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The Journal of Arthroplasty Jan 2024Efficacy, clinical outcomes, and complications following hip fusion conversion to total hip arthroplasty (THA) surgery have been explored in several studies with... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Efficacy, clinical outcomes, and complications following hip fusion conversion to total hip arthroplasty (THA) surgery have been explored in several studies with controversial findings and no consensus.
METHODS
Comprehensive search of online databases was performed through December 2022 for prepost clinical trials using MeSH keywords. Harris hip score (HHS), leg length discrepancy (LLD), pain score, and range of motion (ROM) were considered as clinical outcomes along with implant survival and complications. The retrieved studies were assessed for methodologic quality. Weighted mean difference (WMD) with 95% confidence interval (CI) were calculated using random effects meta-analysis taking into account for heterogeneity. Subgroup meta-analysis as well as sensitivity analysis were performed.
RESULTS
Findings of meta-analysis on 34 trials showed that HHS increase after THA (WMD: 42.3; 95% confidence interval (CI): 38 to 47). Subgroup analyses indicated that cementless prosthesis, length of arthrodesis <12 years, age <45 years, and studies with good quality have more HHS improvement. The LLD decreased 21 mm (95% CI: 19 to 24 mm) based on 21 trials. The range of motion (ROM) reached to 89 (95% CI: 84 to 95) for flexion, 32 (95% CI: 27 to 37) for abduction, 25 (95% CI: 21 to 29) for adduction, 29 (95% CI: 25 to 33) for external rotation, and 25 (95% CI: 20 to 31) for internal rotation after surgery. The most common complication was heterotopic ossification (14%).
CONCLUSION
Conversion of an ankylosed hip to THA leads to improved hip function and leg discrepancy with relatively notable rate of complications. Our findings could provide a framework to guide surgeons and decision makers.
Topics: Humans; Middle Aged; Arthroplasty, Replacement, Hip; Treatment Outcome; Arthrodesis; Retrospective Studies; Hip Prosthesis
PubMed: 37541602
DOI: 10.1016/j.arth.2023.07.021 -
World Neurosurgery Oct 2023Thoracic ossification of ligamentum flavum (TOLF) is a rare disease that often results in worsening neurologic sequelae if left untreated. Although the gold standard...
BACKGROUND
Thoracic ossification of ligamentum flavum (TOLF) is a rare disease that often results in worsening neurologic sequelae if left untreated. Although the gold standard treatment for TOLF is open posterior laminectomy, it is often accompanied by high rates of complications and perioperative morbidity. There have been studies looking into feasibility of endoscopic posterior decompression for TOLF, citing potential for lower perioperative morbidity and achieving similar functional outcomes to its open laminectomy counterparts. We provide an up-to-date systematic review of clinical outcomes after endoscopic posterior decompression for TOLF from the latest assemblage of evidence.
METHODS
A systematic review of the technique was conducted from May 2000 to May 2023. Articles were selected based on PRISMA guidelines. Eligibility of studies was independently by 2 reviewers, with disagreements resolved by a third author.
RESULTS
Nineteen primary references comprising 337 patients with TOLF who underwent endoscopic posterior decompression were included in the systematic review. Mean follow-up time across all studies ranged from 8.9 to 65.3 months. Mean age ranged from 51.2 to 63 years, with mean intraoperative blood loss ranging from 15 to 62 mL. There is significant improvement in visual analog scale (VAS) score, VAS back, VAS leg, modified Japanese Orthopaedic Association score, and Oswestry Disability Index compared with preoperative recorded values across all studies, with low rates of complications reported.
CONCLUSIONS
Endoscopic posterior spinal decompression is a safe and effective technique for treatment of TOLF, with a low rate of complications and improvement in pain and function.
Topics: Humans; Middle Aged; Laminectomy; Osteogenesis; Ligamentum Flavum; Ossification, Heterotopic; Retrospective Studies; Thoracic Vertebrae; Decompression, Surgical; Treatment Outcome
PubMed: 37480986
DOI: 10.1016/j.wneu.2023.07.066 -
Orthopaedic Surgery Sep 2023Posterior olecranon fracture dislocations (POFDs) were considered posterior Monteggia lesions, which were less described in the literature. The purpose of this study was... (Review)
Review
Posterior olecranon fracture dislocations (POFDs) were considered posterior Monteggia lesions, which were less described in the literature. The purpose of this study was to provide a systematic review of the diagnosis, treatment, prognosis, and complications of POFDs in adults. A systematic review was performed to identify all relevant studies on the POFDs in the PubMed, Web of Science, Embase, and MEDLINE databases. The methodological quality of the studies was scored using the Methodological Index for Non-Randomized Studies (MINORS). A total of 117 patients were identified in the nine studies selected. The high-energy injuries accounted for 42.7% of the included studies. The rates of concomitant coronoid process, radial head fractures, and lateral collateral ligament injury were 84.6% (99/117), 87.2% (102/117), and 5% (6/117), respectively. The procedure was performed with a dorsal mid longitudinal approach to reconstruct all injury components. The postoperative clinical scores included the Broberg/Morrey rating, with a mean rating of excellent or good at 66%, the mean DASH score was 20.6, and the mean ASES score was 83. The flexion and extension arc and forearm rotation arcs were 100° and 134°, respectively. Complications included arthrosis in 28.2% (33/117) of cases, fracture nonunion or delayed union in 9.4% (11/117) of cases, heterotopic ossification in 7% (8/117) of cases, and the re-operation rate was 16% (19/117). There was nearly no postoperative ulnohumeral instability. The main characteristics of POFDs were disruptions of the trochlear notch, including the olecranon and coronoid processes, and severe radial head fractures, while the lateral collateral ligament was spared. Although the POFDs had a low frequency of instability, the prognosis was relatively poor. The POFDs should be considered independently.
Topics: Humans; Adult; Olecranon Fracture; Treatment Outcome; Fracture Fixation, Internal; Joint Dislocations; Ulna Fractures; Elbow Joint; Radius Fractures; Range of Motion, Articular; Retrospective Studies
PubMed: 37461239
DOI: 10.1111/os.13820 -
Revista Espanola de Cirugia Ortopedica... 2024To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on... (Review)
Review
Less superior adjacent syndrome and lower reoperation rate. Medium- and long-term results of cervical arthroplasty versus anterior cervical arthrodesis: Systematic review and meta-analysis of randomized clinical trials.
OBJECTIVE
To compare medium- and long-term postoperative surgical results, especially the adjacent syndrome rate, adverse event rate, and reoperation rate, of patients operated on with cervical arthroplasty or anterior cervical arthrodesis in published randomized clinical trials (RCTs), at one cervical level.
METHODS
Systematic review and meta-analysis. Thirteen RCTs were selected. The clinical, radiological and surgical results were analyzed, taking the adjacent syndrome rate and the reoperation rate as the primary objective of the study.
RESULTS
Two thousand nine hundred and sixty three patients were analyzed. The cervical arthroplasty group showed a lower rate of superior adjacent syndrome (P<0.001), lower reoperation rate (P<0.001), less radicular pain (P=0.002), and a better score of neck disability index (P=0.02) and SF-36 physical component (P=0.01). No significant differences were found in the lower adjacent syndrome rate, adverse event rate, neck pain scale, or SF-36 mental component. A range of motion of 7.91 degrees was also found at final follow-up, and a heterotopic ossification rate of 9.67% in patients with cervical arthroplasty.
CONCLUSION
In the medium and long-term follow-up, cervical arthroplasty showed a lower rate of superior adjacent syndrome and a lower rate of reoperation. No statistically significant differences were found in the rate of inferior adjacent syndrome or in the rate of adverse events.
PubMed: 37423383
DOI: 10.1016/j.recot.2023.06.016 -
Revista Brasileira de Ortopedia Jun 2023The objective of this study was to conduct a systematic review and meta-analysis of relevant randomized control trials (RCTs) to determine the role of ibuprofen, as well...
The objective of this study was to conduct a systematic review and meta-analysis of relevant randomized control trials (RCTs) to determine the role of ibuprofen, as well as the optimum dose and duration of therapy, in preventing the incidence of heterotopic ossification (HO) after primary total hip arthroplasty (THA). A literature search was performed using the PubMed/MEDLINE and Cochrane Library databases for RCTs that compared the use of ibuprofen versus placebo as prophylaxis for HO in patients after THA. The main outcomes for this study were overall occurrence of HO, occurrence according to the Brooker classification, and gastrointestinal complications. A total of 27 potential articles were identified from the database. Eventually, four trials with 1,153 patients were included in the final analysis. When compared with placebo, the use of ibuprofen is associated with a reduction in the incidence of HO at the 3- and 12-month follow-up appointments, as well as the incidence of Brooker II and III HO ( < 0.05). However, there was no significant difference between the ibuprofen and placebo groups in terms of treatment discontinuation due to gastrointestinal complications or the incidence of Brooker I and IV HO ( > 0.05). The existing data indicates that ibuprofen is safe and efficacious in reducing the total incidence of HO along with Brooker II and III HO at follow-up. However, due to the small number of studies, the conclusions are limited; therefore, more high-quality clinical trials are required to develop guidelines for optimal dose and duration of therapy.
PubMed: 37396093
DOI: 10.1055/s-0042-1748947 -
EFORT Open Reviews Jul 2023Comminuted fractures with poor bone quality in the elderly are associated with poor outcomes. An alternative to open reduction and internal fixation (ORIF) alone,...
Comparison of primary total hip arthroplasty with limited open reduction and internal fixation vs open reduction and internal fixation for geriatric acetabular fractures: a systematic review and meta-analysis.
PURPOSE
Comminuted fractures with poor bone quality in the elderly are associated with poor outcomes. An alternative to open reduction and internal fixation (ORIF) alone, primary or acute total hip arthroplasty (aTHA), allows early mobilization with full weight bearing. In this study, we aim to analyze whether treatment of aTHA with/withtout ORIF (limited ORIF) vs ORIF alone yields better intra-operative results, functional outcomes, and less complications.
METHODS
PubMed, Cochrane, Embase, and Scopus databases were searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Random-effects model and 95% confidence intervals were used. The outcomes of interest were surgery time, blood loss, length of hospital stay, Harris hip score (HHS), 36-Item Short Form Survey (SF-36), complication rate, surgical site infection rate, heterotopic ossification rate, reoperation rate, and mortality rate.
RESULTS
Ten observational studies with a total of 642 patients (415 ORIF alone and 227 aTHA with/without ORIF) were included in the systematic review. Compared to ORIF alone, aTHA with limited ORIF provided higher HHS (P = 0.029), better physical function (P = 0.008), better physical component summary (P = 0.001), better mental component summary (P = 0.043) in postoperative 1-year SF-36, lesser complication rate (P = 0.001), and lesser reoperation rate (P = 0.000), but however greater bodily pain (P = 0.001) in acetabular fractured elderlies.
CONCLUSIONS
Acute THA with limited ORIF is favorable alternative to ORIF technique alone. It provided better HHS, physical, and mental component summary in SF-36 and yielded lower complication and reoperation rate compare to ORIF alone.
PubMed: 37395715
DOI: 10.1530/EOR-21-0099 -
ANZ Journal of Surgery 2023To systematically investigate if aspirin (ASA), used as venous thromboembolism (VTE) prophylaxis, plays a role in the prevention of heterotopic ossification (HO)... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To systematically investigate if aspirin (ASA), used as venous thromboembolism (VTE) prophylaxis, plays a role in the prevention of heterotopic ossification (HO) following total hip arthroplasty (THA) and if ASA dosage impacted the rate of HO.
METHODS
Eligible studies published from January 2000 to July 2022 were identified from the computerized searching of PubMed, Scopus and Web of Science. HO was defined according to Brooker Classification. Pooled risk ratios (OR) and 95% confidence interval (CI) were estimated under a random-effect model. Additionally, combined HO incidences were compared according to ASA dosage (a regular dose of 325 bid vs. a low dose of 81 mg bid/162 mg qd).
RESULTS
Thirteen studies were included. ASA administered for VTE prophylaxis was significantly associated with a reduced risk of all-grade HO following THA (univariate, OR: 0.50, 95% CI: 0.34-0.74, P < 0.001; multivariate, OR: 0.60, 95% CI: 0.49-0.73, P < 0.001). Similar results could be observed for high-grade HO (univariate, OR: 0.57, 95% CI: 0.36-0.89, P = 0.015; multivariate, OR: 0.50, 95% CI: 0.27-0.92, P = 0.026). There was a non-significant trend towards a higher incidence of HO formation for low-dose ASA (31%, 95% CI: 29-34%), compared with regular-dose ASA (21%, 95% CI: 11-33%) (P = 0.069 under test of interaction).
CONCLUSIONS
ASA can be an effective option for HO prophylaxis. More well-designed trials with long-term follow-ups are encouraged to confirm the current findings and to investigate the effect of ASA dosage on HO reduction.
Topics: Humans; Aspirin; Arthroplasty, Replacement, Hip; Venous Thromboembolism; Ossification, Heterotopic; Incidence
PubMed: 37043691
DOI: 10.1111/ans.18447 -
Spine Jul 2023Systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
This study aimed to assess the incidence of heterotopic ossification (HO) 10 years after cervical disk replacement (CDR).
SUMMARY OF BACKGROUND DATA
HO is a common complication after CDR and may limit the range of motion of the artificial disk. As HO usually progresses slowly, a long-term follow-up is required to better understand its incidence. In recent years, the increasing number of original articles reporting 10-year outcomes gives us the opportunity to better understand the long-term incidence of HO.
MATERIALS AND METHODS
We searched PubMed, Medline, Embase, and Cochrane Library databases to identify eligible studies. The incidence of HO was pooled, and subgroup analysis was performed. Meta-regression analyses were conducted to identify factors contributing to heterogeneity.
RESULTS
Eleven studies with at least 10 years of follow-up comprising 1140 patients who underwent CDR were included. The pooled incidence of overall HO was 70% (95% CI, 60%-81%) at 10 years postoperatively, 60% (95% CI, 44%-75%) at five or six years postoperatively, and 50% (95% CI, 27%-72%) at one or two years postoperatively. The pooled incidence of severe HO (grade 3 or 4) was 37% (95% CI, 29%-45%), and mild HO (grade 1 to 2) was 30% (95% CI, 17%-44%) at 10 years of follow-up. Pooled range of motion decreased from 8.59° before surgery to 7.40° 10 years after surgery. Subgroup analysis showed that HO incidence differed according to the prosthesis type. The earlier publication was associated with a higher pooled incidence of severe HO in the meta-regression analysis.
CONCLUSIONS
This is the first meta-analysis providing detailed information on the pooled 10-year incidence of HO after CDR. The incidence of HO seems to increase with the length of follow-up.
LEVEL OF EVIDENCE
3.
Topics: Humans; Cervical Vertebrae; Incidence; Neck; Ossification, Heterotopic; Range of Motion, Articular; Retrospective Studies; Total Disc Replacement; Treatment Outcome
PubMed: 37036304
DOI: 10.1097/BRS.0000000000004674 -
Indian Journal of Orthopaedics Apr 2023The study aims to identify the optimal approach for femoral head fracture (FHF) by comparing the postoperative complications and outcome score of the Kocher-Langenbeck...
Comparison of Postoperative Complications Between Trochanter Flip Osteotomy and Kocher-Langenbeck Approaches for the Treatment of Femoral Head Fractures: A Systematic Review and Meta-analysis.
PURPOSE
The study aims to identify the optimal approach for femoral head fracture (FHF) by comparing the postoperative complications and outcome score of the Kocher-Langenbeck posterior approach (KLP) and trochanteric flip osteotomy (TFO) through a systematic review and meta-analysis.
METHODS
MEDLINE, Embase and the Cochrane Library were systematically searched for studies published up to 22 January 2023, which compared TFO to the KLP for FHF treatment. The main outcomes of this meta-analysis were the rate of postoperative complications including osteonecrosis of the femoral head (ONFH), heterotopic ossification (HO), and total hip replacement (THR) conversion rate and Thompson-Epstein (T-E) score at the final follow-up.
RESULTS
We included four studies with 57 cases of FHFs; 27 and 30 patients underwent TFO and the KLP, respectively. Following the pooled analysis, HO incidence was significantly higher in TFO than in the KLP (OR = 4.03; 95% CI 1.10-14.81; = 0.04; = 0%), but there were no differences in other variables, including the incidence of ONFH (OR = 0.41; 95% CI 0.07-2.35; = 0.32; = 0%), THR conversion rate (OR = 0.82; 95% CI 0.16-4.29; = 0.81; = 0%), and number of inferior results in the T-E score (OR = 0.49; 95% CI 0.14-1.73; = 0.27; = 0%).
CONCLUSIONS
Amongst the posterior approaches for FHFs, the KLP and TFO did not present significant clinical and radiological differences; hence, the approach can be selected depending on the surgeon's experience and preference.
PubMed: 37006726
DOI: 10.1007/s43465-023-00846-1 -
BMC Musculoskeletal Disorders Mar 2023Progressive osseous heteroplasia (POH) is a rare genetic condition that causes progressive ossification. This usually results from an inactivating mutation of the...
BACKGROUND
Progressive osseous heteroplasia (POH) is a rare genetic condition that causes progressive ossification. This usually results from an inactivating mutation of the paternal GNAS gene. Herein, we report a case of POH caused by a novel mutation in exon 2 of the GNAS gene.
CASE PRESENTATION
A 5-year-old Chinese boy was referred to our hospital for a growing mass in his right foot. Although laboratory findings were normal, radiographic imaging revealed severe ossification in his right foot and smaller areas of intramuscular ossification in his arms and legs. A de novo mutation (c.175C > T, p.Q59X) in exon 2 of the GNAS gene was identified, prompting a diagnosis of POH. We conducted a systematic literature review to better understand this rare disease.
CONCLUSION
We have discovered that a de novo nonsense mutation in exon 2 of GNAS can lead to POH. Our literature review revealed that ankylosis of the extremities is the primary clinical outcome in patients with POH. Unlike other conditions such as fibrodysplasia ossificans progressiva (FOP), patients with POH do not experience respiratory failure. However, much remains to be learned about the relationship between the type of GNAS gene mutation and the resulting POH symptoms. Further research is needed to understand this complex and rare disease. This case adds to our current understanding of POH and will contribute to future studies and treatments.
Topics: Male; Humans; Child, Preschool; GTP-Binding Protein alpha Subunits, Gs; Rare Diseases; Ossification, Heterotopic; Myositis Ossificans; Exons; Mutation; Chromogranins
PubMed: 37003989
DOI: 10.1186/s12891-023-06371-4