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Foot & Ankle Orthopaedics Jul 2022End-stage ankle osteoarthritis often requires one of 2 major surgical procedures: total ankle arthroplasty or ankle arthrodesis. Although the gold standard has been...
BACKGROUND
End-stage ankle osteoarthritis often requires one of 2 major surgical procedures: total ankle arthroplasty or ankle arthrodesis. Although the gold standard has been arthrodesis, patients with diabetes represent a unique cohort that requires additional considerations because of their decreased mobility and risk factors for cardiovascular complications. The purpose of this study is to review odds of major and minor adverse events for patients with diabetes and patients without diabetes in both total ankle arthroplasty and ankle arthrodesis.
METHODS
A total of 14 articles published between 2010 and 2020 were included in this review. Databases included PubMed, Scopus, MEDLINE/Embase, and Cochrane Library. Key words included ankle arthroplasty, total ankle arthroplasty, ankle arthrodesis, and diabetes.
RESULTS
The total number of procedures was 26 287, comprising 13 830 arthroplasty and 12 457 arthrodesis procedures. There was a significant association between patients with diabetes treated with arthrodesis and major adverse events (odds ratio [OR] 1.880, 95% CI 1.279, 2.762), whereas no significant association was observed between patients with diabetes treated with arthroplasty and major adverse events (OR 1.106, 95% CI 0.871, 1.404).
CONCLUSION
This meta-analysis suggests patients with diabetes to be at significantly higher risk for major and minor adverse events after undergoing ankle arthrodesis. However, it suggests no significant differences in major adverse events between patients with diabetes and patients without diabetes having undergone total ankle arthroplasty.
LEVEL OF EVIDENCE
Level III, systematic review and meta-analysis.
PubMed: 35924005
DOI: 10.1177/24730114221112955 -
Frontiers in Public Health 2022Traditionally paired meta-analysis revealed inconsistencies in the safety and effectiveness of surgical interventions. We conducted a network meta-analysis to assess... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Traditionally paired meta-analysis revealed inconsistencies in the safety and effectiveness of surgical interventions. We conducted a network meta-analysis to assess various treatments' clinical efficacy and safety for pure cervical radiculopathy.
METHODS
The Embase, PubMed, and Cochrane Library databases were searched for randomized controlled trials (RCTs) comparing different treatment options for patients with pure cervical radiculopathy from inception until October 23, 2021. The primary outcomes were postoperative success rates, postoperative complication rates, and postoperative reoperation rates. The pooled data were subjected to a random-effects consistency model. The protocol was published in PROSPERO (CRD42021284819).
RESULTS
This study included 23 RCTs ( = 1,844) that evaluated various treatments for patients with pure cervical radiculopathy. There were no statistical differences between treatments in the consistency model in terms of major clinical effectiveness and safety outcomes. Postoperative success rates were higher for anterior cervical foraminotomy (ACF: probability 38%), posterior cervical foraminotomy (PCF: 24%), and anterior cervical discectomy with fusion and additional plating (ACDFP: 21%). Postoperative complication rates ranked from high to low as follows: cervical disc replacement (CDR: probability 32%), physiotherapy (25%), ACF (25%). Autologous bone graft (ABG) had better relief from arm pain (probability 71%) and neck disability (71%). Among the seven surgical interventions with a statistical difference, anterior cervical discectomy with allograft bone graft plus plating (ABGP) had the shortest surgery time.
CONCLUSIONS
According to current results, all surgical interventions can achieve satisfactory results, and there are no statistically significant differences. As a result, based on their strengths and patient-related factors, surgeons can exercise discretion in determining the appropriate surgical intervention for pure cervical radiculopathy. CRD42021284819.
Topics: Cervical Vertebrae; Humans; Postoperative Complications; Radiculopathy; Spinal Fusion; Treatment Outcome
PubMed: 35910906
DOI: 10.3389/fpubh.2022.892042 -
Spine Deformity Nov 2022To assess clinical and safety outcomes associated with different rod materials and diameters in adult spinal deformity (ASD) surgery. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess clinical and safety outcomes associated with different rod materials and diameters in adult spinal deformity (ASD) surgery.
METHODS
A systematic literature review and meta-analysis evaluated ASD surgery using pedicle screw fixation systems with rods of different materials and sizes. Postoperative outcomes (i.e., Cobb, sagittal vertical axis, and pelvic tilt angle) and complications (i.e., pseudarthrosis and rod breakage) were assessed. Random effects models (REMs) pooled data for outcomes reported in ≥ 2 studies.
RESULTS
Among 50 studies evaluating ASD surgery using pedicle screw fixation systems, 17 described rod material/diameter. Postoperative outcomes did not statistically differ between cobalt-chromium (CoCr) vs. titanium (Ti) rods (n = 2 studies; mean [95% confidence interval (CI)] sagittal vertical axis angle: CoCr 37.00° [18.58°-55.42°] and Ti 32.58° [24.62°-40.54°]; mean [95% CI] pelvic tilt angle: CoCr 26.20° [22.87°-29.53°] and Ti 20.15° [18.0°-22.31°]). The pooled proportion (95% CI) of pseudarthrosis was 15% (7-22%) for CoCr and 12% (- 8-32%) for stainless steel (SS) (n = 2 studies each; Chi = 0.07, p = 0.79). The pooled proportion (95% CI) of broken rods was 12% (1-22%) for Ti (n = 3 studies) and 10% (2-19) for CoCr (n = 1 study). Among 6.0-6.35 mm rods, the pooled (95% CI) postoperative Cobb angle (n = 2) was 12.01° (9.75°-14.28°), sagittal vertical axis angle (n = 4) was 35.32° (30.02°-40.62°), and pelvic tilt angle was 21.11° (18.35°-23.86°).
CONCLUSIONS
For ASD patients undergoing posterior fixation and fusion, there are no statistically significant differences in postoperative outcomes or complications among rods of varying materials and diameters. Benchmark postsurgical outcomes and complication rates by rod material and diameter are provided.
LEVEL OF EVIDENCE
III.
Topics: Adult; Humans; Spinal Fusion; Stainless Steel; Titanium; Chromium Alloys; Pseudarthrosis; Cobalt; Chromium
PubMed: 35904725
DOI: 10.1007/s43390-022-00556-y -
BioMed Research International 2022This paper presents a systematic study in reviewing the application of finite element method for the analysis of correction mechanism of spine deformity due to... (Review)
Review
This paper presents a systematic study in reviewing the application of finite element method for the analysis of correction mechanism of spine deformity due to scoliosis. The study is aimed at systematically (1) reviewing the use of finite element analysis in spine deformity case, (2) reviewing the modelling of pedicle screw and rod system in scoliosis surgery, and (3) analysing and discussing gap between the studies. Using the restricted key phrases, the review gathered studies from 2001 to 2021 from various electronic databases (Scopus, ScienceDirect, PubMed, Medline, and WorldCAT). Studies were included if they reported a finite element study on spine deformity. Studies that did not fully disclose their methodology and results had significant discrepancies, not published in English or not yet published were all disqualified. Regardless of inconsistencies in the methodological design of the studies, the quality of all papers was above the acceptable level. A total of fifteen manuscripts were considered for inclusion and were given a comprehensive review. This study indicates that analysing the forces acting on the spine, as well as the interrelationship between the force, stress, and degree of correction (which measured as the Cobb angle), could help to improve the corrective mechanism procedure of spine deformity. Pedicle screws and its placement strategies are also important as it influence the corrective forces for scoliosis treatment. Hence, the findings of this study could potentially be used as a guidance to develop a reliable finite element analysis that can predict the biomechanics responses during the corrective spine deformity treatment.
Topics: Connective Tissue Diseases; Finite Element Analysis; Humans; Pedicle Screws; Scoliosis; Spinal Fusion; Spine
PubMed: 35898687
DOI: 10.1155/2022/5147221 -
Bone & Joint Open Jul 2022Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to...
AIMS
Revision rates for ankle arthroplasties are higher than hip or knee arthroplasties. When a total ankle arthroplasty (TAA) fails, it can either undergo revision to another ankle replacement, revision of the TAA to ankle arthrodesis (fusion), or amputation. Currently there is a paucity of literature on the outcomes of these revisions. The aim of this meta-analysis is to assess the outcomes of revision TAA with respect to surgery type, functional outcomes, and reoperations.
METHODS
A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Medline, Embase, Cinahl, and Cochrane reviews were searched for relevant papers. Papers analyzing surgical treatment for failed ankle arthroplasties were included. All papers were reviewed by two authors. Overall, 34 papers met the inclusion criteria. A meta-analysis of proportions was performed.
RESULTS
Six papers analyzed all-cause reoperations of revision ankle arthroplasties, and 14 papers analyzed failures of conversion of a TAA to fusion. It was found that 26.9% (95% confidence interval (CI) 15.4% to 40.1%) of revision ankle arthroplasties required further surgical intervention and 13.0% (95% CI 4.9% to 23.4%) of conversion to fusions; 14.4% (95% CI 8.4% to 21.4%) of revision ankle arthroplasties failed and 8% (95% CI 4% to 13%) of conversion to fusions failed.
CONCLUSION
Revision of primary TAA can be an effective procedure with improved functional outcomes, but has considerable risks of failure and reoperation, especially in those with periprosthetic joint infection. In those who undergo conversion of TAA to fusion, there are high rates of nonunion. Further comparative studies are required to compare both operative techniques.Cite this article: 2022;3(7):596-606.
PubMed: 35880516
DOI: 10.1302/2633-1462.37.BJO-2022-0038.R1 -
Foot and Ankle Surgery : Official... Dec 2022Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Total ankle arthroplasty (TAA) is increasingly used as a treatment for end-stage ankle arthropathy. However, TAA may be more sensitive to complications, failure and subsequent re-operations compared to ankle arthrodesis. The aim of this systematic review and meta-analysis is to generate an overview of complications of TAA surgery.
METHODS
PubMed, EMBASE and the Cochrane library were searched between 2000 and 2020 to identify all papers reporting on complications in TAA surgery. Meta-analysis was conducted based on type of complication in TAA surgery. Pooled estimates of complications were calculated using a random effects model. Risk of bias and quality was assessed using the Cochrane risk of bias and ROBINS-I tools. The confidence in estimates was rated and described according to the recommendations of the GRADE working group.
RESULTS
One hundred twenty-seven studies were included in this systematic review. All combined, they reported on 16.964 TAAs with an average follow-up of 47.99 ± 29.18 months. Complications with highest reported pooled incidence were intra-operative fracture 0.06 (95 %CI 0.04-0.08) (GRADE Very low) and impingement 0.06 (95 %CI 0.04-0.08) (GRADE low) respectively.
CONCLUSION
Reported complication incidence of TAA surgery is still high and remains a significant clinical problem that can be severely hampering long-term clinical survival of the prosthesis. The results of this systematic review and meta-analysis can help guide surgeons in informing their patient about complication risks. Implementation of more stringent patient selection criteria might contribute to diminishing TAA complication rates.
Topics: Humans; Retrospective Studies; Arthroplasty, Replacement, Ankle; Arthrodesis; Ankle Joint; Reoperation; Treatment Outcome
PubMed: 35872118
DOI: 10.1016/j.fas.2022.07.004 -
European Spine Journal : Official... Oct 2022With the increase in life expectancy and consequent aging of the population, degenerative lumbar spine diseases tend to increase its number exponentially. Several... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
With the increase in life expectancy and consequent aging of the population, degenerative lumbar spine diseases tend to increase its number exponentially. Several treatment options are available to treat degenerative spinal diseases, such as laminectomies, posterior fusions, and interbody fusions, depending on their locations, correction necessities, and surgeon philosophy. With the advance in technology and surgical knowledge, minimally invasive techniques (MIS) arose as a solution to reduce surgical morbidity, while maintaining the same benefits as the traditionally/open surgeries. Several studies investigated the possible advantages of MIS techniques against the traditional open procedures. However, those articles are usually focused only on one technique or on one pathology.
METHODS
The electronic databases, including PubMed, Google Scholar, Ovid, and BVS, were systematically reviewed. Only original articles in English or Portuguese were added to the review, the revision was performed following the PRISMA guideline.
RESULTS
Fifty-three studies were included in the meta-analysis. Of the studied outcomes the Length of Stay Odds of complications, Blood Loss, and Surgery costs presented significantly favored MIS approaches, while the Last FUP ODI score, and Surgery Time did not differ among the groups.
CONCLUSION
Minimally invasive techniques are a remarkably interesting option to traditional open surgeries, as these procedures showed a significant reduction in blood loss, hospitalization time, complications, and surgical costs.
Topics: Humans; Lumbar Vertebrae; Lumbosacral Region; Minimally Invasive Surgical Procedures; Retrospective Studies; Spinal Fusion; Treatment Outcome
PubMed: 35871660
DOI: 10.1007/s00586-022-07327-3 -
European Review For Medical and... Jul 2022Synthetic hydroxyapatite (HA) and its related materials have made great progress in basic research and clinical application in spinal repair and reconstruction. However,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Synthetic hydroxyapatite (HA) and its related materials have made great progress in basic research and clinical application in spinal repair and reconstruction. However, the effect of HA and its composites used in spinal fusion still remained controversial. This meta-analysis aimed at evaluating the efficacy and safety of HA compared with autologous bone.
MATERIALS AND METHODS
A systematic search in PubMed, MEDLINE, China National Knowledge Internet, EMBASE, and the Cochrane Library was conducted for relevant studies from inception until May 2021. Studies investigating the application of HA and its related composites in spinal fusion were selected for analysis.
RESULTS
The operation time of patients treated with artificial bone containing HA was less than that of patients with autologous bone (p = 0.02). The amount of operative blood loss in patients in the HA group was less than that in the autograft group (p = 0.007). Patients treated with autologous bone got a more significant advantage in fusion rate at 6 months (p = 0.009). Nevertheless, there was no significant difference in the fusion rate between patients in the two groups at 12 months or no less than 24 months postoperatively (p = 0.24; p = 0.87). Compared to the autograft group, the HA group significantly decreased postoperative adverse events (p = 0.03). Furthermore, there was no significant difference in the Oswestry Disability Index (p = 1.00) nor the Visual Analogue Scale score (p = 0.94) between the two groups.
CONCLUSIONS
This meta-analysis suggests that the clinical application of HA and its related composite materials in spinal reconstruction is comparable to that of autologous bone, with satisfactory efficacy and safety.
Topics: Bone Transplantation; Durapatite; Humans; Lumbar Vertebrae; Spinal Fusion; Spine; Treatment Outcome
PubMed: 35856351
DOI: 10.26355/eurrev_202207_29183 -
Surgical Neurology International 2022Dropped head syndrome (DHS) is uncommon and involves severe weakness of neck-extensor muscles resulting in a progressive reducible cervical kyphosis. The first-line... (Review)
Review
BACKGROUND
Dropped head syndrome (DHS) is uncommon and involves severe weakness of neck-extensor muscles resulting in a progressive reducible cervical kyphosis. The first-line management consists of medical treatment targeted at diagnosing underlying pathologies. However, the surgical management of DHS has not been well studied.
METHODS
Here, we systematically reviewed the PubMed and Cochrane databases for DHS using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All relevant articles up to March 31, 2022, were analyzed. The patient had to be ≥18 years with DHS and had to have undergone surgery with outcomes data available. Outcomes measurements included neurological status, rate of failure (RF), horizontal gaze, and complications.
RESULTS
A total of 22 articles selected for this study identified 54 patients who averaged 68.9 years of age. Cervical arthrodesis without thoracic extension was performed in seven patients with a RF of 71%. Cervicothoracic arthrodesis was performed in 46 patients with an RF of 13%. The most chosen upper level of fusion was C2 in 63% of cases, and the occiput was included only in 13% of patients. All patients neurologically stabilized or improved, while 75% of undergoing anterior procedures exhibited postoperative dysphagia and/or airway-related complications.
CONCLUSION
The early surgery for patients with DHS who demonstrate neurological compromise or progressive deformity is safe and effective and leads to excellent outcomes.
PubMed: 35855142
DOI: 10.25259/SNI_456_2022 -
Foot and Ankle Surgery : Official... Dec 2022This study aimed to evaluate the use of distraction arthroplasty for ankle osteoarthritis, with respect to patient reported outcome measures (PROMs), complications,... (Review)
Review
BACKGROUND
This study aimed to evaluate the use of distraction arthroplasty for ankle osteoarthritis, with respect to patient reported outcome measures (PROMs), complications, range of motion and radiographic outcomes.
METHODS
A computer-based search was performed in PubMed, Cinahl, Embase, Scopus and ISI Web of Science. Two reviewers independently performed title/abstract and full-text screening. Quality assessment was performed using The Methodological Index for Non-Randomised Studies (MINORS) and Joanna Briggs Institute criteria.
RESULTS
Whilst all studies evaluating PROMs reported significant (P < 0.05) improvement, these were either below or only slightly above the minimally clinically important difference. The rate of conversion to arthrodesis or total ankle arthroplasty was high, with failure rates of up to 52% reported.
CONCLUSION
Due to the inconsistent improvements in PROMs, which are likely overestimated due to substantial bias, and the high failure rate, this review suggests that distraction arthroplasty is not currently an effective treatment option for ankle arthritis.
LEVEL OF EVIDENCE
Level IV, systematic review of level I to IV studies.
Topics: Humans; Ankle Joint; Osteoarthritis; Arthroplasty, Replacement, Ankle; Arthrodesis; Range of Motion, Articular; Treatment Outcome
PubMed: 35853785
DOI: 10.1016/j.fas.2022.07.005