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Clinical Orthopaedics and Related... May 2017In the assessment of possible periprosthetic knee infection, various imaging modalities are used without consensus regarding the most accurate technique. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In the assessment of possible periprosthetic knee infection, various imaging modalities are used without consensus regarding the most accurate technique.
QUESTIONS/PURPOSES
To perform a meta-analysis to compare the accuracy of various applied imaging modalities in the assessment of periprosthetic knee infection.
METHODS
A systematic review and meta-analysis was conducted with a comprehensive search of MEDLINE and Embase in accordance with the PRISMA and Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) recommendations to identify clinical studies in which periprosthetic knee infection was investigated with different imaging modalities. The sensitivity and specificity of each imaging technique were determined and compared with the results of microbiologic and histologic analyses, intraoperative findings, and clinical followup of more than 6 months. A total of 23 studies, published between 1990 and 2015, were included for meta-analysis, representing 1027 diagnostic images of symptomatic knee prostheses. Quality of the included studies showed low concerns regarding external validity, whereas internal validity indicated more concerns regarding the risk of bias. The most important concerns were found in the lack of uniform criteria for the diagnosis of a periprosthetic infection and the flow and timing of the included studies. Differences among techniques were tested at a probability less than 0.05 level. Where there was slight overlap of confidence intervals for two means, it is possible for the point estimates to be statistically different from one another at a probability less than 0.05. The z-test was used to statistically analyze differences in these situations.
RESULTS
Bone scintigraphy was less specific than all other modalities tested (56%; 95% CI, 0.47-0.64; p < 0.001), and leukocyte scintigraphy (77%; 95% CI, 0.69-0.85) was less specific than antigranulocyte scintigraphy (95%; 95% CI, 0.88-0.98; p < 0.001) or combined leukocyte and bone marrow scintigraphy (93%; 95% CI, 0.86-0.97; p < 0.001). Fluorodeoxyglucose positron emission tomography (FDG-PET) (84%; 95% CI, 0.76-0.90) was more specific than bone scintigraphy (56%; 95% CI, 0.47-0.64; p < 0.001), and less specific than antigranulocyte scintigraphy (95%; 95% CI, 0.88-0.98; p = 0.02) and combined leukocyte and bone marrow scintigraphy (93%; 95% CI, 0.86-0.97; p < 0.001). Leukocyte scintigraphy (88%; 95% CI, 0.81-0.93; p = 0.01) and antigranulocyte scintigraphy (90%; 95% CI, 0.78-0.96; p = 0.02) were more sensitive than FGD-PET (70%; 95% CI, 0.56-0.81). However, because of broad overlapping of confidence intervals, no differences in sensitivity were observed among the other modalities, including combined bone scintigraphy (93%; 95% CI, 0.85-0.98) or combined leukocyte and bone marrow scintigraphy (80%; 95% CI, 0.66-0.91; p > 0.05 for all paired comparisons).
CONCLUSIONS
Based on current evidence, antigranulocyte scintigraphy and combined leukocyte and bone marrow scintigraphy appear to be highly specific imaging modalities in confirming periprosthetic knee infection. Bone scintigraphy was a highly sensitive imaging technique but lacks the specificity needed to differentiate among various conditions that cause painful knee prostheses. FDG-PET may not be the preferred imaging modality because it is more expensive and not more effective in confirming periprosthetic knee infection.
LEVEL OF EVIDENCE
Level III, diagnostic study.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Knee; Bone Marrow; Child; Child, Preschool; Female; Fluorodeoxyglucose F18; Granulocytes; Humans; Knee Joint; Knee Prosthesis; Leukocytes; Male; Middle Aged; Positron-Emission Tomography; Predictive Value of Tests; Prosthesis-Related Infections; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Treatment Outcome; Young Adult
PubMed: 28050818
DOI: 10.1007/s11999-016-5218-0 -
BMC Musculoskeletal Disorders Apr 2023Mechanically aligned total knee arthroplasty (MATKA) is a well-established procedure. Kinematically aligned TKA (KATKA) has been proposed to restore and preserve... (Meta-Analysis)
Meta-Analysis
Postoperative clinical outcomes for kinematically, restricted kinematically, or mechanically aligned total knee arthroplasty: a systematic review and network meta-analysis of randomized controlled trials.
BACKGROUND
Mechanically aligned total knee arthroplasty (MATKA) is a well-established procedure. Kinematically aligned TKA (KATKA) has been proposed to restore and preserve pre-arthritic knee anatomy. However, normal knee anatomy varies widely, and there have been concerns regarding restoring unusual anatomy. Accordingly, restricted KATKA (rKATKA) was introduced to reproduce constitutional knee anatomy within a safe range. This network meta-analysis (NMA) aimed to evaluate the clinical and radiological outcomes of the surgeries.
METHODS
We performed a database search on August 20, 2022, which included randomized controlled trials (RCTs) comparing any two of the three surgical TKA techniques for knee osteoarthritis. We conducted a random-effects NMA within the frequentist framework and evaluated confidence in each outcome using the Confidence in Network Meta-Analysis tool.
RESULTS
Ten RCTs with 1,008 knees and a median follow-up period of 1.5 years were included. The three methods might result in little to no difference in range of motion (ROM) between methods. In patient-reported outcome measures (PROMs), the KATKA might result in a slight improvement compared with the MATKA (standardized mean difference, 0.47; 95% confidence interval [CI], 0.16-0.78; very low confidence). There was little to no difference in revision risk between MATKA and KATKA. KATKA and rKATKA showed a slight valgus femoral component (mean difference [MD], -1.35; 95% CI, -1.95-[-0.75]; very low confidence; and MD, -1.72; 95% CI, -2.63-[-0.81]; very low confidence, respectively) and a slight varus tibial component (MD, 2.23; 95% CI, 1.22-3.24; very low confidence; and MD, 1.25; 95% CI, 0.01-2.49; very low confidence, respectively) compared with MATKA. Tibial component inclination and hip-knee-ankle angle might result in little to no difference between the three procedures.
CONCLUSIONS
KATKA and rKATKA showed similar ROM and PROMs and a slight variation in the coronal component alignment compared with MATKA. KATKA and rKATKA are acceptable methods in short- to mid-term follow-up periods. However, long-term clinical results in patients with severe varus deformity are still lacking. Surgeons should choose surgical procedures carefully. Further trials are warranted to evaluate the efficacy, safety, and subsequent revision risk.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Prosthesis; Network Meta-Analysis; Biomechanical Phenomena; Randomized Controlled Trials as Topic; Knee Joint; Osteoarthritis, Knee
PubMed: 37095485
DOI: 10.1186/s12891-023-06448-0 -
Annals of the Royal College of Surgeons... Jan 2015Total hip arthroplasty is one of the most commonly performed orthopaedic procedures. Despite this, medical evidence to inform the choice of surgical approach is lacking.... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Total hip arthroplasty is one of the most commonly performed orthopaedic procedures. Despite this, medical evidence to inform the choice of surgical approach is lacking. Currently in the UK, the two most frequently performed approaches to the hip are the posterior and the direct lateral.
METHODS
This systematic review was performed according to Cochrane guidelines following an extensive search for prospective controlled trials published in any language before January 2014. Of the 728 records identified from searches, 6 prospective studies (including 3 randomised controlled trials) involving 517 participants provided data towards this review.
FINDINGS
Compared with the lateral approach, the posterior approach conferred a significant reduction in the risk of Trendelenburg gait (odds ratio [OR]: 0.31, p=0.0002) and stem malposition (OR: 0.24, p=0.02), and a non-significant reduction in dislocation (OR: 0.37, p=0.16) and heterotopic ossification (OR: 0.41, p=0.13). Neither approach conferred a functional advantage. We draw attention to the paucity of evidence and the need for a further randomised trial.
Topics: Adult; Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Postoperative Complications; Treatment Outcome
PubMed: 25519259
DOI: 10.1308/003588414X13946184904008 -
The Knee Dec 2015Unicompartmental knee arthroplasty (UKA) has gained popularity in patients with isolated unicompartmental osteoarthritis. To our knowledge no systematic review has... (Review)
Review
BACKGROUND
Unicompartmental knee arthroplasty (UKA) has gained popularity in patients with isolated unicompartmental osteoarthritis. To our knowledge no systematic review has assessed and compared survivorship of medial and lateral UKA. We performed a systematic review assessing medial and lateral UKA survivorship and comparing survivorship in cohort studies and registry-based studies.
METHODS
A search was performed using PubMed, Embase and Cochrane systems. Ninety-six eligible studies reported survivorship, of which fifty-eight reported medial and sixteen reported lateral UKA survivorship. Nineteen cohort studies and seven registry-based studies reported combined medial and lateral survivorship.
RESULTS
The five-year, ten-year and fifteen-year medial UKA survivorship was 93.9%, 91.7% and 88.9%, respectively. Lateral UKA survivorship was 93.2%, 91.4% and 89.4% at five-year, ten-year and fifteen-year, respectively. No statistical difference between both compartments was found. At twenty years and twenty-five years survivorship of medial UKA was 84.7% and 80%, respectively, but no studies reported lateral UKA survivorship at these follow-up intervals. Survivorship of cohort studies was not significantly higher compared to registry-based studies at five years (94.3 vs. 91.7, respectively, p=0.133) but was significantly higher at ten years (90.5 vs. 84.1, p=0.015).
CONCLUSION
This is the first systematic review that shows no difference in the five-, ten- and fifteen-year survivorship of medial and lateral UKA. We found a lower survivorship in the registry-based studies compared to cohort studies.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Prosthesis Design; Range of Motion, Articular; Registries; Time Factors; Treatment Outcome
PubMed: 26507286
DOI: 10.1016/j.knee.2015.09.011 -
Journal of Oral and Maxillofacial... Feb 2018There are different total temporomandibular joint (TMJ) prostheses on the market but no comparison of their efficacy. The purpose of this meta-analysis was to evaluate... (Meta-Analysis)
Meta-Analysis
PURPOSE
There are different total temporomandibular joint (TMJ) prostheses on the market but no comparison of their efficacy. The purpose of this meta-analysis was to evaluate the effectiveness of different TMJ replacement (TJR) systems.
MATERIALS AND METHODS
A systematic review and meta-analysis was performed using the PubMed, Embase, Medline, and Cochrane Library search engines in May 2017 to identify qualified studies. Outcome measurements were changes in maximal incisal opening (MIO), pain, dietary limitations, and functional deficiencies from before to after TJR. Analyses of heterogeneity, sensitivity, and publication bias were performed. A fixed-effects model was used for the meta-analysis of pooled weighted mean differences in pre- versus postoperative MIO, pain, diet, and function.
RESULTS
Twenty studies with 1,262 patients were included in the meta-analysis. Comparison of the TJR systems showed no real difference for pre- versus postoperative MIO, pain, diet, and function. MIO and functional efficiency decreased gradually over time, but effective pain relief and improvements in dietary limitations were stable with no relevant differences during follow-up. Comparison of the custom and stock devices showed similar results for pre- and postoperative MIO, pain, function, and diet.
CONCLUSION
This analysis showed no relevant difference in treatment outcomes among the TJR systems.
Topics: Arthroplasty, Replacement; Humans; Joint Prosthesis; Prosthesis Design; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 28919368
DOI: 10.1016/j.joms.2017.08.022 -
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 -
Knee Surgery, Sports Traumatology,... Mar 2023The purpose of this systematic review and metanalysis was to assess clinical and radiological outcomes of metaphyseal sleeves and cones and to identify their possible... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this systematic review and metanalysis was to assess clinical and radiological outcomes of metaphyseal sleeves and cones and to identify their possible advantages and disadvantages.
METHODS
A comprehensive search from the inception of the databases to March 2021 was performed on Medline, Scopus, CINAHL, Cochrane, Embase, Ovid, and Google scholar databases. Coleman Methodology Score was used for quality assessment. Author, year of publication, type of study, level of evidence, sample size, number of patients, number of knees treated, mean age, gender, mean follow-up, clinical outcomes, complications, the reason for revision and, type of prosthesis were extracted for analysis. Clinical studies providing data about patient's outcomes after the primary and Total Knee Arthroplasty revision with the usage of sleeves or cones and a minimum of 2 years of follow-up were included.
RESULTS
The literature search and cross-referencing resulted in a total of 93 articles, but only 30 articles were appropriate for the systematic review. Comparable clinical results were reported between cones and sleeves. The meta-analysis showed a greater incidence of intraoperative fractures in patients treated with sleeves (1.6%, [95% CI 0.7; 3.4] in cones and 4.6%, [95% CI 3.3; 6.4] in sleeves, p = 0.01), while the risk of postoperative fractures (4.3%, [95% CI 2.7; 7] in cones and 2.1%, [95% CI 1.2; 3.5] in sleeves, p = 0.04) and infections (8.5%, [95% CI 6; 12] in cones and 3.7%, [95% CI 2.1; 7.3] in sleeves, p = 0.03) was higher with cones.
CONCLUSION
A higher incidence of intraoperative fracture was reported in patients treated with sleeves, while a higher rate of postoperative fractures and infections was described in patients treated with cones. Nonetheless, complications were reported in both groups.
LEVEL OF EVIDENCE
III.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Prosthesis; Prosthesis Design; Reoperation; Radiography; Fractures, Bone; Knee Joint; Retrospective Studies
PubMed: 35234976
DOI: 10.1007/s00167-022-06914-7 -
Knee Surgery, Sports Traumatology,... Dec 2022The purpose of this systematic review was to synthesise the available literature and critically appraise current evidence on the functional and radiographic outcomes as... (Review)
Review
PURPOSE
The purpose of this systematic review was to synthesise the available literature and critically appraise current evidence on the functional and radiographic outcomes as well as reoperation and revision rates of custom partial knee arthroplasty, i.e., unicompartmental knee arthroplasty (UKA), bicompartmental knee arthroplasty (BKA), and patellofemoral arthroplasty (PFA).
MATERIAL AND METHODS
This systematic review was performed in accordance with the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and a protocol was registered with Prospero. On 25 May 2021, two authors independently searched and screened Level I-IV studies that reported on outcomes of custom partial knee arthroplasty using the databases of MEDLINE, EMBASE, and the Cochrane Library without restriction on date of publication. Findings from eligible articles were synthesised and tabulated, and quality assessments were done according to the guidelines of the Joanna Briggs Institute (JBI) Checklists.
RESULTS
Fifteen articles were eligible for data extraction, of which two comparative and four case series were on custom UKA (follow-up, 0-9 months), one comparative and five case series on custom BKA (follow-up, 0.25-72 months), and three case series on custom PFA (follow-up, 2-119 months). Three studies on custom UKA reported mean Knee Society Score (KSS) Knee of 86-94 and mean KSS Function of 94-95, and two studies on custom BKA reported mean KSS Knee of 90-94 and KSS function of 81, whereas one study on custom PFA reported KSS Knee of 91 and KSS Function of 89. Custom implants tended to have less bone-implant mismatch compared to off the shelf (OTS) implants. Revision rates were 3-25% for custom UKA (at 0-109 months), 3-5% for custom BKA (at 12-72 months), and 0-14% for custom PFA (at 2-119 months).
CONCLUSION
Due to the small number of comparative studies and lack of consistency in reported outcomes, it remains difficult to ascertain the benefits of custom partial knee arthroplasty. Anecdotal evidence suggests that, compared to OTS implants, custom implants result in less bone-implant mismatch and that 78-91% of patients are either satisfied or very satisfied after custom partial knee arthroplasty.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Treatment Outcome
PubMed: 34792611
DOI: 10.1007/s00167-021-06766-7 -
British Medical Bulletin 2012Although the clinical and functional outcomes of patients undergoing knee arthroplasty have widely been investigated, there is little information on the postoperative... (Review)
Review
INTRODUCTION
Although the clinical and functional outcomes of patients undergoing knee arthroplasty have widely been investigated, there is little information on the postoperative sport activity status.
SOURCES OF DATA
We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 25 February 2011, using various combinations of the keyword terms 'Knee arthroplasty', 'Knee replacement', 'Total Knee replacement', 'Unicondylar Knee replacement', 'Knee Prosthesis', 'Sport Activity', 'Return To Sport Activity Level' and 'Recreational Sporting Level'. Twenty-two articles published in peer-reviewed journals were included in this review.
AREAS OF AGREEMENT
Patients report improved outcomes, in terms of pain, symptoms, activities of daily living, sport activity and quality of life, compared with preoperative status. Only low-impact physical activities are recommended. The Coleman Methodology Score showed great heterogeneity in the study design, patients' characteristics, management methods and outcome assessment, and generally low methodological quality.
AREAS OF CONTROVERSY
Data are too heterogeneous to allow for definitive conclusions on long-term outcomes of total knee arthroplasty. It is not possible to compare the post-operative sport activity status of the patients.
GROWING POINTS
Validated and standardized measures should be used to report outcomes of patients undergoing knee arthroplasty. Function surveys that better depict sport activities, and include actual physical function testing, should be used.
RESEARCH
There is a need to perform appropriately powered randomized clinical trials using standard diagnostic assessment, and a common and validated scoring system comparing reported outcomes and the duration of follow-up >2 years.
Topics: Arthroplasty, Replacement, Knee; Humans; Knee Joint; Knee Prosthesis; Prosthesis Design; Recovery of Function; Sports; Treatment Outcome
PubMed: 21565802
DOI: 10.1093/bmb/ldr009 -
International Orthopaedics Mar 2017Instability following total hip arthroplasty remains a common and disabling complication. The dual mobility cup (DMC) allows a reduction in the dislocation rate. An... (Review)
Review
PURPOSE
Instability following total hip arthroplasty remains a common and disabling complication. The dual mobility cup (DMC) allows a reduction in the dislocation rate. An increasing number of studies have been undertaken to better understand DMC long term outcomes and complications. The goal of this systematic review was to clarify its different uses and outcomes according to the indications.
METHODS
A comprehensive literature review was performed using the keywords 'dual mobility' and 'tripolar cup' with no limit regarding the year of publication. One hundred seventy six publications were identified.
RESULTS
Current literature shows that "contemporary" dual mobility cup are a significant indication to manage instability following primary and revision hip arthroplasty. Survivorship at midterm is comparable to other articulations for primary THA, but is more difficult to evaluate in revision. Intra-prosthetic dislocation, wear, and loosening are now uncommon with new generations of DMC.
CONCLUSIONS
Compared to previous generations of DMC, the current "contemporary" DMC presents a significant improvement. Current literature reveals a tendency to increase the indications but further studies with long term follow up remain important to consolidate these findings.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Hip Dislocation; Hip Joint; Hip Prosthesis; Humans; Middle Aged; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 28004142
DOI: 10.1007/s00264-016-3377-y