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BMC Musculoskeletal Disorders Jun 2024The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has... (Comparative Study)
Comparative Study
Salvage Latarjet may provide worse outcomes in terms of recurrent instability and returning to sports compared to primary Latarjet: a systematic review of comparative studies.
BACKGROUND
The Latarjet procedure (LP) is performed as a primary stabilization procedure (primary LP) and a salvage procedure when an earlier shoulder stabilization procedure has failed (salvage LP). However, whether primary LP or salvage LP provides better outcomes for anterior shoulder instability remains unknown.
METHODS
Two independent reviewers performed the literature search based on the PRISMA guidelines. A comprehensive search of PubMed, Embase, web of science and Cochrane Library was performed from their inception date to December 4, 2023. Inclusion criteria mainly included the comparison of postoperative outcomes between primary and salvage LP, English language, and full text availability. Two reviewers independently examined the literature, collected data, and evaluated the methodological robustness of the included studies. The Methodological Index for Nonrandomized Studies was used to evaluate the quality of nonrandomized studies. Recurrent instability, complications, reoperations, return to sports, patient-reported outcomes, and range of motion were assessed. Statistical evaluations were conducted using Manager V.5.4.1 (The Cochrane Collaboration, Software Update, Oxford, UK).
RESULTS
Twelve studies were included in the systematic review, with 940 shoulders undergoing primary LP and 631 shoulders undergoing salvage LP. Statistically significant differences in favor of primary LP were found in 2 of the 11 and 2 of 4 included studies in terms of recurrent instability and returning to the same sports (RTS) at preinjury level, respectively. In terms of the visual analog scale, subjective shoulder value and the Western Ontario Shoulder Instability Index, 2 of the 4, 1 of the 3 and 1 of the 3 included studies reported statistically significant differences in favor of primary LP. Differences were not noticed regarding complications, reoperations, the time to RTS, the Rowe score, the Athletic Shoulder Outcome Scoring System, and forward flexion.
CONCLUSION
Current evidence suggests that compared with primary LP, salvage LP may provide inferior postoperative outcomes in terms of recurrent instability and the rate of RTS at preinjury level. Primary and salvage LP may yield comparable efficacy in terms of complications, reoperations, the rate of RTS, the time to RTS, pain, shoulder function, and range of motion.
PROSPERO ID
CRD42023492027.
Topics: Humans; Joint Instability; Return to Sport; Salvage Therapy; Recurrence; Shoulder Joint; Treatment Outcome; Range of Motion, Articular; Shoulder Dislocation; Reoperation; Orthopedic Procedures
PubMed: 38937741
DOI: 10.1186/s12891-024-07593-w -
The Iowa Orthopaedic Journal 2024Acetabular dysplasia has a wide range of prevalence reported in the literature. This variation is likely due to differences in the population under investigation and...
BACKGROUND
Acetabular dysplasia has a wide range of prevalence reported in the literature. This variation is likely due to differences in the population under investigation and studies focusing on cohorts with hip pain and osteoarthritis. There are reports of radiographic hip dysplasia prevalence for adults without hip pain but there is no systematic review of these studies to document the incidence in the general population. The purpose of this systematic review was to provide a full summary of all studies that report prevalence of hip dysplasia in adults without hip pain.
METHODS
PRISMA guidelines were utilized as an outline for this systematic review. Articles were pulled from PubMed, OVID Medline, Embase, SCOPUS, Cochrane Central Register of Clinical Trials, and clinicaltrials.gov from their inception dates to 1/7/24. Studies were included if participants were asymptomatic and reported rates of prevalence.
RESULTS
Fourteen studies were included in this systematic review. There were 10,998 hips from 5,506 participants included in this analysis. The overall prevalence of radiographic hip dysplasia was 2.3%. Eight studies of 5,930 hips reported the prevalence of hip dysplasia by sex. The prevalence rate in these studies was 3.8% in females and 2.7% in males.
CONCLUSION
Acetabular dysplasia based on radiographic measurements is relatively common in the general adult population. Furthermore, females have a higher prevalence rate when compared to males. It is important to recognize the incidence of hip dysplasia in the asymptomatic adult population as we recommend surgical treatment for patients who present with hip pain and dysplasia. Further studies should investigate the natural history of untreated and treated hip dysplasia. .
Topics: Humans; Prevalence; Adult; Radiography; Hip Dislocation; Male; Female
PubMed: 38919354
DOI: No ID Found -
The Iowa Orthopaedic Journal 2024Hip dysplasia is a leading cause of hip osteoarthritis. While periacetabular osteotomy (PAO) is effective for relieving pain and dysfunction caused by hip dysplasia in... (Review)
Review
BACKGROUND
Hip dysplasia is a leading cause of hip osteoarthritis. While periacetabular osteotomy (PAO) is effective for relieving pain and dysfunction caused by hip dysplasia in adolescents and young adults, there is concern that patients over 40 years of age will have an increased risk of persistent dysfunction and need for total hip arthroplasty. Current available evidence for PAO in older adults is limited and there is no systematic review in the literature focusing on this topic. The current systematic review offers insight into the demographics, patient-reported outcome measure (PROM) scores, and hip survivorship from total hip arthroplasty in patients over 40 years older treated for hip dysplasia with PAO.
METHODS
The review was conducted under the guidelines for the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Databases that were searched included PubMed, OVID Medline, SCOPUS, Embase, Cochrane Library, and clinicaltrials.gov. Studies were screened based on predetermined inclusion and exclusion criteria.
RESULTS
Five studies were included in this systematic review. Enrollment years were 1990-2013. In total, there were 335 hips with mean ages between 43.5-47.2 years. Mean follow up was 4-10.8 years. Most patients that underwent hip preservation had Tonnis osteoarthritis grade 0-1. There was contradicting evidence whether patients >40 years did better or worse compared to <40 years; although, most patients in the >40 years group had good outcomes after PAO. PAO survivorship ranged from 67-100% depending on the study. Complications ranged from 2-36% of cases depending on the study; although, none of these complications had lasting effects.
CONCLUSION
Patients over 40 years old appear to have positive outcomes when treated for hip dysplasia with PAO, though these patients were likely selected for no to minimal osteoarthritis, high functional status, and good health. PAO should be considered for patients with hip dysplasia over 40 years old without hip arthritis, though we recommend very selective indications. .
Topics: Humans; Osteotomy; Adult; Acetabulum; Middle Aged; Osteoarthritis, Hip; Arthroplasty, Replacement, Hip; Treatment Outcome; Hip Dislocation; Female; Male
PubMed: 38919352
DOI: No ID Found -
The Iowa Orthopaedic Journal 2024Early post-operative pain control is essential to facilitate rapid recovery after orthopaedic surgery. Despite periacetabular osteotomy (PAO) being the gold standard...
BACKGROUND
Early post-operative pain control is essential to facilitate rapid recovery after orthopaedic surgery. Despite periacetabular osteotomy (PAO) being the gold standard treatment of prearthritic hip dysplasia, there is limited evidence assessing efficacy of early post-operative pain management strategies. Recent literature has focused on non-opioid supplemental treatments such as nerve blocks or local wound infiltration. The purpose of this systematic review was to assess efficacy of these interventions to reduce pain, facilitate mobilization, reduce length of stay after PAO surgery.
METHODS
A systematic review was created under the guidance of PRISMA from databases that included PubMed, OVID Medline, Embase, SCOPUS, Cochrane Central Register of Clinical Trials, and clinicaltrials.gov from their creation dates to 12/21/23. These studies were screen based on predetermined inclusion and exclusion criteria.
RESULTS
A total of six studies were included in this analysis from independent institutions. Three investigated nerve blocks (fascia iliaca, pericapsular, transversus abdominis), one investigated local wound infiltration with ropivacaine, one investigated high-dose dexamethasone, and the last investigated removal of the epidural catheter on postoperative (POD) 1 compared to POD 2. There were heterogeneous outcomes that were measured from these studies. In general, nerve blocks decreased opioid use, pain, and length of hospital stay. The local wound infiltration decreased pain on POD 3 and 4. Removing the epidural catheter on POD1 compared to POD 2 decreased pain and length of stay. High-dose dexamethasone use decreased opioid use on POD 1, otherwise, there was no difference in pain.
CONCLUSION
In summary, supplemental pain management strategies peri-operatively for PAO surgery can decrease pain, opioid use, and length of hospital stay, though there are few studies assessing these interventions. Limiting opioid use after surgery reduces known negative consequences of the medication and facilitates rapid recovery. Clinical trials are needed that assess efficacy of supplemental pain management strategies after PAO surgery. .
Topics: Humans; Osteotomy; Pain, Postoperative; Pain Management; Acetabulum; Nerve Block; Hip Dislocation; Length of Stay; Pain Measurement
PubMed: 38919337
DOI: No ID Found -
Archives of Orthopaedic and Trauma... Jun 2024Acetabular erosion is an important complication in hemiarthroplasty and may lead to total hip arthroplasty as a conversion. The results of total hip arthroplasty as a... (Review)
Review
INTRODUCTION
Acetabular erosion is an important complication in hemiarthroplasty and may lead to total hip arthroplasty as a conversion. The results of total hip arthroplasty as a conversion remain unclear. We performed a systematic review and meta-analysis to compare the outcome of total hip arthroplasty as a conversion with primary total hip arthroplasty.
MATERIALS AND METHODS
PRISMA guidelines were used and Pubmed, Embase and the Cochrane libraries were searched. Both, studies comparing the outcome of total hip arthroplasty as a conversion with the outcome of primary total hip arthroplasty and the outcome of cohort studies limited to total hip arthroplasty as a conversion, were included. Risk of bias was assessed using the Methodological Index for Non Randomized Studies checklist. Meta-analysis was performed concerning pooled annual revision, dislocation and infection rates.
RESULTS
A total of 27 studies were available for analysis; four comparative studies and 23 cohort studies. Comparative studies were defined as high quality and cohort studies as medium quality. Analysis revealed a significantly higher overall revision risk (Hazard Ratio 1.72, 95% confidence interval 1.39 to 2.14) after total hip arthroplasty as a conversion compared to primary total hip arthroplasty. The annual revision rate of total hip arthroplasty as a conversion was 1.63% (95% confidence interval 1.14 to 2.33) in the comparative studies and 1.40% (95% confidence interval 1.17 to 1.66) in the cohort studies. A pooled infection rate of 4.34% (95% confidence interval 2.66 to 7.01) and dislocation rate of 4.79% (95% confidence interval 3.02 to 7.53), was found.
CONCLUSIONS
Literature concerning the results of total hip arthroplasty as a conversion is limited. The risk of revision after conversion of hemiarthroplasty is higher compared to primary total hip arthroplasty.
PubMed: 38904682
DOI: 10.1007/s00402-024-05385-4 -
The Journal of Arthroplasty Jun 2024Sarcopenia is a progressive loss of skeletal muscle mass and function. It is associated with adverse outcomes after several orthopaedic procedures. However, its role in...
BACKGROUND
Sarcopenia is a progressive loss of skeletal muscle mass and function. It is associated with adverse outcomes after several orthopaedic procedures. However, its role in total joint arthroplasty(TJA) is not fully explored. Therefore, we wanted to conduct a systematic review and meta-analysis to answer the following questions:(1) What is the prevalence of sarcopenia in patients undergoing TJA?;(2) What factors are associated with the prevalence of sarcopenia in patients undergoing TJA?;What is the impact of sarcopenia on medical outcomes following TJA?;and (4) What is the impact of sarcopenia on surgical outcomes following TJA?
METHODS
Electronic databases PubMed, Scopus, Cochrane, and Google Scholar were searched. The data was pooled using the random-effects model and graphically represented by a forest plot. We included a total of thirteen studies, evaluating 399,097 patients.
RESULTS
The pooled prevalence of sarcopenia was 20.1%(95% CI[confidence interval] 13.6 to 28.8%; P<0.00001;I=94.7%) in total knee arthroplasty(TKA) and 5.2%(95% CI 0.1 to 69.7%;P=0.128;I=99.6%) in total hip arthroplasty(THA). Meta-regression found no links between age, sex, body mass index(BMI), diabetes, obesity, arthroplasty type, and sarcopenia prevalence in TJA. Sarcopenia increased risk of blood transfusion (OR [odds ratio] 4.68[95% CI 3.51 to 6.25];P<0.00001), pneumonia (OR 1.94[95% CI 1.14 to 3.30];P=0.01),Urinary Tract Infection UTI (OR 1.64 [95% CI 1.31 to 2.05];P<0.001), prosthetic fracture (OR 2.12[95% CI 1.51 to 2.98];P<0.0001), prosthetic dislocation (OR 1.99[95% CI 1.62 to 2.44];P<0.00001), and mechanical loosening (OR 1.78[95% CI 1.43 to 2.22];P<0.00001) in TKA. Sarcopenic patients were at an increased the risk of UTI (OR 1.79 [95% CI 1.32 to 2.43];P=0.0002) and prosthetic loosening (OR 1.97[95% CI 1.10 to 3.53];P=0.02) post-THA.
CONCLUSION
Baseline sarcopenia was prevalent in patients undergoing TJA. It was associated with an increased risk of UTI and prosthetic loosening following TKA and THA. Increased risk of blood transfusion, pneumonia, prosthetic fractures, and mechanical loosening following TKA.
PubMed: 38901711
DOI: 10.1016/j.arth.2024.06.021 -
Journal of Clinical Medicine Jun 2024: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and... (Review)
Review
Reverse Shoulder Arthroplasty versus Non-Operative Treatment of Three-Part and Four-Part Proximal Humerus Fractures in the Elderly Patient: A Pooled Analysis and Systematic Review.
: The treatment of complex proximal humerus fractures in elderly patients is not yet fully elucidated. Of all treatment options, reverse shoulder arthroplasty (RSA) and non-operative treatment (NOT) appear to provide the best results. Evidence to guide the choice between the two is sparse. Therefore, this review provides an overview of the available evidence on RSA versus NOT. : Studies comparing complex proximal humerus fractures in patients aged >65 years treated either with RSA or NOT were included for systematic review and direct comparison via pooled analysis of patient-rated outcome and range of motion. Indirect comparison of case series and non-comparative studies on either treatment was performed separately. : Three comparative studies including 77 patients treated with RSA and 81 treated non-operatively were analysed. The RSA group scored better for both the Constant-Murley score (mean difference 6 points) and DASH score (mean difference 8 points). No differences were detected in ASES, PENN score, pain scores, or range of motion between treatment groups. The most common complications for RSA were infection (3%), nerve injury (2%), and dislocation (2%). Reoperation was required in 5%. In the NOT group, common complications included malunion (42%), osteonecrosis (25%), and non-union (3%); no reoperation was required. Patient satisfaction was equal in both groups. : The functional outcomes and range of motion after RSA seemed satisfactory and potentially superior to NOT in elderly patients. Patient satisfaction was comparable despite a high malunion and osteonecrosis rate in the non-operative treatment group, which did not require re-interventions.
PubMed: 38893055
DOI: 10.3390/jcm13113344 -
Journal of Clinical Medicine May 2024: Recurrent shoulder instability following Bankart lesion repair often necessitates surgical revision. This systematic review aims to understand the failure rates of... (Review)
Review
: Recurrent shoulder instability following Bankart lesion repair often necessitates surgical revision. This systematic review aims to understand the failure rates of arthroscopic revision Bankart repair. : Following the PRISMA guidelines and registered on PROSPERO, this systematic review examined twenty-five articles written between 2000 and 2024. Two independent reviewers assessed eligibility across three databases, focusing on recurrent instability as the primary endpoint, while also noting functional measures, adverse events, revision operations, and return-to-sport rates when available. : The key surgical techniques for recurrent instability post-Bankart repair were identified, with revision arthroscopic Bankart being the most common (685/1032). A comparative analysis revealed a significantly lower recurrence for open coracoid transfer compared to arthroscopic revision Bankart repair (9.67% vs. 17.14%; < 0.001), while no significant difference was observed between remplissage plus Bankart repair and Bankart repair alone (23.75% vs. 17.14%; = 0.24). The majority of studies did not include supracritical glenoid bone loss or engaging Hill-Sachs lesions, and neither subcritical nor non-engaging lesions significantly influenced recurrence rates ( = 0.85 and = 0.80, respectively). : Revision arthroscopic Bankart repair remains a viable option in the absence of bipolar bone loss; however, open coracoid transfer appears to have lower recurrence rates than arthroscopic Bankart repair, consistent with prior evidence. Further studies should define cutoffs and investigate the roles of critical glenoid bone loss and off-track Hill-Sachs lesions. Preoperative measurements of GBL on three-dimensional computed tomography and characterizing lesions based on glenoid track will help surgeons to choose ideal candidates for arthroscopic revision Bankart repair.
PubMed: 38892778
DOI: 10.3390/jcm13113067 -
JBJS Reviews Jun 2024Multiple hemiarthroplasty (HA) approaches exist for femoral neck fracture (FNF) treatment. However, there is no consensus on the superiority of one approach for... (Meta-Analysis)
Meta-Analysis Comparative Study
A Comparison of Surgical Approaches for Hip Hemiarthroplasty Performed for the Treatment of Femoral Neck Fracture: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials.
BACKGROUND
Multiple hemiarthroplasty (HA) approaches exist for femoral neck fracture (FNF) treatment. However, there is no consensus on the superiority of one approach for postoperative outcomes. This study assessed outcomes among randomized controlled trials (RCTs) comparing the posterior approach (PA), direct lateral approach (DLA), anterolateral approach (ALA), and the direct anterior approach (DAA) in HA for FNF.
METHODS
PubMed, Ovid/MEDLINE, Scopus, Cochrane Central Registry of Controlled Trials, and Cochrane Database of Systematic Reviews were queried in February 2024. A frequentist model network meta-analysis of eligible prospective RCTs compared outcomes among approaches using P-scores.
RESULTS
Of 1,481 retrieved studies, 11 RCTs totaling 1,513 FNF patients who underwent HA through a PA (n = 446; 29.5%), DLA (n = 481; 31.8%), ALA (n = 296; 19.6%), or DAA (n = 290; 19.2%) with median (interquartile range) follow-up of 6 (4.5-12.0) months were included for meta-analysis. DAA was associated with statistically increased operative duration (mean difference [MD], 1.89 minutes; 95% CI, 0.08 to 3.69 minutes; p < 0.001) compared with a PA, whereas an ALA was associated with statistically greater blood loss compared with a PA (MD, 5.81 mL; 95% CI, 4.11 to 7.50 mL; p < 0.001). There were no differences in the incidence of fracture, dislocation, infection, complications, revision, nor 1-year mortality among approaches. There were also no differences in hip nor pain score improvement at latest follow-up, although with high heterogeneity (I2 = 85.7% and 94.2%, respectively).
CONCLUSION
This study found no clinical difference in improvement in pain, function, nor in revision outcomes and operative characteristics among HA approaches for FNF, and each approach had a similar adverse event profile. Despite limited randomized evidence, these findings suggest comparable short-term efficacy and safety of all approaches.
LEVEL OF EVIDENCE
Therapeutic, Level I. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Femoral Neck Fractures; Hemiarthroplasty; Randomized Controlled Trials as Topic; Network Meta-Analysis
PubMed: 38889234
DOI: 10.2106/JBJS.RVW.24.00067 -
Frontiers in Public Health 2024Cannabis use may be increasing as countries legalize it and it becomes socially acceptable. A history of cannabis use may increase risk of complications after various... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Cannabis use may be increasing as countries legalize it and it becomes socially acceptable. A history of cannabis use may increase risk of complications after various kinds of surgery and compromise functional recovery. Here we systematically reviewed and meta-analyzed available evidence on how history of cannabis use affects recovery after hip or knee arthroplasty (THA/TKA).
METHODS
The PubMed, EMBASE, and Web of Science databases were comprehensively searched and studies were selected and analyzed in accordance with the PRISMA guidelines. The methodological quality of included studies was assessed based on the Newcastle-Ottawa Scale, while quality of evidence was evaluated according to the "Grading of recommendations assessment, development, and evaluation" system. Data on various outcomes were pooled when appropriate and meta-analyzed.
RESULTS
The systematic review included 16 cohort studies involving 5.91 million patients. Meta-analysis linked history of cannabis use to higher risk of the following outcomes: revision (RR 1.68, 95% CI 1.31-2.16), mechanical loosening (RR 1.77, 95% CI 1.52-2.07), periprosthetic fracture (RR 1.85, 95% CI 1.38-2.48), dislocation (RR 2.10, 95% CI 1.18-3.73), cardiovascular events (RR 2.49, 95% CI 1.22-5.08), cerebrovascular events (RR 3.15, 95% CI 2.54-3.91), pneumonia (RR 3.97, 95% CI 3.49-4.51), respiratory failure (RR 4.10, 95% CI 3.38-4.97), urinary tract infection (RR 2.46, 95% CI 1.84-3.28), acute kidney injury (RR 3.25, 95% CI 2.94-3.60), venous thromboembolism (RR 1.48, 95% CI 1.34-1.63), and deep vein thrombosis (RR 1.42, 95% CI 1.19-1.70). In addition, cannabis use was associated with significantly greater risk of postoperative transfusion (RR 2.23, 95% CI 1.83-2.71) as well as higher hospitalization costs.
CONCLUSION
History of cannabis use significantly increases the risk of numerous complications and transfusion after THA or TKA, leading to greater healthcare costs. Clinicians should consider these factors when treating cannabis users, and pre-surgical protocols should give special consideration to patients with history of cannbis use.
Topics: Humans; Arthroplasty, Replacement, Knee; Arthroplasty, Replacement, Hip; Postoperative Complications
PubMed: 38827608
DOI: 10.3389/fpubh.2024.1377688