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Journal of Orthopaedic Surgery and... Dec 2023Extended reality (XR), including virtual reality, augmented reality (AR), and mixed reality, has been used to help achieve accurate acetabular cup placement in total hip... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Extended reality (XR), including virtual reality, augmented reality (AR), and mixed reality, has been used to help achieve accurate acetabular cup placement in total hip arthroplasty (THA). This study aimed to compare the differences between XR-assisted and conventional THA.
METHODS
In this systematic review and meta-analysis, electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to September 10, 2023. The outcomes were accuracy of inclination and anteversion, duration of surgery, and intraoperative blood loss. Meta-analysis was performed using Review Manager 5.4 software.
RESULTS
A total of five studies with 396 patients were included in our study. The pooled results indicated AR-assisted THA had better accuracy of inclination and anteversion than conventional THA (SMD = - 0.51, 95% CI [- 0.96 to - 0.07], P = 0.02; SMD = - 0.96, 95% CI [- 1.19 to - 0.72], P < 0.00001), but duration of surgery and intraoperative blood loss were similar in the two groups.
CONCLUSION
This systematic review and meta-analysis found that AR-assisted THA had better accuracy of inclination and anteversion than conventional THA, but the duration of surgery and intraoperative blood loss were similar in the two groups. Based on the pooled results, we suggested that AR can provide more precise acetabular cup placement than conventional methods in THA.
Topics: Humans; Arthroplasty, Replacement, Hip; Augmented Reality; Blood Loss, Surgical; Acetabulum; Surgery, Computer-Assisted; Hip Prosthesis
PubMed: 38042852
DOI: 10.1186/s13018-023-04421-0 -
Chiropractic & Manual Therapies Sep 2023Spinal manipulation (SM) is a recommended and effective treatment for musculoskeletal disorders. Biomechanical (kinetic) parameters (e.g. preload/peak force, rate of... (Review)
Review
BACKGROUND
Spinal manipulation (SM) is a recommended and effective treatment for musculoskeletal disorders. Biomechanical (kinetic) parameters (e.g. preload/peak force, rate of force application and thrust duration) can be measured during SM, quantifying the intervention. Understanding these force-time characteristics is the first step towards identifying possible active ingredient/s responsible for the clinical effectiveness of SM. Few studies have quantified SM force-time characteristics and with considerable heterogeneity evident, interpretation of findings is difficult. The aim of this study was to synthesise the literature describing force-time characteristics of manual SM.
METHODS
This scoping literature review is reported following the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) statement. Databases were searched from inception to October 2022: MEDLINE (Ovid), Embase, CINAHL, ICL, PEDro and Cochrane Library. The following search terms and their derivatives were adapted for each platform: spine, spinal, manipulation, mobilization or mobilisation, musculoskeletal, chiropractic, osteopathy, physiotherapy, naprapathy, force, motor skill, biomechanics, dosage, dose-response, education, performance, psychomotor, back, neck, spine, thoracic, lumbar, pelvic, cervical and sacral. Data were extracted and reported descriptively for the following domains: general study characteristics, number of and characteristics of individuals who delivered/received SM, region treated, equipment used and force-time characteristics of SM.
RESULTS
Of 7,607 records identified, 66 (0.9%) fulfilled the eligibility criteria and were included in the analysis. Of these, SM was delivered to the cervical spine in 12 (18.2%), the thoracic spine in 40 (60.6%) and the lumbopelvic spine in 19 (28.8%) studies. In 6 (9.1%) studies, the spinal region was not specified. For SM applied to all spinal regions, force-time characteristics were: preload force (range: 0-671N); peak force (17-1213N); rate of force application (202-8700N/s); time to peak thrust force (12-938ms); and thrust duration (36-2876ms).
CONCLUSIONS
Considerable variability in the reported kinetic force-time characteristics of SM exists. Some of this variability is likely due to differences in SM delivery (e.g. different clinicians) and the measurement equipment used to quantify force-time characteristics. However, improved reporting in certain key areas could facilitate more sophisticated syntheses of force-time characteristics data in the future. Such syntheses could provide the foundation upon which dose-response estimates regarding the clinical effectiveness of SM are made.
Topics: Humans; Biomechanical Phenomena; Bone Diseases; Cervical Vertebrae; Chiropractic; Manipulation, Spinal
PubMed: 37705030
DOI: 10.1186/s12998-023-00512-1 -
European Journal of Orthopaedic Surgery... Jan 2024Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and... (Review)
Review
PURPOSE
Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and is associated with a high rate of secondary osteoarthritis; therefore, a combined hip procedure (CHP) or ORIF with acute total hip arthroplasty, may be beneficial in this population. The objective of this study was to perform a systematic review of all reported cases of CHP.
METHODS
PubMed, Embase, Scopus, and Cochrane databases were searched for studies analyzing acetabular fractures in the elderly managed with a combined hip procedure (CHP). The research was performed following the PRISMA guidelines. The included studies' methodological quality was evaluated using the MINORS score. The present study was registered on PROSPERO.
RESULTS
Eleven clinical studies were included in the final analysis. The mean age was 74.4 (63.2-78) years. Low-energy trauma was the most common mechanism of injury (64%). The most prevalent fracture pattern was the anterior column and posterior hemitransverse (ACPHT) (30.6%). The Kocher-Langenbeck approach was preferred for ORIF of posterior fractures and hip arthroplasty. The ilioinguinal approach and modified Stoppa were generally used for anterior fractures. The overall complication rate was 12.2%, and hip dislocation was the most frequent cause of reoperation (4.4%). The average Harris Hip Score reported postoperatively was 81.6 points, which was considered "good."
CONCLUSIONS
CHP is a safe treatment for elderly acetabular fractures with an acceptable complication and reoperation rate that results in good clinical outcomes.
LEVEL OF EVIDENCE
Level of evidence IV.
Topics: Humans; Aged; Arthroplasty, Replacement, Hip; Acetabulum; Fracture Fixation, Internal; Hip Fractures; Fractures, Bone; Open Fracture Reduction; Spinal Fractures; Treatment Outcome; Retrospective Studies
PubMed: 37640795
DOI: 10.1007/s00590-023-03701-z -
International Journal of Environmental... Aug 2023The current study analysed whether the osteogenic stimuli of exercises and sports have an independent effect on bone mineral density (BMD). Studies with a design having... (Meta-Analysis)
Meta-Analysis Review
Effects of Exercise and Sports Intervention and the Involvement Level on the Mineral Health of Different Bone Sites in the Leg, Hip, and Spine: A Systematic Review and Meta-Analysis.
The current study analysed whether the osteogenic stimuli of exercises and sports have an independent effect on bone mineral density (BMD). Studies with a design having two different cohorts were searched and selected to distinguish the effect due to long-term involvement (i.e., athletes vs. non-active young with good bone health) and due to the planning of intervention (i.e., pre- vs. post-training) with exercises and sports. Moreover, only studies investigating the bone sites with a body-weight support function (i.e., lower limb, hip, and spine regions) were reviewed, since the osteogenic effects have incongruous results. A meta-analysis was performed following the recommendations of PRISMA. Heterogeneity () was determined by combining Cochran's Q test with the Higgins test, with a significance level of α = 0.05. The studies reporting the effect of involvement in exercise and sports showed high heterogeneity for the lower limb, total hip, and spine ( = 90.200%, 93.334%, and 95.168%, respectively, with < 0.01) and the effect size on sports modalities (Hedge's = 1.529, 1.652, and 0.417, respectively, with < 0.05) ranging from moderate to high. In turn, the studies reporting the effect of the intervention planning showed that there was no heterogeneity for the lower limb ( = 0.000%, = 0.999) and spine ( = 77.863%, = 0.000); however, for the hip, it was moderate ( = 49.432%, = 0.054), with a low effect between the pre- and post-training moments presented only for the hip and spine (Hedge's = 0.313 and 0.353, respectively, with < 0.05). The current analysis supported the effect of involvement in exercise and sports by evidencing the effect of either weight-bearing or non-weight-bearing movements on BMD at the femoral, pelvic, and lumbar bones sites of the athletes when comparing to non-athletes or non-active peers with healthy bones. Moreover, the effect of different exercise and sports interventions highlighted the alterations in the BMD in the spine bone sites, mainly with long-term protocols (~12 months) planned with a stimulus with high muscle tension. Therefore, exercise and sport (mainly systematic long-term practice) have the potential to increase the BMD of bones with body-weight support beyond the healthy values reached during life phases of youth and adulthood.
Topics: Adolescent; Humans; Leg; Exercise; Sports; Bone and Bones; Bone Density; Lower Extremity
PubMed: 37569078
DOI: 10.3390/ijerph20156537 -
Journal of Pediatric Orthopedics. Part B Jul 2024Acetabular dysplasia is one of the most common causes of early hip osteoarthritis and hip replacement surgery. Recent literature suggests that acetabular dysplasia does...
Acetabular dysplasia is one of the most common causes of early hip osteoarthritis and hip replacement surgery. Recent literature suggests that acetabular dysplasia does not always originate at infancy, but can also develop later during childhood. This systematic review aims to appraise the literature on prevalence numbers of acetabular dysplasia in children after the age of 2 years. A systematic search was performed in several scientific databases. Publications were considered eligible for inclusion if they presented prevalence numbers on acetabular dysplasia in a general population of healthy children aged 2-18 years with description of the radiological examination. Quality assessment was done using the Newcastle-Ottawa score. Acetabular dysplasia was defined mild when: the center-edge angle of Wiberg (CEA-W) measured 15-20°, the CEA-W ranged between -1 to -2SD for age, or based on the acetabular index using thresholds from the Tönnis table. Severe dysplasia was defined by a CEA-W < 15°, <-2SD for age, or acetabular index according to Tönnis. Of the 1837 screened articles, four were included for review. Depending on radiological measurement, age and reference values used, prevalence numbers for mild acetabular dysplasia vary from 13.4 to 25.6% and for severe acetabular dysplasia from 2.2 to 10.9%. Limited literature is available on prevalence of acetabular dysplasia in children after the age of 2 years. Prevalence numbers suggest that acetabular dysplasia is not only a condition in infants but also highly prevalent later in childhood.
Topics: Humans; Prevalence; Acetabulum; Child; Child, Preschool; Radiography; Adolescent; Developmental Dysplasia of the Hip
PubMed: 37555638
DOI: 10.1097/BPB.0000000000001113 -
Journal of Orthopaedic Surgery and... Aug 2023The positioning of implant components for total hip arthroplasty (THA) is essential for joint stability, polyethylene liner wear, and range of motion. One potential... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The positioning of implant components for total hip arthroplasty (THA) is essential for joint stability, polyethylene liner wear, and range of motion. One potential benefit of the direct anterior approach (DAA) for THA is the ability to use intraoperative fluoroscopy for acetabular cup positioning and limb-length evaluation. Previous studies comparing intraoperative fluoroscopy with no fluoroscopy during DAA have reported conflicting results. This meta-analysis aimed to evaluate whether intraoperative fluoroscopy improves component positioning compared to no fluoroscopy during direct anterior total hip arthroplasty.
METHODS
A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. We searched Web of Science, EMBASE, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, and Wanfang database in May 2023 to identify studies involving intraoperative fluoroscopy versus no fluoroscopy during direct anterior total hip arthroplasty. Finally, we identified 1262 hips assessed in seven studies.
RESULTS
There were no significant differences in terms of acetabular cup inclination angle (ACIA, P = 0.21), ACIA within safe zone rate (P = 0.97), acetabular cup anteversion angle (ACAA, P = 0.26); ACAA within safe zone rate (P = 0.07), combined safe zone rate (P = 0.33), and limb-length discrepancy (LLD, P = 0.21) between two groups.
CONCLUSION
Even though intraoperative fluoroscopy was not related to an improvement in cup location or LDD. With fewer experienced surgeons, the benefit of intraoperative fluoroscopy might become more evident. More adequately powered and well-designed long-term follow-up studies were required to determine whether the application of the intraoperative fluoroscopy for direct anterior total hip arthroplasty will have clinical benefits and improve the survival of prostheses.
Topics: Arthroplasty, Replacement, Hip; Hip Joint; Hip Prosthesis; Retrospective Studies; Acetabulum
PubMed: 37553600
DOI: 10.1186/s13018-023-04023-w -
Biomedical Engineering Online Jul 2023Osteoporosis is a significant health problem in the skeletal system, associated with bone tissue changes and its strength. Machine Learning (ML), on the other hand, has... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Osteoporosis is a significant health problem in the skeletal system, associated with bone tissue changes and its strength. Machine Learning (ML), on the other hand, has been accompanied by improvements in recent years and has been in the spotlight. This study is designed to investigate the Diagnostic Test Accuracy (DTA) of ML to detect osteoporosis through the hip dual-energy X-ray absorptiometry (DXA) images.
METHODS
The ISI Web of Science, PubMed, Scopus, Cochrane Library, IEEE Xplore Digital Library, CINAHL, Science Direct, PROSPERO, and EMBASE were systematically searched until June 2023 for studies that tested the diagnostic precision of ML model-assisted for predicting an osteoporosis diagnosis.
RESULTS
The pooled sensitivity of univariate analysis of seven studies was 0.844 (95% CI 0.791 to 0.885, I = 94% for 7 studies). The pooled specificity of univariate analysis was 0.781 (95% CI 0.732 to 0.824, I = 98% for 7 studies). The pooled diagnostic odds ratio (DOR) was 18.91 (95% CI 14.22 to 25.14, I = 93% for 7 studies). The pooled mean positive likelihood ratio (LR) and the negative likelihood ratio (LR) were 3.7 and 0.22, respectively. Also, the summary receiver operating characteristics (sROC) of the bivariate model has an AUC of 0.878.
CONCLUSION
Osteoporosis can be diagnosed by ML with acceptable accuracy, and hip fracture prediction was improved via training in an Architecture Learning Network (ALN).
Topics: Humans; Pelvic Bones; Osteoporosis; Algorithms; Hip Fractures; Machine Learning
PubMed: 37430259
DOI: 10.1186/s12938-023-01132-9 -
Hip International : the Journal of... Jan 2024Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed.
PURPOSE
In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy.
METHODS
A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures.
RESULTS
From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference [SMD] 95% confidence interval [CI]): -4.05; -4.78 to -3.32), function (-2.81; -3.89 to -1.74), and QOL (-4.10; -4.43 to -3.77) were significantly poorer preoperatively.Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference [SPD] 1.35; 95% CI, 1.02-1.67) and 2 years postoperatively (1.35; 1.16-1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09-1.35) and 2 years (1.06; 0.9-1.22) and QOL at 1 year (1.36; 1.22-1.5) and 2 years (1.3; 1.1-1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia.
CONCLUSIONS
Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants.
REGISTRATION
PROSPERO (CRD42020144748).
Topics: Adult; Humans; Acetabulum; Activities of Daily Living; Arthralgia; Arthroplasty, Replacement, Hip; Hip Dislocation; Hip Dislocation, Congenital; Hip Joint; Osteotomy; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 37306161
DOI: 10.1177/11207000231179610 -
Osteoporosis International : a Journal... Sep 2023Identifying the full scope of pelvic fracture patterns in older adults has gained clinical importance since the last decennium. CT is recommended as the golden standard;... (Review)
Review
Identifying the full scope of pelvic fracture patterns in older adults has gained clinical importance since the last decennium. CT is recommended as the golden standard; however, MRI has even greater diagnostic accuracy. Dual energy computed tomography (DECT) is a new and promising imaging technique, but the diagnostic accuracy in the context of pelvic fragility fractures (FFPs) has not been widely established. The aim was to provide insight into the diagnostic accuracy of different imaging techniques and the relevance for clinical practice. A systematic search was performed in the PubMed database. All studies that reported on CT, MRI or DECT imaging techniques in older adults who suffered a pelvic fracture were reviewed and, if relevant, included. Eight articles were included. In up to 54% of the patients, additional fractures were found on MRI compared to CT, and in up to 57% of the patients on DECT. The sensitivity of DECT for posterior pelvic fracture detection was similar to MRI. All patients without fractures on CT appeared to have posterior fractures on MRI. After additional MRI, 40% of the patients had a change of classification. DECT and MRI showed very similar results in terms of diagnostic accuracy. Over a third of all patients appear to have a more severe fracture classification after MRI, the majority changing to Rommens type 4. However, in only a few patients who changed of fracture classification, a change of therapy was advised. This review suggests that MRI and DECT scans are superior in diagnosing FFPs.
Topics: Humans; Aged; Tomography, X-Ray Computed; Fractures, Bone; Magnetic Resonance Imaging; Pelvic Bones; Radionuclide Imaging; Sensitivity and Specificity; Retrospective Studies
PubMed: 37286662
DOI: 10.1007/s00198-023-06812-9 -
Archives of Orthopaedic and Trauma... Oct 2023Liner malseating is well described in ceramic-on-ceramic total hip arthroplasties (THAs). However, limited information is known on this complication among dual-mobility... (Review)
Review
BACKGROUND
Liner malseating is well described in ceramic-on-ceramic total hip arthroplasties (THAs). However, limited information is known on this complication among dual-mobility articulations. As such, this systematic review analyzed liner malseating in dual-mobility THAs concerning prevalence, clinical implications, and associated risk factors.
METHODS
A PRISMA criteria-based systematic review was performed, and PubMed, Web of Science, MEDLINE, and Cochrane used as data bases. All original studies from 1980 to 2022 were considered eligible for inclusion, and Methodological Index for Nonrandomized Studies (MINORS) used for quality assessment.
RESULTS
In total, five retrospective cohort studies with 2330 patients (2673 dual-mobility THAs) were included. Mean age was 66.9 years, mean BMI was 29.8 kg/m2, and 35% of patients were female. Rates of malseating ranged from 0.15% to 5.8%, with a total of 53 malseated liners identified throughout all studies (1.98%). Based on THA manufacturer, malseating occurred in 48 Stryker (1.96%) and 5 Biomet Zimmer (2.14%) THAs. Mean clinical follow-up was 2.2 years (mean range, 1.3 to 6.4 years). Except one patient reporting of pain at 2 years, no revision or negative clinical implication was noted in any of the malseated liners, including normal ranged metal ions measured in four cases. A smaller acetabular component size was identified as a statistically significant risk factor for malseating in one study. Mean MINORS score was 9.8.
CONCLUSIONS
Liner malseating is a rare finding in patients undergoing THAs with dual-mobility articulations. While prelim results demonstrate no negative clinical consequences to date, existing studies are limited, refer to short-term outcomes only, and do not prospectively follow-up affected patients.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Female; Aged; Male; Arthroplasty, Replacement, Hip; Hip Prosthesis; Retrospective Studies; Prosthesis Design; Acetabulum; Prosthesis Failure; Reoperation
PubMed: 37036501
DOI: 10.1007/s00402-023-04855-5