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Indian Journal of Orthopaedics Mar 2023Tuberculosis of the hip joint is a debilitating disease that can result in severe joint destruction, eventually leading to painful arthritis of the hip. Total hip... (Review)
Review
INTRODUCTION
Tuberculosis of the hip joint is a debilitating disease that can result in severe joint destruction, eventually leading to painful arthritis of the hip. Total hip arthroplasty (THA) in patients with advanced arthritis offers a painless and mobile joint with good functional outcome but some aspects of THA in TB hip have been controversial in the past due to the concerns of disease reactivation, especially when disease activity is factored in. Various factors like timing of surgery, Antitubercular therapy (ATT) initiation timing, reactivation, complications etc needs to be evaluated very carefully before planning for such cases.
METHODS
Electronic databases like MEDLINE, EMBASE, Cochrane library, Clinicaltrials gov and OpenGrey were searched. The key words used were "Tuberculosis", "Tuberculosis of hip", Hip tuberculosis, "TB", "THR", "total hip replacement", "total hip arthroplasty","THA", "ankylosed hip", "fused hip", "arthrodesis" along with boolean operators "AND" and "OR". Out of a total of 1634 articles, 38 were selected for full text review and 22 articles were finally included in the study.
RESULTS
For the timing of surgery most authors relied on the inflammatory markers to settle down with ATT before performing THA. 15 authors advocated use of pre-operative ATT with 6 studies recommending at least 2 weeks and 3 studies advocating atleast 3 months of ATT pre surgery.Single stage THA was performed in most studies(214 hips vs 18 hips) as opposed to 2 or 3 stage surgery. In the active disease 72.8% of the hips had uncemented prosthesis, 25.6% hips underwent cemented and 1.5% hips had hybrid THA fixation. Overall reactivation of the infection was seen in 2.47% cases. All authors reported excellent clinical improvement (mean HHS improvement 37.17 to 88.62).
PubMed: 36825271
DOI: 10.1007/s43465-023-00817-6 -
Turkish Neurosurgery 2023To review the literature for the role and outcome of growing rod surgeries in patients with cerebral palsy associated neuromuscular scoliosis.
AIM
To review the literature for the role and outcome of growing rod surgeries in patients with cerebral palsy associated neuromuscular scoliosis.
MATERIAL AND METHODS
A systematic search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic literature search was conducted of PubMed and Embase databases. Patient demographics, type of growing rod used, lengthening and complications were analyzed from the included studies.
RESULTS
A total of 11 studies with poor overall study quality (Level of evidence IV, V) were included in the study. A total of 181 patients with mean age 6.8 ± 1.3 (5-13 range) years at index surgery and mean follow-up of 3.02 ± 1.3 (2-5.8 range) years were included in the study, with a female preponderance. The most common curve and instrumentation was thoraco-lumbar and conventional dual growing rods respectively. All studies showed improvement in Cobb?s angle and pelvic obliquity. There was better improvement in pelvic obliquity if pelvis was included in instrumentation. Wound related complications (34.6%) were most commonly noted.
CONCLUSION
Overall growing rod construct has shown questionable outcomes in cerebral palsy patients with scoliosis in terms of the complication rate observed although allowing growth of the spinal column with regular lengthenings. Magnetic controlled growth rods hold a bright promise for the future considering its ability to maintain correction as well as the lower rate of complications The benefits and risk of immediate fusion with respect to growth sparing surgeries should be considered before the decision.
Topics: Humans; Female; Child, Preschool; Child; Scoliosis; Cerebral Palsy; Spinal Fusion; Spine; Pelvis; Retrospective Studies; Treatment Outcome; Follow-Up Studies
PubMed: 36799279
DOI: 10.5137/1019-5149.JTN.41939-22.2 -
Archives of Orthopaedic and Trauma... Aug 2023Ankle arthrodesis (AA) is often fixed using cannulated screws. The irritation from metalwork is a relatively common complication, but there is no consensus regarding the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Ankle arthrodesis (AA) is often fixed using cannulated screws. The irritation from metalwork is a relatively common complication, but there is no consensus regarding the need to remove the screws on a systematic basis. The aim of this study was to determine (1) the proportion of screws removed after AA and (2) whether predictors of screw removal could be identified.
METHODS
This PRISMA-compliant systematic review was part of a larger previous protocol registered on the PROSPERO platform. Multiple databases were searched including studies in which patients undergone AA using screws as exclusive fixation method were followed. Data were harvested regarding the cohort, the study design, the surgical technique, the nonunion and complication rate at the longest follow-up. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS).
RESULTS
Forty-four series of patients from thirty-eight studies (1990 ankles, 1934 patients) were selected. The average follow-up was 40.8 months (range 12-110). In all studies, hardware was removed due to symptoms reported by patients and related to the screws. The pooled proportion of removal of metalwork was 3% (95% CI 2-4). The pooled proportion of fusion was 96% (95%CI 95-98), while the pooled proportion of complications and reoperations (excluding the removal of metalwork) stood at 15% (95% CI 11-18) and 3% (95% CI 2-4), respectively. The mean mCMS (50.8 ± 8.1, range 35-66) revealed only an overall fair quality of studies. The univariate analysis and the multivariate model showed that the year of publication (R = - 0.004; p = 0.01) and the number of screws (R = 0.08; p = 0.01) were associated with the screw removal rate. Specifically, we found that over time the removal rate decreased by 0.4% per year and that the use of three screws instead of two reduced the risk of removal of metalwork by 8%.
CONCLUSIONS
In this review, removal of metalwork after ankle arthrodesis using cannulated screws was needed in 3% of cases at an average follow-up of 40.8 months. It was indicated only in case of symptoms related to soft tissue irritation from screws. The use of three screws was paradoxically related to a reduced risk of removal of screws as compared to two-screw constructs.
LEVEL OF EVIDENCE
Level IV, systematic review of Level IV.
Topics: Humans; Ankle; Ankle Joint; Bone Screws; Arthrodesis; Retrospective Studies
PubMed: 36795152
DOI: 10.1007/s00402-023-04813-1 -
Acta Neurochirurgica May 2023Occipitocervical fusion (OCF) is a procedure performed for multiple upper cervical pathologies. A common postprocedural complication of OCF is dysphagia, which has been... (Review)
Review
BACKGROUND
Occipitocervical fusion (OCF) is a procedure performed for multiple upper cervical pathologies. A common postprocedural complication of OCF is dysphagia, which has been linked to the narrowing of the pharyngeal space due to fixation in a hyper-flexed angle. Postoperative dysphagia is linked to reduced quality of life, prolonged hospital stay, aspiration pneumonia, and increased mortality. This has led to investigations of the association between sagittal radiographic angles and dysphagia following OCF.
METHODS
A systematic review of the literature was performed to explore the current evidence regarding cervical sagittal radiographic measurements and dysphagia following OCF. A search strategy was carried out using the PubMed, Embase, and Web of Science databases from their dates of inception until August 2022. Only original English-language studies were considered. Moreover, studies had to include the correlation between dysphagia and at least one radiographic measurement in the sagittal plane.
RESULTS
The search and subsequent selection process yielded eight studies that were included in the final review, totaling 329 patients in whom dysphagia had been assessed and graded. The dysphagia score by Bazaz et al. (Spine 27, 22:2453-2458, 2002) was used most often. The pooled incidence of dysphagia, in the early postoperative period, was estimated at 26.4%. At long-term follow-up (range: 17-72 months), about one-third of patients experienced resolution of symptoms, which resulted in a long-term post-OCF dysphagia incidence of 16.5%. Across the studies included, six different radiographic parameters were used to derive several measures which were repeatedly and significantly associated with the occurrence of dysphagia.
CONCLUSIONS
The high incidence of postoperative dysphagia following OCF warrants close monitoring of patients, especially in the short-term postoperative period. These patients may be assessed through standardized tools where the one by Bazaz et al. was the most commonly used. Moreover, there are several radiographic measurements that can be used to predict the occurrence of dysphagia. These findings may serve as a basis for strategies to prevent the occurrence of dysphagia after OCF.
Topics: Humans; Deglutition Disorders; Quality of Life; Spinal Fusion; Cervical Vertebrae; Radiography; Postoperative Complications
PubMed: 36781463
DOI: 10.1007/s00701-023-05509-6 -
Journal of Craniovertebral Junction &... 2022Lumbar spinal degenerative disease (LSDD), unresponsive to conservative therapy, is commonly treated by surgical decompression and interbody fusion. Since facet joint... (Review)
Review
OBJECTIVE
Lumbar spinal degenerative disease (LSDD), unresponsive to conservative therapy, is commonly treated by surgical decompression and interbody fusion. Since facet joint incompetence has been suggested as responsible for the entire phenomenon of spinal degeneration, facet stabilization can be considered as an alternative technique to treat symptomatic spinal degenerative disease. The purpose of this study was to systematically review the literature for studies utilizing lumbar facet joint fixation techniques for LSDD to assess their safety and efficacy.
METHODS
A systematic literature review was performed following the preferred reporting items for systematic reviews and meta-analyses statement, with no limits in terms of date of publication. Demographic data, inclusion criteria, clinical and radiological outcome, frequency of adverse events (AEs), and follow-up time were evaluated.
RESULTS
A total of 19 studies were included with a total of 1577 patients. The techniques used for facet arthrodesis were Goel intra-articular spacers in 21 patients (5.3%), Facet Wedge in 198 patients (15.8%), facet screws fixation techniques in 1062 patients (52.6%), and facet joints arthroplasty in 296 patients (26.3%). Clinical outcomes were assessed through the evaluation of pain relief and improvement in functional outcome. Radiological outcomes were assessed by the evaluation of proper positioning of instrumentation, solid bony fusion rate, and preservation of disk height. AE's mainly observed were pseudoarthrosis, reoperation, instrumentation displacement/malpositioning/migration, neurological impairment, deep vein thrombosis, and infections. The mean follow-up time ranged from 6 months to 11.7 years.
CONCLUSION
Our data demonstrate that facet joint arthrodesis appears to be effective in managing LSDD. These findings, however, are limited by the small sample size of patients. Accordingly, larger series are needed before formal recommendations can be made.
PubMed: 36777906
DOI: 10.4103/jcvjs.jcvjs_112_22 -
PloS One 2023Adjacent segment disease (ASD) is a common complication after lumbar fusion and is still traditionally treated by open surgery. In recent years, with the development of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Adjacent segment disease (ASD) is a common complication after lumbar fusion and is still traditionally treated by open surgery. In recent years, with the development of minimally invasive techniques, percutaneous endoscopic surgery(PES) has been used for the treatment of ASD after lumbar fusion due to its unique benefits. Nevertheless, it remains unclear about its significant clinical efficacy and advantages over conventional open surgery.
OBJECTIVES
To evaluate the clinical efficacy and safety of PES in the treatment of ASD after lumbar fusion.
STUDY DESIGN
A systematic review and meta-analysis studies about the role of PES in managing ASD after lumbar fusion.
METHODS
A systematic search review was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, VIP, WanFang, and SinoMed databases from the start of their construction to 15 November 2021. Eligible studies included references to clinical trials of PES for ASD after open lumbar fusion. Observations included pain relief, recovery of postoperative function, overall excellent rates, and indicators of the advantages of minimally invasive surgery compared to conventional surgery. Postoperative complications and recurrence rates were also recorded.
RESULTS
A total of 24 studies, including 20 single-arm studies and 4 clinical control studies, all involving 928 patients were included. A total of 694 patients were included in the single-arm analysis. The results of the single-arm meta-analysis showed that PES could significantly reduce low back and leg pain and improve the functional status of the lumbar spine in patients with ASD after open lumbar fusion compared to preoperatively, and had good clinical efficacy after surgery. A total of 234 patients were included in the four clinically controlled studies, and the results of the meta-analysis showed that PES could clearly reduce pain and improve lumbar function, with no significant difference in efficacy between PES and open surgery. However, PES has a lower surgical incision, less intraoperative bleeding, and shorter operative time and length of hospital stay compared to open surgery. Moreover, it has a lower rate of postoperative recurrence as well as complications and a longer duration of efficacy.
CONCLUSIONS
On the basis of the available clinical literature and the results of this study, PES could achieve satisfactory clinical effects in ASD treatment after lumbar fusion. Compared with conventional open surgery, PES can not only obtain similar clinical results, but also had the advantages of less trauma and faster recovery. Nevertheless, a randomized controlled study is still needed to validate the findings of this study.
TRIAL REGISTRATION
Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022298387.
Topics: Humans; Endoscopy; Treatment Outcome; Minimally Invasive Surgical Procedures; Lumbar Vertebrae; Pain; Spinal Fusion; Retrospective Studies; Randomized Controlled Trials as Topic
PubMed: 36745653
DOI: 10.1371/journal.pone.0280135 -
Journal of Wrist Surgery Feb 2023Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a...
Proximal row carpectomy (PRC) is a motion-sparing procedure for radiocarpal arthritis with reliable results. Traditionally, proximal capitate arthritis is a contraindication to PRC; however, PRC with modifications are proposed to circumvent this contraindication. PRC modifications can be broadly grouped into capitate resurfacing (CR) and capsular interposition (CI) procedures which could expand PRC indications. Our primary question was to characterize the outcomes achievable with various PRC modifications. Our secondary question was to determine which PRC modification was the optimal procedure when capitate arthritis was present. A systematic review was conducted to examine the outcomes of modified PRC procedures. Independent reviewers appraised multiple databases for PRC studies with modifications for capitate arthritis in adult patients (age >18 years) with a minimum of three cases and extractable outcomes. Modified PRC procedures included capsular/allograft interposition, resurfacing capitate pyrocarbon implants, and osteochondral grafting. Pertinent outcomes included patient demographics, range-of-motion, grip strength, patient-reported outcomes, and complications, including salvage rates. Overall, 18 studies met the inclusion criteria-10 studies ( = 147) on CI and 8 studies on CR ( = 136). PRC with CI had the greatest flexion-extension arc and grip strength. Complications were marginally higher in the CR group (4%), while the CI group had a higher conversion to total wrist arthrodesis (10%). Techniques to address capitate arthritis center around resurfacing or soft tissue interposition. PRC modifications with CI produces better range-of-motion and grip strength but higher conversion to total wrist arthrodesis. Higher conversion rates may be attributable to longer follow-up periods in studies examining CI compared with CR. This is a Level III study.
PubMed: 36644731
DOI: 10.1055/s-0042-1751013 -
BioMed Research International 2023We conducted this meta-analysis to provide better evidence of the efficacy of manual therapy (MT) on adolescent idiopathic scoliosis (AIS). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
We conducted this meta-analysis to provide better evidence of the efficacy of manual therapy (MT) on adolescent idiopathic scoliosis (AIS).
METHODS
All RCTs of MT for the management of patients with AIS were included in the present study. The treatment difference between the experimental and control group was mainly MT. The outcomes consisted of the total effective rate, the Cobb angle, and Scoliosis Research Society-22 (SRS-22) questionnaire score. Electronic database searches were conducted from database inception to July 2022, including the Cochrane Library, PubMed, Web of Science, Embase, Wanfang Data, CNKI, and VIP. The pooled data were analyzed using RevMan 5.4 software.
RESULTS
Four RCTs with 213 patients in the experimental group were finally included. There are 2 studies of standalone MT in the experimental group and 3 studies of MT with identical conservative treatments in the control group. Three trials reported total effective rate, and a statistically significant difference was found ( = 0.004). Three trials reported Cobb angle, and a statistical difference was found ( = 0.01). Then, sensitivity analysis showed that there was a significant difference in the additional MT subgroup ( < 0.00001) while not in the standalone MT subgroup ( = 0.41). Three trials reported SRS-22 scores ( = 0.55) without significant differences.
CONCLUSION
There is insufficient data to determine the effectiveness of spinal manipulation limited by the very low quality of included studies. High-quality studies with appropriate design and follow-up periods are warranted to determine if MT may be beneficial as an adjunct therapy for AIS. Currently, there is no evidence to support spinal manipulation.
Topics: Humans; Adolescent; Scoliosis; Randomized Controlled Trials as Topic; Kyphosis; Manipulation, Spinal; Spinal Fusion
PubMed: 36644168
DOI: 10.1155/2023/7928429 -
Current Oncology (Toronto, Ont.) Dec 2022This systematic review investigated the functional outcomes and complications of reconstruction methods after talar tumor resection. A systematic search of PubMed,... (Review)
Review
This systematic review investigated the functional outcomes and complications of reconstruction methods after talar tumor resection. A systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases identified 156 studies, of which 20 (23 patients) were ultimately included. The mean Musculoskeletal Tumor Society scores in the groups reconstructed using tibiocalcaneal fusion ( = 17), frozen autograft ( = 1), and talar prosthesis ( = 5) were 77.6 (range 66-90), 70, and 90 (range 87-93), respectively. Regarding complications, sensory deficits were observed in one patient (6%) and venous thrombosis in two patients (12%) in the tibiocalcaneal fusion group, while osteoarthritis was observed in one patient (100%) in the frozen autograft group. No complications were observed in the talar prosthesis group. Reconstruction with talar prosthesis seems preferable to conventional tibiocalcaneal fusion after talar tumor resection because it offers better function and fewer complications. However, as this systematic review included only retrospective studies with a small number of patients, its results require re-evaluation in future randomized controlled trials with larger numbers of patients.
Topics: Humans; Talus; Retrospective Studies; Neoplasms
PubMed: 36547183
DOI: 10.3390/curroncol29120769 -
World Neurosurgery Feb 2023This systematic review and meta-analysis were performed to investigate evidence for the comparison of lumbar dynamic stabilization device Coflex (Surgalign, Deerfield,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This systematic review and meta-analysis were performed to investigate evidence for the comparison of lumbar dynamic stabilization device Coflex (Surgalign, Deerfield, IL) with posterior lumbar fusion for lumbar spinal stenosis).
METHODS
Relational databases were searched to October 2022. The main outcome measures included operation time, Japanese Orthopedic Association score (JOA), visual analog scale (VAS), Oswestry disability index (ODI), total complications, and adjacent segment degeneration (ASD). Statistical analysis was performed with Review Manager 5.3 (Cochrane Collaboration).
RESULTS
A total of 26 studies were included. The main results of this meta-analysis showed lumbar dynamic stabilization device Coflex had shorter operation time (mean difference [MD] -50.77 min, 95% CI -57.24 to -44.30, P < 0.00001), less intraoperative blood loss (MD -122.21 mL, 95% CI -129.68 to -94.74, P < 0.00001), and shorter hospital stays (MD -3.21 days, 95% CI -4.04 to -2.37, P < 0.00001). What's more, the JOA score and ODI score were higher in the Coflex group during early follow-up. Yet, there was no significant difference between the 2 groups with the extension of follow-up time. Moreover, the Coflex group had a lower VAS score than fusion treatment (P < 0.00001). Finally, the Coflex group had lower total complications rate (P = 0.03), lower ASD rate (P = 0.001), and higher range of motion (P < 0.00001), but there was no significant difference in reoperation rate and internal fixation problems rate.
CONCLUSIONS
Current evidence suggests that lumbar dynamic stabilization device Coflex is superior to posterior lumbar fusion in early follow-up. However, considering that the dynamic stabilization device group also has its limitations, these findings need to be further verified by multicenter, double-blind, and large-sample randomized controlled trials.
Topics: Humans; Spinal Stenosis; Treatment Outcome; Spinal Fusion; Decompression, Surgical; Lumbar Vertebrae; Retrospective Studies; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 36481444
DOI: 10.1016/j.wneu.2022.11.141