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Journal of Orthopaedic Surgery and... May 2022The present systematic review investigated possible factors which may influence the surgical outcome of minimally invasive surgery for total hip arthroplasty (MIS THA). (Review)
Review
INTRODUCTION
The present systematic review investigated possible factors which may influence the surgical outcome of minimally invasive surgery for total hip arthroplasty (MIS THA).
METHODS
In January 2022, the Embase, Google Scholar, PubMed, and Scopus databases were accessed. All the clinical trials investigating the clinical outcome of MIS THA were considered.
RESULTS
Data from 9486 procedures were collected. Older age was moderately associated with greater Visual Analogue Scale (VAS) (P = 0.02) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (P = 0.009) at last follow-up, and shorter surgical duration (P = 0.01). Greater body mass index (BMI) at baseline was moderately associated with greater cup anteversion (P = 0.0009), Oxford Hip Score (OHS) at last follow-up (P = 0.04), longer surgical duration (P = 0.04), increased leg length discrepancy (P = 0.02), and greater rate of infection (P = 0.04). Greater VAS at baseline was weakly associated with greater VAS at last follow-up (P < 0.0001), total estimated blood lost (P = 0.01), and lower value of Harris Hip Score (HHS) (P = 0.0005). Greater OHS at baseline was associated with greater post-operative VAS (P = 0.01). Greater WOMAC at baseline was associated with lower cup anteversion (P = 0.009) and greater VAS (P = 0.02). Greater HHS at baseline was associated with shorter hospitalisation (P = 0.001).
CONCLUSION
Older age and greater BMI may represent negative prognostic factors for MIS THA. The clinical outcome is strongly influenced by the preoperative status of patients.
Topics: Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Leg Length Inequality; Minimally Invasive Surgical Procedures; Pain Measurement; Treatment Outcome
PubMed: 35585545
DOI: 10.1186/s13018-022-03168-4 -
BMC Geriatrics Aug 2022Some studies associate frailty and postoperative mortality in hip or knee replacement patients, and others have explored the relationship between the frailty index and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Some studies associate frailty and postoperative mortality in hip or knee replacement patients, and others have explored the relationship between the frailty index and changes in postoperative mortality in hip or knee replacement patients, but their findings are not consistent. This meta-analysis and systematic review aimed to pool the results of existing studies to explore whether frailty is an independent risk factor for postoperative mortality in patients with lower limb arthroplasty (including hip or knee arthroplasty).
METHODS
On December 15, 2021, we searched the relevant articles from the PubMed, Embase, Medline (via Ovid), China National Knowledge Infrastructure (CNKI) and Wan Fang Med Online databases. We used the Newcastle-Ottawa Scale (NOS) to assess the quality of the articles that met the exclusion and inclusion criteria. R Studio was used to analyze the effect sizes (based on the random model integration) on the extracted data. Meanwhile, potential publication bias and sensibility analysis were performed.
RESULTS
We included seven studies, which included a total of 460,594 patients, for quantitative analysis. Overall, frailty increased the risk of mortality in lower limb arthroplasty patients compared to those without frailty, as measured by a pooled risk ratio (RR) of 2.46 (95% confidence interval [CI]: 1.81-3.33). Additionally, subgroup analysis based on population revealed that the pooled RRs for total knee arthroplasty (TKA) patients in three studies and total hip arthroplasty (THA) patients in four studies were 2.61 (95% CI: 2.26-3.02) and 3.18 (95% CI: 1.92-5.28), respectively, for TKA patients in three studies and THA patients in four studies. Additionally, these statistically significant positive associations persisted in subgroup analyses by study design, geographic region, and follow-up period.
CONCLUSION
Frailty is an independent risk factor for postoperative mortality in patients undergoing lower limb arthroplasty, according to our findings. This suggests that frailty may be a predictor of preoperative risk stratification for patients with such elective surgery and could alert doctors and nurses of early screening and medical care interventions in patients with such a need for surgery to reduce postoperative mortality in lower limb arthroplasty patients.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Frailty; Humans; Lower Extremity; Odds Ratio
PubMed: 35999509
DOI: 10.1186/s12877-022-03369-w -
The Journal of Arthroplasty Oct 2019Knee kinematics is an analysis of motion pattern that is utilized to assess a comparative, biomechanical performance of healthy nonimplanted knees, injured nonimplanted... (Meta-Analysis)
Meta-Analysis
Knee kinematics is an analysis of motion pattern that is utilized to assess a comparative, biomechanical performance of healthy nonimplanted knees, injured nonimplanted knees, and various prosthetic knee designs. Unfortunately, a consensus between implanted knee kinematics and outcomes has not been reached. One might hypothesize that the kinematic variances between the nonimplanted and implanted knee might play a role in patient dissatisfaction following TKA. There is a wide range of TKA designs available today. With such variety, it is important for surgeons and engineers to understand the various geometries and kinematic profiles of available prostheses. The purpose of this review is to provide readers with the pertinent information related to TKA kinematics.
Topics: Aged; Arthroplasty, Replacement, Knee; Biomechanical Phenomena; Computer-Aided Design; Female; Fluoroscopy; Humans; Imaging, Three-Dimensional; Knee; Knee Joint; Knee Prosthesis; Magnetic Resonance Imaging; Male; Polyethylene; Prosthesis Design; Prosthesis Failure; Range of Motion, Articular; Rotation
PubMed: 31229370
DOI: 10.1016/j.arth.2019.05.037 -
The Surgeon : Journal of the Royal... Jun 2021Urinary tract infection (UTI) are very common in the general population, however it is unclear whether UTI is a risk factor of prosthetic joint infection (PJI). Our... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Urinary tract infection (UTI) are very common in the general population, however it is unclear whether UTI is a risk factor of prosthetic joint infection (PJI). Our purposes were: (1) To determine whether UTI is a risk factor of PJI after joint replacement, and (2) to determine whether the microorganisms causing PJI and UTI are the same.
METHODS
PubMed, Web of Science, the Cochrane Library, and EMBASE were searched systematically for studies. The effect sizes of RR were calculated for included studies that reported raw counts with 95% CIs. The aim 1 of the study is a meta-analysis; the aim 2 is a systematic review.
RESULTS
The aim 1 indicated that the risk of PJI was significantly higher in the UTI group than in the control group (RR = 3.17; 95% CI, 2.19-4.59). The aim 2 indicated that the microorganisms of UTI and PJI were the same in the same patient, and these included Enterococcus faecalis, and Pseudomonas, which supports the theory of PJI occurring via the haematogenous route from the genitourinary tract that harbours bacteria in UTI.
CONCLUSION
This study identified UTI as being significantly associated with PJI after joint arthroplasty and PJI occurring via the haematogenous route from the genitourinary tract harbouring bacteria in UTI. Therefore, postponing surgery and even treating patients with known UTI preoperatively are recommended.
Topics: Arthritis, Infectious; Arthroplasty, Replacement, Hip; Humans; Prosthesis-Related Infections; Risk Factors; Urinary Tract Infections
PubMed: 32451284
DOI: 10.1016/j.surge.2020.04.010 -
The Journal of Arthroplasty Oct 2020Oral and intravenous (IV) acetaminophen has become widely used perioperatively as part of a multi-modal pain management protocol for primary total joint arthroplasty... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Oral and intravenous (IV) acetaminophen has become widely used perioperatively as part of a multi-modal pain management protocol for primary total joint arthroplasty (TJA). The purpose of our study is to evaluate the efficacy and safety of acetaminophen in support of the combined clinical practice guidelines of the American Association of Hip and Knee Surgeons, American Academy of Orthopaedic Surgeons, Hip Society, Knee Society, and American Society of Regional Anesthesia and Pain Management.
METHODS
We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for studies published prior to September 2019 on acetaminophen in primary TJA. All included studies underwent qualitative and quantitative homogeneity testing followed by a systematic review and direct comparison meta-analysis to assess the efficacy and safety of acetaminophen.
RESULTS
In total, 1287 publications were critically appraised yielding 17 publications representing the best available evidence for analysis. Oral and IV acetaminophen demonstrates the ability to safely reduce postoperative pain and opioid consumption during the inpatient hospital stay. No evidence was available to assess the efficacy and safety of oral acetaminophen after discharge.
CONCLUSION
Moderate evidence supports the use of oral and IV acetaminophen as a non-opioid adjunct for pain management during the inpatient hospitalization. Strong evidence supports the safety of oral and IV acetaminophen when appropriately administered to patients undergoing primary TJA. Although there is lack of robust evidence for use of acetaminophen following discharge, it remains a low-cost and low-risk option as part of a multimodal pain regimen.
Topics: Acetaminophen; Analgesics, Opioid; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Pain, Postoperative
PubMed: 32563592
DOI: 10.1016/j.arth.2020.05.037 -
Journal of Shoulder and Elbow Surgery Oct 2022Unexpected positive cultures (UPCs) are very commonly found during shoulder arthroplasty when surgeons send intraoperative cultures to rule out periprosthetic joint... (Review)
Review
BACKGROUND
Unexpected positive cultures (UPCs) are very commonly found during shoulder arthroplasty when surgeons send intraoperative cultures to rule out periprosthetic joint infection (PJI) without clinical or radiographic signs of infection. Cutibacterium acnes is thought to be the most common bacteria cultured in this setting; however, the implications of an unexpected positive result are neither well defined nor agreed upon within the literature. The current review evaluates the incidence of UPCs and C acnes in reverse total arthroplasty; the clinical significance, if any, of these cultures; and various prognostic factors that may affect UPC incidence or recovery following PJI.
METHODS
A systematic review was performed with PRISMA guidelines using PubMed, CINAHL, and Scopus databases. Inclusion criteria included studies published from January 1, 2000, to May 20, 2021, that specifically reported on UPCs, native or revision shoulder surgery, and any study that directly addressed one of our 6 proposed clinical questions. Two independent investigators initially screened 267 articles for further evaluation. Data on study design, UPC rate/speciation, UPC risk factors, and UPC outcomes were analyzed and described.
RESULTS
A total of 22 studies met the inclusion criteria for this study. There was a pooled rate of 27.5% (653/2373) deep UPC specimen positivity, and C acnes represented 76.4% (499/653) of these positive specimens. Inanimate specimen positivity was reported at a pooled rate of 20.1% (29/144) across 3 studies. Male patients were more likely to have a UPC; however, the significance of prior surgery, surgical approach, and type of surgery conflicted across multiple articles. Patient-reported outcomes and reoperation rates did not differ between positive-UPC and negative-UPC patients. The utilization of antibiotics and treatment regimen varied across studies; however, the reinfection rates following surgery did not statistically differ based on the inclusion of antibiotics.
CONCLUSION
UPCs are a frequent finding during shoulder surgery and C acnes represents the highest percentage of cultured bacteria. Various preoperative risk factors, surgical techniques, and postoperative treatment regimens did not significantly affect the incidence of UPCs as well as the clinical outcomes for UPC vs. non-UPC patients. A standardized protocol for treatment and follow-up would decrease physician uncertainty when faced with a UPC from shoulder surgery. Given the results of this review, shoulder surgeons can consider not drastically altering the postoperative clinical course in the setting of UPC with no other evidence of PJI.
Topics: Anti-Bacterial Agents; Arthritis, Infectious; Arthroplasty; Arthroplasty, Replacement, Shoulder; Bacteria; Humans; Male; Propionibacterium acnes; Prosthesis-Related Infections; Reoperation; Shoulder Joint
PubMed: 35513254
DOI: 10.1016/j.jse.2022.03.019 -
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 -
Journal of Shoulder and Elbow Surgery Nov 2022Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy, irreparable rotator cuff tears, glenoid deformity, and other challenging clinical scenarios, including fracture sequelae and revision shoulder arthroplasty. There has been a wide range of reported outcomes and postoperative complication rates reported in the literature. The purpose of this systematic review and meta-analysis is to provide an updated review of the clinical outcomes and complication rates following primary rTSA.
METHODS
A systematic review and meta-analysis was performed to evaluate outcomes and complications following primary rTSA according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Demographics, range of motion, patient-reported outcome measures (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES] and Constant scores), number of complications, and revisions were extracted, recorded, and analyzed from the included articles.
RESULTS
Of the 1415 studies screened, 52 studies met the inclusion criteria comprising a total of 5824 shoulders. The mean age at the time of surgery was 72 years (range: 34-93), and the mean follow-up was 3.9 years (range: 2-16). Patients demonstrated a mean improvement of 56° in active flexion, 50° in active abduction, and 14° in active external rotation. Regarding functional outcome scores, rTSA patients demonstrated a mean clinically significant improvement of 37 in Constant score (minimal clinically important difference [MCID] = 5.7) and ASES score (42.0; MCID = 13.6). The overall complication rate for rTSA was 9.4% and revision rate of 2.6%. Complications were further subdivided into major medical complications (0.07%), shoulder- or surgical-related complications (5.3%), and infections (1.2%). The most frequently reported shoulder- or surgical-related complications were scapular notching (14.4%), periprosthetic fracture (0.8%), glenoid loosening (0.7%), and prosthetic dislocation (0.7%).
DISCUSSION
Primary rTSA is a safe and reliable procedure with low complication, revision, infection, and scapular notching rates. Additionally, patients demonstrated clinically significant improvements in both range of motion and clinical outcome scores.
Topics: Humans; Adult; Middle Aged; Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; Shoulder Joint; Rotator Cuff Injuries; Joint Prosthesis; Range of Motion, Articular; Treatment Outcome; Retrospective Studies
PubMed: 35870805
DOI: 10.1016/j.jse.2022.06.005 -
Knee Surgery, Sports Traumatology,... Dec 2022Unexpected positive intraoperative cultures (UPIC) found in revision total knee arthroplasty (TKA) are difficult to interpret. Management goes along with risks for both... (Review)
Review
PURPOSE
Unexpected positive intraoperative cultures (UPIC) found in revision total knee arthroplasty (TKA) are difficult to interpret. Management goes along with risks for both over- and undertreating a potential periprosthetic joint infection (PJI). The objective of this systematic review was to determine the prevalence of UPIC in revision TKA surgery, evaluate the diagnostic workup process and the postoperative treatment, and assess outcome regarding re-revision rates.
METHODS
Evidence was gathered from Medline (PubMed) and Embase published from January 2000 until April 2021. Nine studies with data of UPIC in revision TKA and outcome after at least 2 years of follow-up were identified.
RESULTS
The calculated prevalence of UPIC in aseptic knee revision surgery was 8.32%. However, the diagnostical approach differs as well as the used criteria to confirm PJI in presumed aseptic revision surgery. The work-up generally consists of a serum C-reactive protein and Erythrocyte Sedimentation Rate, joint fluid aspiration for culture and white blood cell count and formula, and radiographic imaging. Collection of intraoperative cultures is widely used, but inconsistent in sample amount and incubation time. Once a single UPIC is found, surgeons tend to treat it in different ways. Regarding re-revision rates, the weighted arithmetic mean in the included studies was 18.45% in the unsuspected PJI group compared to 2.94% in the aseptic group. There also seems to be a trend towards higher re-revision rates when a higher number of intraoperative cultures are positive.
CONCLUSION
The interpretation of UPIC in revision TKA is of utmost importance since the decision whether to treat a UPIC as an unsuspected PJI has a major impact on implant survival and re-revision rate. Different criteria are used to differentiate between unsuspected PJI and contamination in true aseptic failure, and the heterogeneity amongst the included papers impedes to state a clear recommendation, integrating not only quantitative findings, but also qualitative data such as virulence of the identified microorganism.
LEVEL OF EVIDENCE
Systematic review, III.
Topics: Humans; Arthroplasty, Replacement, Knee; Prosthesis-Related Infections; Prevalence; Arthritis, Infectious; Reoperation; Retrospective Studies
PubMed: 35031821
DOI: 10.1007/s00167-021-06856-6 -
Hip International : the Journal of... Nov 2020The major joint registries report better survivorship for ceramic on polyethylene over metal on polyethylene bearings in total hip arthroplasty and it is generally... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The major joint registries report better survivorship for ceramic on polyethylene over metal on polyethylene bearings in total hip arthroplasty and it is generally accepted that this is due to a lower polyethylene wear rate. We used evidence synthesis to compare survivorship, polyethylene wear rates and metal ion levels for metal-on-polyethylene (MoP) and ceramic-on-polyethylene (CoP) bearings. If wear rates are not dissimilar this difference in revision rate may have another cause. Modular junctions are a potential source of corrosion and it is postulated that this may result in higher revision rates.
METHODS
We performed a systematic review and meta-analysis comparing the survivorship of MoP and CoP bearings. Odds ratio (95% CI) of revision was calculated. Mean difference (MD) and 95% confidence intervals (CI) were used to compare secondary outcomes of polyethylene wear and metal ion levels. Meta-analysis was performed with a Mantel-Haenszel Random-Effects Model.
RESULTS
6 randomised controlled trials were included. There was no statistically significant difference between MoP and CoP revision rate (OR 1.04; 95% CI, 0.37-2.90, I = 0%, 0.94), linear bearing wear (MD 0.00 mm; 95% CI, -0.05 -0.05, I = 98%, 0.90), nor volumetric bearing wear (MD 33.57 mm; 95% CI, -215.56-282.70, I = 98%, 0.79). No studies evaluated metal ion levels.
CONCLUSIONS
We found no evidence of a difference in revision rates nor linear and volumetric wear between MoP and CoP bearings in the randomised controlled trials currently available. Our study therefore does not advocate the additional cost associated with the use of ceramic heads in combination with polyethylene bearings in order to minimise revision rates. This contrasts the findings of studies and the major joint registries.
Topics: Arthroplasty, Replacement, Hip; Ceramics; Hip Prosthesis; Humans; Polyethylene; Prosthesis Design; Prosthesis Failure; Registries; Reoperation; Risk Factors
PubMed: 32933331
DOI: 10.1177/1120700019866428