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Clinical Oral Implants Research Oct 2018The aim of this review was to determine the clinical performance of dental implants that are intentionally tilted when compared with implants that are placed following... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of this review was to determine the clinical performance of dental implants that are intentionally tilted when compared with implants that are placed following the long axis of the residual alveolar ridge.
MATERIALS AND METHODS
A systematic review of the scientific literature using a predefined research question (PICO) and search strategy was undertaken. This search included five electronic databases. Two independent reviewers examined electronic databases and performed a manual review following search strategy to accomplish the item generation and reduction. Included articles were evaluated to determine the level of evidence. Data were extracted only from level I and level II studies, based on the Oxford Centre for Evidence-based Medicine-Levels of Evidence (March 2009). If included studies were homogeneous in nature, data were to be accumulated. However, if included studies were heterogeneous in nature, only descriptive data would be reviewed and analyzed.
RESULTS
A total of 811 articles were identified through the PICO question and search strategy. Detailed review of the abstracts and articles resulted in further item reduction, and 46 articles were included for full-text review. A total of 42 articles were then selected for inclusion in the systematic review. The identified articles included two level I and 20 level II studies. In addition, 15 level IV, one gray literature, and four previous systematic reviews with meta-analyses were also used in the study. The extracted data from the included studies demonstrated heterogeneity that prevented quantitative assessment, and only one level II study directly compared tilted and axially placed implants. Assessment of the descriptive data demonstrated no differences in implant survival, marginal bone loss, prosthesis survival, or patient-reported outcome measures (PROMs) whether implants are placed axially or with intentional inclination of the coronal aspect of the implant toward the distal aspect of edentulous jaws.
CONCLUSIONS
Based upon the systematic review of the literature, an analysis of the descriptive data suggested no differences in clinical performance between implants that are placed in an axial position relative to the residual alveolar ridge when compared with implants that are intentionally tilted toward the distal aspect of edentulous jaws.
Topics: Alveolar Bone Loss; Alveolar Process; Databases, Factual; Dental Implantation, Endosseous; Dental Implants; Dental Prosthesis Design; Humans; Jaw, Edentulous; Patient Reported Outcome Measures; Prosthesis Failure
PubMed: 30328193
DOI: 10.1111/clr.13294 -
Medicine Jul 2018Laminoplasty (LP) and laminectomy with fusion (LF) were recognized as two reliable and effective way in treating multilevel cervical ossification of the posterior... (Meta-Analysis)
Meta-Analysis Review
Comparison of laminoplasty versus laminectomy and fusion in the treatment of multilevel cervical ossification of the posterior longitudinal ligament: A systematic review and meta-analysis.
BACKGROUND
Laminoplasty (LP) and laminectomy with fusion (LF) were recognized as two reliable and effective way in treating multilevel cervical ossification of the posterior longitudinal ligament (OPLL). However, there was no clear conclusion on which method is better. A meta-analysis was conducted to evaluate the clinical results between LP and LF in the treatment of multilevel cervical OPLL.
METHODS
An extensive search of literature was performed in PubMed, Embase, the Cochrane library, CNKI (Chinese database), and WANFANG (Chinese database). The following outcomes were extracted: the Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS), cervical lordosis, cervical range of motion (ROM), complications, blood loss, and operation time. Data analysis was conducted with RevMan 5.3.
RESULTS
A total of 11 studies were included in the final analysis. The results indicated that no significant differences between LP and LF group in terms of preoperative JOA scores (P = .58), postoperative JOA scores (P = .60), JOA scores improvement rate (P = 0.64), preoperative VAS (P = .34), postoperative VAS (P=.20), preoperative range of motion (ROM) (P = .10), postoperative ROM (P = .18), preoperative cervical lordosis (P = .56), C5 palsy (P = .16), and axial pain (P = .21). LF group showed larger postoperative cervical lordosis than LP group [standardized mean difference (SMD) = 1.13 (2.03, 0.24), P = .01]. However, LP group showed lower operation time [mean difference (MD) = 19.42 (26.87, 11.97), P < .001] and blood loss [MD = 94.78 (179.05, 10.51), P = .03] than LF group.
CONCLUSION
Both LP and LF can achieve clinical improvement in the treatment of multilevel cervical OPLL. LF was superior to LP in maintaining cervical lordosis. However, LP showed lower surgical trauma than LF. Kyphosis line (K-line) may be a good criterion in the selection of posterior surgery. LP was performed for the patients with K-line (+) and LF for K-line (-).
Topics: Cervical Vertebrae; Female; Humans; Laminectomy; Laminoplasty; Male; Operative Time; Ossification of Posterior Longitudinal Ligament; Pain Measurement; Postoperative Complications; Range of Motion, Articular; Spinal Fusion; Treatment Outcome
PubMed: 30024545
DOI: 10.1097/MD.0000000000011542 -
European Radiology Sep 2018Juvenile idiopathic arthritis (JIA) can cause structural damage. However, data on conventional radiography (CR) in JIA are scant. (Review)
Review
BACKGROUND
Juvenile idiopathic arthritis (JIA) can cause structural damage. However, data on conventional radiography (CR) in JIA are scant.
OBJECTIVE
To provide pragmatic guidelines on CR in each non-systemic JIA subtype.
METHODS
A multidisciplinary task force of 16 French experts (rheumatologists, paediatricians, radiologists and one patient representative) formulated research questions on CR assessments in each non-systemic JIA subtype. A systematic literature review was conducted to identify studies providing detailed information on structural joint damage. Recommendations, based on the evidence found, were evaluated using two Delphi rounds and a review by an independent committee.
RESULTS
74 original articles were included. The task force developed four principles and 31 recommendations with grades ranging from B to D. The experts felt strongly that patients should be selected for CR based on the risk of structural damage, with routine CR of the hands and feet in rheumatoid factor-positive polyarticular JIA but not in oligoarticular non-extensive JIA.
CONCLUSION
These first pragmatic recommendations on CR in JIA rely chiefly on expert opinion, given the dearth of scientific evidence. CR deserves to be viewed as a valuable tool in many situations in patients with JIA.
KEY POINTS
• CR is a valuable imaging technique in selected indications. • CR is routinely recommended for peripheral joints, when damage risk is high. • CR is recommended according to the damage risk, depending on JIA subtype. • CR is not the first-line technique for imaging of the axial skeleton.
Topics: Adolescent; Arthritis, Juvenile; Child; Female; Humans; Male; Radiography
PubMed: 29582130
DOI: 10.1007/s00330-018-5304-7 -
European Journal of Surgical Oncology :... Sep 2017The surgical choice for grade 1 chondrosarcoma has been debated for decades. Intralesional resection can minimize the damage caused by surgery and offer better... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The surgical choice for grade 1 chondrosarcoma has been debated for decades. Intralesional resection can minimize the damage caused by surgery and offer better functional outcome. However, controversy remains about whether it will result in higher rates of local recurrence and metastasis, fewer complications, and better functional outcome compared with resection with wide margin. This systematic review and updated meta-analysis therefore compared intralesional resection and resection with wide margin in terms of local recurrence, metastasis, complications, and functional outcome.
METHODS
Medline, Embase, and the Cochrane Library were comprehensively searched in December 2016 to identify studies comparing intralesional resection and resection with wide margin for central grade 1 chondrosarcoma. Data of interest were extracted and analyzed using Review Manager 5.3.
RESULTS
Ten studies involving 394 patients were included, with 214 patients who had intralesional resection and 180 patients who had resection with wide margin for grade 1 chondrosarcoma. Intralesional resection was associated with lower complication rates (P < 0.0001) and better Musculoskeletal Tumor Society score (MSTS). There were no significant differences in terms of overall local recurrence (P = 0.27), local recurrence based on adjuvant therapies (P = 0.22), local recurrence in studies that included lesions of the hand, foot, pelvis, and axial skeleton (P = 0.55), and metastasis (P = 0.74) between groups.
CONCLUSION
Intralesional resection provides lower complications and better functional outcome with no significant increase in the risk of recurrence and metastasis. We think it is a suitable treatment for central grade 1 chondrosarcoma.
Topics: Bone Neoplasms; Chondrosarcoma; Humans; Margins of Excision; Musculoskeletal System; Neoplasm Grading; Neoplasm Metastasis; Neoplasm Recurrence, Local; Postoperative Complications
PubMed: 28666625
DOI: 10.1016/j.ejso.2017.05.022 -
Journal of Orthopaedics and... Sep 2017Pelvic posture and kinematics influence acetabular orientation and are therefore expected to be involved in the pathomechanics of femoroacetabular impingement (FAI).... (Review)
Review
BACKGROUND
Pelvic posture and kinematics influence acetabular orientation and are therefore expected to be involved in the pathomechanics of femoroacetabular impingement (FAI). This systematic review aims to determine whether FAI patients show pelvic postures or patterns of motion contributing to impingement or, conversely, develop compensatory postures and patterns of motion preventing it.
MATERIALS AND METHODS
PubMed/MEDLINE, Embase, Google Scholar and the Cochrane Library were systematically searched to find all the studies that measured pelvic positional and/or kinematic data in humans (patients or cadaveric specimens) affected by FAI.
RESULTS
Twelve items were selected and grouped according to the main field of investigation. No quantitative data synthesis was allowed due to methodological heterogeneity. Pelvic posture and kinematics seem to play a relevant role in FAI. The patients, especially if symptomatic, show a paradoxical lack of pelvic back tilt in standing hip flexions, i.e., in squatting, that enhances femoroacetabular engagement. Such an aberrant pattern might depend on a lower pelvic incidence. On the contrary, active hip flexion in decubitus elicits a compensatory, more pronounced back tilt to facilitate hip flexion without impingement. Stair climbing shows a compensatory pattern of augmented pelvic axial rotation and augmented peak forward tilt to reduce painful hip motions, namely internal rotation and extension.
CONCLUSION
In FAI patients, pelvic posture and kinematics are sometimes an expression of compensatory mechanisms developed to reduce pain and discomfort, and sometimes an expression of paradoxical responses that further enhance the impingement pathomechanism.
LEVEL OF EVIDENCE
IV.
Topics: Acetabulum; Biomechanical Phenomena; Femoracetabular Impingement; Femur Head; Femur Neck; Hip Joint; Humans; Pelvic Bones; Posture; Spine
PubMed: 28150180
DOI: 10.1007/s10195-016-0439-2 -
JBJS Reviews Nov 2016As the most viable method for investigating in vivo anterior cruciate ligament (ACL) rupture, video analysis is critical for understanding ACL injury mechanisms and...
BACKGROUND
As the most viable method for investigating in vivo anterior cruciate ligament (ACL) rupture, video analysis is critical for understanding ACL injury mechanisms and advancing preventative training programs. Despite the limited number of published studies involving video analysis, much has been gained through evaluating actual injury scenarios.
METHODS
Studies meeting criteria for this systematic review were collected by performing a broad search of the ACL literature with use of variations and combinations of video recordings and ACL injuries. Both descriptive and analytical studies were included.
RESULTS
Descriptive studies have identified specific conditions that increase the likelihood of an ACL injury. These conditions include close proximity to opposing players or other perturbations, high shoe-surface friction, and landing on the heel or the flat portion of the foot. Analytical studies have identified high-risk joint angles on landing, such as a combination of decreased ankle plantar flexion, decreased knee flexion, and increased hip flexion.
CONCLUSIONS
The high-risk landing position appears to influence the likelihood of ACL injury to a much greater extent than inherent risk factors. As such, on the basis of the results of video analysis, preventative training should be applied broadly. Kinematic data from video analysis have provided insights into the dominant forces that are responsible for the injury (i.e., axial compression with potential contributions from quadriceps contraction and valgus loading). With the advances in video technology currently underway, video analysis will likely lead to enhanced understanding of non-contact ACL injury.
Topics: Anterior Cruciate Ligament Injuries; Female; Humans; Image Processing, Computer-Assisted; Knee Joint; Male; Models, Biological; Range of Motion, Articular; Video Recording
PubMed: 27922985
DOI: 10.2106/JBJS.RVW.15.00116 -
Clinical and Experimental Rheumatology 2016Anti-tumour necrosis factor (TNF) agents are recommended as second-line therapy for patients with axial spondyloarthropathies. This analysis reviewed data on studies... (Review)
Review
Anti-tumour necrosis factor (TNF) agents are recommended as second-line therapy for patients with axial spondyloarthropathies. This analysis reviewed data on studies investigating the efficacy and tolerability of anti-TNF agents in patients with non-radiographic axial spondyloarthritis (nr-axSpA) who had failed first-line non-steroidal anti-inflammatory (NSAID) treatment. Efficacy data from RCTs were used to calculate the number needed to treat (NNT) for individual anti-TNFs and then the cost per responder was determined to provide an indication of the value of each therapy. A systematic literature review and analysis of search results over the period January 2008 to September 2014 identified four randomised placebo-controlled trials that were included in the analysis. Adalimumab, etanercept and certolizumab pegol were all effective and well tolerated in patients with nr-axSpA. A patient was more likely to reach ASAS20 or ASAS40 when treated with etanercept or adalimumab, the NNT was lowest for adalimumab, and the risk of adverse events was higher with certolizumab pegol 200 mg every 2 weeks. The cost per responder (NNT) was lowest for adalimumab, followed closely by certolizumab 400 mg every 4 weeks, intermediate for certolizumab 200 mg every 2 weeks and highest for etanercept. Although all anti-TNF agents were associated with clinical improvement in patients with nr-axSpA, adalimumab presented a better cost per responder than etanercept and certolizumab pegol.
Topics: Adalimumab; Biological Products; Certolizumab Pegol; Cost-Benefit Analysis; Drug Costs; Etanercept; Humans; Models, Economic; Randomized Controlled Trials as Topic; Recovery of Function; Remission Induction; Sacroiliac Joint; Spine; Spondylarthritis; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha
PubMed: 27385374
DOI: No ID Found -
Expert Review of Clinical Immunology Jun 2016Psoriatic arthritis (PsA) is characterized by chronic inflammation of peripheral joints and axial skeleton, associated with a strong genetic background. Clinics include... (Review)
Review
Psoriatic arthritis (PsA) is characterized by chronic inflammation of peripheral joints and axial skeleton, associated with a strong genetic background. Clinics include enthesitis or dactylitis and extra-articular involvement as uveitis or inflammatory bowel disease, while treatment options range from nonsteroidal anti-inflammatory drugs (NSAIDs) to biologics, targeting TNF α or Th17. No serum autoantibody is associated with PsA, while other biomarkers have been proposed for early diagnosis or to predict treatment response. To better discuss this area of growing interest we performed a systematic review of the literature on biomarkers in PsA. Our research retrieved 408 papers, and 38 were included in the analysis. Based on the available literature, we draw some recommendations for the use of biomarkers in the management of patients with PsA.
Topics: Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis, Psoriatic; Biomarkers; Genetic Predisposition to Disease; Humans; Inflammation; Joints; Th17 Cells; Tumor Necrosis Factor-alpha
PubMed: 26821681
DOI: 10.1586/1744666X.2016.1147954 -
Arthritis Care & Research Oct 2016We conducted a systematic review to evaluate the associations of knee alignment or trochlear morphology (measured on imaging) with presence, severity, onset, and/or... (Review)
Review
OBJECTIVE
We conducted a systematic review to evaluate the associations of knee alignment or trochlear morphology (measured on imaging) with presence, severity, onset, and/or progression of patellofemoral osteoarthritis (PFOA).
METHODS
We prospectively registered our protocol with PROSPERO (International prospective register of systematic reviews) and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to report this review. We searched 10 electronic databases, screened citing articles, and reviewed reference lists. We extracted data and evaluated methodologic quality. Due to study design heterogeneity, we used a best-evidence synthesis to summarize the evidence.
RESULTS
We included 16 publications (2,892 participants, 66% women) after removing 4 papers that did not meet our threshold for methodologic quality. There were 11 cross-sectional and 5 longitudinal papers. The target population was knee OA in 11 studies, PFOA in 2 studies, and other knee conditions in 3 studies. Alignment or morphology was measured using radiographs in 8 studies, magnetic resonance imaging in 7 studies, and computed tomography in 2 papers. Limitations include substantial heterogeneity in samples and methods, short followup times in longitudinal studies, and a small number of studies that specifically recruited participants with PFOA.
CONCLUSION
There is strong evidence that PFOA is associated with both trochlear morphology and frontal plane knee alignment, while evidence is limited but consistent in the sagittal and axial planes. These findings suggest that alignment should be evaluated clinically in individuals with PFOA. Clinical interventions targeting knee alignment warrant further investigation.
Topics: Cross-Sectional Studies; Femur; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Osteoarthritis, Knee; Patellofemoral Joint; Prospective Studies; Radiography; Tibia; Tomography, X-Ray Computed
PubMed: 26814979
DOI: 10.1002/acr.22842 -
Pain Physician 2015The sacroiliac joint is well known as a cause of low back and lower extremity pain. Prevalence estimates are 10% to 25% in patients with persistent axial low back pain... (Review)
Review
BACKGROUND
The sacroiliac joint is well known as a cause of low back and lower extremity pain. Prevalence estimates are 10% to 25% in patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis based on multiple diagnostic studies and systematic reviews. However, at present there are no definitive management options for treating sacroiliac joint pain.
OBJECTIVE
To evaluate the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions.
STUDY DESIGN
A systematic review of the diagnostic accuracy and therapeutic effectiveness of sacroiliac joint interventions.
METHODS
The available literature on diagnostic and therapeutic sacroiliac joint interventions was reviewed. The quality assessment criteria utilized were the Quality Appraisal of Reliability Studies (QAREL) checklist for diagnostic accuracy studies, Cochrane review criteria to assess sources of risk of bias, and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) criteria for randomized therapeutic trials and Interventional Pain Management Techniques-Quality Appraisal of Reliability and Risk of Bias Assessment for Nonrandomized Studies (IPM-QRBNR) for observational therapeutic assessments. The level of evidence was based on a best evidence synthesis with modified grading of qualitative evidence from Level I to Level V. Data sources included relevant literature published from 1966 through March 2015 that were identified through searches of PubMed and EMBASE, manual searches of the bibliographies of known primary and review articles, and all other sources.
OUTCOME MEASURES
For the diagnostic accuracy assessment, and for the therapeutic modalities, the primary outcome measure of pain relief and improvement in functional status were utilized.
RESULTS
A total of 11 diagnostic accuracy studies and 14 therapeutic studies were included. The evidence for diagnostic accuracy is Level II for dual diagnostic blocks with at least 70% pain relief as the criterion standard and Level III evidence for single diagnostic blocks with at least 75% pain relief as the criterion standard. The evidence for cooled radiofrequency neurotomy in managing sacroiliac joint pain is Level II to III. The evidence for conventional radiofrequency neurotomy, intraarticular steroid injections, and periarticular injections with steroids or botulinum toxin is limited: Level III or IV.
LIMITATIONS
The limitations of this systematic review include inconsistencies in diagnostic accuracy studies with a paucity of high quality, replicative, and consistent literature. The limitations for therapeutic interventions include variations in technique, variable diagnostic standards for inclusion criteria, and variable results.
CONCLUSION
The evidence for the accuracy of diagnostic and therapeutic effectiveness of sacroiliac joint interventions varied from Level II to Level IV.
Topics: Humans; Low Back Pain; Outcome and Process Assessment, Health Care; Pain Management; Sacroiliac Joint
PubMed: 26431129
DOI: No ID Found