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Orthopaedic Surgery Jul 2024Frozen shoulder (FS) is a painful and debilitating condition affecting the shoulder joint. When patients fail to improve after conservative treatments, operative... (Meta-Analysis)
Meta-Analysis Comparative Study Review
OBJECTIVE
Frozen shoulder (FS) is a painful and debilitating condition affecting the shoulder joint. When patients fail to improve after conservative treatments, operative treatments including arthroscopic capsular release (ACR) and manipulation under anesthesia (MUA) are recommended. However, the comparison between these two interventions remains controversial. This study aimed to compare the efficacy and safety of ACR and MUA for refractory FS.
METHODS
A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. PubMed, EMBASE, Cochrane Library, and Web of Science were searched for eligible studies until December 10, 2023. Meta-analyses were conducted using Manager V.5.3.3. Pooled effect sizes were expressed as the weighted mean difference (WMD) or odds ratio (OR) with 95% confidence intervals (CIs).
RESULTS
A total of eight comparative studies with 768 patients were included. Compared with MUA, ACR had statistically better Δ VAS (WMD, -0.44; 95% CI, -0.71 to -0.18; I = 6%; p = 0.001) at over 12-month follow-up, which did not reach the minimal clinically important difference (MCID). Other outcomes regarding pain relief, function, and range of motion (ROM) improvements were not statistically different between the two groups at different follow-up timepoints. Compared with the MUA group, the ACR group had a significantly higher rate of severe complications (OR, 4.14; 95% CI, 1.01 to 16.94; I2 = 0%; p = 0.05), but comparable rates of mild complications and additional intervention.
CONCLUSIONS
In treating refractory FS, ACR demonstrated comparable pain relief, functional and ROM improvements, rates of mild complications and additional intervention but a higher risk of severe complications to MUA during short-term follow-up periods. Notably, ACR exhibited statistically superior improvement in the long-term pain relief compared to the MUA group, although it did not reach the MCID.
Topics: Humans; Bursitis; Arthroscopy; Joint Capsule Release; Manipulation, Orthopedic; Range of Motion, Articular
PubMed: 38747000
DOI: 10.1111/os.14077 -
The American Journal of Sports Medicine May 2024The redislocation rate after arthroscopic Bankart repair (BR) among patients with a Hill-Sachs lesion (HSL) may be reduced with the use of remplissage.
Remplissage May Decrease the Redislocation Rate After Arthroscopic Bankart Repair in Patients With an Engaging Hill-Sachs Defect: A Systematic Review and Meta-analysis of Studies With Minimal 2-Year Follow-up.
BACKGROUND
The redislocation rate after arthroscopic Bankart repair (BR) among patients with a Hill-Sachs lesion (HSL) may be reduced with the use of remplissage.
PURPOSE
To investigate the outcomes of adding remplissage to an arthroscopic BR in patients with concomitant HSL.
STUDY DESIGN
Meta-analysis; Level of evidence, 3.
METHODS
PubMed and ScienceDirect databases were searched between February 2022 and April 2023 with the terms "remplissage" and "shoulder instability" according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were formed using the population, intervention, control, and outcome method; the investigation included studies that compared BR with and without remplissage and had ≥24 months of follow-up.
RESULTS
From 802 articles found during the initial search, 7 studies with a total of 837 patients-558 receiving isolated BR (BR group) and 279 receiving BR with remplissage (BR+REMP)-were included. The probability of recurrence of instability among patients with an engaging HSL was significantly diminished in the BR+REMP group compared with the BR group (odds ratio, 0.11; 95% CI, 0.05 to 0.24; < .001). Regarding shoulder range of motion, the BR+REMP group achieved increased forward flexion (mean difference [MD], 1.97°; 95% CI, 1.49° to 2.46°; < .001) and decreased external rotation in adduction (MD, -1.43°; 95% CI, -2.40° to -0.46°; = .004) compared with the BR group. Regarding patient-reported outcome measures, the BR+REMP group had Rowe (MD, 2.53; 95% CI, -1.48 to 6.54; = .21) and Western Ontario Shoulder Instability Index (WOSI) (MD, -61.60; 95% CI, -148.03 to 24.82; = .162) scores that were comparable with those of the BR group.
CONCLUSION
Remplissage resulted in a 9-fold decrease in the recurrence of instability after arthroscopic BR in patients with HSL. Remplissage not only led to an increase in forward flexion but also only slightly limited patients' external rotation in adduction. WOSI and Rowe scores after remplissage at the final 24-month follow-up were comparable with those obtained after isolated Bankart repair.
PubMed: 38742747
DOI: 10.1177/03635465241249492 -
Clinics in Shoulder and Elbow Jun 2024Radial head arthroplasty allows a high degree of customizability, and implant polarity has emerged as an important variable. The purpose of this meta-analysis was to...
BACKGROUND
Radial head arthroplasty allows a high degree of customizability, and implant polarity has emerged as an important variable. The purpose of this meta-analysis was to evaluate differences in functional and clinical outcomes between patients receiving monopolar and bipolar radial head prosthetic implants.
METHODS
A systematic review and meta-analysis were employed, and 65 articles were identified in three databases. Twelve articles contained non-English or insufficient text and were consequently excluded, and 20 others did not contain sufficient data or follow-up. The remaining 33 articles were qualitatively and quantitatively reviewed.
RESULTS
In total, 33 populations were identified, with 809 unduplicated patients: 565 with monopolar and 244 with bipolar implants. In these respective patients, the mean follow-up was 40.2 and 56.9 months. Average Mayo Elbow Performance Score were 86.7 and 87.4 (P=0.80), respectively; average Disability of the Arm, Shoulder, and Hand scores were 17.9 and 14.7 (P=0.47), and average final flexion/extension arcs were 119.4° and 118.7° (P=0.48). Revision rates were 4.07% and 6.56%, while complication rates were 19.65% and 20.08% in the respective monopolar and bipolar patients. These increased relative risks associated with bipolar implants were not significant.
CONCLUSIONS
Radial head implant polarity does not appear to affect functional outcomes. While bipolar prosthetic design may increase the risks of revision and complications, the increases were not significant. Level of evidence: IV.
PubMed: 38738328
DOI: 10.5397/cise.2023.01088 -
Clinics in Shoulder and Elbow Jun 2024Recurrent anterior shoulder dislocation (RASD) in cases of seizure disorders (SDs) total 50%-80% of all SD-associated shoulder instabilities. Based on the extent of bone...
Latarjet operation carries three times the risk of failure in seizure versus non-seizure recurrent anterior dislocation of the shoulder joint: outcome of a systematic review with meta-analysis.
BACKGROUND
Recurrent anterior shoulder dislocation (RASD) in cases of seizure disorders (SDs) total 50%-80% of all SD-associated shoulder instabilities. Based on the extent of bone loss, treatment options include bony and soft-tissue reconstructions, arthroplasty, and arthrodesis. The primary objective of this paper was to review the treatment options for RASD in SDs.
METHODS
Several bibliographic databases were searched for RASD treatment options in SD patients. The demographic outcome measures, the failure rate (defined as the relative risk of recurrence of dislocation postoperation), and the postoperative seizure recurrence rate were recorded.
RESULTS
We pooled 171 cases (187 shoulders) from 11 studies. Of these, one, five, two, two, and one reports studied Bankart's operation with remplissage (27 cases/29 shoulders), the Latarjet procedure (106/118), bone block operation (21/23), arthroplasty (11/11), and arthrodesis (6/6), respectively, in treating SD-associated RASD. The relative risk of failure between SD and non-SD patients was 3.76 (1.3610.38) after the Latarjet operation. The failure rates were 17% and 13% for Bankart's operation with remplissage and the Latarjet procedure in SD patients, respectively, but 0% each for bone block operation, arthroplasty, and arthrodesis. The total rate of seizure recurrence after operation was 33% of the pooled cases.
CONCLUSIONS
SD recurrence in the postoperative period, the size of the bone block, and the muscular attachments to a small coracoid autograft are the determinants of failure among various reconstructive operations in SD-associated RASD. Level of evidence: III.
PubMed: 38738326
DOI: 10.5397/cise.2023.00948 -
Cureus May 2024Despite being a generally successful procedure, pain following reverse total shoulder arthroplasty (rTSA) is a known complication. The aim of this systematic review is... (Review)
Review
Despite being a generally successful procedure, pain following reverse total shoulder arthroplasty (rTSA) is a known complication. The aim of this systematic review is to identify preoperative risk factors for pain following rTSA to encourage evidence-based interventions, inform clinicians, and aid in surgical planning. Studies that reported preoperative risk factors and pain after rTSA were included. Studies which reported outcome measures that incorporated pain scores yet did not display them independently, studies which only reported intraoperative risk factors, and studies involving participants under 18 were excluded. The search was conducted on May 31, 2023, across the following databases: PubMed, Web of Science, Embase, Scopus, and Cochrane Central Register of Controlled Trials. Four independent researchers conducted this systematic review, and a descriptive analysis was subsequently performed. Twenty-five studies were included following the evaluation of full-text articles, involving a total of 9,470 shoulders. Preoperative risk factors identified were categorised into the following groups: BMI, smoking, radiographic findings, age and sex, prior surgery, functional ability and pain, and psychosocial. The strongest associations identified were preoperative opioid use and smoking, which were both associated with worse pain outcomes following rTSA; other preoperative risk factors highlighted in this review showed either weak or no correlation. Preoperative opioid use and smoking are likely risk factors for the development of pain after rTSA. Although the studies included varying levels of quality, the identification of modifiable risk factors is useful in optimising management prior to surgery and guiding patient expectations. The lack of evidence regarding associations with non-modifiable risk factors further reinforces the potential benefits of the procedure on diverse population groups and is useful in itself for assessing the candidacy of patients for the procedure, particularly when postoperative pain is a factor being considered.
PubMed: 38736766
DOI: 10.7759/cureus.60041 -
Sensors (Basel, Switzerland) May 2024Shoulder pain represents the most frequently reported musculoskeletal disorder, often leading to significant functional impairment and pain, impacting quality of life.... (Review)
Review
Shoulder pain represents the most frequently reported musculoskeletal disorder, often leading to significant functional impairment and pain, impacting quality of life. Home-based rehabilitation programs offer a more accessible and convenient solution for an effective shoulder disorder treatment, addressing logistical and financial constraints associated with traditional physiotherapy. The aim of this systematic review is to report the monitoring devices currently proposed and tested for shoulder rehabilitation in home settings. The research question was formulated using the PICO approach, and the PRISMA guidelines were applied to ensure a transparent methodology for the systematic review process. A comprehensive search of PubMed and Scopus was conducted, and the results were included from 2014 up to 2023. Three different tools (i.e., the Rob 2 version of the Cochrane risk-of-bias tool, the Joanna Briggs Institute (JBI) Critical Appraisal tool, and the ROBINS-I tool) were used to assess the risk of bias. Fifteen studies were included as they fulfilled the inclusion criteria. The results showed that wearable systems represent a promising solution as remote monitoring technologies, offering quantitative and clinically meaningful insights into the progress of individuals within a rehabilitation pathway. Recent trends indicate a growing use of low-cost, non-intrusive visual tracking devices, such as camera-based monitoring systems, within the domain of tele-rehabilitation. The integration of home-based monitoring devices alongside traditional rehabilitation methods is acquiring significant attention, offering broader access to high-quality care, and potentially reducing healthcare costs associated with in-person therapy.
Topics: Humans; Shoulder Pain; Telerehabilitation; Wearable Electronic Devices; Quality of Life; Shoulder; Monitoring, Physiologic; Home Care Services; Physical Therapy Modalities
PubMed: 38733040
DOI: 10.3390/s24092936 -
BMC Musculoskeletal Disorders May 2024This systemic review and meta-analysis aimed to evaluate the clinical outcomes of proximal humeral fracture in elderly patient fixation using locked plate with or... (Meta-Analysis)
Meta-Analysis
BACKGROUND
This systemic review and meta-analysis aimed to evaluate the clinical outcomes of proximal humeral fracture in elderly patient fixation using locked plate with or without cement augmentation.
METHODS
The databases of PubMed, Embase, and Cochrane Library were searched in August 2023 for literature comparing the clinical outcomes of patients with PHFs treated with locked plate alone and locked plate augmented with cement. Data describing study design; level of evidence; inclusion criteria; demographic information; final follow-up; revision rate; implant failure rate; avascular necrosis rate; total complication rate; constant score; and disability of arm, shoulder, and hand (DASH) score were collected.
RESULTS
Eight studies (one randomized-controlled trial and seven observational studies), involving 664 patients, were identified. Compared with locked plates alone, using cement-augmented locked plates reduced the implant failure rate (odds ratio (OR) = 0.19; 95% confidence interval (CI) 0.10-0.39; P < 0.0001) and total complication rate (OR = 0.45; 95% CI 0.29-0.69; P = 0.0002) and improved DASH scores (mean difference (MD) = 2.99; 95% CI 1.00-4.98; P = 0.003). However, there was no significant difference in clinical outcomes, including revision rate, avascular necrosis rate, and constant score.
CONCLUSION
In this review and meta-analysis, fixation of the PHFs in elderly patients using locked plates with or without cement augmentation has no significant difference in revision rate, but the implant failure and total complication rates may be lesser on using the cement-augmented locked plate for fixation than on using a locked plate alone. Good results are expected for most patients treated with this technique.
TRIAL REGISTRATION
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)21 guidelines were followed to conduct this systematic review and meta-analysis and was registered as a protocol in PROSPERO (CRD42022318798).
Topics: Humans; Bone Plates; Shoulder Fractures; Fracture Fixation, Internal; Bone Cements; Aged; Treatment Outcome; Aged, 80 and over; Postoperative Complications; Reoperation
PubMed: 38730497
DOI: 10.1186/s12891-024-07502-1 -
BMC Musculoskeletal Disorders May 2024Reduction manipulation using self-reduction procedures such as Stimson, Milch, and Boss-Holtzach should be easy and effective and also require less force, pain... (Meta-Analysis)
Meta-Analysis Comparative Study
BACKGROUND AND OBJECTIVE
Reduction manipulation using self-reduction procedures such as Stimson, Milch, and Boss-Holtzach should be easy and effective and also require less force, pain medication, and outside assistance. This technique should not cause damage to arteries, nerves, or shoulder joint components. Self-reduction is straightforward and can be done in clinics, making it ideal for people who suffer from shoulder joint dislocation frequently. The goal of this study is to compare the effectiveness of supervised self-reduction procedures vs. physician-assisted treatments in the treatment of anterior shoulder dislocations.
METHOD
We conducted a comprehensive search on PubMed, Scopus, Web of Science, and Cochrane up to March 22, 2023, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Relevant articles were reviewed, with a focus on studies comparing supervised self-reduction techniques to physician-assisted techniques in cases of anterior shoulder dislocation.
RESULTS
Four papers in all were included in the meta-analysis. One prospective trial, one case-control study, one randomized clinical trial, and one retrospective trial made up these studies. The studies involved 283 patients in the physician-assisted group and 180 patients in the supervised self-reduction group. They were carried out in four European countries: Italy, Germany, Portugal, and Spain. The success rate of supervised self-reduction techniques was significantly higher, with an odds ratio of 2.71 (95% CI 1.25-5.58, p-value = 0.01). Based on the Visual Analog Scale (VAS) score, the physician-assisted group reported significantly higher maximum pain, with a mean difference of 1.98 (95% CI 1.24-2.72, p-value < 0.01). The self-reduction approaches exhibit shorter reduction time in comparison to physician-assisted groups. In addition, the self-reduction groups do not document any complications. Based on the GRADE system, the level of assurance in the evidence was high.
CONCLUSION
Supervised self-reduction techniques outperform in terms of success rate and reduction-related maximum pain. These techniques could be used as an effective first-line treatment for anterior shoulder dislocation, potentially reducing the need for analgesics and emergency room visits.
Topics: Humans; Shoulder Dislocation; Treatment Outcome; Shoulder Joint; Manipulation, Orthopedic; Self Care
PubMed: 38730336
DOI: 10.1186/s12891-024-07379-0 -
Journal of Shoulder and Elbow Surgery May 2024The prevalence of reverse total shoulder arthroplasty (rTSA) has grown rapidly. As indications for the procedure expand, the proportion of patients who have satisfactory... (Review)
Review
BACKGROUND
The prevalence of reverse total shoulder arthroplasty (rTSA) has grown rapidly. As indications for the procedure expand, the proportion of patients who have satisfactory outcomes after rTSA has not been well defined. This systematic literature review explores overall patient satisfaction after rTSA and defines patient satisfaction based on indication for surgery.
METHODS
A literature search was performed for studies describing patient satisfaction after rTSA in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Papers were included if they investigated patient satisfaction after rTSA at a minimum of 2-year follow-up. Data were collected on patient demographics, including age, gender, and body mass index (BMI). Follow-up duration, indication for surgery, and patient reported outcome measures (PROMs) relating to patient satisfaction were also recorded.
RESULTS
There were a total of 5234 patients and 5288 shoulders from the 45 included studies. The overall study population was 61.2% female and the average age was 71.1 years (range 23-99). Satisfaction results were recorded at final follow-up, with average follow-up of 49.1 months (range 24-228). Overall patient satisfaction ranged from 77.7 to 87.8%, depending on patient satisfaction PROMs. When stratified by diagnosis, patients with a diagnosis of glenohumeral osteoarthritis (GHOA) rated better satisfaction on all metrics when compared to patients with a diagnosis of cuff tear arthropathy (CTA) or massive rotator cuff tear (MRCT).
CONCLUSION
This systematic review demonstrated that patients who undergo rTSA for either GHOA, CTA, or MRCT are generally satisfied with their procedure, with the rate of satisfaction highest in GHOA. Focusing on patient satisfaction may provide the best overall assessment of health care quality in a very understandable and tangible form. Overall satisfaction rate is valuable information for patient education and can be utilized as part of effective surgical counseling.
PubMed: 38719073
DOI: 10.1016/j.jse.2024.03.036 -
Journal of Clinical Anesthesia Sep 2024The suitability of ambulatory surgery for patients with obstructive sleep apnea (OSA) remains controversial. This systematic review and meta-analysis aimed to evaluate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The suitability of ambulatory surgery for patients with obstructive sleep apnea (OSA) remains controversial. This systematic review and meta-analysis aimed to evaluate the odds of perioperative adverse events in patients with OSA undergoing ambulatory surgery, compared to patients without OSA.
METHODS
Four electronic databases were searched for studies published between January 1, 2011 and July 11, 2023. The inclusion criteria were: adult patients with diagnosed or high-risk of OSA undergoing ambulatory surgery; perioperative adverse events; control group included; general and/or regional anesthesia; and publication on/after February 1, 2011. We calculated effect sizes as odds ratios using a random effects model, and additional sensitivity analyses were conducted.
RESULTS
Seventeen studies (375,389 patients) were included. OSA was associated with an increased odds of same-day admission amongst all surgery types (OR 1.94, 95% CI 1.46-2.59, I:79%, P < 0.00001, 11 studies, n = 347,342), as well as when only orthopedic surgery was considered (OR 2.68, 95% CI 2.05-3.48, I:41%, P < 0.00001, 6 studies, n = 132,473). Three studies reported that OSA was strongly associated with prolonged post anesthesia care unit (PACU) length of stay (LOS), while one study reported that the association was not statistically significant. In addition, four studies reported that OSA was associated with postoperative respiratory depression/hypoxia, with one large study on shoulder arthroscopy reporting an almost 5-fold increased odds of pulmonary compromise, 5-fold of myocardial infarction, 3-fold of acute renal failure, and 5-fold of intensive care unit (ICU) admission.
CONCLUSIONS
Ambulatory surgical patients with OSA had almost two-fold higher odds of same-day admission compared to non-OSA patients. Multiple large studies also reported an association of OSA with prolonged PACU LOS, respiratory complications, and/or ICU admission. Clinicians should screen preoperatively for OSA, optimize comorbidities, adhere to clinical algorithm-based management perioperatively, and maintain a high degree of vigilance in the postoperative period.
Topics: Humans; Sleep Apnea, Obstructive; Ambulatory Surgical Procedures; Postoperative Complications; Length of Stay; Adult; Anesthesia Recovery Period; Anesthesia, General
PubMed: 38718686
DOI: 10.1016/j.jclinane.2024.111464