-
Journal of Indian Society of... 2023Platelet concentrates (PCs) are biological agents known to promote soft as well as hard tissue healing. The review aimed at evaluating the effectiveness of PCs for... (Review)
Review
Platelet concentrates (PCs) are biological agents known to promote soft as well as hard tissue healing. The review aimed at evaluating the effectiveness of PCs for treating peri-implantitis (PI). Five electronic databases were systematically reviewed followed by a handsearch of relevant journals. The selected studies focused on the predetermined primary and secondary outcomes. The primary outcomes were bleeding on probing, probing depth, marginal bone level. RevMan 5.4.1 software was used for risk bias analysis. The search retrieved 12 articles, and only one study compared PC and open flap debridement. Other three studies with different control arms were included to evaluate the overall effect of different PCs in treatment of PI. High heterogeneity was found regarding study design, sample size, surgical techniques, and methods for preparing PCs. The use of platelet-rich fibrin for PI over conventional therapy was beneficial in improving clinical parameters. In addition, PC when combined with graft materials provided a significant improvement in parameters assessed. The preliminary data regarding the use of different PC in treatment of PI seem to be promising. However, due to lack of comparative randomized controlled trials, future clinical research is necessary to comment on the role of PCs for treating PI.
PubMed: 37152466
DOI: 10.4103/jisp.jisp_622_21 -
Acta Orthopaedica Apr 2023Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND PURPOSE
Wrist arthroscopy is used increasingly, but its benefits and harms are unclear. This systematic review aimed to identify all published randomized controlled trials on wrist arthroscopy and synthesize the evidence of the benefits and harms of wrist arthroscopic procedures.
METHODS
We searched CENTRAL, MEDLINE, and Embase for randomized controlled trials comparing wrist-arthroscopic surgery with corresponding open surgery, placebo surgery, a non-surgical treatment, or no treatment. We estimated the treatment effect with a random effect meta-analysis using patient reported outcome measure (PROM) as primary outcome where several studies assessed the same intervention.
RESULTS
Of 7 included studies, none compared wrist arthroscopic procedures with no treatment or placebo surgery. 3 trials compared arthroscopically assisted reduction with fluoroscopic reduction of intra-articular distal radius fractures. The certainty of evidence was low to very low for all comparisons. The benefit of arthroscopy was clinically unimportant (smaller than what patients may consider meaningful) at all time points. 2 studies compared arthroscopic and open resection of wrist ganglia, finding no significant difference in recurrence rates. 1 study estimated the benefit of arthroscopic joint debridement and irrigation in intra-articular distal radius fractures, showing no clinically relevant benefit. 1 study compared arthroscopic triangular fibrocartilage complex repair with splinting in distal radioulnar joint instability in people with distal radius fractures, finding no evidence of benefits for repair at the long-term follow-up but the study was unblinded, and the estimates imprecise.
CONCLUSION
The current limited evidence from RCTs does not support benefits of wrist arthroscopy compared with open or non-surgical interventions.
Topics: Humans; Wrist; Arthroscopy; Wrist Joint; Wrist Injuries; Joint Instability; Radius Fractures; Treatment Outcome
PubMed: 37114362
DOI: 10.2340/17453674.2023.11957 -
BMC Oral Health Apr 2023Peri-implantitis is the most difficult biological complication associated with dental implants, often requiring surgical treatments in advanced stages. This study... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Peri-implantitis is the most difficult biological complication associated with dental implants, often requiring surgical treatments in advanced stages. This study compares the effectiveness of different surgical methods for peri-implantitis.
METHODS
Randomized controlled trials (RCTs) of different surgical treatments for peri-implantitis were extracted from EMBASE, Web of Science, Cochrane Library databases, and PubMed systematically. Pairwise comparisons and network meta-analyses (NMA) were conducted to analyze the effect of surgical treatments on probing depth (PD), radiographic bone fill (RBF), mucosal recession (MR), bleeding on probing (BOP), and clinical attachment level (CAL). In addition, risk of bias, quality of evidence, and statistical heterogeneity of the selected studies were evaluated. A total of 13 articles were included in this study, involving open flap debridement (OFD), resective therapy (RT), and augmentative therapy (AT) with and without adjunctive treatments (laser therapy, photodynamic therapy, local antibiotics, phosphoric acid, and ozone therapy).
RESULTS
AT improved RBF and CAL more than OFD, but does not outperform OFD in reducing peri-implant soft-tissue inflammation. AT, OFD and RT did not significantly alter the levels of MR. Addition of ozone therapy improved the effect of AT, but addition of photodynamic therapy did not affect PD reduction and CAL gain significantly. Similarly, adjuvant treatment with phosphoric acid during RT did not significantly change the outcome of BOP.
CONCLUSIONS
Within the limitation of this systematic review and NMA, AT was superior to OFD in improving peri-implantitis outcomes. While adjunct use of ozone therapy may further improve the efficacy of AT, the limited evidence supporting this combination therapy argues for cautionary interpretation of these results.
Topics: Humans; Peri-Implantitis; Network Meta-Analysis; Phosphoric Acids; Ozone
PubMed: 37076816
DOI: 10.1186/s12903-023-02956-6 -
Archives of Orthopaedic and Trauma... Sep 2023While large progress has been achieved in identifying and treating the most common pathogens involved in periprosthetic joint infections (PJI), there remains limited... (Review)
Review
INTRODUCTION
While large progress has been achieved in identifying and treating the most common pathogens involved in periprosthetic joint infections (PJI), there remains limited knowledge on atypical pathogens such as Corynebacterium. For that reason, we analyzed infection and diagnostical characteristics, as well as treatment outcome in Corynebacterium PJI.
METHODS
A systematic review was performed based on a structured PubMed and Cochrane Library analysis using the PRISMA algorithm. The search was performed by 2 independent reviewers, and articles from 1960 to 2022 considered eligible for inclusion. Out of 370 search results, 12 studies were included for study synthesis.
RESULTS
In total, 52 cases of Corynebacterium PJI were identified (31 knees, 16 hips, 4 elbows, 1 shoulder). Mean age was 65 years, with 53% females, and a mean Charlson Comorbidity Index of 3.9. The most common species was Corynebacterium striatum in 37 cases (71%). Most patients were treated with two-stage exchange (40%), isolated irrigation and debridement (21%), and resection arthroplasty (19%). Mean duration of antibiotic treatment was 8.5 weeks. At a mean follow-up of 2.5 years, there were 18 reinfections (33%), and 39% were for Corynebacterium. Initial infection by Corynebacterium striatum species was predictive of reoperation (p = 0.035) and reinfection (p = 0.07).
CONCLUSION
Corynebacterium PJI affects multimorbid and elderly patients, with one in three developing a reinfection at short term. Importantly, the relative majority of reinfections was for persistent Corynebacterium PJI.
Topics: Female; Humans; Aged; Male; Prosthesis-Related Infections; Reinfection; Follow-Up Studies; Retrospective Studies; Anti-Bacterial Agents; Treatment Outcome; Corynebacterium; Reoperation
PubMed: 36995473
DOI: 10.1007/s00402-023-04844-8 -
Endoscopy International Open Mar 2023Endoscopic necrosectomy is limited by the proximity of necrosis to the gastrointestinal tract. Percutaneous endoscopic necrosectomy (PEN) is a minimally invasive...
Endoscopic necrosectomy is limited by the proximity of necrosis to the gastrointestinal tract. Percutaneous endoscopic necrosectomy (PEN) is a minimally invasive endoscopic method of percutaneous debridement. Studies regarding its efficacy and safety are lacking. The purpose of this study was to assess the efficacy and safety of PEN in necrotizing pancreatitis. Pubmed, Ovid, Cochrane, Scopus and Web of Science Database were searched from inception through February 2021. Dual extraction and quality assessment of studies using Cochrane risk of bias tool were performed independently by two authors. The primary outcome was defined as clinical success of PEN. Secondary outcomes included periprocedural morbidity, mortality, and long-term morbidity and mortality. Sixteen observational studies including 282 subjects were analyzed. The average reported age of the participants was 50.3 years. Patients with reported gender included 39 % females and 61 % males. The success rate as defined by complete resolution of necrosis and removal of drainage catheters/stents was 82 % (95 % confidence interval 77-87). The mean size of pancreatic necrosis was 14.86 cm (5-54 cm). The periprocedural morbidity rate was 10 %, while there was no reported periprocedural mortality. The long-term morbidity rate was reported as 23 % and mortality at follow-up was 16 %. PEN is a novel method of endoscopic management of pancreatic necrosis. Based on our meta-analysis of retrospective studies, it represents a safe treatment modality with high rates of clinical success and low rates of perioperative morbidity and mortality. This study supports the use of PEN when conventional endoscopic therapy is not feasible.
PubMed: 36968976
DOI: 10.1055/a-1935-4738 -
World Journal of Emergency Surgery :... Mar 2023To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the available evidence.
METHODS
Data sources were PubMed, Embase, Web of Science, Cochrane Library, and reference lists. The study included observational trials that compared HBO with non-HBO, or standard care. The primary outcome was the mortality rate. Secondary outcomes were the number of debridement, amputation rate and complication rate. Relative risks or standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively.
RESULTS
A total of retrospective cohort and case-control studies were included, including 49,152 patients, 1448 who received HBO and 47,704 in control. The mortality rate in the HBO group was significantly lower than that in the non-HBO group [RR = 0.522, 95% CI (0.403, 0.677), p < 0.05]. However, the number of debridements performed in the HBO group was higher than in the non-HBO group [SMD = 0.611, 95% CI (0.012, 1.211), p < 0.05]. There was no significant difference in amputation rates between the two groups [RR = 0.836, 95% CI (0.619, 1.129), p > 0.05]. In terms of complications, the incidence of MODS was lower in the HBO group than in the non-HBO group [RR = 0.205, 95% CI (0.164, 0.256), p < 0.05]. There was no significant difference in the incidence of other complications, such as sepsis, shock, myocardial infarction, pulmonary embolism, and pneumonia, between the two groups (p > 0.05).
CONCLUSION
The current evidence suggests that the use of HBO in the treatment of NSTI can significantly reduce the mortality rates and the incidence rates of complications. However, due to the retrospective nature of the studies, the evidence is weak, and further research is needed to establish its efficacy. It is also important to note that HBO is not available in all hospitals, and its use should be carefully considered based on the patient's individual circumstances. Additionally, it is still worthwhile to stress the significance of promptly evaluating surgical risks to prevent missing the optimal treatment time.
Topics: Humans; Soft Tissue Infections; Hyperbaric Oxygenation; Retrospective Studies; Debridement; Combined Modality Therapy
PubMed: 36966323
DOI: 10.1186/s13017-023-00490-y -
Journal of Orthopaedic Surgery and... Mar 2023The aim of this study was to compare the clinical outcomes of culture-negative periprosthetic joint infection (CN PJI) with those of culture-positive periprosthetic... (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim of this study was to compare the clinical outcomes of culture-negative periprosthetic joint infection (CN PJI) with those of culture-positive periprosthetic joint infection (CP PJI).
METHODS
Data were obtained from Embase, Web of Science and EBSCO for all available studies comparing the clinical outcomes of CN PJI with those of CP PJI. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess clinical outcomes. Subgroup analyses were performed to explain heterogeneity among the included studies. Publication bias was estimated using Begg's funnel plot. Sensitivity analysis was performed to test the stability of pooled results.
RESULTS
Thirty studies with 1630 (38.7%) CN PJI and 2577 (61.3%) CP PJI were included in this meta-analysis. The pooled results of the included studies showed that overall failure rate in CN PJI group (19.0%, 309/1630) was significantly lower than that in CP PJI group (23.4%, 604/2577) (OR 0.63, 95% CI 0.47-0.84, P = 0.002). We performed the subgroup analysis based on the surgical strategies, the pooled results of nine studies for patients undergoing debridement, antibiotics and implant retention (DAIR) revealed that failure rate in CN PJI group (22.2%, 53/239) was significantly lower than that in CP PJI group (29.3%, 227/775) (OR 0.62, 95% CI 0.43-0.90, P = 0.01), the pooled results of four studies for patients undergoing one-stage revision revealed that failure rate between CN PJI group (11.5%, 11/96) and CP PJI group (7.6%, 27/355) had no significant difference (OR 1.57, 95% CI 0.75-3.26, P = 0.23), and the pooled results of 19 studies for patients undergoing two-stage revision revealed that failure rate in CN PJI group (16.1%, 171/1062) was significantly lower than that in CP PJI group (20.4%, 206/1010) (OR 0.52, 95% CI 0.34-0.79, P = 0.002).
CONCLUSIONS
CN PJI group had similar or better survival rate when compared with CP PJI group for patients who underwent DAIR, one-stage or two-stage revision. Negative culture was not a worse prognostic factor for PJI.
Topics: Humans; Treatment Outcome; Prosthesis-Related Infections; Retrospective Studies; Anti-Bacterial Agents; Arthritis, Infectious; Debridement
PubMed: 36927390
DOI: 10.1186/s13018-023-03692-x -
European Journal of Orthopaedic Surgery... Oct 2023Periprosthetic joint infection (PJI) of the knee represents a severe complication after 1.5% to 2% of primary total knee replacement. Although two-stage revision was... (Review)
Review
BACKGROUND
Periprosthetic joint infection (PJI) of the knee represents a severe complication after 1.5% to 2% of primary total knee replacement. Although two-stage revision was considered the gold-standard treatment for PJI of the knee, in the last decades, more studies reported the outcomes of one-stage revisions. This systematic review aims to assess reinfection rate, infection-free survival after reoperation for recurrent infection, and the microorganisms involved in both primary and recurrent infection.
MATERIAL AND METHODS
A systematic review of all studies reporting the outcome of one-stage revision for PJI of the knee up to September 2022, according to PRISMA criteria and AMSTAR2 guidelines, was performed. Patient demographics, clinical, surgical, and postoperative data were recorded.
PROSPERO ID
CRD42022362767.
RESULTS
Eighteen studies with a total of 881 one-stage revisions for PJI of the knee were analyzed. A reinfection rate of 12.2% after an average follow-up of 57.6 months was reported. The most frequent causative microorganism were gram-positive bacteria (71.1%), gram-negative bacteria (7.1%), and polymicrobial infections (8%). The average postoperative knee society score was 81.5, and the average postoperative knee function score was 74.2. The infection-free survival after treatment for recurrent infection was 92.1%. The causative microorganisms at reinfections differed significantly from the primary infection (gram-positive 44.4%, gram-negative 11.1%).
CONCLUSION
Patients who underwent a one-stage revision for PJI of the knee showed a reinfection rate lower or comparable to other surgical treatments as two-stage or DAIR (debridement, antibiotics, and implant retention). Reoperation for reinfection demonstrates a lower success compared to one-stage revision. Moreover, microbiology differs between primary infection and recurrent infection. Level of evidence Level IV.
Topics: Humans; Reinfection; Prosthesis-Related Infections; Treatment Outcome; Debridement; Knee Joint; Anti-Bacterial Agents; Reoperation; Arthritis, Infectious; Retrospective Studies
PubMed: 36867259
DOI: 10.1007/s00590-023-03480-7 -
Biomedicines Feb 2023This meta-analysis intended to assess evidence on the efficacy of locally delivered curcumin/turmeric as an adjunctive to scaling and root planing (SRP), on clinical... (Review)
Review
This meta-analysis intended to assess evidence on the efficacy of locally delivered curcumin/turmeric as an adjunctive to scaling and root planing (SRP), on clinical attachment level (CAL) and probing pocket depth (PPD), compared to SRP alone or in combination with chlorhexidine (CHX). RCTs were identified from PubMed, Cochrane Library, BASE, LIVIVO, Dentistry Oral Sciences Source, MEDLINE Complete, Scopus, ClinicalTrials.gov, and eLibrary, until August 2022. The risk of bias (RoB) was assessed with the Cochrane Risk of Bias tool 2.0. A random-effects meta-analysis was performed by pooling mean differences with 95% confidence intervals. Out of 827 references yielded by the search, 23 trials meeting the eligibility criteria were included. The meta-analysis revealed that SRP and curcumin/turmeric application were statistically significantly different compared to SRP alone for CAL (-0.33 mm; = 0.03; 95% CI -0.54 to -0.11; I = 62.3%), and for PPD (-0.47 mm; = 0.024; 95% CI -0.88 to -0.06; I = 95.5%); however, this difference was considered clinically meaningless. No significant differences were obtained between patients treated with SRP and CHX, compared to SRP and curcumin/turmeric. The RoB assessment revealed numerous inaccuracies, thus raising concerns about previous overestimates of potential treatment effects.
PubMed: 36831018
DOI: 10.3390/biomedicines11020481 -
JSES International Jan 2023Fractures of the medial clavicle are uncommon. There is no consensus regarding the optimal treatment of displaced medial clavicle fractures.
BACKGROUND
Fractures of the medial clavicle are uncommon. There is no consensus regarding the optimal treatment of displaced medial clavicle fractures.
METHODS
A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. PubMed, EMBASE, and the Cochrane Library were queried using the terms and to identify all studies reporting on outcomes following either nonoperative or operative treatment of displaced medial clavicle fractures. Data extracted included patient demographics, fracture classification, surgical technique, patient-reported outcomes, physical, and radiographic findings. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) scoring system.
RESULTS
The analysis included 15 studies (mean MINORS score, 10 ± 1.5) with a total of 135 patients (85% male, mean age 47 ± 10.9 years [range, 15-87 years]). Five studies (39 patients) reported outcomes following nonoperative treatment. At a mean follow-up of 27 months, there were 5 (13%) symptomatic nonunions, 2 (5%) malunions, and 2 (5%) delayed unions. Eleven studies (96 patients) reported outcomes following surgical treatment with a mean follow-up of 23 months. There were no reported nonunions. Complications included plate prominence/ irritation (30%) and additional surgery was performed for plate removal (27%), fixation failure (3%), and wound débridement (1%).
CONCLUSION
There is limited, low-quality evidence in the literature to guide treatment of displaced medial clavicle fractures. The available data suggest that surgical treatment is associated with good functional outcomes and a lower risk of nonunion and malunion, compared to nonoperative treatment but plate irritation and further surgery to remove the plate was common.
PubMed: 36820437
DOI: 10.1016/j.jseint.2022.09.010