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Knee Surgery, Sports Traumatology,... Mar 2024The purpose of this systematic review is to consolidate outcomes of obese patients undergoing high tibial osteotomy and to investigate the effect of obesity on...
PURPOSE
The purpose of this systematic review is to consolidate outcomes of obese patients undergoing high tibial osteotomy and to investigate the effect of obesity on postoperative outcomes, including symptomatic relief and time to conversion to arthroplasty.
METHODS
Medline, Embase and Cochrane Library were searched from database inception up to April 2023 according to PRISMA guidelines by two reviewers. Search terms including 'obesity', 'BMI', 'osteotomy' and 'high tibial osteotomy (HTO)' were included to identify all relevant articles. Only studies that explicitly reported outcomes for obese patients were included. Disagreements in study inclusion or quality assessment were resolved by a senior third reviewer. Metrics compared include time to arthroplasty, preoperative and postoperative mechanical tibiofemoral angle (mTFA), patient-reported satisfaction scores and postoperative complications.
RESULTS
Nine studies comparing 973 patients were included. The mean age was 52.7 ± 4.2 years old and 38.4% were male. Six studies performed the medial opening-wedge HTO, and three utilized the medial wedge closing technique. Most studies indicated significant improvement following surgical intervention with satisfactory outcomes in obese and nonobese patients. In addition, differences in complication rates were minimal between obese and nonobese patients (n.s.), while functional scores did not vary significantly. Conversion to total knee arthroplasty was not found to increase in obese patients (n.s.).
CONCLUSION
Obesity does not appear to carry a greater complication risk or worse outcomes following high tibial osteotomies, and surgeons should consider HTO a viable option for young obese patients with symptomatic unicompartmental chondral wear with coronal limb malalignment.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Male; Middle Aged; Female; Arthroplasty, Replacement, Knee; Osteoarthritis, Knee; Treatment Outcome; Tibia; Osteotomy; Obesity; Knee Joint; Retrospective Studies
PubMed: 38410034
DOI: 10.1002/ksa.12084 -
Children (Basel, Switzerland) Feb 2024(1) Aim: The aim of this study was to determine the relationship between lower limb bone deformities and body functions, activity, and participation in ambulant children... (Review)
Review
Bone Deformities through the Prism of the International Classification of Functioning, Disability and Health in Ambulant Children with Cerebral Palsy: A Systematic Review.
(1) Aim: The aim of this study was to determine the relationship between lower limb bone deformities and body functions, activity, and participation in ambulant children with CP and whether changing bone morphology affects outcomes in these domains. (2) Methods: A systematic literature search (PROSPERO CRD42020208416) of studies reporting correlations between measures of lower limb bone deformities and measures of body function, activity or participation, or post-surgical outcomes in these domains was conducted from 1990 to 2023 in Medline, Scopus, and Cochrane Library. We assessed study quality with the Checklist for Case Series (CCS) and a quality assessment developed by Quebec University Hospital. Meta-analysis was not possible; therefore, descriptive synthesis was performed. (3) Results: A total of 12 of 3373 screened articles were included. No studies evaluated the relationships between bone deformities and activity or participation, or the effect of isolated bone surgery on these domains. Correlations between bone deformities and body functions were poor-to-moderate. Internal hip rotation during gait improved after femoral derotation osteotomy. (4) Conclusions: A shift in paradigm is urgently required for the research and management of bone deformities in children with CP to include the activity and participation domains of the ICF, as well as consider more psychological aspects such as self-image.
PubMed: 38397369
DOI: 10.3390/children11020257 -
Knee Surgery, Sports Traumatology,... Mar 2024Patellofemoral instability (PFI) is a common condition that can be caused from multiple factors, including lower limb rotational malalignments. Determining precise...
PURPOSE
Patellofemoral instability (PFI) is a common condition that can be caused from multiple factors, including lower limb rotational malalignments. Determining precise criteria for performing corrective torsional osteotomy can be a daunting task due to the lack of consensus on normal and excessive values and the limited evidence-based data in the postoperative results. The purpose was to assess the clinical, functional and imaging outcomes following derotational distal femoral osteotomy (DDFO) in patients with PFI and/or anterior knee pain (AKP) associated with lower limb rotational malalignments.
METHODS
Searches were conducted on PubMed, EMBASE and Web of Science databases up to October 2023. Studies reporting outcomes after DDFO in patients with PFI and/or AKP were eligible for the systematic review. The primary outcome was imaging metrics, especially femoral anteversion. Secondary outcomes included the patient-reported outcome measures (PROMs) (clinical and functional). Quantitative synthesis involved the use of weighted averages to calculate pre- to postoperative mean differences (MD) and compare them against the minimal clinically important difference (MCID).
RESULTS
Ten studies (309 knees) were included with a mean follow-up of 36.1 ± 11.7 months. Imaging outcomes consistently indicated the correction of femoral anteversion (MD = -19.4 degrees, 95% confidence interval: -20.1 to -18.7) following DDFO. PROMs showed significant improvements in most studies, exceeding the MCID. Patient satisfaction with the DDFO was high (93.3%).
CONCLUSIONS
The DDFO was an effective treatment option for correcting excessive femoral anteversion in patients with PFI associated with clinically relevant functional and clinical improvement and a high satisfaction rate.
LEVEL OF EVIDENCE
Level IV, systematic review of level II-IV studies.
Topics: Humans; Femur; Knee Joint; Treatment Outcome; Patient Satisfaction; Osteotomy; Pain; Patellofemoral Joint
PubMed: 38385776
DOI: 10.1002/ksa.12097 -
Knee Surgery, Sports Traumatology,... Mar 2024To conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing...
PURPOSE
To conduct a systematic review evaluating potential correlations between preoperative articular cartilage integrity on outcomes and survivorship in patients undergoing meniscal allograft transplantation (MAT).
METHODS
A literature search was performed by querying SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 PRISMA statement. Inclusion criteria were limited to studies reporting on outcomes and survivorship following MAT based on preoperative cartilage status.
RESULTS
Sixteen studies, consisting of 1723 patients (n = 1758 total menisci), were identified in six level III and 10 level IV evidence studies. There was high heterogeneity in cartilage grading scales, reporting of concomitant cartilage procedures, and indications for MAT based on osteoarthritis. Patients with lower limb malalignment were either excluded or corrected with an osteotomy. MAT failure rate was reported in nine studies, with four studies reporting a greater rate of failure in knees with higher degrees of cartilage damage. Eight studies reported on clinical outcomes based on cartilage grade, with two studies reporting significant differences in clinical outcomes based on cartilage grade. Of the five studies reporting management of full-thickness chondral defects with cartilage surgery, three studies reported no significant difference in survivorship based on preoperative cartilage grade, while one study reported lower survivorship and one study reported unclear results. No studies found significant differences in survivorship and outcomes between medial and lateral MAT.
CONCLUSIONS
Conflicting results and high variability in reporting of concomitant cartilage repair and indications for MAT exist in studies evaluating the efficacy of MAT based on articular cartilage status. The degree of preoperative chondral damage did not have a strong relationship with clinical outcomes following MAT. Higher degrees of cartilage damage were associated with higher MAT failure rates, with possible improvement in survivorship when treated with an appropriate cartilage procedure.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Cartilage, Articular; Survivorship; Menisci, Tibial; Musculoskeletal Diseases; Osteotomy; Allografts; Follow-Up Studies
PubMed: 38383989
DOI: 10.1002/ksa.12065 -
Journal of Cranio-maxillo-facial... Apr 2024This systematic review aimed to investigate the factors that may contribute to the development of OSA after orthognathic surgery in patients with skeletal class III.... (Review)
Review
This systematic review aimed to investigate the factors that may contribute to the development of OSA after orthognathic surgery in patients with skeletal class III. Electronic searches of PubMed, Embase, Web of Science, and Cochrane databases were conducted up to December 10, 2022. In total, 277 studies were retrieved and screened according to the inclusion and exclusion criteria, and 14 were finally selected. All studies were of medium quality (moderate risk of bias). The occurrence of OSA after orthognathic surgery in patients with class III skeletal relationships depends on surgical factors and patient self-factors. Surgical factors include surgery type, amount of maxillary and mandibular movement, and the patient's postoperative swelling. Patient self-factors include weight, age, gender, and hypertrophy of the soft palate, tonsils, and tongue. According to information in the 14 selected articles, the incidences of OSA after Le Fort I impaction and BSSO setback, BSSO setback, and Le Fort I advancement and BSSO setback were 19.2%, 8.57%, and 0.7%, respectively, mostly accompanied with greater amounts of mandibular recession. However, no clear evidence exists to confirm that orthognathic surgery is a causative factor for postoperative sleep breathing disorders in patients with mandibular prognathism. The wider upper airway in patients with class III skeletal might be the reason for the rare occurrence of OSA after surgery. In addition, obesity and advanced age may lead to sleep apnea after orthognathic surgery. Obese patients should be advised to lose weight preoperatively.
Topics: Humans; Orthognathic Surgery; Osteotomy, Le Fort; Sleep Apnea, Obstructive; Malocclusion, Angle Class III; Mandible; Orthognathic Surgical Procedures; Maxilla; Cephalometry
PubMed: 38383249
DOI: 10.1016/j.jcms.2024.02.014 -
Journal of Orthopaedic Surgery and... Feb 2024This study aimed to systematically compare the efficacy and safety of arthroscopic wafer procedure (AWP) versus ulnar shortening osteotomy (USO) for ulnar impaction... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
This study aimed to systematically compare the efficacy and safety of arthroscopic wafer procedure (AWP) versus ulnar shortening osteotomy (USO) for ulnar impaction syndrome (UIS) treatment.
METHODS
All the studies included in this meta-analysis compared the efficacy of AWP to USO for UIS and were acquired through a comprehensive search across multiple databases. The meta-analysis was performed by calculating the effect sizes with the Cochrane Collaboration's RevMan 5.4 software.
RESULTS
A total of 8 articles were included in this analysis, comprising 148 cases in the AWP group and 163 cases in the USO group. The pooled estimates indicated no significant differences in combined Darrow's Criteria or Modified Mayo Wrist Score, Modified Mayo Wrist Score, DASH scores, grip strength, VAS score, and postoperative ulnar variation. On the other hand, the patients in the AWP group exhibited fewer complications (OR = 0.17, 95%CI 0.05-0.54, P = 0.003) and a lower reoperation rate (OR = 0.12, 95%CI 0.05-0.28, P < 0.00001) than those in the USO group.
CONCLUSIONS
The two surgical techniques were both effective in treating UIS but the AWP group showed fewer complications and a lower reoperation rate. Therefore, AWP may present a superior alternative for UIS treatment.
Topics: Humans; Arthroscopy; Joint Diseases; Osteotomy; Wrist Joint; Wrist; Ulna; Treatment Outcome; Retrospective Studies
PubMed: 38378573
DOI: 10.1186/s13018-024-04611-4 -
Journal of Pediatric Orthopedics. Part B Feb 2024A systematic review of the operative techniques for treating cubitus varus deformity in children was performed using research databases including PubMed and Embase....
A systematic review of the operative techniques for treating cubitus varus deformity in children was performed using research databases including PubMed and Embase. Outcome measurements included mean angular correction of the humerus-elbow-wrist angle, complications, revisions and outcome scores. A total of 45 papers and 911 patients were included. Lateral closing wedge osteotomy (LCWO) (427 patients) was the most common procedure and 5.56% of these patients experienced lateral condylar prominence. This technique had the highest revision rate at 3%. The step-cut osteotomy (111 patients) yielded zero postoperative infections or loss of motion. Distraction osteogenesis (92 patients) was the least common technique. Superficial pin tract infections occurred in 18% of patients and 88.04% of patients reported excellent results, the highest of any technique in this study. The infection rate of dome osteotomy (151 patients) was 9.45% and 4.72% of patients experienced loss of motion. 3D osteotomy (130 patients) had no infections, 87.78% of patients reported excellent outcomes, and 2.22% of patients reported poor outcomes, the lowest of all techniques. For unidimensional correction, LCWO provides a technically simple procedure and reasonable outcomes. Step-cut osteotomy has less lateral condylar prominence but is more complicated than LCWO. Distraction osteogenesis is a minimally invasive alternative to LCWO and step-cut osteotomy, but it has more superficial infections and can be bothersome to patients. For a multidimensional correction, 3D osteotomy is superior to dome osteotomy due to its lower infection rate and higher rate of functionally excellent outcomes.
PubMed: 38375863
DOI: 10.1097/BPB.0000000000001167 -
The Saudi Dental Journal Jan 2024The aim was to evaluate the difference in the heat generated between zirconia (Zr) and steel (SS) drills, during implant site preparation. (Review)
Review
OBJECTIVE
The aim was to evaluate the difference in the heat generated between zirconia (Zr) and steel (SS) drills, during implant site preparation.
MATERIAL AND METHODS
This systematic review followed the PRISMA methodology criteria and used the JBI Critical Assessment Guidelines for Quasi-Experimental Studies for quality assessment. The electronic search was conducted by using the PubMed/MEDLINE, Embase, and Cochrane Library databases to January 2023. The formulated population, intervention, comparison, outcome (PICO) question was "Do zirconia drills generate less heat than steel drills during implant site preparation?". The meta-analysis was based on an inverse variance (IV) method.
RESULTS
This review included 10 studies in vitro that used zirconia drills compared to steel drills with or without coatings. The meta-analysis indicated a significant difference between Zr drills and SS drills, with a lower bone temperature variation with Zr drills.
CONCLUSIONS
Despite the limitations of this review, it was concluded that Zr drills had significantly less temperature variation than SS drills.
PubMed: 38375375
DOI: 10.1016/j.sdentj.2023.09.001 -
Journal of ISAKOS : Joint Disorders &... Jun 2024Patellofemoral instability (PFI) has multiple predisposing anatomic factors, including ligamentous hyperlaxity, coronal and axial malalignment, patella alta, trochlea... (Review)
Review
Femoral internal torsion greater than twenty-five degrees and/or external tibial torsion greater than thirty degrees as measured by computed tomography are threshold values for axial alignment correction in patellofemoral instability.
OBJECTIVES
Patellofemoral instability (PFI) has multiple predisposing anatomic factors, including ligamentous hyperlaxity, coronal and axial malalignment, patella alta, trochlea dysplasia, excessive lateral patellar tilt, and excessive lateral Q vector. Yet, few studies have analyzed surgical thresholds for performing axial alignment corrective osteotomies in the treatment of PFI and patella maltracking. The objective of this systematic literature review was to determine if there is a threshold for axial plane alignment that triggers surgical correction for the treatment of patellar instability in the published literature.
METHODS
Using a predetermined search strategy, a systematic literature search of 10 major databases and gray literature resources was completed. Only studies reporting on patellar instability and outcomes were included. Radiologic indications, additional procedures, outcomes, and complications were reported. Titles and abstracts were screened, and full-text manuscripts were then selected and extracted. Variables related to radiographic and clinical parameters, patient demographics, surgery performed, surgical correction, complications, and reoperations were recorded preoperatively and postoperatively.
RESULTS
A total of 1132 abstracts and titles were screened by two reviewers, yielding 15 eligible studies. The reported threshold identified in our study for axial plane alignment that triggers surgical correction in most of the published literature when discussing PFI was either tibial torsion greater than 30° and/or femoral anteversion greater than 25°. Following rotational osteotomy of one or both long bones, one study (7%) reported improvements in tubercle-sulcus angle, two studies (13%) reported improvements in femoral-tibial angle, and four studies (27%) reported decreases in tibial torsion. For patient-reported outcomes, seven studies (47%) reported improvement in the Kujala score, five studies (33%) reported postoperative improvement in Lysholm, and four studies (27%) reported improvement in the International Knee Documentation Committee (IKDC) score. Nine studies (60%) reported preoperative femoral anteversion; however, only two studies compared pre- and post-operative values (one study reported a decrease in anteversion and another study reported an increase in anteversion).
CONCLUSION
When treating PFI, the reported threshold for axial plane alignment that triggers surgical correction in most of the published literature was tibial torsion greater than 30° and/or femoral anteversion greater than 25° as measured by CT. However, there is no consensus on the axial alignment measurement technique.
LEVEL OF EVIDENCE
III.
Topics: Humans; Joint Instability; Patellofemoral Joint; Femur; Tibia; Osteotomy; Tomography, X-Ray Computed; Patella; Female; Male
PubMed: 38365167
DOI: 10.1016/j.jisako.2024.02.002 -
The American Journal of Sports Medicine Jul 2024Hip arthroscopy in patients with borderline hip dysplasia has satisfactory outcomes at short-term follow-up; however, the data on midterm outcomes are inconsistent, and...
BACKGROUND
Hip arthroscopy in patients with borderline hip dysplasia has satisfactory outcomes at short-term follow-up; however, the data on midterm outcomes are inconsistent, and failure rates are high in some studies, limiting understanding of the role and utility of hip arthroscopy in this patient cohort.
PURPOSE
To provide an up-to-date, evidence-based review of the clinical outcomes of primary hip arthroscopy in patients with frank or borderline hip dysplasia at ≥5-year follow-up and report the failure rate and progression to total hip arthroplasty in this cohort.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they evaluated outcomes of primary hip arthroscopy in patients with lateral center-edge angle (LCEA) <25° at ≥5-year follow-up. Risk of bias assessment was performed using the methodological index for non-randomized studies scoring system. Level of evidence was determined using criteria from the Oxford Centre for Evidence-Based Medicine.
RESULTS
Nine studies were included in this review. Patients with LCEA <25° demonstrated satisfactory clinical outcomes, high patient satisfaction, and significant postoperative improvements in patient-reported outcomes (PROs) at follow-up ranging from a ≥5 to 10 years. Studies comparing patients with dysplasia to those without did not demonstrate significant differences in preoperative, postoperative, or delta PROs or in failure, reoperation, or revision rates. There was no overall significant correlation between outcomes and LCEA stratification.
CONCLUSION
Hip arthroscopy in carefully selected patients with LCEA <25° can be successful at mid- to long-term follow-up and may provide clinical outcomes and failure rates comparable with patients with normal LCEA, understanding that this is a singular, 2-dimensional radiographic measure that does not differentiate instability from impingement or combinations thereof, warranting future studies delineating these differences. These findings suggest that hip dysplasia may not be an absolute contraindication for isolated hip arthroscopy and may serve as a viable intervention with consideration of staged future periacetabular osteotomy (PAO). Importantly, this review does not suggest that hip arthroscopy alters the natural history of dysplasia; therefore, patients with dysplasia should be counseled on the potential utility of PAO by appropriate hip preservation specialists.
Topics: Humans; Arthroscopy; Hip Dislocation; Acetabulum; Arthroplasty, Replacement, Hip; Follow-Up Studies; Treatment Outcome
PubMed: 38333917
DOI: 10.1177/03635465231197177