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Current Medical Research and Opinion May 2017A systematic review and partial meta-analysis is conducted to compare the efficacy and safety of anterior cervical decompression and fusion procedures employing either... (Meta-Analysis)
Meta-Analysis Review
Titanium cages versus autogenous iliac crest bone grafts in anterior cervical discectomy and fusion treatment of patients with cervical degenerative diseases: a systematic review and meta-analysis.
OBJECTIVE
A systematic review and partial meta-analysis is conducted to compare the efficacy and safety of anterior cervical decompression and fusion procedures employing either rectangular titanium cages or iliac crest autografts in patients suffering from cervical degenerative disc diseases.
METHODS
Medline, PubMed, CENTRAL, and Google Scholar databases were searched up to June 2015, using the key words cervical discectomy; bone transplantation; titanium cages; and iliac crest autografts. Outcomes of interbody fusion rates were compared using odds ratios (ORs) with 95% confidence intervals (CIs). Values of the Japanese Orthopaedic Association score, and visual analog scale before and after operation were also compared.
RESULTS
The rate of interbody fusion was similar between patients in the iliac crest autograft and titanium cage groups (pooled OR = 0.33, 95% CI = 0.07 to 1.66, P = .178). The overall analysis showed that patients in the two groups did not have significantly different post-surgery Japanese Orthopaedic Association score (pooled difference in means = -0.05, 95% CI = 0.73 to 0.63, P = .876). Improvement in arm and neck pain scores were assessed with a visual analog scale and differed significantly between patients in the iliac crest autograft and titanium cage groups (pooled difference in means = 0.16, 95% CI = -0.44 to 0.76, P = .610; and pooled difference in means = -0.44, 95% CI = -2.23 to 1.36, P = .634, respectively).
CONCLUSIONS
Our results suggest that the use of titanium cages constitutes a safe and efficient alternative to iliac crest bone autografts for anterior cervical discectomy with fusion.
Topics: Bone Transplantation; Cervical Vertebrae; Comparative Effectiveness Research; Diskectomy; Humans; Ilium; Intervertebral Disc Degeneration; Outcome and Process Assessment, Health Care; Radiography; Spinal Fusion; Titanium; Transplantation, Autologous
PubMed: 28097889
DOI: 10.1080/03007995.2017.1284050 -
Annals of Internal Medicine Jun 2013Recombinant human bone morphogenetic protein-2 (rhBMP-2) is used as a bone graft substitute in spinal fusion, which unites (fuses) bones in the spine. The accuracy and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recombinant human bone morphogenetic protein-2 (rhBMP-2) is used as a bone graft substitute in spinal fusion, which unites (fuses) bones in the spine. The accuracy and completeness of journal publications of industry-sponsored trials on the effectiveness and harms of rhBMP-2 has been called into question.
PURPOSE
To independently assess the effectiveness and harms of rhBMP-2 in spinal fusion and reporting bias in industry-sponsored journal publications.
DATA SOURCES
Individual-patient data (IPD) from 17 industry-sponsored studies; related internal documents; and searches of MEDLINE (1996 to August 2012), other databases, and reference lists.
STUDY SELECTION
Randomized, controlled trials (RCTs) and cohort studies of rhBMP-2 versus any control and uncontrolled studies of harms.
DATA EXTRACTION
Effectiveness outcomes in IPD were recalculated using consistent definitions. Study characteristics and results were abstracted by 1 investigator and confirmed by another. Two investigators independently assessed quality using predefined criteria.
DATA SYNTHESIS
Thirteen RCTs and 31 cohort studies were included. For lumbar spine fusion, rhBMP-2 and iliac crest bone graft were similar in overall success, fusion, and other effectiveness measures and in risk for any adverse event, although rates were high across interventions (77% to 93% at 24 months from surgery). For anterior lumbar interbody fusion, rhBMP-2 was associated with nonsignificantly increased risk for retrograde ejaculation and urogenital problems. For anterior cervical spine fusion, rhBMP-2 was associated with increased risk for wound complications and dysphagia. At 24 months, the cancer risk was increased with rhBMP-2 (risk ratio, 3.45 [95% CI, 1.98 to 6.00]), but event rates were low and cancer was heterogeneous. Early journal publications misrepresented the effectiveness and harms through selective reporting, duplicate publication, and underreporting.
LIMITATIONS
Outcome assessment was not blinded, and ascertainment of harms in trials was poor. No trials were truly independent of industry sponsorship.
CONCLUSION
In spinal fusion, rhBMP-2 has no proven clinical advantage over bone graft and may be associated with important harms, making it difficult to identify clear indications for rhBMP-2. Earlier disclosure of all relevant data would have better informed clinicians and the public than the initial published trial reports did.
PRIMARY FUNDING SOURCE
Yale University and Medtronic.
Topics: Bone Morphogenetic Protein 2; Conflict of Interest; Drug Industry; Humans; Ilium; Incidence; Intervertebral Disc Degeneration; Neoplasms; Off-Label Use; Publication Bias; Publishing; Recombinant Proteins; Spinal Fusion; Transforming Growth Factor beta; Treatment Outcome
PubMed: 23778906
DOI: 10.7326/0003-4819-158-12-201306180-00006 -
Journal of Orthopaedic Trauma Aug 2012To identify and evaluate previously described methods for the measurement, and interpretation, of radiographic outcomes of operatively treated pelvic fractures. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To identify and evaluate previously described methods for the measurement, and interpretation, of radiographic outcomes of operatively treated pelvic fractures.
DATA SOURCES
A systematic review of the available literature was performed using all major databases (MEDLINE, EMBASE, MEDLINE IN-PROGRESS, and Cochrane Central) in August 2009.
STUDY SELECTION
Inclusion criteria were case series, cohort studies, or clinical trials regarding orthopaedic treatment of acute traumatic pelvic ring fractures treated surgically in adults, with at least 12 weeks of radiographic follow-up. Exclusion criteria were case reports or case series of <10 patients, review articles, foreign language articles, and series where time frame of outcome measurement was not stated were excluded.
DATA EXTRACTION
Modality, and timeline, of the radiographic assessment was recorded. Next, the description of the method of radiographic measurement technique used was scrutinized for standardization. The interpretation of the radiographic measurement was evaluated, and any grading scale used was recorded. The interpretation of the quality of the radiographic result as described by each author was recorded. Finally, a qualitative methodological analysis was performed.
DATA SYNTHESIS
Number of standardized radiographic assessment techniques used (3 of 31) and interpretation scales used (13 of 31) were calculated. Nonweighted mean follow-up time (30.6 months) and overall positive radiographic outcomes were calculated (78.6% good or excellent).
CONCLUSIONS
Reporting of radiographic outcomes in pelvic fractures has been done using largely unstandardized and universally untested measurement techniques. The interpretations of these measurements are also inconsistent and untested. Substantive future research is needed in this area.
Topics: Fractures, Bone; Humans; Outcome Assessment, Health Care; Pelvic Bones; Prevalence; Radiographic Image Interpretation, Computer-Assisted; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 22391403
DOI: 10.1097/BOT.0b013e3182323aa2 -
Injury Feb 2022Type-C pelvic fractures are a rare but potentially fatal injury that often leads to poor outcomes, despite surgical fixation. Many fixation methods are used but the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Type-C pelvic fractures are a rare but potentially fatal injury that often leads to poor outcomes, despite surgical fixation. Many fixation methods are used but the optimal method remains contentious, with failure and complications common. This study compared outcomes for each fixation method.
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search of studies which reported on outcomes after surgically treated type-C pelvic fractures was undertaken. Data retrieved included fixation method, length of follow up, surgical revision, and complications rates (hardware breakage, post-operative outcomes, screw mal-positioning, screw loosening, loss of reduction and infection). Study quality was assessed using the Methodological Index for Non-Randomised Studies (MINORS). Pooled revision, outcome and complication rates were calculated using a quality-adjusted model in MetaXL 5.3.
RESULTS
Fifty-two studies met the inclusion criteria representing 1567 patients and 7 fixation methods. The meta-analyses demonstrated high rates of 'less-than-good' outcomes for most fixation methods, with a higher rate for bilateral injuries (overall 23%; unilateral 21% v bilateral 41%). The mean pooled rate for surgical revision rate was 4%, hardware breakage 3%, screw mal-positioning 2%, screw loosening 3%, loss of reduction 5% and infection 4%. Each fixation method had different performance profiles; however, anterior plating outperformed all other fixation methods for patient outcomes, with a 'less-than-good' rate of just 7% vs the pooled mean of 23% and demonstrated at or below pooled mean rates for all complications except revision which was 5%.
CONCLUSIONS
Post-operative outcomes for surgically treated type-C pelvic fractures revealed a 'less-than-good' pooled outcome rate of 23% and a revision rate of 4%. Anterior plates outperformed most other systems particularly for patient reported outcomes. Pooled revision, patient-reported outcome and complication rates for type-C pelvic fractures have not previously been reported and these data provide a benchmark for practice and future research.
Topics: Bone Screws; Fracture Fixation, Internal; Fractures, Bone; Humans; Pelvic Bones; Reoperation
PubMed: 34625237
DOI: 10.1016/j.injury.2021.09.004 -
Archives of Orthopaedic and Trauma... Oct 2023Several studies have reported good to excellent outcomes of revision total hip arthroplasty (rTHA) using allografts for treating severe acetabular bone defects. However,... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Several studies have reported good to excellent outcomes of revision total hip arthroplasty (rTHA) using allografts for treating severe acetabular bone defects. However, precise information on the impact of allograft type and reconstruction method is not available.
MATERIAL AND METHODS
Systematic literature search was performed in Medline and Web of Science including patients with acetabular bone loss classified according to the Paprosky classification who underwent rTHA involving the use of allografts. Studies with a minimum follow-up of 2 years published between 1990 and 2021 were included. Kendall correlation was applied to determine the relationship between Paprosky grade and allograft type use. Proportion meta-analyses with 95% confidence interval (CI) were performed to summarize the success of various reconstruction options, including allograft type, fixation method, and reconstruction system.
RESULTS
Twenty-seven studies met the inclusion criteria encompassing 1561 cases from 1491 patients with an average age of 64 years (range 22-95). The average follow-up period was 7.9 years (range 2-22). Structural bulk and morselized grafts were used in equal proportions for all Paprosky acetabular defect types. Their use increased significantly with the type of acetabular defect (r = 0.69, p = 0.049). The overall success rate ranged from 61.3 to 98.3% with a random effect pooled estimate of 90% [95% CI 87-93]. Trabecular metal augments (93% [76-98]) and shells (97% [84-99]) provided the highest success rates. However, no significant differences between reconstruction systems, allograft types and fixation methods were observed (p > 0.05 for all comparisons).
CONCLUSION
Our findings highlight the use of bulk or morselized allograft for massive bone loss independent of Paprosky classification type and indicate similar good mid- to long-term outcomes of the different acetabular reconstruction options using allografts.
CLINICAL TRIAL REGISTRATION
PROSPERO: CRD42020223093.
Topics: Humans; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Hip Prosthesis; Follow-Up Studies; Allografts; Retrospective Studies; Acetabulum; Reoperation; Bone Transplantation; Prosthesis Failure
PubMed: 36971802
DOI: 10.1007/s00402-023-04843-9 -
Medicine Jul 2022Pelvic bone fractures may cause extensive bleeding; however, the efficacy of tranexamic acid (TXA) usage in pelvic fracture surgery remains unclear. In this systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pelvic bone fractures may cause extensive bleeding; however, the efficacy of tranexamic acid (TXA) usage in pelvic fracture surgery remains unclear. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of TXA in open reduction and internal fixation surgery for pelvic and acetabular fracture.
METHODS
MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before April 22, 2020, that investigated the effect of TXA in the treatment of pelvic and acetabular fracture with open reduction and internal fixation. A pooled analysis was used to identify the differences between a TXA usage group and a control group in terms of estimated blood loss (EBL), transfusion rates, and postoperative complications.
RESULTS
We included 6 studies involving 764 patients, comprising 293 patients who received TXA (TXA group) and 471 patients who did not (control group). The pooled analysis showed no differences in EBL between the groups (mean difference -64.67, 95% confidence interval [CI] -185.27 to -55.93, P = .29). The study period transfusion rate showed no significant difference between the groups (odds ratio [OR] 0.77, 95% CI 0.19-3.14, P = .71, I2 = 82%), nor in venous thromboembolism incidence (OR 1.53, 95% CI 0.44-5.25, P = .50, I2 = 0%) or postoperative infection rates (OR 1.15, 95% CI 0.13-9.98, P = .90, I2 = 48%).
CONCLUSIONS
Despite several studies having recommended TXA administration in orthopedic surgery, our study did not find TXA usage to be more effective than not using TXA in pelvic and acetabular fracture surgery, especially in terms of EBL reduction, transfusion rates, and the risk of postoperative complications.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Fracture Fixation, Internal; Hip Fractures; Humans; Postoperative Complications; Spinal Fractures; Tranexamic Acid
PubMed: 35866801
DOI: 10.1097/MD.0000000000029574 -
Acta Orthopaedica Apr 2023Assessing peri-acetabular bone quality is valuable for optimizing the outcomes of primary total hip arthroplasty (THA) as preservation of good quality bone stock likely... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Assessing peri-acetabular bone quality is valuable for optimizing the outcomes of primary total hip arthroplasty (THA) as preservation of good quality bone stock likely affects implant stability. The aim of this study was to perform a meta-analysis of peri-acetabular bone mineral density (BMD) changes over time measured using quantitative computer tomography (CT) and, second, to investigate the influence of age, sex, and fixation on the change in BMD over time.
METHODS
A systematic search of Embase, Scopus, Web of Science, and PubMed databases identified 19 studies that measured BMD using CT following THA. The regions of interest (ROI), reporting of BMD results, and scan protocols were extracted. A meta-analysis of BMD was performed on 12 studies that reported measurements immediately postoperatively and at follow-up.
RESULTS
The meta-analysis determined that periacetabular BMD around both cemented and uncemented components decreases over time. The amount of BMD loss increased relative to proximity of the acetabular component. There was a greater decrease in cortical BMD over time in females and cancellous BMD for young patients of any sex.
CONCLUSION
Peri-acetabular BMD decreases at different rates relative to its proximity to the acetabular component. Cancellous BMD decreases more in young patients and cortical bone decreases more in females. Standardized reporting parameters and suggested ROI to measure peri-acetabular BMD are proposed, to enable comparison between implant and patient variables in the future.
Topics: Female; Humans; Male; Arthroplasty, Replacement, Hip; Bone Density; Hip Prosthesis; Absorptiometry, Photon; Follow-Up Studies; Osteoarthritis, Hip; Acetabulum; Tomography, X-Ray Computed
PubMed: 37114317
DOI: 10.2340/17453674.2023.11635 -
Orthopaedic Surgery May 2017Giant cell tumor of the bone (GCTB) is a locally aggressive tumor with a certain distant metastatic rate. For sacral GCT (SGCT) and pelvic GCT (PGCT), surgery has its... (Review)
Review
Giant cell tumor of the bone (GCTB) is a locally aggressive tumor with a certain distant metastatic rate. For sacral GCT (SGCT) and pelvic GCT (PGCT), surgery has its limitations, especially for unresectable or recurrent tumors. Selective arterial embolization (SAE) is reported to be an option for treatment in several cases, but there are few systematic reviews on the effects of SAE on SGCT and/or PGCT. Medline and Embase databases were searched for eligible English articles. Inclusion and exclusion criteria were conducted before searching. All the clinical factors were measured by SPSS software, with P-values ≤0.05 considered statistically significant. A total of 9 articles were retrieved, including 44 patients receiving SAE ranging from 1 to 10 times. During the mean follow-up period of 85.8 months, the radiographic response rate was 81.8%, with a local control and overall survival rate of 75% and 81.8%, respectively. No bowel, bladder, or sexual dysfunction was observed. Three patients developed distant metastases and finally died. Patients with primary tumors tended to have better prognosis than those with recurrence (P = 0.039). The favorable outcomes of SAE suggest that it may be an alternative treatment for SGCT and PGCT patients for whom surgery is not appropriate.
Topics: Adolescent; Adult; Aged; Bone Neoplasms; Embolization, Therapeutic; Female; Giant Cell Tumor of Bone; Humans; Male; Middle Aged; Pelvic Bones; Pelvic Neoplasms; Sacrum; Spinal Neoplasms; Treatment Outcome; Young Adult
PubMed: 28644557
DOI: 10.1111/os.12336 -
Cancers May 2024The standard treatment for locally advanced cervical cancer typically includes concomitant chemoradiation, a regimen known to induce severe hematologic toxicity (HT).... (Review)
Review
The standard treatment for locally advanced cervical cancer typically includes concomitant chemoradiation, a regimen known to induce severe hematologic toxicity (HT). Particularly, pelvic bone marrow dose exposure has been identified as a contributing factor to this hematologic toxicity. Chemotherapy further increases bone marrow suppression, often necessitating treatment interruptions or dose reductions. A systematic search for original articles published between 1 January 2006 and 7 January 2024 that reported on chemoradiotherapy for locally advanced cervical cancer and hematologic toxicities was conducted. Twenty-four articles comprising 1539 patients were included in the final analysis. HT of grade 2 and higher was observed across all studies and frequently exceeded 50%. When correlating active pelvic bone marrow and HT, significant correlations were found for volumes between 10 and 45 Gy and HT of grade 3 and higher. Several dose recommendations for pelvic bone and pelvic bone marrow sparing to reduce HT were established, including V10 < 90-95%, V20 < 65-86.6% and V40 < 22.8-40%. Applying dose constraints to the pelvic bone/bone marrow is a promising approach for reducing HT, and thus reliable implementation of therapy. However, prospective randomized controlled trials are needed to define precise dose constraints and optimize clinical strategies.
PubMed: 38791920
DOI: 10.3390/cancers16101842 -
Microsurgery Mar 2022Pelvic ring reconstruction after internal hemipelvectomy is an extremely challenging surgical procedure, and mandatory reconstruction is to provide a durable and... (Review)
Review
INTRODUCTION
Pelvic ring reconstruction after internal hemipelvectomy is an extremely challenging surgical procedure, and mandatory reconstruction is to provide a durable and pain-free functional outcome, especially for young, active patients. One of the most widely employed techniques is reconstruction with a double-barreled fibular free flap (DBF). The aim of our work was an in-depth analysis of the outcome of pelvic ring reconstruction performed using the above-mentioned method, in particular looking for a correlation between the fixation technique and either ambulation status or complications.
MATERIALS AND METHODS
A systematic review was performed in November 2020 using PubMed and MedLine Ovid databases according to the PRISMA guidelines and the results were statistically analyzed.
RESULTS
Studies were published between 1994 and 2015. A DBF was used in each case, with a total of 30 patients. Reconstruction was performed with screws in 13 cases, Cotrel-Dubousset rod fixation in 6, screws and plate in 5, screws with external fixation in 4, and ISOLA in 2. Follow-up time ranged from 3 to 131 months. Functional outcome was excellent in 4 patients and good in 26 patients. Statistical analysis showed no statistical evidence of existing correlation between fixation technique and complications (p = .873), while statistical correlation between age and fixation technique was found (p < .001).
CONCLUSION
Reconstruction of pelvic ring with DBF provides an overall good functional outcome. Our data indicate that there is no statistical evidence of existing correlation between the fixation technique and either complications or ambulation status.
Topics: Bone Plates; Fracture Fixation; Fracture Fixation, Internal; Fractures, Bone; Free Tissue Flaps; Hemipelvectomy; Humans; Pelvic Bones; Retrospective Studies; Treatment Outcome
PubMed: 34498772
DOI: 10.1002/micr.30806