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Journal of Orthopaedic Surgery (Hong... 2023We aimed to systematically compare the clinical and functional outcomes between unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) for the... (Meta-Analysis)
Meta-Analysis Review
We aimed to systematically compare the clinical and functional outcomes between unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) for the treatment of medial knee osteoarthritis (KOA). Literatures were searched from PubMed, EMBASE, the Cochrane library, Wanfang DATA, China National Knowledge Infrastructure (CNKI) and SinoMed database until December 2020. Studies comparing postoperative clinical and functional outcomes of UKA versus HTO were included. Totally, 38 studies were included, including 2368 patients with 2393 knees in HTO group and 6536 patients with 6571 knees in UKA group. There was significant difference in postoperative pain, revision rate, complications, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between HTO and UKA groups ( < 0.05). No significant difference was found in excellent/good surgical results, Lysholm, Hospital for Special Surgery (HSS) score, Knee Society Knee (KSS) score, knee and function score of Knee Society (KSFS) score and Tegner score between these two groups ( > 0.05). UKA produced less postoperative pain, less complications and superior WOMAC score, whereas HTO offered extended range of motion (ROM) and less revision rate.
Topics: Humans; Arthroplasty, Replacement, Knee; Osteoarthritis, Knee; Treatment Outcome; Tibia; Knee Joint; Pain, Postoperative; Osteotomy
PubMed: 36893443
DOI: 10.1177/10225536231162829 -
Medicina (Kaunas, Lithuania) Mar 2023Cartilage regeneration using mesenchymal stem cells (MSCs) has been attempted to improve articular cartilage regeneration in varus knee osteoarthritis (OA) patients... (Review)
Review
Bone Marrow Aspirate Concentrate versus Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells for Combined Cartilage Regeneration Procedure in Patients Undergoing High Tibial Osteotomy: A Systematic Review and Meta-Analysis.
Cartilage regeneration using mesenchymal stem cells (MSCs) has been attempted to improve articular cartilage regeneration in varus knee osteoarthritis (OA) patients undergoing high tibial osteotomy (HTO). Bone marrow aspirate concentrate (BMAC) and human umbilical cord blood-derived MSCs (hUCB-MSCs) have been reported to be effective. However, whether BMAC is superior to hUCB-MSCs remains unclear. This systematic review and meta-analysis aimed to determine the clinical efficacy of cartilage repair procedures with BMAC or hUCB-MSCs in patients undergoing HTO. A systematic search was conducted using three global databases, PubMed, EMBASE, and the Cochrane Library, for studies in which the clinical outcomes after BMAC or hUCB-MSCs were used in patients undergoing HTO for varus knee OA. Data extraction, quality control, and meta-analysis were performed. To compare the clinical efficacy of BMAC and hUCB-MSCs, reported clinical outcome assessments and second-look arthroscopic findings were analyzed using standardized mean differences (SMDs) with 95% confidence intervals (CIs). The present review included seven studies of 499 patients who received either BMAC (BMAC group, = 169) or hUCB-MSCs (hUCB-MSC group, = 330). Improved clinical outcomes were found in both BMAC and hUCB-MSC groups; however, a significant difference was not observed between procedures (International Knee Documentation Committee score; = 0.91, Western Ontario and McMaster Universities OA Index; = 0.05, Knee Society Score (KSS) Pain; = 0.85, KSS Function; = 0.37). On second-look arthroscopy, the hUCB-MSC group showed better International Cartilage Repair Society Cartilage Repair Assessment grade compared with the BMAC group ( < 0.001). Both BMAC and hUCB-MSCs with HTO improved clinical outcomes in varus knee OA patients, and there was no difference in clinical outcomes between them. However, hUCB-MSCs were more effective in articular cartilage regeneration than BMAC augmentation.
Topics: Humans; Osteoarthritis, Knee; Bone Marrow; Fetal Blood; Cartilage, Articular; Treatment Outcome; Mesenchymal Stem Cells; Osteotomy
PubMed: 36984635
DOI: 10.3390/medicina59030634 -
The Knee Jan 2023Osteoarthritis is a prolific condition in an increasingly ageing and obese population. Research into treatments of this condition and their efficacy are vital. Outcomes... (Review)
Review
PURPOSE
Osteoarthritis is a prolific condition in an increasingly ageing and obese population. Research into treatments of this condition and their efficacy are vital. Outcomes of high tibial osteotomy (HTO) for the varus knee is widely reported. There is less evidence for HTO in the valgus knee. This systematic review aimed to compile all literature reporting the outcomes of HTO to correct the valgus knee, focusing on post-operative clinical outcomes.
METHODS
Ovid MEDLINE, Embase and Web of Science were searched using key terms: Osteoarthritis [All Fields] AND High tibial osteotomy [All Fields] AND Lateral OR Valgus [All Fields]. Papers were screened for eligibility based on an inclusion and exclusion criteria. Full text screening was completed by two reviewers and data was extracted from the agreed included papers by one reviewer. Quality assessments of the papers were also conducted.
PROSPERO ID
CRD42021239045.
RESULTS
Across 17 papers reporting 517 knees, the average pre-operative femorotibial and hip-knee-ankle angles were corrected from 13.6 ± 7.0° and 4.9 ± 1.9° valgus to 2.8 ± 2.9° and 1.2 ± 1.7° varus. Studies show that the procedure is successful at offloading the lateral knee compartment and some evidence it can delay the need for a total knee replacement. However, its impact on overall quality of life remains poorly understood.
CONCLUSIONS
High tibial osteotomy may be a viable treatment option for valgus knee deformities caused by lateral compartment osteoarthritis. Nevertheless, research into the procedure remains limited. Importantly, our understanding of the relationship between the achieved alignment and outcome remains largely unknown.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Osteoarthritis, Knee; Quality of Life; Tibia; Knee Joint; Osteotomy
PubMed: 36413904
DOI: 10.1016/j.knee.2022.11.007 -
Journal of Oral Biology and... 2020The recently introduced technique of osseodensification for dental implant involves the use of special drills (Densah) run in a counter-clockwise direction at the... (Review)
Review
The recently introduced technique of osseodensification for dental implant involves the use of special drills (Densah) run in a counter-clockwise direction at the osteotomy site. It is claimed that this causes expansion of the osteotomy site, and increases density of the bone in immediate vicinity of the osteotomy. We reviewed published papers on the primary stability attained using this drilling technique. As a secondary finding, the bone to implant contact (BIC) and the bone area fraction occupancy (BAF) was also compared between the conventional drilling protocol and the osseodensification protocol, among these articles. A Systematic search was performed in PubMed-Medline, Embase and Google Scholar for clinical/animal studies up to November 2018. A total of 12 articles, from a database of 132 articles, consisting of 8 animal histologic studies, 2 human based clinical studies, 1 case series and 1 case report were assessed. 10/12 articles measured the insertion torque values, 7/12 articles measured the BIC and 6/12 articles estimated the BAF between the two techniques. Quality assessment of 8 studies performed using ARRIVE guidelines showed that 6/8 studies had a high score. An average increase in the insertion torque, BIC and BAF was noted in the osseodensification group as compared to the conventional drilling group. Since most of these studies are non-clinical, it can be inferred that osseodensification is an efficient way to enhance primary stability of implants in low density bone in an animal model. However, extrapolation to long term clinical success cannot be ascertained until further evidence becomes available.
PubMed: 31737477
DOI: 10.1016/j.jobcr.2019.10.002 -
World Journal of Plastic Surgery 2023The purpose of this article was to systematically review maxillary sinus changes after LeFort. We examined and analyzed the anatomical abnormalities that occurred... (Review)
Review
BACKGROUND
The purpose of this article was to systematically review maxillary sinus changes after LeFort. We examined and analyzed the anatomical abnormalities that occurred following LeFort I osteotomy, as well as the abnormalities of maxillary sinus volume (MSV) before and after the operation.
METHODS
A systematic search was conducted on various databases, such as Google Scholar, PubMed, and Scopus. The articles used were in English and original. This study was conducted until September 2023, and after reviewing the articles, several keywords, such as "Maxillary sinus" and "LeFort I osteotomy", were employed. The obtained data were evaluated based on the PICO framework.
RESULTS
Findings from 15 studies showed that the amount of MSV decreased before and after the operation (considering the three dimensions of the sinus, the measurement was performed linearly). These reduction values differed between men and women, with men having a greater reduction. As is the case with other operations, there were some side effects associated with this type of operation that some patients experienced postoperatively.
CONCLUSION
In both male and female patients, the MSV was reduced after one-piece and multi-segment osteotomies. Nonetheless, one-piece LeFort I osteotomy showed a higher reduction in MSV than the multi-segment osteotomy method, according to this systematic review and meta-analysis.
PubMed: 38226188
DOI: 10.61186/wjps.12.3.3 -
BMC Musculoskeletal Disorders Apr 2023Multiple surgical interventions exist for the treatment of symptomatic knee osteoarthritis, but the surgeon and patient may often have difficulty deciding which... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Multiple surgical interventions exist for the treatment of symptomatic knee osteoarthritis, but the surgeon and patient may often have difficulty deciding which interventions are the best option.
METHODS
We conducted a systematic review to identify randomized clinical trials (RCTs) that compared complications, revisions, reoperations, and functional outcomes among TKA (total knee arthroplasty), UKA (unicompartmental knee arthroplasty), HTO (high tibial osteotomy), BCA (bicompartmental knee arthroplasty), BIU (bi-unicompartmental knee arthroplasty), and KJD (knee joint distraction). The PubMed, Embase, and Cochrane databases were reviewed for all studies comparing two or more surgical interventions. Direct-comparison meta-analysis and network meta-analysis (NMA) were performed to combine direct and indirect evidence. The risk of bias was assessed using the revised Cochrane risk of bias tool for RCTs.
RESULTS
This NMA and systematic review included 21 studies (17 RCTs), with a total of 1749 patients. The overall risk-of-bias assessment of the RCTs revealed that 7 studies had low risk, 5 had some concerns, and 9 had high risk. SUCRA (the surface under the cumulative ranking curve) rankings revealed that KJD had the greatest risk of appearing postoperative complications, revisions, and reoperations, and UKA or TKA had the lowest risk. The majority of comparisons among various treatments showed no difference for functional outcomes.
CONCLUSION
Each surgical intervention is noninferior to other treatments in functional outcomes, but UKA and TKA are better options to treat OA according to SUCRA rankings by comparing complications, revisions, and reoperations. KJD is an imperfect option for treating OA. Other treatments should be carefully considered for each patient in accordance with their actual conditions. However, this conclusion is limited by the selection of reviewed publications and individual variation of surgical indications for patients.
TRIAL REGISTRATION
This study was registered with Research Registry (reviewregistry1395).
Topics: Humans; Osteoarthritis, Knee; Network Meta-Analysis; Treatment Outcome; Tibia; Knee Joint
PubMed: 37087428
DOI: 10.1186/s12891-023-06403-z -
Frontiers in Pediatrics 2022To systematically review the current articles to compare the efficacy and safety of 3D navigation-assisted osteotomy of DDH with conventional osteotomy of DDH in... (Review)
Review
OBJECTIVE
To systematically review the current articles to compare the efficacy and safety of 3D navigation-assisted osteotomy of DDH with conventional osteotomy of DDH in children. Study design Databases such as PubMed, Embase, Cochrane Library were searched, from inception to April, 2022, for studies applying 3D navigation-assisted osteotomy in DDH children.
METHODS
There were 626 articles identified. According to the search strategy and inclusion criteria, 7 studies were finally included, with a total of 288 cases. Study screening, data extraction, and quality assessment were conducted by two reviewers independently. Data analyses were performed using RevMan 5.4 software.
RESULTS
There were 7 retrospective cohort studies included. Meta-analysis showed that 3D navigation-assisted DDH osteotomy resulted in shorter duration of surgery [ = 88%, REM, MD = 22.86, 95%CI (-27.29, -18.43), < 0.00001], less radiation exposure during surgery [ = 53%, REM, MD = 2.76, 95%CI (-3.15, -2.37), < 0.00001], and less intraoperative bleeding [ = 94%, REM, MD = 26.83, 95%CI (-39.24, -14.41), < 0.0001], compared with conventional DDH osteotomy. There was a significant difference in the number of patients with McKay clinical function graded as poor between the two groups [ = 0%, FEM, RR = 0.20, 95%CI (0.05, 0.74), = 0.02], whereas there were no significantly statistical differences in the corrected acetabular index angle, postoperative leg length discrepancy, and number of patients with Severin x-ray graded as poor between the two groups (> 0.05).
CONCLUSION
3D navigation-assisted pelvis and thighbone osteotomy for DDH children could shorten duration of surgery and reduce intraoperative bleeding and x-ray exposure, presenting definite therapeutic effect.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42022333767.
PubMed: 36440344
DOI: 10.3389/fped.2022.1021981 -
Orthopaedics & Traumatology, Surgery &... Jun 2022Periacetabular osteotomy (PAO) is a major hip preservation surgery for developmental dysplasia of the hip. It is inevitably associated with significant blood loss, so it... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Periacetabular osteotomy (PAO) is a major hip preservation surgery for developmental dysplasia of the hip. It is inevitably associated with significant blood loss, so it requires frequent transfusions and could be a cause of perioperative morbidity. However, to date, a large number of studies has not evaluated the effect of antifibrinolytic agents in PAO. Therefore we performed a systematic review and meta-analysis to assess if antifibrinolytics would be effective in reducing blood loss and transfusion rate after PAO surgery.
METHODS
In this systematic review and meta-analysis, MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before April 4, 2020, that investigated the effect of antifibrinolytic agents in PAO. A pooled analysis was designed to identify differences between antifibrinolytic and control groups focusing on blood loss, transfusion, operation time, postoperative venous thromboembolism (VTE), and length of hospital stay.
RESULTS
We included five studies involving 507 patients (antifibrinolytic group: 256; control group: 251). The pooled analysis showed that the control group had a greater total estimated blood loss (EBL) than the antifibrinolytic group (mean difference [MD]=-257.60mL, 95% confidence interval [CI] -389.68 to -125.53, p=0.0001), but there were no statistical differences in intraoperative EBL (MD=-46.46mL, 95% CI: -192.57 to 99.64, p=0.53). The allogenic transfusion rate was higher in the control group than in the antifibrinolytic group (odds ratio [OR] 0.21, 95% CI: 0.10-0.43, p<0.0001), but there was no difference in the autogenic transfusion rate (OR 0.35, 95% CI: 0.09-1.43, p=0.14). The pooled result showed no difference in operation time (MD=9.13min, 95% CI: -8.54 to 26.80, p=0.31). For the VTE rate, a pooled analysis was not conducted due to the lack of data. The length of hospital stay showed no differences (MD=-0.51 days, 95% CI: -1.17 to 0.16, p=0.13).
CONCLUSIONS
Antifibrinolytic use in PAO has positive effects in terms of reduced total EBL and allogenic transfusion rate.
LEVEL OF EVIDENCE
III; meta-analysis.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Blood Transfusion; Humans; Osteotomy; Tranexamic Acid; Venous Thromboembolism
PubMed: 35292390
DOI: 10.1016/j.otsr.2022.103271 -
Children (Basel, Switzerland) Jul 2022Legg-Calvè-Perthes disease (LCPD) is a common childhood disease that usually occurs in 4- to 12-year-old children. Surgical treatment consists of femoral, pelvic, or... (Review)
Review
BACKGROUND
Legg-Calvè-Perthes disease (LCPD) is a common childhood disease that usually occurs in 4- to 12-year-old children. Surgical treatment consists of femoral, pelvic, or combined osteotomies. This comprehensive review aimed to investigate the mid- and long-term outcome of the surgical treatment.
METHODS
A systematic review of PubMed, Science Direct, and MEDLINE databases was performed by two independent authors, using the keywords "outcome", "surgical treatment", "pelvic osteotomy", "femoral osteotomy", and "Legg-Calvè-Perthes disease" to evaluate studies of any level of evidence that reported the surgical outcome of LCPD. The result of every stage was reviewed and approved by two senior investigators.
RESULTS
A total of 2153 articles were found. At the end of the screening, we selected 23 articles eligible for full-text reading according to the inclusion and exclusion criteria. Our analysis showed that the main prognostic factors for surgical outcome in patients with LCPD are the age at onset and the degree of initial disease severity.
CONCLUSIONS
Surgical treatment in patients older than 6 years has excellent results in Herring B and B/C hips and poor results in Herring C hips, with a slight advantage for patients between 6 and 8 years old.
PubMed: 36010012
DOI: 10.3390/children9081121 -
European Journal of Orthopaedic Surgery... Aug 2023This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial... (Meta-Analysis)
Meta-Analysis Review
Could anterior closed-wedge high tibial osteotomy be a viable option in patients with high posterior tibial slope who undergo anterior cruciate ligament reconstruction? A systematic review and meta-analysis.
PURPOSE
This study aims to examine the clinical and radiological outcomes of patients who underwent ACL reconstruction (ACLR) combined with anterior closed-wedge high tibial osteotomy (ACW-HTO) for posterior tibial slope (PTS) reduction to investigate the efficacy of this procedure in improving anterior knee stability and preventing graft failure in primary and revision ACLR.
METHODS
A literature search was conducted in six databases (PubMed, Embase, Medline, Web of Science, Cochrane, and Scopus). The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The initial screening identified 1246 studies. Each eligible clinical article was screened according to the Oxford Centre for Evidence-Based Medicine 2011 levels of evidence (LoE), excluding clinical studies of LoE V. Quality assessment of the articles was performed using the ROBINS-I methodological evaluation. This systematic review and meta-analysis was registered on the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that were possible to perform a meta-analysis, a p < 0.05 was considered statistically significant.
RESULTS
Five clinical studies were included in the final analysis. A total of 110 patients were examined. Pre- and post-operative clinical and objective tests that assess anteroposterior knee stability, PTS, clinical scores, and data on surgical characteristics, complications, return to sports activity, and graft failure after ACLR were investigated. A meta-analysis was conducted using R software, version 4.1.3 (2022, R Core Team), for Lysholm score and PTS outcomes. A statistically significant improvement for both these clinical and radiological outcomes (p < 0.05) after the ACW-HTO surgical procedure was found.
CONCLUSION
ACLR combined with ACW-HTO restores knee stability and function with satisfactory clinical and radiological outcomes in patients with an anterior cruciate ligament injury associated with a high PTS and seems to have a protective effect from further ruptures on the reconstructed ACL.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Anterior Cruciate Ligament; Knee Joint; Anterior Cruciate Ligament Injuries; Tibia; Osteotomy; Anterior Cruciate Ligament Reconstruction; Retrospective Studies
PubMed: 36308547
DOI: 10.1007/s00590-022-03419-4