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Clinical Orthopaedics and Related... Jun 2016Although Lisfranc injuries are uncommon, representing approximately 0.2% of all fractures, they are complex and can result in persistent pain, degenerative arthritis,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although Lisfranc injuries are uncommon, representing approximately 0.2% of all fractures, they are complex and can result in persistent pain, degenerative arthritis, and loss of function. Both open reduction and internal fixation (ORIF) and primary fusion have been proposed as treatment options for these injuries, but debate remains as to which approach is better.
QUESTIONS/PURPOSES
We asked whether ORIF or primary fusion led to (1) fewer reoperations for hardware removal; (2) less frequent revision surgery; (3) higher patient outcome scores; and (4) more frequent anatomic reduction.
METHODS
A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Three trials met the criteria for inclusion within the meta-analysis. Qualifying articles for the meta-analysis had data extracted independently by two authors (NS, AF). The quality of each study was assessed using the Center for Evidence Based Medicine's evaluation strategy; data were extracted from articles rated as good and fair: two and one article, respectively.
RESULTS
The risk ratio for hardware removal was 0.23 (95% confidence interval [CI], 0.11-0.45; p < 0.001) indicating more hardware removal for ORIF than fusion. For other revision surgery, the risk ratio for ORIF was 0.36 (95% CI, 0.08-1.59; p = 0.18) favoring neither. Similarly, neither was favored using patient-reported outcomes; the standard mean difference was calculated to be 0.50 (95% CI, -2.13 to 3.12; p = 0.71). When considering the risk of nonanatomic alignment, neither was favored (risk ratio, 1.48; 95% CI, 0.34-6.38; p = 0.60).
CONCLUSIONS
The surgeon should consider the increased risk of hardware removal along with its associated morbidity and discuss this with the patient preoperatively when considering ORIF of Lisfranc injuries. Because no new trials have been performed since 2012, further randomized controlled trials will be needed improve our understanding of these interventions.
LEVEL OF EVIDENCE
Level I, therapeutic study.
Topics: Arthrodesis; Chi-Square Distribution; Device Removal; Foot Bones; Foot Injuries; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Humans; Ligaments, Articular; Odds Ratio; Open Fracture Reduction; Postoperative Complications; Reoperation; Risk Factors; Treatment Outcome
PubMed: 26022112
DOI: 10.1007/s11999-015-4366-y -
Orthopaedic Surgery Apr 2020While osteoarthritis is a common degenerative disease, ankle osteoarthritis is a subdivision that has received little attention. Two effective ways to treat... (Comparative Study)
Comparative Study Meta-Analysis
Comparison of the Efficiency and Safety of Total Ankle Replacement and Ankle Arthrodesis in the Treatment of Osteoarthritis: An Updated Systematic Review and Meta-analysis.
While osteoarthritis is a common degenerative disease, ankle osteoarthritis is a subdivision that has received little attention. Two effective ways to treat osteoarthritis of the ankle are total ankle replacement (TAR) and ankle arthrodesis (AAD). Whether TAR or AAD is more beneficial for treatment is controversial. The purpose of this meta-analysis was to compare the efficiency (clinical outcome and patient satisfaction) and safety (complications and survival) of these two procedures. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was performed as a guideline for this study. Three electronic databases, PubMed, Web of Science, and Cochrane Library, were searched up to May 2019, with no language restrictions. Prospective or retrospective comparative studies were identified. The outcomes included clinical outcome, patient satisfaction, complications, and survival. Review Manager (Revman) 5.3 software was used to conduct the data analysis. We only selected literature from the past 5 years (no earlier than 2015). Seven comparative studies were included. There were six cohort studies and one cross-sectional study. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of cohort studies, and The Agency for Healthcare Research and Quality (AHRQ) checklist was chosen to assess the quality of cross-sectional studies. No significant difference was observed for efficiency and safety. Clinical outcome was included in five studies with four different scoring systems. Two of them used the American Orthopaedic Foot & Ankle Society (AOFAS) questionnaire scores to assess the two procedures (mean difference, -4.26; 95% confidence interval [CI], -11.37-2.85; P = 0.24; I = 1%). Patient satisfaction (risk ratio [RR], 0.96; 95% CI, 0.65-1.40; P = 0.82; I = 54%), complications (RR, 1.15; 95% CI, 0.16-8.21; P = 0.89; I = 84%), and survival (RR, 1.91; 95% CI, 0.33-11.08; P = 0.47; I = 90%) showed no significant difference between the TAR group and the AAD group. This meta-analysis showed no statistically significant difference between TAR and AAD in clinical outcome, patient satisfaction, complications, and survival. This revealed that TAR and AAD could appear to have similar results in these aspects. Therefore, the present results are not sufficient to conclude which of these two methods is better. Further studies are needed to obtain more clues.
Topics: Ankle Joint; Arthrodesis; Arthroplasty, Replacement, Ankle; Humans; Osteoarthritis; Patient Satisfaction; Treatment Outcome
PubMed: 32227465
DOI: 10.1111/os.12635 -
The Journal of Hand Surgery May 2010To perform a systematic review of the treatment of Kienböck's disease to test the hypothesis that none of the reported treatments for Kienböck's disease is superior... (Review)
Review
PURPOSE
To perform a systematic review of the treatment of Kienböck's disease to test the hypothesis that none of the reported treatments for Kienböck's disease is superior with respect to outcomes of pain, motion, grip strength, and radiographic measures.
METHODS
We searched PubMed, Medline, and the Cochrane Review for articles published between 1998 and 2008 reporting outcomes of treatment for Kienböck's disease. Patients were grouped by stage of disease. Early stages were defined as Lichtman stage I, II, and IIIa, and 'late' stages as IIIb and IV. The groups were then analyzed on the basis of treatment; procedures performed on subjects in the early group included vascularized bone grafting (VBG), metaphyseal core decompression, and radial osteotomy, whereas the procedures performed on subjects in the late group included VBG, radial osteotomy, partial arthrodesis, proximal row carpectomy, tendon ball arthroplasty, and nonsurgical treatment.
RESULTS
We found no statistically significant difference between any of the treatment groups for subjective pain outcomes. In terms of objective measures, statistically significant improvement (p<.05) was seen in range of motion after radial osteotomy and VBG in early-stage patients and after all interventions, except partial arthrodesis and nonsurgical treatment, for late-stage patients. Grip strength was significantly improved in early-stage patients after radial osteotomy and VBG and for all late-stage patients, except among those managed nonsurgically. Changes in Stahl and carpal height index scores were not statistically significant regardless of intervention, except after radial osteotomy in the early group, where they statistically worsened.
CONCLUSIONS
Based on retrospective data from uncontrolled studies, no active treatment is superior in the treatment of Kienböck's disease and there are insufficient data to determine whether the outcomes of any intervention are superior to placebo or the natural history of the disease.
Topics: Arthrodesis; Arthroplasty; Bone Transplantation; Decompression, Surgical; Humans; Lunate Bone; Osteonecrosis; Osteotomy; Pain Measurement
PubMed: 20438990
DOI: 10.1016/j.jhsa.2010.02.002 -
Health Technology Assessment... Mar 2023We aimed to compare the clinical effectiveness, cost-effectiveness and complication rates of total ankle replacement with those of arthrodesis (i.e. ankle fusion) in the...
BACKGROUND
We aimed to compare the clinical effectiveness, cost-effectiveness and complication rates of total ankle replacement with those of arthrodesis (i.e. ankle fusion) in the treatment of end-stage ankle osteoarthritis.
METHODS
This was a pragmatic, multicentre, parallel-group, non-blinded randomised controlled trial. Patients with end-stage ankle osteoarthritis who were aged 50-85 years and were suitable for both procedures were recruited from 17 UK hospitals and randomised using minimisation. The primary outcome was the change in the Manchester-Oxford Foot Questionnaire walking/standing domain scores between the preoperative baseline and 52 weeks post surgery.
RESULTS
Between March 2015 and January 2019, 303 participants were randomised using a minimisation algorithm: 152 to total ankle replacement and 151 to ankle fusion. At 52 weeks, the mean (standard deviation) Manchester-Oxford Foot Questionnaire walking/standing domain score was 31.4 (30.4) in the total ankle replacement arm ( = 136) and 36.8 (30.6) in the ankle fusion arm ( = 140); the adjusted difference in the change was -5.6 (95% confidence interval -12.5 to 1.4; = 0.12) in the intention-to-treat analysis. By week 52, one patient in the total ankle replacement arm required revision. Rates of wound-healing issues (13.4% vs. 5.7%) and nerve injuries (4.2% vs. < 1%) were higher and the rate of thromboembolic events was lower (2.9% vs. 4.9%) in the total ankle replacement arm than in the ankle fusion arm. The bone non-union rate (based on plain radiographs) in the ankle fusion arm was 12.1%, but only 7.1% of patients had symptoms. A post hoc analysis of fixed-bearing total ankle replacement showed a statistically significant improvement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score (-11.1, 95% confidence interval -19.3 to -2.9; = 0.008). We estimate a 69% likelihood that total ankle replacement is cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over the patient's lifetime.
LIMITATIONS
This initial report contains only 52-week data, which must therefore be interpreted with caution. In addition, the pragmatic nature of the study means that there was heterogeneity between surgical implants and techniques. The trial was run across 17 NHS centres to ensure that decision-making streams reflected the standard of care in the NHS as closely as possible.
CONCLUSIONS
Both total ankle replacement and ankle fusion improved patients' quality of life at 1 year, and both appear to be safe. When total ankle replacement was compared with ankle fusion overall, we were unable to show a statistically significant difference between the two arms in terms of our primary outcome measure. The total ankle replacement versus ankle arthrodesis (TARVA) trial is inconclusive in terms of superiority of total ankle replacement, as the 95% confidence interval for the adjusted treatment effect includes both a difference of zero and the minimal important difference of 12, but it can rule out the superiority of ankle fusion. A post hoc analysis comparing fixed-bearing total ankle replacement with ankle fusion showed a statistically significant improvement of total ankle replacement over ankle fusion in Manchester-Oxford Foot Questionnaire walking/standing domain score. Total ankle replacement appears to be cost-effective compared with ankle fusion at the National Institute for Health and Care Excellence's cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained over a patient's lifetime based on long-term economic modelling.
FUTURE WORK
We recommend long-term follow-up of this important cohort, in particular radiological and clinical progress. We also recommend studies to explore the sensitivity of clinical scores to detect clinically important differences between arms when both have already achieved a significant improvement from baseline.
TRIAL REGISTRATION
This trial is registered as ISRCTN60672307 and ClinicalTrials.gov NCT02128555.
FUNDING
This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in ; Vol. 27, No. 5. See the NIHR Journals Library website for further project information.
Topics: Humans; Arthroplasty, Replacement, Ankle; Ankle; Quality of Life; Osteoarthritis; Cost-Benefit Analysis; Arthrodesis; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 37022932
DOI: 10.3310/PTYJ1146 -
Foot (Edinburgh, Scotland) Mar 2023Talonavicular arthrodesis is associated with a rate of non-union that ranges from 3 % to 37 %. Various fixation devices have been reported for talonavicular arthrodesis... (Review)
Review
UNLABELLED
Talonavicular arthrodesis is associated with a rate of non-union that ranges from 3 % to 37 %. Various fixation devices have been reported for talonavicular arthrodesis including screws, staples, plates, K-wires and intraosseous fix systems, however there is no definitive gold standard. This systematic review aims to compare clinical outcomes between different fixation devices for talonavicular arthrodesis.
METHODS
MEDLINE, EMBASE, CENTRAL and Google Scholar were reviewed for studies reporting on outcomes of different fixation techniques for talonavicular arthrodesis indicated for osteoarthritis, inflammatory and post-traumatic arthritis from 1946 to 2021. The primary outcome measure was union rate. Secondary outcome measures included functional improvement, cost, quality of life and patient satisfaction.
RESULTS
9 articles involving 141 cases of talonavicular arthrodesis were identified. Fusion rates were as follows: screw fixation (n = 75): 87.5 % to 100 %, staple fixation (n = 13): 100 %, intraosseous fix system (n = 16): 100 %, and K-wire fixation (n = 2): 100 %. One study utilised a dorsal locking plate with two supplemented compression screws (n = 9, fusion rate= 100 %) and two studies used a combination of screws with staples (n = 26, fusion rate= 96 %). 7 of 9 studies measured functional outcomes and pain relief with improvement demonstrated in all fixation techniques. Quality of life, satisfaction and cost were inadequately reported amongst the included studies. All studies were rated as serious risk of bias.
CONCLUSION
This systematic review consolidates the evidence for outcomes of different fixation techniques for TN arthrodesis, however a definitive judgement regarding the best fixation technique is unobtainable from current clinical evidence, due to lack of high-quality studies. With review of biomechanical studies and the limited clinical data, fixation with plate plus screw is most promising and would warrant further comparative study.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Quality of Life; Arthrodesis; Osteoarthritis; Bone Screws; Patient Satisfaction; Retrospective Studies
PubMed: 36842364
DOI: 10.1016/j.foot.2023.101966 -
European Spine Journal : Official... May 2021Interbody cages are commonly used to augment interbody fusion. Commonly used materials include titanium (Ti) and polyetheretherketone (PEEK), with their inherent... (Meta-Analysis)
Meta-Analysis Review
Titanium (Ti) cages may be superior to polyetheretherketone (PEEK) cages in lumbar interbody fusion: a systematic review and meta-analysis of clinical and radiological outcomes of spinal interbody fusions using Ti versus PEEK cages.
AIM
Interbody cages are commonly used to augment interbody fusion. Commonly used materials include titanium (Ti) and polyetheretherketone (PEEK), with their inherent differences. The aim of this study is to perform a systematic review and meta-analysis to compare between the various clinical and radiological outcomes of Ti and PEEK interbody spinal cages.
METHODS
A systematic review and meta-analysis comparing clinical and radiological outcomes between Ti and PEEK interbody cages in patients undergoing spinal fusion was performed. PubMed, Scopus, Web of Science, Embase, and Cochrane Central Register of Controlled Trials database were searched. All studies that compared the clinical and radiological outcomes of patients who underwent Ti and PEEK cages were included. Subgroup analyses was performed to differentiate between patients who had cervical and lumbar interbody fusion.
RESULTS
A total of 11 articles were identified, with a total of 743 patients. Spinal fusion rates at final follow-up did not differ between Ti and PEEK cages (OR 1.50, 95% CI 0.57-3.94, P = 0.41), although in patients undergoing lumbar fusion, Ti cages demonstrated superior fusion (OR 2.12, 95% CI 1.05-4.28, P = 0.04). In patients with non-infective etiologies, Ti cages had a higher rate of cage subsidence (RR 2.17, 95% CI 1.13-4.16, P = 0.02). Both types of cages had similar operating time, postoperative hematoma formation, neuropathic pain, segmental angle correction and postoperative clinical outcome improvement.
CONCLUSION
In non-infective lumbar spine conditions, Ti cage may be the superior option due to the higher fusion rate.
LEVEL OF EVIDENCE
III.
Topics: Benzophenones; Humans; Ketones; Lumbar Vertebrae; Polyethylene Glycols; Polymers; Spinal Fusion; Titanium; Treatment Outcome
PubMed: 33555365
DOI: 10.1007/s00586-021-06748-w -
Medicine Mar 2021Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ankle fusion is the primary treatment for advanced ankle arthritis. With the advancement of arthroscopy technology, ankle arthroscopy fusion has shown many advantages over traditional surgery. However, there are few related studies globally, and evidence-based medicine is needed to verify the reliability and feasibility of ankle arthroscopy fusion.
OBJECTIVE
To compare the clinical efficacy and safety of arthroscopic ankle arthrodesis and open ankle arthrodesis.
METHODS
We searched the databases of PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure [CNKI], Wanfang Database, and VIP Database for published prospective or retrospective controlled studies of arthroscopic-assisted ankle fusion in the treatment of advanced ankle arthritis. The dates were limited from the construction of the library to June 30, 2019. Literature was included based on the principles and methods of evidence-based medicine. Literature retrieval, data extraction, and quality assessment were performed by 2 independent reviewers using the Cochrane 5.1 risk bias assessment tool. The methodological bias of the literature was evaluated, and a meta-analysis was using by RevMan 5.3 software.
RESULTS
A total of 18 studies and 1102 patients were included in the study, including 551 in the arthroscopic surgery group and 551 in the open surgery group. Arthroscopy-assisted surgery for advanced ankle arthritis was more effective than open surgery in terms of fusion rate (odd ratio[OR] = 3.32, 95% confidence interval[CI]:2.16, 5.10), fusion time (mean difference[MD] = -2.31, 95% CI:-4.63, -2.21), intraoperative blood loss (MD = -43.37, 95%CI: -48.49, -38.25), hospital stay (MD = -1.80, 95%CI: -2.28, -1.33), and visual analog scale score (MD = -1.75, 95%CI: -2.04, -1.46). In addition, rate of complications (OR = 0.33, 95%CI: 0.21, 0.52) was superior to open ankle fusion (P < .00001).
CONCLUSION
Arthroscopic ankle arthrodesis has more advantages than open ankle arthrodesis in improving the fusion rate and reducing complications, which is worthy of clinical application.
PROSPERO REGISTRATION NUMBER
CRD42020195727.
Topics: Ankle Joint; Arthrodesis; Arthroscopy; Blood Loss, Surgical; Feasibility Studies; Humans; Length of Stay; Osteoarthritis; Postoperative Complications; Randomized Controlled Trials as Topic; Recovery of Function; Reproducibility of Results; Severity of Illness Index; Treatment Outcome
PubMed: 33725876
DOI: 10.1097/MD.0000000000024998 -
Spine Sep 2018Systematic review and meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis Review
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To compare the efficacy of the use of either bisphosphonates or teriparatide on radiographic and functional outcomes of patients that had thoracolumbar spinal fusion.
SUMMARY OF BACKGROUND DATA
Controversy exists as to whether bisphosphonates interfere with successful spinal arthrodesis. An alternative osteoporosis medication is teriparatide, a synthetic parathyroid hormone that has an anabolic effect on osteoblast function. To date, there is limited comparative data on the influence of bisphosphonates or teriparatide on spinal fusion.
METHODS
A systematic search of medical reference databases was conducted for comparative studies on bisphosphonate or teriparatide use after thoracolumbar spinal fusion. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcomes assessed include fusion rates, risk of screw loosening, cage subsidence, and vertebral fracture.
RESULTS
No statistically significant differences were noted between bisphosphonates and control groups regarding fusion rate and risk of screw loosening (fusion: odds ratio [OR] = 2.2, 95% confidence interval [CI]: 0.87-5.56, P = 0.09; loosening: OR = 0.45, 95% CI: 0.14-1.48, P = 0.19). Teriparatide use was associated with higher fusion rates than bisphosphonates (OR = 2.3, 95% CI: 1.55-3.42, P < 0.0001). However, no statistically significant difference was noted between teriparatide and bisphosphonates regarding risk of screw loosening (OR = 0.37, 95% CI: 0.12-1.18, P = 0.09). Lastly, bisphosphonate use was associated with decreased odds of cage subsidence and vertebral fractures compared to controls (subsidence: OR = 0.29, 95% CI 0.11-0.75, P = 0.01; fracture: OR = 0.18, 95% CI 0.07-0.48, P = 0.0007).
CONCLUSION
Bisphosphonates do not appear to impair successful spinal fusion compared to controls although teriparatide use is associated with higher fusion rates than bisphosphonates. In addition, bisphosphonate use is associated with decreased odds of cage subsidence and vertebral fractures compared to controls that had spinal fusion.
LEVEL OF EVIDENCE
3.
Topics: Bone Density Conservation Agents; Clinical Trials as Topic; Diphosphonates; Humans; Lumbar Vertebrae; Osteoporosis; Spinal Fractures; Spinal Fusion; Teriparatide; Thoracic Vertebrae
PubMed: 29462070
DOI: 10.1097/BRS.0000000000002608 -
World Neurosurgery Nov 2022The main purpose of this systematic review and meta-analysis was to estimate the incidence of implant-associated complications and fusion rates for the Goel-Harms... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The main purpose of this systematic review and meta-analysis was to estimate the incidence of implant-associated complications and fusion rates for the Goel-Harms technique (GHT) and to show potential factors affecting the complications and nonunion development.
METHODS
A systematic search of the PubMed database according to PRISMA guidance was performed. The main inclusion criteria comprised description of fusion rate and/or implant-associated complications rate.
RESULTS
This systematic review included 86 articles focused on the results of surgery in 4208 patients. The rate of screw-related complications was as follows: 1) vertebral artery (VA) injury, 2.8%; 2) screw malposition in the direction of the VA, 5.8%; and 3) C2 nerve root irritation, 6.1%. The nonunion rate was 4.2%. Transpedicular screw insertion to the C1 and C2 vertebrae were the safest regarding VA injury and correlated with lower blood loss. For C1-C2 fusion, there was no statistical difference for the different bone graft localization. C2 nerve root irritation rate did not depend on screw insertion technique. The use of a freehand technique did not correlate with a high rate of screw-related complications.
CONCLUSIONS
The Goel-Harms technique is a promising method of C1-C2 fusion, with a relatively low nonunion and VA injury rate. It can be performed safely without C-arm or navigation system assistance. Transpedicular screw insertion trajectories to the C1 and C2 vertebrae were safest regarding VA injury and blood loss volume. Further comparative studies of various C1-C2 stabilization methods with a high level of significance should be carried out to identify the optimal approach.
Topics: Humans; Spinal Fusion; Atlanto-Axial Joint; Cervical Vertebrae; Bone Screws; Postoperative Complications; Joint Instability
PubMed: 36089281
DOI: 10.1016/j.wneu.2022.09.016 -
European Spine Journal : Official... Jun 2016Although pain is generally regarded as originating in the lumbar spine, it has been estimated that in 15-30 % of patients, LBP originates from the sacroiliac joint (SIJ). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND CONTEXT
Although pain is generally regarded as originating in the lumbar spine, it has been estimated that in 15-30 % of patients, LBP originates from the sacroiliac joint (SIJ).
PURPOSE
To determine whether sacroiliac joint fusion (SIJF) for LBP is effective in reducing pain when the SIJ is known to be the pain generator.
STUDY DESIGN/SETTING
Systematic review and meta-analysis.
METHODS
A systematic literature review and meta-analysis was performed of observational studies describing outcome of SIJF in patients with LBP. Outcome measures were VAS pain, ODI, SF-36 PCS/MCS and Majeed score. The following databases were searched: PubMed, Web of Science, Embase, Medline and Google scholar. The methodological quality of selected studies was assessed using the National Heart Lung and Blood Institute case series quality assessment tool. Meta-analysis was used to combine the studies for each outcome and forest plots were prepared. Outcomes were expressed as mean difference (MD).
RESULTS
Six studies were included in the meta-analysis with a mean follow-up of 17.6 months. All outcomes showed statistical and clinical improvement (VAS pain MD: 54.8; 95 % CI 48.6, 61.0; n = 380; p < 0.001, ODI MD: 14.5; 95 % CI 8.4, 20.6; n = 102; p < 0.001, SF-36 PCS MD: -19.5; 95 % CI -24.7, -14.2; n = 140; p < 0.001, SF-36 MCS MD: -8.5; 95 % CI -12.9, -4.1; n = 198; p < 0.001 and Majeed score MD: -35.4; 95 % CI -48.5, -22.2; n = 140; p < 0.001).
CONCLUSIONS
SIJF appears to be a satisfactory procedure for alleviating pelvic girdle pain.
Topics: Arthrodesis; Humans; Low Back Pain; Pelvic Girdle Pain; Sacroiliac Joint; Visual Analog Scale
PubMed: 26957096
DOI: 10.1007/s00586-016-4490-8