfusion OR: 0.85, 95% CI: 0.82-0.89/OR: 0.84, 95% CI: 0.82-0.87.
CONCLUSIONS
Recommendation: primary neuraxial anaesthesia is preferred for knee arthroplasty, given several positive postoperative outcome benefits; evidence level: low, weak recommendation.
RECOMMENDATION
neuraxial anaesthesia is recommended for hip arthroplasty given associated outcome benefits; evidence level: moderate-low, strong recommendation. Based on current evidence, the consensus group recommends neuraxial over general anaesthesia for hip/knee arthroplasty.
TRIAL REGISTRY NUMBER
PROSPERO CRD42018099935.
Topics: Anesthesia, Epidural; Anesthesia, General; Anesthesia, Spinal; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Evidence-Based Medicine; Humans; Postoperative Complications; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31351590
DOI: 10.1016/j.bja.2019.05.042 -
The Journal of Bone and Joint Surgery.... Oct 2021Enhanced Recovery After Surgery (ERAS) has become increasingly implemented to reduce costs, to increase efficiency, and to optimize patient outcomes after a surgical...
BACKGROUND
Enhanced Recovery After Surgery (ERAS) has become increasingly implemented to reduce costs, to increase efficiency, and to optimize patient outcomes after a surgical procedure. This study aimed to systematically review the effect of ERAS after primary elective total hip arthroplasty (THA) or total knee arthroplasty (TKA) on hospital length of stay, total procedure-related morbidity, and readmission.
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and with guidance from the Cochrane Handbook for Systematic Reviews of Interventions. MEDLINE, Embase, and Cochrane databases were searched from inception (1946 for MEDLINE and 1974 for Embase; Cochrane is a composite of multiple databases and thus does not report a standard inception date) until January 15, 2020. Prospective nonrandomized cohort studies and randomized controlled trials comparing adult patients undergoing elective primary THA or TKA with ERAS or traditional protocols were included. Articles examining outpatient, nonelective, or revision surgical procedures were excluded. Two reviewers independently assessed the risk of bias and extracted data. The primary outcome was length of stay. The secondary outcomes included total procedure-related morbidity and readmission.
RESULTS
Of the 1,018 references identified (1,017 identified through an electronic search and 1 identified through a manual search), 9 individual studies met inclusion criteria. Data were reported from 7,789 participants, with 2,428 receiving ERAS and 5,361 receiving traditional care. Narrative synthesis was performed instead of meta-analysis, given the presence of moderate to high risk of bias, wide variation of ERAS interventions, and inconsistent methods for assessing and reporting outcomes among included studies. Adherence to ERAS protocols consistently reduced hospital length of stay. Few studies demonstrated reduced total procedure-related morbidity, and there was no significant effect on readmission rates.
CONCLUSIONS
ERAS likely reduced the length of stay after primary elective THA and TKA, with a more pronounced effect in selected healthier patient populations. We found minimal to no impact on perioperative morbidity or readmission. The quality of existing evidence was limited because of study heterogeneity and a significant risk of bias. Further high-quality research is needed to definitively assess the impact of ERAS on total joint arthroplasty.
LEVEL OF EVIDENCE
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Enhanced Recovery After Surgery; Humans; Recovery of Function
PubMed: 34166275
DOI: 10.2106/JBJS.20.02169 -
Medicina (Kaunas, Lithuania) May 2022: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both... (Review)
Review
: The aim of this systematic review was to determine whether prehabilitation before total hip arthroplasty, in the form of exercise therapy, education alone, or both together, improves postoperative outcomes, such as physical functioning, compared with no intervention. : A systematic literature search was performed in the online databases PubMed, PEDro and Cochrane Library using the following search keywords: "prehabilitation", "preoperative care", and "total hip replacement". : A total of 400 potentially relevant studies were identified. After title, abstract and full-text screening, 14 studies fulfilled all inclusion criteria and were included in this systematic review. Patients who completed exercise-based prehabilitation before their operation showed significant postoperative improvements compared with no intervention in the following tests: six-minute walk test, Timed Up and Go test, chair-rise test, and stair climbing. For various other assessments, such as the widely used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hip disability and Osteoarthritis Outcome Score (HOOS), 36-item Short Form Survey (SF-36) and Barthel Index, no significant differences in outcomes regarding exercise therapy were reported in the included studies. Education alone had no effect on postoperative outcomes. : Prehabilitation in the form of a prehabilitation exercise therapy is an effective prehabilitation measure with regard to postoperative physical functioning, while prehabilitation in the form of education has no significant effects. No negative effects of prehabilitation on the outcomes examined were reported.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Osteoarthritis; Postural Balance; Preoperative Care; Preoperative Exercise; Time and Motion Studies
PubMed: 35744005
DOI: 10.3390/medicina58060742 -
Osteoarthritis and Cartilage Jul 2019Falls are common after total hip arthroplasty (THA) and total knee arthroplasty (TKA). While previous studies have investigated various risk factors for falls in... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Falls are common after total hip arthroplasty (THA) and total knee arthroplasty (TKA). While previous studies have investigated various risk factors for falls in patients following THA and TKA, no systematic reviews have summarized these risk factors. Therefore, the current systematic review aimed to summarize evidence regarding risk factors for falls in patients after THA and/or TKA.
METHODS
MEDLINE, EMBASE, CINAHL, SPORTDiscus, and Physiotherapy Evidence Database (from inception to June 30, 2018) were searched. The methodological quality and quality of evidence of the included studies were assessed by two independent reviewers. Relevant data regarding participants' characteristics, study design, follow-up time points, and identified risk factors were extracted. Meta-analyses and narrative syntheses were performed.
RESULTS
Twelve studies with a total of 1,292,689 participants were included. Twenty-nine identified risk factors for post-THA/TKA falls were classified into either inpatient or post-discharge risk factors. Key risk factors for both post-THA and/or post-TKA inpatient falls that showed moderate level of evidence included: postoperative complications or comorbidities and revision THA/TKA. Likewise, risk factors for post-discharge falls after THA and/or TKA that demonstrated moderate level of evidence included: medications, psychiatric diseases, living alone, prior history of TKA, falls history and female gender. The quality of the included studies varied and sample sizes were not justified.
CONCLUSIONS
This review summarized both non-modifiable and modifiable risk factors for post-THA/TKA falls. Our findings highlight the importance of developing strategies to lower the falls risk among patients following THA/TKA.
Topics: Accidental Falls; Age Factors; Aged; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Female; Humans; Male; Middle Aged; Osteoarthritis, Hip; Osteoarthritis, Knee; Prevalence; Prognosis; Risk Assessment; Severity of Illness Index; Sex Factors
PubMed: 31028883
DOI: 10.1016/j.joca.2019.04.006 -
American Journal of Physical Medicine &... Jan 2023We sought to systematically review the evidence on the benefits and harms of prehabilitation interventions for patients who are scheduled to undergo elective, unilateral...
We sought to systematically review the evidence on the benefits and harms of prehabilitation interventions for patients who are scheduled to undergo elective, unilateral total knee arthroplasty or total hip arthroplasty surgery for the treatment of primary osteoarthritis. We searched PubMed, Embase, The Cochrane Central Register of Controlled Trials, CINAHL, PsycINFO, Scopus, and ClinicalTrials.gov from January 1, 2005, through May 3, 2021. We selected for inclusion randomized controlled trials and adequately adjusted nonrandomized comparative studies of prehabilitation programs reporting performance-based, patient-reported, or healthcare utilization outcomes. Three researchers extracted study data and assessed risk of bias, verified by an independent researcher. Experts in rehabilitation content and complex interventions independently coded rehabilitation interventions. The team assessed strength of evidence. While large heterogeneity across evaluated prehabilitation programs limited strong conclusions, evidence from 13 total knee arthroplasty randomized controlled trials suggest that prehabilitation may result in increased strength and reduced length of stay and may not lead to increased harms but may be comparable in terms of pain, range of motion, and activities of daily living (all low strength of evidence). There was no evidence or insufficient evidence for all other outcomes after total knee arthroplasty. Although there were six total hip arthroplasty randomized controlled trials, there was no evidence or insufficient evidence for all total hip arthroplasty outcomes.
Topics: Humans; Arthroplasty, Replacement, Hip; Preoperative Exercise; Activities of Daily Living; Arthroplasty, Replacement, Knee; Knee Joint
PubMed: 35302954
DOI: 10.1097/PHM.0000000000002006 -
European Journal of Orthopaedic Surgery... Oct 2023There are several approaches to THA, and each has their respective advantages and disadvantages. Previous meta-analysis included non-randomised studies that introduce... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There are several approaches to THA, and each has their respective advantages and disadvantages. Previous meta-analysis included non-randomised studies that introduce further heterogeneity and bias to the evidence presented. This meta-analysis aims to present level I evidence by comparing functional outcomes, peri-operative parameters and complications of direct anterior approach (DAA) versus posterior approach (PA) or lateral approach (LA) in THA.
PATIENTS AND METHODS
A comprehensive multi-database search (PubMed, OVID Medline, EMBASE) was conducted from date of database inception to 1st December 2020. Data from randomised controlled trials comparing outcomes of DAA versus PA or LA in THA were extracted and analysed.
RESULTS
Twenty-four studies comprising 2010 patients were included in this meta-analysis. DAA has a longer operative time (MD = 17.38 min, 95%CI: 12.28, 22.47 min, P < 0.001) but a shorter length of stay compared to PA (MD = - 0.33 days, 95%CI: - 0.55, - 0.11 days, P = 0.003). There was no difference in operative time or length of stay when comparing DAA versus LA. DAA also had significantly better HHS than PA at 6 weeks (MD = 8.00, 95%CI: 5.85, 10.15, P < 0.001) and LA at 12 weeks (MD = 2.23, 95%CI: 0.31, 4.15, P = 0.02). There was no significant difference in risk of neurapraxia for DAA versus LA or in risk of dislocations, periprosthetic fractures or VTE between DAA and PA or DAA and LA.
CONCLUSION
The DAA has better early functional outcomes with shorter mean length of stay but was associated with a longer operative time than PA. There was no difference in risk of dislocations, neurapraxias, periprosthetic fractures or VTE between approaches. Based on our results, choice of THA approach should ultimately be guided by surgeon experience, surgeon preference and patient factors.
LEVEL OF EVIDENCE I
Meta-analysis of randomised controlled trials.
Topics: Humans; Arthroplasty, Replacement, Hip; Periprosthetic Fractures; Venous Thromboembolism; Treatment Outcome; Joint Dislocations
PubMed: 37010580
DOI: 10.1007/s00590-023-03528-8 -
The Journal of Arthroplasty Aug 2019Displaced femoral neck fractures (DFNF) are common and can be treated with osteosynthesis, hemiarthroplasty (HA), or total hip arthroplasty (THA). There is no consensus... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
Displaced femoral neck fractures (DFNF) are common and can be treated with osteosynthesis, hemiarthroplasty (HA), or total hip arthroplasty (THA). There is no consensus as to which intervention is superior in managing DFNF.
METHODS
Studies were identified through a systematic search of the MEDLINE database, EMBASE database, and Cochrane Controlled Trials. Included studies were randomized or controlled trials (1966 to August 2018) comparing THA with HA for the management of DFNF. (https://www.crd.york.ac.uk/PROSPERO Identifier: CRD42018110057).
RESULTS
Seventeen studies were included totaling 1364 patients (660 THA and 704 HA). THA was found to be superior to HA in terms of risk of reoperation, Harris Hip Score and Quality of Life (Short Form 36). Overall, the risk of dislocation was greater in THA group than HA in the first 4 years, after which there was no difference. There was no difference between THA and HA in terms of mortality or infection.
CONCLUSION
Overall, THA appears to be superior to HA. THA should be the recommended intervention for DFNF in patients with a life expectancy >4 years and in patients younger than 80 years. However, both HA and THA are reasonable interventions in patients older than 80 years and with shorter life expectancy.
Topics: Age Factors; Arthroplasty, Replacement, Hip; Femoral Neck Fractures; Fracture Fixation, Internal; Hemiarthroplasty; Humans; Joint Dislocations; Quality of Life; Reoperation; Treatment Outcome
PubMed: 31060915
DOI: 10.1016/j.arth.2019.03.070 -
Journal of Surgical Orthopaedic Advances 2023With improved implants and younger patients undergoing total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA), there are increased expectations to return to...
With improved implants and younger patients undergoing total hip arthroplasty (THA) and hip resurfacing arthroplasty (HRA), there are increased expectations to return to high-impact activities. Recommendations regarding return to running following hip arthroplasty remain unclear. A search of the PubMed database was conducted, and all publications referencing running following THA or HRA published between January 1, 2000, and September 1, 2020, were included in the systematic review. Patient demographics, surgical variables, activity measures, and revision rates were recorded for each study. A total of 225 unique citations were identified, of which four manuscripts met the eligibility criteria. Eighty-nine of 121 (73.6%) preoperative runners returned to running postoperatively. All four studies reported mean postoperative UCLA activity scores of at least nine. More patients returned to running following HRA than THA with lower rates of revision. Further research with longer postoperative follow-up is necessary to provide definitive recommendations for running following arthroplasty procedures. (Journal of Surgical Orthopaedic Advances 32(1):001-004, 2023).
Topics: Humans; Arthroplasty, Replacement, Hip; Treatment Outcome; Running; Reoperation; Hip Prosthesis
PubMed: 37185068
DOI: No ID Found