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Clinical Biomechanics (Bristol, Avon) Mar 2020The aim of this systematic review with meta-analysis was to determine the change in gait biomechanics after total ankle replacement and ankle arthrodesis for end-stage... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this systematic review with meta-analysis was to determine the change in gait biomechanics after total ankle replacement and ankle arthrodesis for end-stage osteoarthritis.
METHODS
Electronic databases were searched up until May 2019. Peer-reviewed journal studies including adult participants suffering from end-stage ankle osteoarthritis and reporting pre- and post-operative kinematics, kinetics and spatio-temporal effects of total ankle replacement and ankle arthrodesis during walking were included with a minimum of 12 months follow-up. Seventeen suitable studies were identified and assessed according to methodological and biomechanical qualities. Meta-analysis was performed by calculating the effect size using standard mean differences between pre- and post-operative gait status.
FINDINGS
Seventeen studies with a total of 883 patients were included. Meta-analysis revealed moderate evidence of an improvement in lower limb kinematics, kinetics and spatio-temporal parameters after total ankle replacement. Moderate evidence indicated an increase in ankle moment, hip range of motion and walking speed after ankle arthrodesis.
INTERPRETATION
The currently available evidence base of research papers evaluating changes in gait biomechanics after total ankle replacement and ankle arthrodesis is limited by a lack of prospective research, low sample sizes and heterogeneity in the patho-etiology of ankle osteoarthritis. Following total ankle replacement, improvements were demonstrated for spatio-temporal, kinematic and kinetic gait patterns compared to the pre-operative measures. Improvements in gait mechanics after ankle arthrodesis were limited to walking speed and ankle moment. Increased hip range of motion after ankle arthrodesis could represent a sign of compensation for the lack of ankle motion.
Topics: Ankle; Arthrodesis; Arthroplasty, Replacement, Ankle; Biomechanical Phenomena; Gait; Humans; Osteoarthritis; Range of Motion, Articular; Walking Speed
PubMed: 32044672
DOI: 10.1016/j.clinbiomech.2020.01.015 -
Journal of Neurosurgery. Spine Sep 2023Lateral lumbar interbody fusion (LLIF) is a workhorse surgical approach for lumbar arthrodesis. There is growing interest in techniques for performing single-position...
OBJECTIVE
Lateral lumbar interbody fusion (LLIF) is a workhorse surgical approach for lumbar arthrodesis. There is growing interest in techniques for performing single-position surgery in which LLIF and pedicle screw fixation are performed with the patient in the prone position. Most studies of prone LLIF are of poor quality and without long-term follow-up; therefore, the complication profile related to this novel approach is not well known. The objective of this study was to perform a systematic review and pooled analysis to understand the safety profile of prone LLIF.
METHODS
A systematic review of the literature and a pooled analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies reporting prone LLIF were assessed for inclusion. Studies not reporting complication rates were excluded.
RESULTS
Ten studies meeting the inclusion criteria were analyzed. Overall, 286 patients were treated with prone LLIF across these studies, and a mean (SD) of 1.3 (0.2) levels per patient were treated. The 18 intraoperative complications reported included cage subsidence (3.8% [3/78]), anterior longitudinal ligament rupture (2.3% [5/215]), cage repositioning (2.1% [2/95]), segmental artery injury (2.0% [5/244]), aborted prone interbody placement (0.8% [2/244]), and durotomy (0.6% [1/156]). No major vascular or peritoneal injuries were reported. Sixty-eight postoperative complications occurred, including hip flexor weakness (17.8% [21/118]), thigh and groin sensory symptoms (13.3% [31/233]), revision surgery (3.8% [3/78]), wound infection (1.9% [3/156]), psoas hematoma (1.3% [2/156]), and motor neural injury (1.2% [2/166]).
CONCLUSIONS
Single-position LLIF in the prone position appears to be a safe surgical approach with a low complication profile. Longer-term follow-up and prospective studies are needed to better characterize the long-term complication rates related to this approach.
Topics: Humans; Lumbar Vertebrae; Postoperative Complications; Spinal Fusion; Reoperation; Vascular System Injuries; Retrospective Studies
PubMed: 37310041
DOI: 10.3171/2023.4.SPINE221180 -
The Journal of Foot and Ankle Surgery :... 2011First metatarsal-cuneiform joint arthrodesis is a commonly performed procedure to correct first ray pathology. The most widely accepted approach is curettage and 2... (Comparative Study)
Comparative Study Review
First metatarsal-cuneiform joint arthrodesis is a commonly performed procedure to correct first ray pathology. The most widely accepted approach is curettage and 2 crossed compression screw fixation followed by a period of non-weight-bearing. Despite adequate joint preparation and stable internal fixation, nonunion has been cited as a known complication. This can lead to the need for revision surgery, which is undesirable and drives healthcare costs. To further investigate this topic, we conducted a systematic review to determine the rate of nonunion after the first metatarsal-cuneiform joint arthrodesis using curettage and 2 crossed compression screw fixation. Studies were eligible for inclusion only if they involved the following: arthrodesis of the first metatarsal-cuneiform joint with curettage and 2 crossed compression screw fixation, a minimum of 25 feet, with a mean follow-up of at least 6 months, and a period of postoperative non-weight-bearing. After considering all the potentially eligible references, 1 (1.8%) evidence-based medicine level I and 4 (7.3%) evidence-based medicine level IV studies met our inclusion criteria. A total of 537 patients (599 feet), 54 (10%) males and 483 (90%) females, with a weighted mean age of 49.4 years, were included. For those studies that specified the exact follow-up, the weighted mean was 30.9 months. A total of 30 nonunions (5%) were reported, with 17 (56.7%) symptomatic. The results of our systematic review revealed a relatively high rate of nonunion for first metatarsal-cuneiform joint arthrodesis with curettage and 2 crossed compression screw fixation, even when performed by experienced surgeons. Therefore, given the available data, additional prospective investigations are warranted, especially in the evaluation and comparison of fixation constructs and postoperative management.
Topics: Arthrodesis; Bone Screws; Combined Modality Therapy; Curettage; Female; Follow-Up Studies; Fractures, Ununited; Humans; Incidence; Male; Metatarsal Bones; Metatarsophalangeal Joint; Risk Assessment
PubMed: 21908206
DOI: 10.1053/j.jfas.2011.08.003 -
The Journal of Foot and Ankle Surgery :... 2020Ankle arthrodesis (AA) and total ankle arthroplasty (TAA) are the 2 primary surgical treatments for patients with end-stage ankle arthritis. The comparative outcomes... (Meta-Analysis)
Meta-Analysis Review
Clinical Outcomes of Total Ankle Arthroplasty Versus Ankle Arthrodesis for the Treatment of End-Stage Ankle Arthritis in the Last Decade: a Systematic Review and Meta-analysis.
Ankle arthrodesis (AA) and total ankle arthroplasty (TAA) are the 2 primary surgical treatments for patients with end-stage ankle arthritis. The comparative outcomes between AA and TAA using modern techniques remain unclear. A systematic search to identify all relevant articles comparing AA with TAA was conducted through 3 online databases. The clinical outcomes were extracted for meta-analysis, including AOFAS (American Orthopaedic Foot & Ankle Society) score, VAS (visual analog scale), AOS (Ankle Osteoarthritis Scale), gait analysis, ROM (range of motion), satisfaction, complication, and reoperation. Our meta-analysis shows no heterogeneity in any subgroup analyses. There were no significant differences in AOFAS total, pain, and alignment scores between the AA and TAA groups. The TAA group had significant improvement in AOFAS function score compared with the AA group. There was no significant difference in VAS and AOS total scores between the 2 groups. No significant differences in gait analysis were observed between the 2 groups. The TAA group had significant improvement in both ROM and change in ROM compared with the AA group. There was no significant difference in satisfaction rate between the 2 groups. The TAA group had significantly higher complication and reoperation rates compared with the AA group. Our meta-analysis provides updated evidence on clinical outcomes comparing AA with TAA using third-generation implants. The TAA group had better improvement in AOFAS function and ROM than the AA group. No significant differences in pain relief, gait analysis, or patient satisfaction were observed between the 2 groups.
Topics: Ankle; Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Retrospective Studies; Treatment Outcome
PubMed: 32709528
DOI: 10.1053/j.jfas.2019.10.008 -
The Bone & Joint Journal Oct 2019Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing...
AIMS
Postoperative rehabilitation regimens following ankle arthrodesis vary considerably. A systematic review was conducted to determine the evidence for weightbearing recommendations following ankle arthrodesis, and to compare outcomes between different regimens.
PATIENTS AND METHODS
MEDLINE, Web of Science, Embase, and Scopus databases were searched for studies reporting outcomes following ankle arthrodesis, in which standardized postoperative rehabilitation regimens were employed. Eligible studies were grouped according to duration of postoperative nonweightbearing: zero to one weeks (group A), two to three weeks (group B), four to five weeks (group C), or six weeks or more (group D). Outcome data were pooled and compared between groups. Outcomes analyzed included union rates, time to union, clinical scores, and complication rates.
RESULTS
A total of 60 studies (2426 ankles) were included. Mean union rates for groups A to D were 93.2%, 95.5%, 93.0%, and 93.0%, respectively. Mean time to union was 10.4 weeks, 14.5 weeks, 12.4 weeks, and 14.4 weeks for groups A to D, respectively. Mean complication rates were 22.3%, 23.0%, 27.1%, and 28.7% for groups A to D, respectively. Reporting of outcome scores was insufficient to conduct meaningful analysis.
CONCLUSION
Outcomes following ankle arthrodesis appear to be similar regardless of the duration of postoperative nonweightbearing, although the existing literature is insufficient to make definitive conclusions. Cite this article: 2019;101-B:1256-1262.
Topics: Age Factors; Aged; Ankle Joint; Arthrodesis; Female; Humans; Male; Middle Aged; Pain Measurement; Postoperative Care; Range of Motion, Articular; Recovery of Function; Risk Assessment; Sex Factors; Weight-Bearing
PubMed: 31564155
DOI: 10.1302/0301-620X.101B10.BJJ-2019-0207.R1 -
Clinical Spine Surgery May 2016Systematic review. (Comparative Study)
Comparative Study Review
STUDY DESIGN
Systematic review.
OBJECTIVE
To determine the fusion rate of an anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), and axial arthrodesis at the lumbosacral junction in adult patients undergoing surgery for 1- and 2-level degenerative spine conditions.
SUMMARY OF BACKGROUND DATA
An L5/S1 interbody fusion is a commonly performed procedure for pathology such as spondylolisthesis with stenosis; however, it is unclear if 1 technique leads to superior fusion rates.
MATERIALS AND METHODS
A systematic search of MEDLINE was conducted for literature published between January 1, 1992 and August 17, 2014. All peer-reviewed articles related to the fusion rate of L5/S1 for an ALIF, TLIF, or axial interbody fusion were included.
RESULTS
In total, 42 articles and 1507 patients were included in this systematic review. A difference in overall fusion rates was identified, with a rate of 99.2% (range, 96.4%-99.8%) for a TLIF, 97.2% (range, 91.0%-99.2%) for an ALIF, and 90.5% (range, 79.0%-97.0%) for an axial interbody fusion (P=0.005). In a paired analysis directly comparing fusion techniques, only the difference between a TLIF and an axial interbody fusion was significant. However, when only cases in which bilateral pedicle screws supported the interbody fusion, no statistical difference (P>0.05) between the 3 techniques was identified.
CONCLUSIONS
The current literature available to guide the treatment of L5/S1 pathology is poor, but the available data suggest that a high fusion rate can be expected with the use of an ALIF, TLIF, or axial interbody fusion. Any technique-dependent benefit in fusion rate can be eliminated with common surgical modifications such as the use of bilateral pedicle screws.
Topics: Arthrodesis; Humans; Lumbar Vertebrae; Sacrum; Spinal Diseases; Spinal Fusion
PubMed: 26841206
DOI: 10.1097/BSD.0000000000000356 -
British Medical Bulletin Dec 2017In advanced stages of ankle osteoarthritis (OA), ankle arthrodesis (AA) or total ankle arthroplasty (TAR) may be necessary. Our purpose is to compare AA and total ankle... (Comparative Study)
Comparative Study Review
INTRODUCTION
In advanced stages of ankle osteoarthritis (OA), ankle arthrodesis (AA) or total ankle arthroplasty (TAR) may be necessary. Our purpose is to compare AA and total ankle replacement for the surgical management of end stage ankle OA.
SOURCES OF DATA
We conducted a literature search of PubMed, Medline, CINAHL, Cochrane, Embase and Google Scholar databases using the terms 'ankle' in combination with 'OA', 'arthrodesis', 'arthroplasty', 'joint fusion', 'joint replacement'. Studies where treatment was exclusively total ankle replacement or AA were excluded. Treatment characteristics and outcome parameters (overall postoperative outcome and complication rate) were reviewed.
AREAS OF AGREEMENT
When counseling patients who are considering their options with regard to ankle arthritis treatment, surgeons should determine on an individual basis which procedure is more suitable.
AREAS OF CONTROVERSY
TAR has become an accepted treatment for end-stage OA, but revision rates for TAR are significant higher than for AA (odds ratio 2.28 95% confidence interval [CI], 1.63-3.19; P < 0.0001).
GROWING POINTS
The results of TAA are gradually improving, but the procedure cannot yet be recommended for the routine management of ankle OA.
AREAS TIMELY FOR DEVELOPING RESEARCH
Although there is some evidence to support TAR to conserve ankle motion and offer improved function and decreased pain with high satisfaction rates, revision rates for TAR are significantly higher than revision rates for AA. Proper patient selection should be better addressed in future studies for successful treatment of end-stage ankle OA.
LEVEL OF EVIDENCE
Systematic review, level III.
Topics: Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Joint Prosthesis; Osteoarthritis; Postoperative Complications; Range of Motion, Articular; Treatment Outcome; Weight-Bearing
PubMed: 29186357
DOI: 10.1093/bmb/ldx042 -
The Journal of Foot and Ankle Surgery :... 2011Arthrodesis of the first metatarsal-phalangeal joint (MTPJ) has been proposed for treatment of first MTPJ pathology because of the perceived safety and efficacy.... (Comparative Study)
Comparative Study Review
Arthrodesis of the first metatarsal-phalangeal joint (MTPJ) has been proposed for treatment of first MTPJ pathology because of the perceived safety and efficacy. Nonunion of the arthrodesis site has been purported as a common complication. The author undertook a systematic review of the electronic databases and other relevant sources to identify material relating to the incidence of nonunion and other complications after arthrodesis of the first MTPJ. In an effort to procure the highest quality studies available, the studies were eligible for inclusion only if they involved patients undergoing arthrodesis of the first MTPJ using modern osteosynthesis techniques (1980 onward time restriction), included a minimum of 30 feet in the publication, and evaluated patients at a mean follow-up of ≥12 months' duration. The studies were also required to include details of any complications requiring surgical intervention, had not primarily involved only rheumatoid arthritis as an indication, and had not involved the use of a structural bone graft. A total of 37 studies involving a total of 2,818 first MTPJ arthrodesis procedures were identified that met the inclusion criteria. The weighted mean age of the patients was 59.3 years, the follow-up was 34.3 months, and the union time was 64.3 days. For those studies that specifically mentioned the indications for first MTPJ arthrodesis, 2,656 joints were included as follows: severe hallux valgus (47.2%), hallux rigidus (32%), rheumatoid arthritis (11.5%), and revision of failed surgery (9.3%). Osteosynthesis involved 3 main configurations: compression screws, dorsal plate and screws, or staples. The overall nonunion incidence was 5.4% (153 of 2,818), with symptomatic nonunion occurring in 32.7% (50 of 153) of all nonunions (1.8% total incidence; 50 of 2,818). The overall incidence of malunion was 6.1% (39 of 640), with dorsal malunion accounting for 87.1% (34 of 39). The overall incidence of hardware removal was 8.5% (69 of 817). The historical comment that nonunion occurs in approximately 10% of attempted first MTPJ arthrodesis procedures is inaccurate. The incidence of malunion and hardware removal is inappropriately high, and efforts to determine effective methods of decreasing their incidence should be undertaken. Additionally, there is still a need for methodologically sound prospective cohort studies focusing on the use of arthrodesis of the first MTPJ for purely severe hallux valgus and specific grades of hallux rigidus, as well as specific forms of osteosynthesis, because this has only been infrequently reported in small series.
Topics: Adult; Age Distribution; Aged; Arthrodesis; Bone Screws; Female; Follow-Up Studies; Fractures, Ununited; Hallux Rigidus; Humans; Incidence; Male; Metatarsal Bones; Metatarsophalangeal Joint; Middle Aged; Radiography; Risk Assessment; Sex Distribution
PubMed: 21840737
DOI: 10.1053/j.jfas.2011.06.012 -
Annals of Plastic Surgery Dec 2020Scapholunate advanced collapse (SLAC) of the wrist is one of the most common patterns of degenerative arthritis in the wrist. Surgical intervention is warranted for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Scapholunate advanced collapse (SLAC) of the wrist is one of the most common patterns of degenerative arthritis in the wrist. Surgical intervention is warranted for individuals with symptomatic SLAC and degenerative disease that affects the radioscaphoid joint. The most popular options for motion-preserving reconstruction and treatment of this disease include 4-corner arthrodesis and proximal row carpectomy. The purpose of this article was to conduct a systematic literature review and meta-analysis to identify any differences in the clinical outcomes of 4-corner arthrodesis and proximal row carpectomy for the treatment of SLAC.
METHODS
An electronic literature search of PubMed, Embase, OVID, and the Cochrane Library was conducted to identify studies evaluating the clinical outcomes of 4-corner arthrodesis versus proximal row carpectomy for the treatment of SLAC. Primary outcome measures included flexion/extension range of motion, grip strength, and level of pain.
RESULTS
Eight studies encompassing 311 patients met the inclusion criteria for the meta-analysis. Our meta-analysis indicated that when compared with 4-corner arthrodesis, patients who underwent proximal row carpectomy had statistically significantly increased flexion/extension range of motion by 6.2 degrees, significantly increased grip strength by 1.52%, and reduced level of pain by 0.3.
CONCLUSIONS
This study demonstrated that in comparative studies, there was a statistical difference favoring proximal row carpectomy to 4-corner arthrodesis for the treatment of SLAC. Although these differences were statistically significant, they remain very small and lack clinical relevance. This study further supports that both of these treatment options are equivalent for the treatment of this disease. Although not clinically significant, compared with 4-corner arthrodesis, patients treated with proximal row carpectomy had increased range of motion, increased grip strength, and decreased pain. Limitations to these findings are the small number of studies available and the increased heterogeneity between the studies. Further studies need to be conducted to confirm these findings.
Topics: Arthrodesis; Carpal Bones; Hand Strength; Humans; Range of Motion, Articular; Treatment Outcome; Wrist Joint
PubMed: 32384352
DOI: 10.1097/SAP.0000000000002398 -
European Spine Journal : Official... Jan 2017Surgical approaches for multi-level cervical spondylotic myelopathy (CSM) include posterior cervical surgery via laminectomy and fusion (LF) or expansive laminoplasty... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical approaches for multi-level cervical spondylotic myelopathy (CSM) include posterior cervical surgery via laminectomy and fusion (LF) or expansive laminoplasty (EL). The relative benefits and risks of either approach in terms of clinical outcomes and complications are not well established. A systematic review and meta-analysis was conducted to address this topic.
METHODS
Electronic searches were performed using six databases from their inception to January 2016, identifying all relevant randomized controlled trials (RCTs) and non-RCTs comparing LF vs EL for multi-level cervical myelopathy. Data was extracted and analyzed according to predefined endpoints.
RESULTS
From 10 included studies, there were 335 patients who underwent LF compared to 320 patients who underwent EL. There was no significant difference found postoperatively between LF and EL groups in terms of postoperative JOA (P = 0.39), VAS neck pain (P = 0.93), postoperative CCI (P = 0.32) and Nurich grade (P = 0.42). The total complication rate was higher for LF compared to EL (26.4 vs 15.4 %, RR 1.77, 95 % CI 1.10, 2.85, I = 34 %, P = 0.02). Reoperation rate was found to be similar between LF and EL groups (P = 0.52). A significantly higher pooled rate of nerve palsies was found in the LF group compared to EL (9.9 vs 3.7 %, RR 2.76, P = 0.03). No significant difference was found in terms of operative time and intraoperative blood loss.
CONCLUSIONS
From the available low-quality evidence, LF and EL approaches for CSM demonstrates similar clinical improvement and loss of lordosis. However, a higher complication rate was found in LF group, including significantly higher nerve palsy complications. This requires further validation and investigation in larger sample-size prospective and randomized studies.
Topics: Cervical Vertebrae; Humans; Laminectomy; Laminoplasty; Postoperative Complications; Spinal Cord Diseases; Spinal Fusion
PubMed: 27342611
DOI: 10.1007/s00586-016-4671-5