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The Bone & Joint Journal Mar 2022The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated... (Comparative Study)
Comparative Study Meta-Analysis
Synovial fluid calprotectin performs better than synovial fluid polymerase chain reaction and interleukin-6 in the diagnosis of periprosthetic joint infection : a systematic review and meta-analysis.
AIMS
The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated the performance characteristics of polymerase chain reaction (PCR), interleukin-6 (IL6), and calprotectin of synovial fluid in the diagnosis of PJI.
METHODS
We performed systematic search of PubMed, Embase, The Cochrane Library, Web of Science, and Science Direct from the date of inception of each database through to 31 May 2021. Studies which described the diagnostic accuracy of synovial fluid PCR, IL6, and calprotectin using the Musculoskeletal Infection Society criteria as the reference standard were identified.
RESULTS
Overall, 31 studies were identified: 20 described PCR, six described IL6, and five calprotectin. The sensitivity and specificity were 0.78 (95% confidence interval (CI) 0.67 to 0.86) and 0.97 (95% CI 0.94 to 0.99), respectively, for synovial PCR;, 0.86 (95% CI 0.74 to 0.92), and 0.94 (95% CI 0.90 to 0.96), respectively, for synovial IL6; and 0.94 (95% CI 0.82 to 0.98) and 0.93 (95% CI 0.85 to 0.97), respectively, for synovial calprotectin. Likelihood ratio scattergram analyses recommended clinical utility of synovial fluid PCR and IL6 as a confirmatory test only. Synovial calprotectin had utility in the exclusion and confirmation of PJI.
CONCLUSION
Synovial fluid PCR and IL6 had low sensitivity and high specificity in the diagnosis of PJI, and is recommended to be used as confirmatory test. In contrast, synovial fluid calprotectin had both high sensitivity and specificity with utility in both the exclusion and confirmation of PJI. We recommend use of synovial fluid calprotectin studies in the preoperative workup of PJI. Cite this article: 2022;104-B(3):311-320.
Topics: Humans; Interleukin-6; Joint Prosthesis; Leukocyte L1 Antigen Complex; Polymerase Chain Reaction; Prosthesis-Related Infections; Sensitivity and Specificity; Synovial Fluid
PubMed: 35227091
DOI: 10.1302/0301-620X.104B3.BJJ-2021-1320.R1 -
Osteoarthritis and Cartilage May 2011To summarize literature on the concurrent and predictive validity of MRI-based measures of osteoarthritis (OA) structural change. (Review)
Review
OBJECTIVE
To summarize literature on the concurrent and predictive validity of MRI-based measures of osteoarthritis (OA) structural change.
METHODS
An online literature search was conducted of the OVID, EMBASE, CINAHL, PsychInfo and Cochrane databases of articles published up to the time of the search, April 2009. 1338 abstracts obtained with this search were preliminarily screened for relevance by two reviewers. Of these, 243 were selected for data extraction for this analysis on validity as well as separate reviews on discriminate validity and diagnostic performance. Of these 142 manuscripts included data pertinent to concurrent validity and 61 manuscripts for the predictive validity review. For this analysis we extracted data on criterion (concurrent and predictive) validity from both longitudinal and cross-sectional studies for all synovial joint tissues as it relates to MRI measurement in OA.
RESULTS
Concurrent validity of MRI in OA has been examined compared to symptoms, radiography, histology/pathology, arthroscopy, CT, and alignment. The relation of bone marrow lesions, synovitis and effusion to pain was moderate to strong. There was a weak or no relation of cartilage morphology or meniscal tears to pain. The relation of cartilage morphology to radiographic OA and radiographic joint space was inconsistent. There was a higher frequency of meniscal tears, synovitis and other features in persons with radiographic OA. The relation of cartilage to other constructs including histology and arthroscopy was stronger. Predictive validity of MRI in OA has been examined for ability to predict total knee replacement (TKR), change in symptoms, radiographic progression as well as MRI progression. Quantitative cartilage volume change and presence of cartilage defects or bone marrow lesions are potential predictors of TKR.
CONCLUSION
MRI has inherent strengths and unique advantages in its ability to visualize multiple individual tissue pathologies relating to pain and also predict clinical outcome. The complex disease of OA which involves an array of tissue abnormalities is best imaged using this imaging tool.
Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Bone Marrow Diseases; Cartilage, Articular; Disease Progression; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Osteoarthritis; Pain; Prognosis; Radiography; Reproducibility of Results; Synovial Membrane; Synovitis; Young Adult
PubMed: 21396463
DOI: 10.1016/j.joca.2010.10.029 -
Orthopaedics & Traumatology, Surgery &... Feb 2021This systematic review and meta-analysis aims to provide consensus regarding the degree of optimal extended arthroscopic capsular release in addition to a standard... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This systematic review and meta-analysis aims to provide consensus regarding the degree of optimal extended arthroscopic capsular release in addition to a standard rotator interval release in the treatment of idiopathic frozen shoulder.
MATERIALS AND METHODS
The systematic review was conducted using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. All articles that reported the outcomes of capsular release in idiopathic frozen shoulder were included. A total of 18 articles with 629 patients and 811 shoulders were included. Clinical outcomes analysed include differences between pre and postoperative ranges of motion (ROM), Visual Analog Score (VAS) reduction, Simple Shoulder Test (SST) scores and Constant scores. Patients were grouped by technique: anterior-inferior capsular release (Group 1), anterior-inferior-posterior capsular release (Group 2), and 360-degree capsular release (Group 3) at follow up points 3,6 and 12 months.
RESULTS
Comparing ROM, Group 1 had greater early abduction (p<0.01), early (p<0.01) and overall external rotation (p<0.01) than Group 2, as well as greater early flexion (p<0.01), early abduction (p<0.01), early (p<0.01) and overall internal rotation (p<0.01) than Group 3. Group 2 had greater early (p=0.03) and overall flexion (p<0.01) than Group 1, as well as greater early (p<0.01) and overall flexion (p<0.01), early abduction (p<0.01) and early internal rotation (p<0.01) than Group 3. Group 3 had greater overall flexion (p<0.01) than Group 1 and greater overall external rotation (p<0.01) than Group 2. Comparing VAS scores, the less extensive releases saw the greatest significant postoperative reduction. Group 2 had greater mean improvements in postoperative Constant scores than Group 1 (p<0.01) and Group 3 (p<0.01), while SST scores were significantly higher in Group 1 (p<0.01).
CONCLUSION
This systematic review and meta-analysis suggests that less extensive releases may result in better functional and pain scores. Addition of a posterior release offers increased early internal rotation, which was not sustained over time, but provides early and sustained flexion improvements. A complete 360 release may not provide any further benefit. There were no significant differences in the complication rates amongst the 3 techniques.
LEVEL OF STUDY
II; Meta-analysis and systematic review.
Topics: Arthroscopy; Bursitis; Humans; Joint Capsule Release; Range of Motion, Articular; Shoulder Joint; Treatment Outcome
PubMed: 33333264
DOI: 10.1016/j.otsr.2020.102766 -
Indian Journal of Orthopaedics Feb 2023Adhesive capsulitis is clinically characterized by the gradual progressive painful loss of active and passive motion caused by the formation of adhesions of the joint... (Review)
Review
INTRODUCTION
Adhesive capsulitis is clinically characterized by the gradual progressive painful loss of active and passive motion caused by the formation of adhesions of the joint capsule. Adhesive Capsulitis of the Hip (ACH) is not a well-explored clinical condition when compared to adhesive capsulitis of shoulder because of the underdiagnosis and rarity of this condition
MATERIALS AND METHODS
Cochrane, Scopus, Pubmed, Embase, and Web of Science databases were searched for original studies on ACH till December 2021 following Cochrane and PRISMA guidelines. Year of publication, authors, number of cases, baseline characteristics of the studies, causes described, presentation, associated conditions, method of diagnosis, treatment to be given, functional outcomes, and complications was extracted from each study.
RESULTS
16 articles were included in this review. 3 of the included studies were retrospective case-control studies, 6 were case series and the remaining 7 were case reports. A total of 224 ACH cases were recorded. Pain and stiffness of the hips were the most common clinical features. Investigations like serology, radiograph, and MRI have been used to rule out other conditions. Arthrography has been used to confirm the diagnosis in 7 studies. Spontaneous recovery is expected in one to two years. Management has been in the form of physiotherapy, intra-articular injection, and arthroscopy.
CONCLUSION
Literature on ACH is limited because of the rarity of the condition. The disease has a favorable prognosis with the possibility of spontaneous recovery. Physiotherapy has been the first line of management. Intractable cases require surgical intervention.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s43465-022-00808-z.
PubMed: 36777126
DOI: 10.1007/s43465-022-00808-z -
Surgical Technology International Nov 2020Treatment of post-surgical pain is predicated by an understanding of pain generators. The purpose of this review is to identify sensory dependent areas of the shoulder...
INTRODUCTION
Treatment of post-surgical pain is predicated by an understanding of pain generators. The purpose of this review is to identify sensory dependent areas of the shoulder and discuss their correlation in treating postoperative pain.
MATERIALS AND METHODS
Pubmed, Embase, and Cochrane Database of Systemic Reviews were searched (key terms: "Nociception" or "sensory pain receptors" or "pain map" or "neuroanatomy and shoulder" or "rotator cuff") to identify studies in the current literature (1966-2018) regarding sensory innervation of the shoulder and rotator cuff. The search was limited to the English language, human studies, and publication types to reviews and clinical studies. Articles written in other languages besides English, animal studies, abstracts, and conference notes were excluded. Each search result was investigated for relevant physiological information of the nerve endings and nociceptors as well as pertinent information and figures that illustrated the location of the identified receptors.
RESULTS
A total of 12 articles were identified that addressed the sensory innervation of the shoulder. The shoulder capsule has the highest sensory nerve density. The attachment sites between the labrum and the capsule and glenoid rim were also found to be highly sensory dependent, in contrast to the peri-core zone at the capsulolabral junction, which was found to be less concentrated with fascicles and sensory nerve endings. The subacromial bursa is also a highly sensory dependent structure, with a more concentrated neural network on the coracoacromial side compared to other quadrants of the bursa. Cutaneous locations of sensory fibers on the shoulder are best defined by mapping the pressure pain threshold (PPT) of various locations on the shoulder. The most sensory dependent locations of the shoulder were found to be the posterior border of the acromion, the glenohumeral joint, the anterior deltoid, and the upper trapezius.
CONCLUSION
This review examined the origin of pain in the shoulder, the location of cutaneous pain receptors, and receptors in each major part of the shoulder. Providing analgesia to these densely innervated areas of the shoulder can potentially reduce pain associated with surgical trauma. In addition, knowledge of the sensory dependent areas of the shoulder may elicit consideration of alternative incision sites and surgical protocols to decrease the insult to nociceptors in these locations. These changes could possibly decrease the narcotic requirement in the postoperative period.
Topics: Humans; Pain, Postoperative; Rotator Cuff; Rotator Cuff Injuries; Shoulder; Shoulder Joint
PubMed: 33080040
DOI: No ID Found -
Cureus Oct 2023The pathology of the shoulder is among the most widespread medical presentations and may be a result of existing anatomical variations. Therefore, the knowledge of the... (Review)
Review
The pathology of the shoulder is among the most widespread medical presentations and may be a result of existing anatomical variations. Therefore, the knowledge of the variations is vital for physicians and clinicians, tasked with treating patients presenting similar complaints to minimize misdiagnosis and prevent iatrogenic injuries. Therefore, the main objective of the present systematic review the variations in pectoralis minor muscle origin and insertion/attachment point. The study also seeks to better inform physicians and clinicians of the task of treating patients with various pathology problems and to ascertain that, upon identification, the pectoralis minor muscle variants are aptly appreciated. The search method used in this systematic review entails the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol, and the searching of several online databases, for studies focusing on variations in pectoralis minor muscles. The author reviewer evaluated the studies for eligibility, and the selection criteria for the studies used are described below. This systematic review has disclosed that, in some individuals, the pectoralis minor muscles have their origins in the second, third, and fourth ribs, even as others have their origin in the third and fourth ribs. Still, the systematic review has disclosed that, in certain individuals, the insertion of the pectoralis minor muscle occurs at the supraspinatus tendon, even as there are anomalies in the pectoralis minor insertion points linked to subacromial impingement, possible compression of the brachial plexus anteromedial and the axillary artery, and the subcoracoid impingement.
PubMed: 37916251
DOI: 10.7759/cureus.46329 -
Journal of Orthopaedic Surgery (Hong... 2020Periprosthetic joint infection (PJI) is the most common complication after artificial joint replacement as previously reported. However, the main problem at present is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Periprosthetic joint infection (PJI) is the most common complication after artificial joint replacement as previously reported. However, the main problem at present is its difficulty in diagnosis. This systematic review and meta-analysis aimed to compare the diagnostic accuracy of -defensin, D-dimer, and interleukin-6 (IL-6) in clinical practice.
METHOD
Online databases were systematically searched until June 18th, 2020 with keywords and medical sub-headings terms. Studies mentioned the sensitivity and specificity of biological markers in detecting PJI were included in our study. The sensitivity, specificity, and diagnostic odds ratios (DORs) were obtained after integration.
RESULTS
A total of 34 studies with 1036 patients diagnosing as PJI were included for comparing -defensin, D-dimer, and IL-6. The sensitivity and specificity of -defensin for PJI were 0.88 and 0.96, and the DOR was 189 (95% CI 72-496), respectively. The sensitivity and specificity of D-dimer (0.82 and 0.72) and IL-6 (0.80 and 0.89) were lower than -defensin.
CONCLUSION
The detection of -defensin is a promising biomarker for diagnosing PJI. The optional cut-off needs to be curtained when using other biomarkers.
Topics: Biomarkers; Fibrin Fibrinogen Degradation Products; Humans; Interleukin-6; Prosthesis-Related Infections; Synovial Fluid; alpha-Defensins
PubMed: 33225796
DOI: 10.1177/2309499020971861 -
BMC Musculoskeletal Disorders Apr 2020Prior studies have compared the posterior capsule repair group in primary total hip arthroplasty by posterior approach with the control group without posterior capsule... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prior studies have compared the posterior capsule repair group in primary total hip arthroplasty by posterior approach with the control group without posterior capsule repair suggesting that the posterior capsule repair group had better clinical outcomes. However, it is still a controversy which treatment is more helpful for hip diseases. The purpose of our article is to obtain the postoperative outcomes between the 2 procedures.
METHODS
We performed a systematic search by browsing the MEDLINE, EMBASE, Cochrane Library. There is no restriction on the date of publication. Before we submit our manuscript, we have re-searched the literatures again, including the articles which directly compared the postoperative outcomes of the 2 procedures.
RESULTS
A total of 8 comparative studies were included in our meta-analysis. The posterior capsule repair group showed less dislocation rate, higher HHS, and even less postoperative bleeding volume. Meanwhile, there is no significant difference in ROM between 2 groups.
CONCLUSION
In conclusion, according to current evidences, repairing posterior capsule during primary THA may have better functional outcomes, less dislocation incidence, and less loss of blood.
Topics: Arthroplasty, Replacement, Hip; Connective Tissue; Hip Dislocation; Hip Joint; Humans; Incidence; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 32316961
DOI: 10.1186/s12891-020-03244-y -
Oral Surgery, Oral Medicine, Oral... Oct 2006To evaluate the evidence for the efficacy of magnetic resonance imaging (MRI) in the diagnosis of disk position and configuration, disk perforation, joint effusion, and... (Review)
Review
OBJECTIVE
To evaluate the evidence for the efficacy of magnetic resonance imaging (MRI) in the diagnosis of disk position and configuration, disk perforation, joint effusion, and osseous and bone marrow changes in the temporomandibular joint.
STUDY DESIGN
A PubMed literature search with specific indexing terms and a hand search were made. Two reviewers assessed the level of evidence of relevant publications as high, moderate, or low. Based on this, the evidence grade for diagnostic efficacy was rated as strong, moderately strong, limited, or insufficient.
RESULTS
The literature search yielded 494 titles, of which 22 were relevant. No publication had a high level of evidence, and 12 had moderate and 10 low levels of evidence. The evidence grade for diagnostic efficacy expressed as sensitivity, specificity, and predictive values was insufficient.
CONCLUSION
That evidence is insufficient emphasizes the need for high-quality studies on the diagnostic efficacy of MRI, incorporating accepted methodologic criteria.
Topics: Bone Marrow; Decision Making; Humans; Likelihood Functions; Magnetic Resonance Imaging; Observer Variation; Osteoarthritis; Patient Care Planning; Prognosis; ROC Curve; Reproducibility of Results; Sensitivity and Specificity; Synovial Fluid; Temporomandibular Joint; Temporomandibular Joint Disc; Temporomandibular Joint Disorders
PubMed: 16997121
DOI: 10.1016/j.tripleo.2006.02.001 -
Expert Review of Hematology 2016Some promising cartilage and synovium biomarkers are at various stages of development and awaiting further validation in larger patient populations with osteoarthritis... (Review)
Review
Some promising cartilage and synovium biomarkers are at various stages of development and awaiting further validation in larger patient populations with osteoarthritis (OA). Various reports have shown increased levels of inflammatory biomarkers, both locally (synovial fluid) and systemically (serum and plasma) in such patients. The clinical value of these parameters in combination with imaging biomarkers in order to predict early onset and the burden of OA is being investigated. This review article aims to describe the potential usefulness of synovial and cartilage biomarkers for the diagnosis and prognosis of hemophilic arthropathy (HA) by using the existing literature on OA as an applicable model. A systematic review found that serum cartilage oligomeric matrix protein (sCOMP) is elevated in patients with knee OA and is sensitive to OA disease progression.
Topics: Biomarkers; Cartilage; Cartilage Oligomeric Matrix Protein; Chondroitin Sulfates; Collagen Type II; Humans; Osteoarthritis; Severity of Illness Index; Synovial Fluid
PubMed: 26761216
DOI: 10.1586/17474086.2016.1141674