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JBJS Reviews Mar 2022Previous studies have shown that utilization and outcomes of total joint arthroplasty (TJA) are not equivalent across different patient cohorts. This systematic review...
BACKGROUND
Previous studies have shown that utilization and outcomes of total joint arthroplasty (TJA) are not equivalent across different patient cohorts. This systematic review was designed to evaluate the currently available evidence regarding the effect that patient race has, if any, on utilization and outcomes of lower-extremity arthroplasty in the United States.
METHODS
A literature search of the MEDLINE database was performed using keywords such as "disparities," "arthroplasty," "race," "joint replacement," "hip," "knee," "inequities," "inequalities," "health," and "outcomes" in all possible combinations. All English-language studies with a level of evidence of I through IV published over the last 20 years were considered for inclusion. Quantitative and qualitative analyses were performed on the collected data.
RESULTS
A total of 82 articles were included. There was a significantly lower utilization rate of lower-extremity TJA among Black, Hispanic, and Asian patients compared with White patients (p < 0.05). Black and Hispanic patients had lower expectations regarding postoperative outcomes and their ability to participate in various activities after surgery, and they were less likely than White patients to be familiar with the arthroplasty procedure prior to presentation to the orthopaedic surgeon (p < 0.05). Black patients had increased risks of major complications, readmissions, revisions, and discharge to institutional care after TJA compared with White patients (p < 0.05). Hispanic patients had increased risks of complications (p < 0.05) and readmissions (p < 0.0001) after TJA compared with White patients. Black and Hispanic patients reached arthroplasty with poorer preoperative functional status, and all minority patients were more likely to undergo TJA at low-quality, low-volume hospitals compared with White patients (p < 0.05).
CONCLUSIONS
This systematic review shows that lower-extremity arthroplasty utilization differs by racial/ethnic group, and that some of these differences may be partly explained by patient expectations, preferences, and cultural differences. This study also shows that outcomes after lower-extremity arthroplasty differ vastly by racial/ethnic group, and that some of these differences may be driven by differences in preoperative functional status and unequal access to care.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Arthroplasty, Replacement; Arthroplasty, Replacement, Knee; Healthcare Disparities; Hispanic or Latino; Humans; Knee Joint; United States
PubMed: 35231001
DOI: 10.2106/JBJS.RVW.21.00161 -
Journal of Orthopaedic Science :... Jan 2024Focus on reviewing a vigorous research effort to improve the safety profile of vancomycin powder (VP) and its optimal dose in reducing periprosthetic joint infection... (Meta-Analysis)
Meta-Analysis
A systematic review and meta-analysis comparing intrawound vancomycin powder and povidone iodine lavage in the prevention of periprosthetic joint infection of hip and knee arthroplasties.
BACKGROUND
Focus on reviewing a vigorous research effort to improve the safety profile of vancomycin powder (VP) and its optimal dose in reducing periprosthetic joint infection (PJI) is the need of the hour. This systematic review and meta-analysis attempt to explore the ongoing use of VP and VP + povidone iodine (PI) lavage to prevent PJI of hip/knee arthroplasties and highlights its challenges among the orthopedic community about the existence of the major organism and its frequency in total joint arthroplasty (TJA) patients.
METHODS
We searched PubMed/MEDLINE, EMBASE databases regarding the outcomes of vancomycin powder (VP) and VP + povidone iodine (PI) combination in preventing periprosthetic joint infection of hip and knee arthroplasties.
RESULTS
In 5 of 7 studies, the combination of vancomycin powder (VP) and povidone iodine (PI) lavage have shown a lower risk of periprosthetic joint infection (PJI) in acute and high-risk hip and knee arthroplasties patients, with less or without serious adverse events and readmissions; while four of seven studies using VP-only found increasing rates of PJI in primary total knee arthroplasty and partial hip replacement in elderly patients with comorbidities, and significantly causes aseptic wound complications compared to the control group.
CONCLUSIONS
Intra-articular vancomycin powder (VP) and povidone iodine (PI) lavage showed a significant reduction of periprosthetic joint infection in primary and revision total joint arthroplasty. Before its widespread use in clinical settings, prospective randomized studies and, most importantly, its long-term efficacy and safety are recommended.
Topics: Humans; Aged; Vancomycin; Arthroplasty, Replacement, Knee; Anti-Bacterial Agents; Povidone-Iodine; Powders; Therapeutic Irrigation; Prosthesis-Related Infections; Prospective Studies; Arthroplasty, Replacement, Hip; Arthritis, Infectious; Retrospective Studies
PubMed: 36470703
DOI: 10.1016/j.jos.2022.11.013 -
The Journal of Hand Surgery... Jun 2023Arthritis of the distal interphalangeal joint (DIPJ) can result in significant functional limitations and pain. While arthrodesis is the most common surgical...
Arthritis of the distal interphalangeal joint (DIPJ) can result in significant functional limitations and pain. While arthrodesis is the most common surgical intervention, this can decrease grip strength and have other limitations. DIPJ arthroplasty may be an appealing alternative in select patient with this study aiming to review the outcomes of this procedure. A search was conducted according to PRISMA guidelines using PubMed, Embase and Ovid Medline from date of inception to April 2022. Relevant studies were included if they reported on complications and functional outcomes of DIPJ arthroplasty. Data was then extracted and analysed. Seven studies were included including 171 patients with 269 digits. The mean age was 62.1 years, with 81% of the cohort being female. The indication for surgery was osteoarthritis in 97% of patients. Surgical approaches varied from dorsal transverse, dorsal T-incision, dorsal H-incision to radial incisions. A silicone implant was used in all patients. A total of 97.7% of patients were satisfied with their outcome, and pain improved or eliminated in all patients where it was reported. Joint stability was noted in 97.4% of cases. The mean preoperative DIPJ range of motion was 24° and improved to 36° post-operation. The mean preoperative extensor lag was 24° and reduced to 13° post operation. The rate of re-operation was 7.1%. DIPJ arthroplasty may be a viable alternative to arthrodesis in certain settings, providing high patient satisfaction, improvements in digital range of motion and relief of pain. However, the available literature is sparse, and limited by low-quality studies and heterogenous outcome reporting. Level III (Therapeutic).
Topics: Humans; Female; Middle Aged; Male; Joint Prosthesis; Finger Joint; Arthroplasty; Osteoarthritis; Patient Satisfaction
PubMed: 37501548
DOI: 10.1142/S2424835523500443 -
Hand Surgery & Rehabilitation Apr 2024Thumb osteoarthritis is a frequent pathology, mainly affecting the elderly. The surgical treatment initially described and having proved its worth is total... (Review)
Review
OBJECTIVE
Thumb osteoarthritis is a frequent pathology, mainly affecting the elderly. The surgical treatment initially described and having proved its worth is total trapeziectomy. Since the advent of trapeziometacarpal prostheses, several studies showed the non-inferiority of this technique on clinical criteria, with superiority in bone sparing, although neither technique demonstrated overall superiority. We therefore examined the specific complications of each surgical technique by analyzing their nature and prevalence through a review of the literature to compare them on these new parameters.
METHODS
Seventy-four of the 320 articles reviewed were included, 38 of which concerned trapeziectomy, and 36 concerned prostheses, for a total of 4,865 patients. They were original studies, involving adults undergoing trapeziometacarpal arthroplasty or trapeziectomy, published after 2015, reporting at least one well-described complication.
RESULTS
6.13% of trapeziectomies presented severe complications (in particular thumb collapse and metacarpophalangeal hyperextension), 3.31% moderate complications and 1.90% minor complications, leading to a 2.0% revision rate. 23.88% of prostheses had severe complications (loosening, dislocation and wear), 5.06% moderate complications and 1.36% minor complications, leading to a 12.8% revision rate. In addition, we analyzed more recent prosthesis designs separately, and found lower prevalence of severe complications (16.56%) and revision surgery (4.3%).
CONCLUSION
Revision surgery for trapeziometacarpal prostheses is usually only a standard trapeziectomy with the same follow-up as first-line trapeziectomy, whereas revision surgery for trapeziectomies is much more complex and the results are uncertain. For this reason, we would reserve total trapeziectomy for revision surgeries and patients with low functional demand for whom a second surgery is not desirable. Further studies could confirm this attitude, especially focusing on the latest generation of dual mobility implants.
Topics: Humans; Trapezium Bone; Osteoarthritis; Joint Prosthesis; Carpometacarpal Joints; Postoperative Complications; Thumb; Arthroplasty, Replacement; Prosthesis Failure; Reoperation
PubMed: 38408727
DOI: 10.1016/j.hansur.2024.101672 -
BioMed Research International 2022During total knee arthroplasty (TKA), surgeons mobilize the patella to facilitate clear visualization of the articular surfaces and allow better prosthesis placement.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
During total knee arthroplasty (TKA), surgeons mobilize the patella to facilitate clear visualization of the articular surfaces and allow better prosthesis placement. According to the manipulation, this manipulation can be divided into patellar eversion and noneversion. However, the effect of patellar eversion in TKA is controversial, with substantial variability in clinical practice. This systematic review is aimed at assessing the adverse effects of patellar eversion and patellar noneversion duration in TKA.
METHODS
This updated systematic literature review identified randomized controlled trials comparing patellar eversion and noneversion durations in TKA. Two investigators independently extracted data and evaluated the quality of the studies. A meta-analysis was performed using RevMan version 5.3.
RESULTS
Nine studies with a total of 608 patients (730 knees) were included. Of these, 374 knees were classified in the eversion group and 356 knees in the noneversion group. The quality of the studies was high. The results showed that patellar eversion could increase the postoperative complication rate (relative risk [RR] = 1.67; 95% confidence interval [CI], 1.09-2.54; = 0.02) and postoperative pain before discharge (mean deviation [MD] = 0.19; 95% CI, 0.04-0.34; = 0.01), compared to noneversion. Additionally, patellar eversion could prolong the time until the patient is able to raise the leg while straightened (MD = 0.42; 95% CI, 0.24-0.59; < 0.00001) and increase the length of stay (MD = 0.65; 95% CI, 0.05-1.25; = 0.03). However, patellar eversion did not influence postoperative pain at 1 year (MD = 0.02; 95% CI, -0.23-0.28; = 0.85), operative time (MD = -2.66; 95% CI, -8.84-3.52; = 0.40), recovery of quadriceps force throughout the follow-up period, and Insall-Salvati ratio (MD = -0.04; 95% CI, [-0.11-0.02]; = 0.23).
CONCLUSIONS
The patellar eversion could increase the postoperative complication rate and postoperative pain. Current evidence supports the avoidance of patellar eversion in TKA. Further large-sample and long-term trials are required to validate these results.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Pain, Postoperative; Patella; Postoperative Complications; Quadriceps Muscle; Range of Motion, Articular; Treatment Outcome
PubMed: 35528168
DOI: 10.1155/2022/2454337 -
The Journal of Hand Surgery... Dec 2021: Unconstrained pyrocarbon and metal-on-polyethylene (MoP) proximal interphalangeal (PIP) joint arthroplasty is an increasingly popular alternative to silicone implants...
: Unconstrained pyrocarbon and metal-on-polyethylene (MoP) proximal interphalangeal (PIP) joint arthroplasty is an increasingly popular alternative to silicone implants and arthrodesis. This systematic review appraises their outcomes. : 30 studies comprising 1,324 joints (813 pyrocarbon, 511 MoP) were included. Mean patient age was 59 years (38 to 78) and mean follow-up period was 54 months (1.2 to 380). : There were mean improvements of 4.5 points (2 to 6.9) in pain Visual Analogue Score, 10.5° (-26 to 58) in range of motion (ROM), 3.1 kg (-4 to 7) in grip strength, 0.6 kg (-1.5 to 2) in pinch strength, and 18 points (-3 to 29) in the Disabilities of the Arm, Shoulder and Hand score, with no significant differences between implant types. ROM gains, in particular, deteriorated over time. Clinical complications were frequent (23%), and significantly more common with pyrocarbon, as were radiographic complications. However, most were mild-moderate and did not necessarily correlate with negative outcomes or dissatisfaction. Overall reoperation rate was 21%, and revision rate 11%, both more frequent with pyrocarbon. Most revisions were within 24 months, beyond which survival was maintained up to ten years. : Unconstrained PIP joint arthroplasty is effective at improving pain scores, active ROM, grip/pinch strength, and patient reported outcome measures, particularly in patients with osteoarthritis. Results are generally maintained at least to the medium term, although gains diminish in the longer term. Complication and early revision rates are high, particularly with pyrocarbon implants. The majority of patients express positive attitudes to arthroplasty, with significant improvements in patient-reported outcome measures for both pyrocarbon and MoP implants. Patients with post-traumatic and inflammatory arthropathy are generally less satisfied. There is currently insufficient data to recommend one implant type over another, although the early-to-medium term results of MoP implants are promising. Prospective surveillance via small joint registries is recommended.
Topics: Arthroplasty; Arthroplasty, Replacement, Finger; Finger Joint; Humans; Joint Prosthesis; Middle Aged; Osteoarthritis; Prospective Studies; Treatment Outcome
PubMed: 34789103
DOI: 10.1142/S2424835521500661 -
Journal of Orthopaedic Surgery (Hong... 2023(MAC) prosthetic joint infection (PJI) has been rarely reported.
BACKGROUND
(MAC) prosthetic joint infection (PJI) has been rarely reported.
METHODS
This study aimed to investigate the epidemiology and outcomes of MAC PJI. A systematic review of the literature regarding the MAC infection following total joint arthroplasty including hip and knee joint was performed. Multiple databases were searched for published English-written articles up to May 2023. Studies that reported cases of PJI by MAC were reviewed.
RESULTS
A total of 17 patients were identified and analyzed from 11 published studies. All patients presented with joint symptom of pain or swelling prior to the diagnosis and MAC was confirmed by culture. The most of the patients (16/17 patients, 94.1%) were noted to have underlying medical condition(s) that might have affected immunity. Treatment consisted of anti-MAC medication therapy only in two patients and anti-MAC medication therapy plus surgery in 15 patients. Among the patients who underwent surgery, 14 patients (82.3%) had removal of the prosthesis including seven patients who had two-stage surgery to have reimplantation of the prosthesis. No relapse of MAC infection was reported despite of one case of relapse of infection caused by different pyogenic bacteria. The rate of overall mortality was 29.4%, however, identified attributable mortality due to MAC infection was low (5.9%).
CONCLUSION
PJI by MAC is a rare disease. However, MAC needs to be considered in the differential diagnosis in immunocompromised patients presenting with symptoms of PJI. Two-stage exchange arthroplasty may result in successful treatment outcomes without higher risks of relapse of infection if undertaken in association with appropriate active anti-MAC antibiotic therapy.
Topics: Humans; Mycobacterium avium Complex; Arthroplasty, Replacement, Knee; Arthroplasty, Replacement, Hip; Mycobacterium avium-intracellulare Infection; Prostheses and Implants; Anti-Bacterial Agents; Arthritis, Infectious; Recurrence; Prosthesis-Related Infections; Retrospective Studies
PubMed: 37878458
DOI: 10.1177/10225536231199392 -
Archives of Orthopaedic and Trauma... Oct 2022Evidence demonstrates comparable clinical outcomes across the various surgical approaches to primary total hip arthroplasty (THA). However, high-quality contemporary... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Evidence demonstrates comparable clinical outcomes across the various surgical approaches to primary total hip arthroplasty (THA). However, high-quality contemporary data regarding periprosthetic joint infection (PJI) risk between direct anterior approach (DAA) and other (THA) approaches is lacking. This systematic review and meta-analysis evaluated PJI rates reported in the literature between the DAA and other approaches.
MATERIALS AND METHODS
Five online databases were queried for all studies published from January 1st, 2000 through February 17th, 2021 that reported PJI rates between DAA and other surgical approaches. Studies reporting on primary THAs for osteoarthritis (OA) and that included PJI rates segregated by surgical approach were included. Articles reporting on revision THA, alternative THA etiologies, or minimally invasive techniques were excluded. Mantel-Haenszel (M-H) models were utilized to evaluate the pooled effect of surgical approach on infection rates. Validated risk of bias and methodological quality assessment tools were applied to each study. Multiple sensitivity analyses were conducted to evaluate the robustness of analyses.
RESULTS
28 articles reporting on 653,633 primary THAs were included. No differences were found between DAA cohorts and combined other approaches (OR: 0.95; 95% CI 0.74-1.21; p = 0.67) as well as segregated anterolateral approach cohorts (OR: 0.82, 95% CI 0.64-1.06; p = 0.13). However, DAA patients had a significantly reduced risk of infection compared to those undergoing posterior (OR: 0.66, 95% CI 0.58-0.74; p < 0.0001) and direct lateral (OR: 0.56, 95% CI 0.48-0.65; p < 0.00001) approaches.
CONCLUSION
The DAA to primary THA had comparable or lower PJI risk when compared to other contemporary approaches. The results of the most up-to-date evidence available serve to encourage adult reconstruction surgeons who have already adopted the DAA. Additionally, orthopaedic surgeons considering adoption or use of the direct anterior approach for other reasons should not be dissuaded over theoretical concern for a general increase in the risk of PJI.
LEVEL OF EVIDENCE
Level III.
Topics: Adult; Arthritis, Infectious; Arthroplasty, Replacement, Hip; Humans; Prosthesis-Related Infections; Retrospective Studies; Risk Factors
PubMed: 34595547
DOI: 10.1007/s00402-021-04186-3 -
PloS One 2019The number of periprosthetic joint infections (PJI) after total knee arthroplasty (TKA) is increasing annually. Animal models have been used to clarify their clinical... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The number of periprosthetic joint infections (PJI) after total knee arthroplasty (TKA) is increasing annually. Animal models have been used to clarify their clinical characteristics and the infection mechanism of pathogenic bacteria, However, since the prosthesis design of animal models is not uniform, it is difficult to simulate the environment of clinical PJI.
OBJECTIVES
To retrospect the progress on the prosthesis design of animal models of PJI after TKA and to summarize the criteria for evaluating a clinically representative model of PJI.
METHODS
This systematic review was reported on the basis of Systematic Reviews and Meta-Analyzes (PRISMA). Pubmed, EMbase, Cochrane Library, Web of Science, Wanfang Data and China National Knowledge Infrastructure were researched for animal models of PJI after TKA from database establishment to April 2019 according to Chinese and English retrieval words, including "periprosthetic joint infections and total knee arthroplasty," "periprosthetic joint infections and model," "periprosthetic joint infections and biofilm," and "total knee arthroplasty and model."
RESULTS
A total of 12 quantitative studies were enrolled in our study finally: 8 representative studies described prosthesis designs used in PJI animal models, 4 studies described prosthesis designs in non-infected animal models which were suitable for infection models. The major problems need to be dealed with were prosthesis, installation location, material, the function of separating the articular and medullary cavity, fixation manner, and the procedure of preserving the posterior cruciate ligament.
CONCLUSION
A highly representative design of the animal prosthesis of PJI should meet the following criteria: the surface of the prosthesis is smooth with the formation of biofilm, composed of titanium-6Al-4V or cobalt-chromium-molybdenum alloy; prosthesis can bear weight and is highly stable; and it can connect the joint cavity and medullary cavity simultaneously. To reach a more reliable conclusion, further experiments and improvements are required.
Topics: Animals; Arthritis, Infectious; Arthroplasty, Replacement, Knee; Disease Models, Animal; Humans; Printing, Three-Dimensional; Prosthesis Design; Prosthesis-Related Infections; Radiography; Retrospective Studies
PubMed: 31581252
DOI: 10.1371/journal.pone.0223402 -
Journal of Shoulder and Elbow Surgery Jul 2021Lateralization in reverse shoulder arthroplasty (L-RSA) was proposed to overcome some limitations of the original Grammont-style design (S-RSA). This systematic review... (Meta-Analysis)
Meta-Analysis Review
HYPOTHESIS/BACKGROUND
Lateralization in reverse shoulder arthroplasty (L-RSA) was proposed to overcome some limitations of the original Grammont-style design (S-RSA). This systematic review aims to compare the clinical and functional outcomes and complications of S-RSA with L-RSA, and to assess the individual results of metallic and bony lateralization implants.
METHODS
A systematic search from January 1980 to December 2019 was performed. Studies were selected in 2 phases by 2 independent reviewers; disagreements were solved by discussion. Inclusion criteria were: (1) original studies; (2) written in English or French; (3) adult individuals submitted to RSA surgery; and (4) RSA with a lateralization device in at least one of the groups. Exclusion criteria were: (1) nonoriginal studies or case reports; (2) absence of clinical or radiographic outcomes; and (3) no comparison group using S-RSA. Data were extracted for outcomes of functional status (American Shoulder and Elbow Surgeons, Constant, visual analog scale, Simple Shoulder Test, Subjective Shoulder Value, Activities of Daily Life that require External Rotation, and Disabilities of the Arm, Shoulder, and Hand), range of motion (ROM), complications, revisions, and notching. Meta-analyses were performed when possible. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed.
RESULTS
Fifteen articles/16 studies were included (865 participants: 440 L-RSA and 425 S-RSA). Most studies found no differences between the L-RSA and S-RSA groups in qualitative and meta-analysis for American Shoulder and Elbow Surgeons, Constant, Simple Shoulder Test, Activities of Daily Life that require External Rotation, and Disabilities of the Arm, Shoulder, and Hand scores. Meta-analysis demonstrated significantly lower visual analog scale (1 point) and higher Subjective Shoulder Value (6 points) in L-RSA than in S-RSA. No significant differences were found in the qualitative analyses of most studies regarding ROM in forward elevation, abduction, and internal/external rotation, but meta-analysis reported a significantly higher external rotation in L-RSA groups and specifically in osseous lateralization. Complication rate was significantly lower in L-RSA (odds ratio = 0.38), but no significant differences were found for revision rates. Notching rate was significantly lower in the L-RSA group (odds ratio = 0.14), both for osseous and metallic lateralization.
DISCUSSION/CONCLUSION
This systematic review focused on studies comparing L-RSA and S-RSA and found significantly lower notching and complication rates in L-RSA groups. This review highlighted similar outcomes in clinical scores and a slight advantage for L-RSA in ROM, especially in external rotation. L-RSA was not associated with increased revision rates, while presenting lower complication and notching rates. Inclusion of studies with metallic and osseous lateralization has helped to provide further evidence on this subject, but heterogeneity and low evidence levels of the included studies may limit our conclusions.
Topics: Adult; Arthroplasty, Replacement, Shoulder; Humans; Range of Motion, Articular; Retrospective Studies; Shoulder Joint; Shoulder Prosthesis; Treatment Outcome
PubMed: 33160029
DOI: 10.1016/j.jse.2020.09.041