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Archives of Orthopaedic and Trauma... Sep 2023Combination of regional anaesthesia technique that is most effective in analgesia and postoperative functional outcome with the fewest complications needs investigation.... (Meta-Analysis)
Meta-Analysis
Clinical effects of interspace between the popliteal artery and capsule of the posterior knee block with multimodal analgesia for total knee arthroplasty: a systematic review and meta-analysis.
PURPOSE
Combination of regional anaesthesia technique that is most effective in analgesia and postoperative functional outcome with the fewest complications needs investigation. Interspace between the popliteal artery and the capsule of the posterior knee block (IPACK) has been introduced clinically. We evaluated the efficacy of IPACK in combination with other nerve blocks after total knee arthroplasty.
METHODS
Data were obtained from PubMed, Cochrane Library, Web of Science, and Sciencedirect. Studies that compared outcomes using IPACK combined with other regional nerve blocks after total knee arthroplasty with other analgesic modalities and those which used pain scores or opioid consumption as primary or secondary outcomes were included.
RESULTS
Seventeen articles (20 trials, 1652 patients) were included. IPACK supplementation significantly reduced rest pain scores after total knee arthroplasty at postoperative hours 8-12(95%CI - 0.85 [- 1.36, - 0.34], I = 94%, p = 0.001), postoperative day 1 (95% CI - 0.49 [- 0.85, - 0.14], I = 87%, p = 0.006), and postoperative day 2 (95% CI - 0.28 [- 0.51, -0.05], I2 = 72%, p = 0.02); there was no significant difference at postoperative day 3 or discharge (95% CI - 0.14 [- 0.33, 0.05], I = 0%, p = 0.14). Combination treatment resulted in reduced dynamic pain scores at postoperative hours 8-12 (95%CI - 0.52 [- 0.92, - 0.12], I = 86%, p = 0.01) and postoperative day 1(95% CI - 0.49 [- 0.87, - 0.11], I = 88%, p = 0.01). There was no difference between postoperative day 2(95% CI - 0.29 [- 0.63, 0.05], I = 80%, p = 0.09), postoperative day 3 or discharge (95% CI - 0.45 [- 0.92, 0.02], I = 83%, p = 0.06). In addition, it strongly reduced postoperative opioid consumption within 24 H (95% CI - 0.76 [- 1.13, - 0.39], I = 85%, p < 0.00001), 24-48 H (95% CI - 0.43 [- 0.85, - 0.01], I = 83%, p = 0.04), and total opioid use (95% CI - 0.64 [- 1.07, - 0.22], I = 86%, p = 0.003). Although IPACK supplementation improved timed up and go test and walking distance at postoperative day 2, there was no statistically significant difference at other time periods or obvious improvement in knee range of motion and quadriceps strength. IPACK block supplementation could shorten the length of stay (LOS) (95% CI - 0.40 [- 0.64, - 0.15], I = 70%, p = 0.001) and improve patient satisfaction (95% CI 0.43 [0.01, 0.84], I = 87%, p = 0.04).
CONCLUSION
Based on these results, IPACK supplementation, in addition to standard postoperative analgesia, can be used effectively and safely to relieve early postoperative pain after total knee arthroplasty.
Topics: Humans; Arthroplasty, Replacement, Knee; Popliteal Artery; Analgesics, Opioid; Postural Balance; Anesthetics, Local; Time and Motion Studies; Analgesia; Pain, Postoperative
PubMed: 36790543
DOI: 10.1007/s00402-023-04798-x -
Osteoarthritis and Cartilage Aug 2022Multiple biochemical biomarkers have been previously investigated for the diagnosis, prognosis and response to treatment of articular cartilage damage, including... (Review)
Review
OBJECTIVE
Multiple biochemical biomarkers have been previously investigated for the diagnosis, prognosis and response to treatment of articular cartilage damage, including osteoarthritis (OA). Synovial fluid (SF) biomarker measurement is a potential method to predict treatment response and effectiveness. However, the significance of different biomarkers and their correlation to clinical outcomes remains unclear. This systematic review evaluated current SF biomarkers used in investigation of cartilage degeneration or regeneration in the knee joint and correlated these biomarkers with clinical outcomes following cartilage repair or regeneration interventions.
METHOD
PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials, and Embase databases were searched. Studies evaluating SF biomarkers and clinical outcomes following cartilage repair intervention were included. Two researchers independently performed data extraction and Quality Assessment of Diagnostic Accuracy Score 2 (QUADAS-2) analysis. Biomarker inclusion, change following intervention and correlation with clinical outcome was compared.
RESULTS
9 studies were included. Study heterogeneity precluded meta-analysis. There was significant variation in sampling and analysis. 33 biomarkers were evaluated in addition to microRNA and catabolic/anabolic ratios. Five studies reported on correlation of biomarkers with six biomarkers significantly correlated with clinical outcomes following intervention. However, correlation was only demonstrated in isolated studies.
CONCLUSION
This review demonstrates significant difficulties in drawing conclusions regarding the importance of SF biomarkers based on the available literature. Improved standardisation for collection and analysis of SF samples is required. Future publications should also focus on clinical outcome scores and seek to correlate biomarkers with progression to further understand the significance of identified markers in a clinical context.
REGISTRATION NUMBER
PROSPERO CRD42022304298. Study protocol available on PROSPERO website.
Topics: Biomarkers; Cartilage, Articular; Humans; Knee Joint; Osteoarthritis; Osteoarthritis, Knee; Synovial Fluid
PubMed: 35618204
DOI: 10.1016/j.joca.2022.05.007 -
Journal of Orthopaedic Surgery and... Dec 2022Early and accurate detection of periprosthetic joint infection (PJI) after hip and/or knee arthroplasty remains challenging. This systematic review and meta-analysis of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Early and accurate detection of periprosthetic joint infection (PJI) after hip and/or knee arthroplasty remains challenging. This systematic review and meta-analysis of diagnostic test accuracy studies aimed to evaluate the diagnostic accuracy of serum and synovial fluid interleukin (IL)-6 in detecting PJI.
METHODS
We searched 3 databases for studies through December 31, 2021, using medical sub-headings terms and keywords. Studies reported sensitivity and specificity of serum and synovial fluid IL-6 in detecting PJI were considered. We calculated the pooled sensitivity, specificity, positive and negative likelihood ratio, diagnostic odds ratio (DOR), and the area under the summary receiver operating characteristic curve (AUC) to evaluate the diagnostic accuracy of serum and synovial fluid IL-6.
RESULTS
Thirty studies were included. The pooled sensitivity, specificity, positive and negative likelihood ratio, DOR, and AUC of serum IL-6 in detecting PJI were 0.76 (0.69-0.81), 0.88 (0.82-0.92), 6.2 (4.3-9.0), 0.28 (0.22-0.35), 22 (14-36), and 0.88 (0.85-0.91), respectively. However, synovial fluid IL-6 achieved a pooled sensitivity of 0.87 (0.75-0.93), specificity of 0.90 (0.85-0.93), positive and negative likelihood ratio of 8.5 (5.3-13.6) and 0.15 (0.08-0.29), DOR of 57 (21-156), and AUC of 0.94 (0.92-0.96), which were higher than serum IL-6.
CONCLUSIONS
Synovial fluid IL-6 test may be a promising test for PJI after hip and/or knee arthroplasty. However, considering the limited volume of synovial fluid and invasive acquisition of synovial fluid IL-6, serum IL-6 test may be also considered.
Topics: Humans; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomarkers; Diagnostic Tests, Routine; Interleukin-6; Prosthesis-Related Infections; Sensitivity and Specificity; Synovial Fluid
PubMed: 36566223
DOI: 10.1186/s13018-022-03458-x -
Journal of Orthopaedic Surgery and... Mar 2022Lipoma arborescens (LA) is a rare benign synovial tumour characterized by the proliferation of mature adipocytes within the synovial cells. Given its rarity, current... (Review)
Review
BACKGROUND
Lipoma arborescens (LA) is a rare benign synovial tumour characterized by the proliferation of mature adipocytes within the synovial cells. Given its rarity, current evidence is mainly based on case reports and case series, and no guidelines are available. The present study investigated the current surgical management and related outcomes of LA in the upper limb.
METHODS
This systematic review was conducted following the PRISMA guidelines. PubMed, Scopus, and Virtual Health Library were accessed in September 2021. Clinical studies evaluating patients with LA undergoing surgical treatment were considered eligible for this systematic review. Only studies which reported data on LA located in the upper limb with histopathological confirmation were considered. Articles that reported data from nonsurgical management were not considered.
RESULTS
A total of 21 studies reporting 22 lesions in 21 patients were assessed. The mean age of the patients was 48.48 years (range 22-77). Most studies evaluated the restoration of range of motion and symptom resolution for the functional outcome assessment. Open or arthroscopic excision and synovectomy were the most common surgical procedures for LA. The concomitant lesions were treated in a single-stage procedure. All patients had satisfactory outcomes after open or arthroscopic excision and synovectomy without recurrence at a mean follow-up of 21.14 months (range 2-60). One patient developed postoperative cellulitis (4.55%).
CONCLUSION
Open and arthroscopic excision combined with synovectomy should be considered the standard treatment option of upper limb LA. Concomitant pathologies can be addressed in a one-stage procedure. Although LA was recognized as a clinical entity decades ago, there is a lack of evidence based guidelines and long term outcome data are unavailable.
Topics: Adult; Aged; Arthroscopy; Humans; Knee Joint; Lipoma; Middle Aged; Soft Tissue Neoplasms; Synovectomy; Synovial Membrane; Treatment Outcome; Young Adult
PubMed: 35246183
DOI: 10.1186/s13018-022-02997-7 -
Journal of Orthopaedic Surgery and... Oct 2021Periprosthetic joint infection is a grievous complication after arthroplasty that greatly affects the quality of life of patients. Rapid establishment of infection... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periprosthetic joint infection is a grievous complication after arthroplasty that greatly affects the quality of life of patients. Rapid establishment of infection diagnosis is essential, but great challenges still exist.
METHODS
We conducted research in the PubMed, Embase, and Cochrane databases to evaluate the diagnostic accuracy of D-lactate for PJI. Data extraction and quality assessment were completed independently by two reviewers. The pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), summarized receiver operating characteristic curve (sROC), and area under the sROC curve (AUC) were constructed using the bivariate meta-analysis framework.
RESULTS
Five eligible studies were included in the quantitative analysis. The pooled sensitivity and specificity of D-lactate for the diagnosis of PJI were 0.82 (95% CI 0.70-0.89) and 0.76 (95% CI 0.69-0.82), respectively. The value of the pooled diagnostic odds ratio (DOR) of D-lactate for PJI was 14.18 (95% CI 6.17-32.58), and the area under the curve (AUC) was 0.84 (95% CI 0.80-0.87).
CONCLUSIONS
According to the results of our meta-analysis, D-lactate is a valuable synovial fluid marker for recognizing PJI, with high sensitivity and specificity.
Topics: Arthritis, Infectious; Biomarkers; Humans; Lactic Acid; Prosthesis-Related Infections; Quality of Life; Synovial Fluid
PubMed: 34656157
DOI: 10.1186/s13018-021-02778-8 -
Clinical Rheumatology Sep 2021Rheumatoid arthritis (RA) is a chronic inflammatory disease that carries high social and economic costs and can lead to permanent disability. RA pathogenesis has not... (Review)
Review
Rheumatoid arthritis (RA) is a chronic inflammatory disease that carries high social and economic costs and can lead to permanent disability. RA pathogenesis has not been completely elucidated yet. Extracellular vesicles (EVs) are membrane-contained vesicles released by cells playing a role in cell-to-cell communication and they could be involved in different diseases. Evidence on the involvement of EVs in RA is currently inconclusive. Therefore, a systematic review on the role of EVs in RA was performed in order to explore this relationship. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research was conducted on PubMed, Scopus, and Embase up to March 5, 2020: 41 studies were analyzed out of 674 screened. The total plasmatic and synovial fluid (SF) EV number seems increased in RA as compared with healthy controls. Both RA plasma and SF contained EVs subpopulations of heterogenous origin, especially derived from platelets and immune system cells. No univocal evidence emerged on miRNA expression and EV content profile within RA patients. EVs showed to enhance pro-inflammatory pathways, such as cytokines and chemokine release and TNF blockade seemed to revert this effect. Our work highlights the requirement to standardize study methodologies in order to make results comparable and draw conclusions that remain, at present, unclear.
Topics: Arthritis, Rheumatoid; Blood Platelets; Extracellular Vesicles; Humans; MicroRNAs; Synovial Fluid
PubMed: 33544235
DOI: 10.1007/s10067-021-05614-w -
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 -
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 -
Neurosurgery Nov 2020Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated...
BACKGROUND
Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated.
OBJECTIVE
To systematically review the current level and quality of evidence supporting OCD-DBS by target region with the goal of establishing a common nomenclature.
METHODS
A systematic literature review was performed using the PubMed database and a patient/problem, intervention, comparison, outcome search with the terms "DBS" and "OCD." Of 86 eligible articles that underwent full-text review, 28 were included for review. Articles were excluded if the target was not specified, the focus on nonclinical outcomes, the follow-up period shorter than 3 mo, or the sample size smaller than 3 subjects. Level of evidence was assigned according to the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint guideline committee recommendations. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Selected publications included 9 randomized controlled trials, 1 cohort study, 1 case-control study, 1 cross-sectional study, and 16 case series. Striatal region targets such as the anterior limb of the internal capsule, ventral capsule/ventral striatum, and nucleus accumbens were identified, but stereotactic coordinates were similar despite differing structural names. Only 15 of 28 articles included coordinates.
CONCLUSION
The striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported.
Topics: Case-Control Studies; Cohort Studies; Cross-Sectional Studies; Deep Brain Stimulation; Humans; Obsessive-Compulsive Disorder; Treatment Outcome
PubMed: 32615588
DOI: 10.1093/neuros/nyaa249