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International Orthopaedics Oct 2016Arthrodesis (AD) of the knee reduces pain and provides stability, but has severe functional and social limitations. There has been ample discussion on the value of a... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Arthrodesis (AD) of the knee reduces pain and provides stability, but has severe functional and social limitations. There has been ample discussion on the value of a conversion of an AD to a total knee arthroplasty (TKA). The aim of this study was to perform a review and meta-analysis of the current literature on conversion of an AD to TKA and assess clinical outcome, complication rate, surgical technique and overall patient-related outcome measures.
METHODS
PubMed, Embase, Web of Science, Cochrane, CENTRAL, CINAHL, Academic Search Premier, ScienceDirect and searching by hand for papers on conversion of AD of the knee to TKA. Two reviewers independently reviewed all titles and abstracts, and extracted the available data. Study eligibility criteria were: conversion of knee AD to TKA, five cases or more and non-oncology patients. Data consisted of study characteristics, patient demographics, clinical outcome and complications. Additionally, details on surgical technique were reviewed.
RESULTS
Of the 866 unique references identified, six papers were included for further analyses, comprising a total of 123 knees with conversion of AD of the knee to TKA. Mean gain of knee flexion was 80 degrees and the mean HSS score improved with 20 points. A complicated postoperative course was found in 65 % of all cases. The most frequent complication was skin necrosis (25 %), followed by arthrofibrosis (13 %), infection (11 %) and revision (11 %). Major complications such as refusion, amputation and death occurred in less than 5 % of all cases.
DISCUSSION
The majority of the papers consisted of small case series of moderate methodological quality, resulting in 123 included knees. Further series are necessary to draw definitive conclusions.
CONCLUSIONS
This is the first systematic review and meta-analysis on conversion of a knee arthrodesis to TKA. Good clinical results can be expected after conversion, albeit at a high risk of postoperative complications.
Topics: Arthrodesis; Arthroplasty, Replacement, Knee; Humans; Joint Diseases; Knee Joint; Recovery of Function; Reoperation
PubMed: 26980621
DOI: 10.1007/s00264-016-3150-2 -
Hand (New York, N.Y.) Nov 2023This study reviews the patient demographics, functional outcomes, and complications of trapeziometacarpal arthrodesis as a treatment for arthritis of the first...
BACKGROUND
This study reviews the patient demographics, functional outcomes, and complications of trapeziometacarpal arthrodesis as a treatment for arthritis of the first carpometacarpal joint.
METHODS
A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Google Scholar. Articles located by the search were independently assessed by title, abstract, or full article review for inclusion or exclusion. Demographic, outcome, and complication data from included articles were extracted, compiled, and analyzed. Frequency-weighted means and proportions were generated.
RESULTS
In total, 21 articles met inclusion and exclusion criteria accounting for 802 patients and 914 thumbs. Average age at time of surgery was 55.4 years, and mean follow-up time was 72.7 months. Arthrodesis techniques include Kirschner-wire fixation (51.3%), plate fixation (24.6%), screw fixation (9.8%), tension band technique (7.1%), staple fixation (7.0%), and none (<0.1%). Mean preoperative Disabilities of the Arm, Shoulder and Hand score was 58 and 25.4 postoperatively (∆ = -32.6 points). Mean preoperative visual analogue scale score was 6.8 and 1.9 postoperatively (∆ = -4.9 points). Mean preoperative grip strength was 15.7 kg, and 23.0 kg postoperatively (∆ = +7.3 kg). In all, 48.7% of thumbs had complications, 15.1% of which were major, while 33.6% were minor. The most common major complication was symptomatic hardware (8.6%) requiring return to the operating room, and the most common minor complications were peritrapezial arthritis (8.5%) and nonunion (8.4%).
CONCLUSIONS
Arthrodesis for arthritis of the trapeziometacarpal joint is associated with good functional outcomes and low to moderate patient-reported disability and pain scores, but a high complication rate.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Carpometacarpal Joints; Osteoarthritis; Thumb; Arthrodesis; Bone Plates
PubMed: 35794840
DOI: 10.1177/15589447221105541 -
JBJS Reviews Nov 2017Hallux rigidus is a common cause of foot pain in the elderly and has a negative impact on quality of life. Several operative treatment options are available for feet... (Review)
Review
BACKGROUND
Hallux rigidus is a common cause of foot pain in the elderly and has a negative impact on quality of life. Several operative treatment options are available for feet that are refractory to conservative treatment. Of these, total joint replacement and arthrodesis of the first metatarsophalangeal joint are the most commonly performed interventions. Nevertheless, it is still not known which intervention results in the best clinical outcome and the fewest complications.
METHODS
PubMed/MEDLINE, Embase, and the Cochrane Library were systematically searched for studies assessing outcome with the American Orthopaedic Foot & Ankle Society-Hallux Metatarsophalangeal Interphalangeal (AOFAS-HMI) score, Foot Function Index (FFI), visual analog scale (VAS) for pain, or Short Form-36 (SF-36) in patients who underwent an arthrodesis or total joint replacement for the treatment of symptomatic hallux rigidus. Secondary outcomes were complications and revision rates. The screening of titles and abstracts, data collection, data extraction, and study quality assessment were performed independently by 2 reviewers. Study quality was determined with use of risk-of-bias tools. Results of included studies were presented in a qualitative manner, and the results of high-quality studies were pooled.
RESULTS
Thirty-three studies, describing a total of 741 arthrodeses and 555 total joint replacements, were included in the qualitative analysis. Six different prostheses were used for total joint replacement, and various fixation techniques were used for arthrodesis. The results of 6 arthrodesis studies and 7 total joint replacement studies were pooled in the quantitative analysis. Pooled results showed superiority of arthrodesis compared with total joint replacement for improving clinical outcome (by 43.8 versus 37.7 points on the AOFAS-HMI score) and reducing pain (a decrease of 6.56 versus 4.65 points on the VAS pain score). Because of the rare reporting of the FFI and SF-36, no comparison could be made for these outcomes. Fewer intervention-related complications (23.1% versus 26.3%) and revisions (3.9% versus 11%) were reported after arthrodesis as compared with total joint replacement, with pain and nonunion and prosthetic loosening being the most commonly reported complications after arthrodesis and total joint replacement, respectively.
CONCLUSIONS
The present systematic review of the literature indicated that arthrodesis is superior for improving clinical outcome and reducing pain, and is less often accompanied by intervention-related complications and revisions, compared with total joint replacement in patients with symptomatic hallux rigidus. Prospective, randomized controlled trials will need to be conducted to verify this conclusion.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Aged; Arthrodesis; Arthroplasty, Replacement; Hallux Rigidus; Humans; Metatarsophalangeal Joint; Middle Aged; Treatment Outcome
PubMed: 29135720
DOI: 10.2106/JBJS.RVW.17.00032 -
The Orthopedic Clinics of North America Oct 2022This review article examines contemporary methods and assesses radiographic outcomes and postoperative complications following the modified Lapidus procedure. A... (Review)
Review
This review article examines contemporary methods and assesses radiographic outcomes and postoperative complications following the modified Lapidus procedure. A systematic review demonstrated significant improvements in intermetatarsal angle, hallux valgus angle, and tibial sesamoid position. We are updating a modified Lapidus technique for achieving triplanar correction of hallux valgus. Two cases of hallux valgus, one primary and one recurrent, are presented. As demonstrated in the systematic review, outcomes of Lapidus procedures create future opportunities. Surprisingly, only 78% of the studies assessed for this review reported on the hallux valgus angle and only 33% reported on tibial sesamoid position.
Topics: Arthrodesis; Hallux Valgus; Humans; Osteotomy; Radiography; Retrospective Studies; Treatment Outcome
PubMed: 36208892
DOI: 10.1016/j.ocl.2022.05.005 -
The Journal of Hand Surgery, European... Mar 2021Surgical management of end-stage rheumatoid wrists is a contentious topic. The standard surgical treatment has traditionally been wrist arthrodesis. Wrist arthroplasty,...
Surgical management of end-stage rheumatoid wrists is a contentious topic. The standard surgical treatment has traditionally been wrist arthrodesis. Wrist arthroplasty, however, offers an alternative that preserves some wrist motion. A systematic review of MEDLINE, EMBASE and CENTRAL databases was conducted. Data from 23 studies representing 343 cases of wrist arthrodesis and 618 cases of wrist arthroplasty were included. Complication rates were 17% for arthrodesis and 19% for arthroplasty, and both procedures were effective at alleviating pain and improving grip strength. Functional assessment by Disabilities of the Arm, Shoulder, and Hand and Patient-Related Wrist Evaluation of arthroplasty patients revealed clinically meaningful functional improvement compared with preoperative measurements. In contrast to previously published findings both procedures demonstrated comparable complication rates. While this can be speculated to be from advancements in prosthetics, robust long-term follow-up data on wrist arthroplasty are not available yet.
Topics: Arthritis, Rheumatoid; Arthrodesis; Arthroplasty; Follow-Up Studies; Humans; Treatment Outcome; Wrist; Wrist Joint
PubMed: 32938290
DOI: 10.1177/1753193420953683 -
The Knee Aug 2022Proximal tibiofibular joint (PTFJ) ganglion cysts are rare; however, their optimal management remains unclear. This study aimed to systematically review the surgical... (Review)
Review
BACKGROUND
Proximal tibiofibular joint (PTFJ) ganglion cysts are rare; however, their optimal management remains unclear. This study aimed to systematically review the surgical treatment options with a focus on recurrence rates and complications.
METHODS
A systematic review of the literature was performed, searching three electronic databases, according to the PRISMA guidelines. The presentation, treatment, and outcomes of PTFJ ganglion cysts of minimum 1-year follow-up was collected. Study quality was assessed using the Modified Downs and Blacks checklist. Surgical interventions were considered ordinally from simple to more extensive as follows; cyst aspiration, cyst excision, cyst excision with an intervention to the PTFJ, either a hemi-resection or arthrodesis.
RESULTS
Twenty-two studies comprising 100 patients (101 knees) met inclusion criteria. Among all patients, pain was present in 59.7%, a lateral fullness in 71.6% and symptoms of the common peroneal nerve in 57.4%. The overall rate of recurrence after primary treatment was 28.9%. Recurrence rates for aspiration, cyst excision, PTFJ hemi-resection and PTFJ arthrodesis were 81.8%, 27.4%, 8.3% and 0%, respectively. Revision excision for recurrence failed in all cases. Outcomes beyond recurrence were poorly reported.
CONCLUSION
Addressing the PTFJ at the time of cyst excision reduces recurrence rates, however, the morbidity from PTFJ hemi-resection and arthrodesis are poorly reported. Whilst primary excision offers resolution in most cases (73%), revision cyst excision in isolation for the treatment of recurrent cysts is an inadequate treatment option. Cyst aspiration is ineffective. Data pertaining to patient reported outcomes for all treatment types are lacking.
Topics: Arthrodesis; Ganglion Cysts; Humans; Knee Joint; Neoplasm Recurrence, Local; Peroneal Nerve
PubMed: 35696835
DOI: 10.1016/j.knee.2022.05.009 -
Foot and Ankle Surgery : Official... Apr 2024Hallux rigidus is the most frequent arthritis of the foot, due to multiple factors. Arthrodesis and interposition arthroplasty are treatments considered in advanced... (Review)
Review
UNLABELLED
Hallux rigidus is the most frequent arthritis of the foot, due to multiple factors. Arthrodesis and interposition arthroplasty are treatments considered in advanced stages of the disease, when conservative treatment has failed. Although arthrodesis may be considered the technique recommended by multiple authors, for patients in whom joint mobility is to be preserved, arthroplasty could represent a reliable alternative. The purpose of this systematic review is to investigate and compare the clinical outcomes and complications of arthrodesis and interposition arthroplasty for moderate and severe stages of hallux rigidus.
METHODS
For this systematic review we searched COCHRANE, EMBASE, PUBMED databases. Twenty-six research papers were obtained, with a total of 1348 feet, which were included for qualitative analysis. The following groups were included: Cartiva hemiarthroplasty (286), double stem silicone arthroplasty (276), total metallic arthroplasty (394) and arthrodesis (392).
RESULTS
In the arthrodesis group, the AOFAS-HMI score was the most used, ranging from 36 to 45 in the preoperative period and from 79 to 89 in the postoperative period. The greatest improvement in the VAS PAIN score was from 86 to 4. The fusion rate was 98.6% of the total number of cases, the most frequent complication was pain due to material discomfort. In the total metallic arthroplasty group, the ROTO-GLIDE system reported an AOFAS score of 95 points, with low complication rates; but, with the TOEFIT-PLUS and BIOMED-MERCK systems, despite the good postoperative value, they report 37% and 15% revision due to aseptic loosening in the series with the longest follow-up, respectively. The Cartiva group showed a significative increase in FAAM ADL and FAAM SPORT from 59.4 to 90.4 and from 60.9 to 89.7, respectively; similarly, 20.5% implant removal and conversion to arthrodesis were reported. Finally, the double stem silicone arthroplasty group, in the series with the longest follow-up, it manages to improve the MOXFQ score from 78.1 to 11.0, with an average range of mobility of 22.3 degrees. Lysis was reported in 10% of cases.
CONCLUSIONS
Arthrodesis has proven to be the best option for the treatment of advanced hallux rigidus. Arthroplasty can be a valid option for patients who demand to maintain the range of mobility of the joint; however, it is important to inform about the complications that may arise in the short and medium term.
LEVEL OF CLINICAL EVIDENCE
II.
Topics: Humans; Hallux Rigidus; Metatarsophalangeal Joint; Arthroplasty; Hemiarthroplasty; Arthrodesis; Silicones; Treatment Outcome; Follow-Up Studies; Retrospective Studies
PubMed: 38262785
DOI: 10.1016/j.fas.2023.12.002 -
International Orthopaedics Jun 2023Total ankle replacement (TAR) or ankle arthrodesis (AA) is the main surgical treatment for end-stage ankle osteoarthritis. However, the therapeutic effect of the two... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Total ankle replacement (TAR) or ankle arthrodesis (AA) is the main surgical treatment for end-stage ankle osteoarthritis. However, the therapeutic effect of the two surgical procedures at different follow-up times remains controversial. The purpose of this meta-analysis is to compare the short-term, medium-term, and long-term safety and efficiency of the two modern surgical treatments.
METHODS
We conducted a comprehensive search in PubMed, EMBASE, Cochrane library databases, Web of Science, and Scopus. The main results were the patient's reported outcome measure (PROM) score, satisfaction, complications, reoperation, and surgery success rate. Different follow-up times and implant designs were used to evaluate the source of heterogeneity. We used a fixed effects model for meta-analysis and I statistic for evaluating heterogeneity.
RESULTS
Thirty-seven comparative studies were included. In the short term, TAR significantly improved clinical scores (AOFAS score: WMD = 7.07, 95% Cl: 0.41-13.74, I = 0.0%; SF-36 PCS score: WMD = 2.40, 95% Cl: 2.22-2.58, I = 0.0%; SF-36 MCS score: WMD = 0.40, 95% Cl: 0.22-0.57, I = 0.0%; VAS for pain: WMD = - 0.50, 95% Cl: - 0.56-0.44, I = 44.3%) and had the lower incidence of revision (RR = 0.43, 95% CI: 0.23-0.81, I = 0.0%) and complications (RR = 0.67, 95% Cl: 0.50-0.90, I = 0.0%). In the medium term, there were still higher improvements in both the clinical scores (SF-36 PCS score: WMD = 1.57, 95% Cl: 1.36-1.78, I = 20.9%; SF-36 MCS score: WMD = 0.81, 95% Cl: 0.63-0.99, I = 48.8%) and the patient satisfaction (RR = 1.24, 95% Cl: 1.08-1.41, I = 12.1%) in the TAR group, but its total complications rate (RR = 1.84, 95% Cl: 1.26-2.68, I = 14.9%) and revision rate (RR = 1.58, 95% CI: 1.17-2.14, I = 84.6%) were significantly higher than that of the AA group. In the long term, there was no significant difference in clinical score and satisfaction, and a higher incidence of revision (RR = 2.32, 95% Cl: 1.70-3.16, I = 0.0%) and complications (RR = 3.18, 95% Cl: 1.69-5.99, I = 0.0%) was observed in TAR than in AA. The result of the third-generation design subgroup was consistent with that of the above pooled results.
CONCLUSION
TAR had advantages over AA in the short term due to better performance in terms of PROMs, complications, and reoperation rates, but its complications become a disadvantage in the medium term. In the long term, AA seems to be favored because of lower complications and revision rates, although there is no difference in clinical scores.
Topics: Humans; Arthroplasty, Replacement, Ankle; Ankle Joint; Follow-Up Studies; Ankle; Treatment Outcome; Osteoarthritis; Arthrodesis; Retrospective Studies
PubMed: 36897362
DOI: 10.1007/s00264-023-05753-6 -
The Spine Journal : Official Journal of... Feb 2023Navigated and robotic pedicle screw placement systems have been developed to improve the accuracy of screw placement. However, the literature comparing the safety and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND CONTEXT
Navigated and robotic pedicle screw placement systems have been developed to improve the accuracy of screw placement. However, the literature comparing the safety and accuracy of robotic and navigated screw placement with fluoroscopic freehand screw placement in thoracolumbar spine surgery has been limited.
PURPOSE
To perform a systematic review and meta-analysis of randomized control trials that compared the accuracy and safety profiles of robotic and navigated pedicle screws with fluoroscopic freehand pedicle screws.
STUDY DESIGN/SETTING
Systematic review and meta-analysis PATIENT SAMPLE: Only randomized controlled trials comparing robotic-assisted or navigated pedicle screws placement with freehand pedicle screw placement in the thoracolumbar spine were included.
OUTCOME MEASURES
Odds ratio (OR) estimates for screw accuracy according to the Gertzbein-Robbins scale and relative risk (RR) for various surgical complications.
METHODS
We systematically searched PubMed and EMBASE for English-language studies from inception through April 7, 2022, including references of eligible articles. The search was conducted according to PRISMA guidelines. Two reviewers conducted a full abstraction of all data, and one reviewer verified accuracy. Information was extracted on study design, quality, bias, participants, and risk estimates. Data and estimates were pooled using the Mantel-Haenszel method for random-effects meta-analysis.
RESULTS
A total of 14 papers encompassing 12 randomized controlled trials were identified (n=892 patients, 4,046 screws). The pooled analysis demonstrated that robotic and navigated pedicle screw placement techniques were associated with higher odds of screw accuracy (OR 2.66, 95% CI 1.24-5.72, p=.01). Robotic and navigated screw placement was associated with a lower risk of facet joint violations (RR 0.09, 95% CI 0.02-0.38, p<.01) and major complications (RR 0.31, 95% CI 0.11-0.84, p=.02). There were no observed differences between groups in nerve root injury (RR 0.50, 95% CI 0.11-2.30, p=.37), or return to operating room for screw revision (RR 0.28, 95% CI 0.07-1.13, p=.07).
CONCLUSIONS
These estimates suggest that robotic and navigated screw placement techniques are associated with higher odds of screw accuracy and superior safety profile compared with fluoroscopic freehand techniques. Additional randomized controlled trials will be needed to further validate these findings.
Topics: Humans; Robotic Surgical Procedures; Pedicle Screws; Robotics; Fluoroscopy; Zygapophyseal Joint; Spinal Fusion; Surgery, Computer-Assisted; Retrospective Studies
PubMed: 36273761
DOI: 10.1016/j.spinee.2022.10.006 -
Knee Surgery, Sports Traumatology,... Apr 2016Tibiotalocalcaneal arthrodesis is aimed to block the ankle joint motion in cases of severe osteoarthritis, avascular necrosis of the talus and/or failure of arthroplasty... (Review)
Review
PURPOSE
Tibiotalocalcaneal arthrodesis is aimed to block the ankle joint motion in cases of severe osteoarthritis, avascular necrosis of the talus and/or failure of arthroplasty operations. This systematic review was carried out to evaluate the clinical outcome after tibiotalocalcaneal arthrodesis using intramedullary nail either open and arthroscopically assisted. Focus was on the success rate of the procedure in terms of union and complications and on the comparison between the techniques.
METHODS
The databases PubMed (Medline), EMBASE and Cochrane Library were searched in order to retrieve relevant studies. All therapeutic level 1-4 studies involving humans with intramedullary nail fixation technique were included. Only studies written in English, Italian, French, Spanish and German were included. Data related to the type of surgery, complications and clinical outcomes were extracted and analysed.
RESULTS
A total of 83 studies were identified, of which 32 studies were eligible for inclusion; 31 case series and one randomized controlled trial. The main reported outcome score was the American Orthopaedic Foot and Ankle Society scale. Almost, all the included studies reported higher than 50% union rates and a significant improvement in terms of the clinical and mechanical ankle function after treatment.
CONCLUSIONS
Results suggest that satisfactory outcomes can be achieved by tibiotalocalcaneal arthrodesis using intramedullary nailing. Low complication rates contribute to make this a safe procedure. No comparison can be done between arthroscopic and open technique, due to the lack of scientific works on the first one.
LEVEL OF EVIDENCE
IV.
Topics: Adult; Aged; Ankle; Ankle Joint; Arthrodesis; Arthroplasty; Bone Nails; Female; Fracture Fixation, Intramedullary; Humans; Male; Middle Aged; Osteoarthritis; Osteonecrosis; Postoperative Complications; Talus; Young Adult
PubMed: 25715850
DOI: 10.1007/s00167-015-3548-1