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European Journal of Orthopaedic Surgery... Jul 2023Rapidly progressive osteoarthritis of the hip is an uncommon and poorly understood condition. No universal definition of RPOH exists, however, a loss of joint space of... (Review)
Review
PURPOSE
Rapidly progressive osteoarthritis of the hip is an uncommon and poorly understood condition. No universal definition of RPOH exists, however, a loss of joint space of 2 mm or more per year or 50% or more in one year with no other cause can be classed as RPOH. Due to the rapid loss of joint space and associated bone loss, total hip arthroplasty is the only viable treatment option. The aim of this systematic review is to assess the outcomes of THA in RPOH.
METHODS
A systematic search of Embase, Medline and CINAHL databases was performed for studies reporting on the outcomes of patients with RPOH as their primary diagnosis for undergoing THA. Patient demographics, surgical techniques, implant selection, blood loss, morbidity and mortality, length of stay and patient-reported outcomes were amongst the data collected.
RESULTS
Eight studies were found to be eligible, reporting on the outcomes of 270 patients with a mean age of 71. The majority of patients (88.1%) were female and the mean Body Mass Index was 27.6 kg/m. Six of the eight studies reported on the need for additional reconstructive devices and procedures including the use of acetabular roof augmentation, acetabular reinforcement devices and revision acetabular components. Two studies reported increased blood loss in RPOH patients compared with non-RPOH patients (945 ml vs. 578 ml and 473.9 g vs. 353.9 g, respectively).
CONCLUSION
RPOH leads to significant pre-operative morbidity and THA for RPOH has been shown to result in greater blood loss, prolonged operative time and increased complexity of the procedure all of which result in increased cost. There is a paucity of data on the long-term outcomes for these patients and more well-constructed studies are therefore required.
Topics: Humans; Male; Female; Aged; Arthroplasty, Replacement, Hip; Acetabulum; Osteoarthritis; Reoperation; Plastic Surgery Procedures; Treatment Outcome; Hip Prosthesis; Osteoarthritis, Hip; Retrospective Studies
PubMed: 36149508
DOI: 10.1007/s00590-022-03396-8 -
BMJ Open Sep 2022This systematic review aims to compare the effects of active monitoring and abduction treatment on the Graf alpha angle, Acetabular Index (AI) and femoral head coverage...
OBJECTIVES
This systematic review aims to compare the effects of active monitoring and abduction treatment on the Graf alpha angle, Acetabular Index (AI) and femoral head coverage in infants with stable developmental dysplasia of the hip (DDH).
DESIGN
Systematic review reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
DATA SOURCES
A search of the PubMed, Embase, Cochrane and Web of Science databases was performed in January 2020 and updated in January 2021.
ELIGIBILITY CRITERIA
(Non-)randomised studies comparing active monitoring with abduction treatment in infants younger than 4 months with stable DDH were included.
DATA EXTRACTION AND SYNTHESIS
All eligible articles were methodologically assessed using the Cochrane risk of bias tools. Data were extracted by summarising the study characteristics and results.
RESULTS
Of the six included studies, two randomised studies were of low risk and two of some concerns. Two non-randomised studies were of serious risk. In total, 544 dysplastic hips (439 infants) were investigated, of which 307 were observed and 237 were treated. Two studies reported a faster improvement of the alpha angle and average acetabular coverage in treated hips at 3 months. No differences in AI between the treatment and observation group after 3 months were reported. In total, 38 infants (12%) in the observation group switched to the treatment group. At the final radiograph, 21 observed hips and 32 treated hips were dysplastic.
CONCLUSIONS
There were no differences in AI between the treatment and observation group after 3 months in infants up to 4 months of age with stable DDH hips. The switch of 38 infants (12%) from the observation to the treatment group corroborates that not all infantile DDH hips will spontaneously progress into normal hips. The small study population sizes and methodological heterogeneity warrant a large randomised controlled trial to study this research question.
PROSPERO REGISTRATION NUMBER
CRD4202123300.
Topics: Acetabulum; Developmental Dysplasia of the Hip; Hip Dislocation, Congenital; Humans; Infant; Monitoring, Physiologic; Radiography; Randomized Controlled Trials as Topic
PubMed: 36123097
DOI: 10.1136/bmjopen-2021-057906 -
Medicina (Kaunas, Lithuania) Aug 2022: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles... (Review)
Review
: Pelvic nonunion and malunion have been documented as rare complications in pelvic fractures and literature describing these topics is severely limited. Articles dedicated solely to pelvic malunion are nearly nonexistent. We conducted a literature search with the goal of providing a summary of the definition, causes, treatment strategies, and outcomes of pelvic malunion correction. : An initial review of the literature was performed using the PubMed, ScienceDirect, and Cochrane Database of Systematic Reviews databases. Search terms used were "malunion" AND "pelvic" OR "pelvis". Duplicate articles, non-English language articles without translations available and non-human subject studies were excluded. : Eleven original publications were found describing experiences with pelvic malunion. Seven of the articles were exclusively dedicated to the topic of pelvic fracture malunion, and only two reported on a series of patients treated for malunion with variably staged procedures. Most reports define pelvic pain as the main indication for surgical correction, along with gait disturbance, standing or sitting imbalance, and urinary or sexual dysfunction. Radiographically, vertical displacement of one to two centimeters and rotation of the hemipelvis of fifteen degrees or more have been described in defining malunion. No treatment algorithms exist, and each patient is treated with a unique work-up and operative plan due to the complexity of the problem. Only one series reported a patient satisfaction rate of 75% following malunion treatment. Conclusions: Pelvic malunion is a rare complication of pelvic ring injury and is seldom discussed in the literature. We found two small case series reporting exclusively on malunion treatment and complications. While some of the combination studies made the distinction in the diagnosis of malunion and nonunion, they rarely differentiated the treatment outcomes between the two categories. This paper describes pelvic malunion and highlights the need for more research into surgical outcomes of treatment specifically regarding functionality, patient satisfaction, and recurrence of preoperative symptoms.
Topics: Fractures, Bone; Fractures, Malunited; Humans; Pelvic Bones
PubMed: 36013565
DOI: 10.3390/medicina58081098 -
Medicina (Kaunas, Lithuania) Aug 2022: Adequate initial fixation of the uncemented acetabular component in total hip arthroplasty is necessary to achieve long-term survival. Although screw fixation... (Meta-Analysis)
Meta-Analysis Review
: Adequate initial fixation of the uncemented acetabular component in total hip arthroplasty is necessary to achieve long-term survival. Although screw fixation contributes to improved cup stability, there is currently no consensus on the use of this method. This study aimed to assess the existing randomized controlled trials (RCTs) on the efficacy and safety of cup fixation in total hip arthroplasty without screws. : We searched the EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases to identify RCTs published before February 2022. Primary outcomes were reoperation, cup migration, and Harris Hip Score. Secondary outcomes were the presence of a radiolucent line in the acetabular region, translation and rotation movement, and polyethylene wear. We conducted meta-analyses using the random-effects models. The revised Cochrane risk-of-bias tool was used to assess the risk of bias for outcomes of interest; the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to summarize the body of evidence. : We included six reports from four studies. Total hip arthroplasty without screw fixation to the acetabular cup had little to no effect on reoperation (pooled relative risk, 0.98; 95% confidence interval, 0.14-6.68; = 0%), cup migration (pooled relative risk, 1.72; 95% confidence interval, 0.29-10.33; = 1%), Harris Hip Score (mean difference, 1.19; 95% confidence interval, -1.31-3.70; = 0%), radiolucent line (pooled relative risk, 5.91; 95% confidence interval, 0.32-109.35), translation and rotation of all axes, and polyethylene wear (mean difference, 0.01; 95% confidence interval, -0.01-0.04; = 0%), with very low certainty of evidence on all measures. : The efficacy of acetabular cups without screw fixation in total hip arthroplasty remains uncertain, suggesting the need for prudent clinical application. Further large-scale, well-designed studies with low risk of bias are required.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Bone Screws; Follow-Up Studies; Hip Prosthesis; Humans; Polyethylenes; Prosthesis Failure; Randomized Controlled Trials as Topic; Reoperation
PubMed: 36013524
DOI: 10.3390/medicina58081058 -
Journal of Neurosurgery. Spine Dec 2022The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading... (Review)
Review
OBJECTIVE
The purpose of this study was to describe the genesis of the AO Spine Sacral and Pelvic Classification System in the context of historical sacral and pelvic grading systems.
METHODS
A systematic search of MEDLINE, EMBASE, Google Scholar, and Cochrane databases was performed consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify all existing sacral and pelvic fracture classification systems.
RESULTS
A total of 49 articles were included in this review, comprising 23 pelvic classification systems and 17 sacral grading schemes. The AO Spine Sacral and Pelvic Classification System represents both the evolutionary product of these historical systems and a reinvention of classic concepts in 5 ways. First, the classification introduces fracture types in a graduated order of biomechanical stability while also taking into consideration the neurological status of patients. Second, the traditional belief that Denis central zone III fractures have the highest rate of neurological deficit is not supported because this subgroup often includes a broad spectrum of injuries ranging from a benign sagittally oriented undisplaced fracture to an unstable "U-type" fracture. Third, the 1990 Isler lumbosacral system is adopted in its original format to divide injuries based on their likelihood of affecting posterior pelvic or spinopelvic stability. Fourth, new discrete fracture subtypes are introduced and the importance of bilateral injuries is acknowledged. Last, this is the first integrated sacral and pelvic classification to date.
CONCLUSIONS
The AO Spine Sacral and Pelvic Classification is a universally applicable system that redefines and reorders historical fracture morphologies into a rational hierarchy. This is the first classification to simultaneously address the biomechanical stability of the posterior pelvic complex and spinopelvic stability, while also taking into consideration neurological status. Further high-quality controlled trials are required prior to the inclusion of this novel classification within a validated scoring system to guide the management of sacral and pelvic injuries.
Topics: Humans; Retrospective Studies; Sacrum; Pelvic Bones; Fractures, Bone; Pelvis; Spinal Fractures
PubMed: 35907199
DOI: 10.3171/2022.5.SPINE211468 -
Medicine Jul 2022Pelvic bone fractures may cause extensive bleeding; however, the efficacy of tranexamic acid (TXA) usage in pelvic fracture surgery remains unclear. In this systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pelvic bone fractures may cause extensive bleeding; however, the efficacy of tranexamic acid (TXA) usage in pelvic fracture surgery remains unclear. In this systematic review and meta-analysis, we aimed to evaluate the efficacy of TXA in open reduction and internal fixation surgery for pelvic and acetabular fracture.
METHODS
MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before April 22, 2020, that investigated the effect of TXA in the treatment of pelvic and acetabular fracture with open reduction and internal fixation. A pooled analysis was used to identify the differences between a TXA usage group and a control group in terms of estimated blood loss (EBL), transfusion rates, and postoperative complications.
RESULTS
We included 6 studies involving 764 patients, comprising 293 patients who received TXA (TXA group) and 471 patients who did not (control group). The pooled analysis showed no differences in EBL between the groups (mean difference -64.67, 95% confidence interval [CI] -185.27 to -55.93, P = .29). The study period transfusion rate showed no significant difference between the groups (odds ratio [OR] 0.77, 95% CI 0.19-3.14, P = .71, I2 = 82%), nor in venous thromboembolism incidence (OR 1.53, 95% CI 0.44-5.25, P = .50, I2 = 0%) or postoperative infection rates (OR 1.15, 95% CI 0.13-9.98, P = .90, I2 = 48%).
CONCLUSIONS
Despite several studies having recommended TXA administration in orthopedic surgery, our study did not find TXA usage to be more effective than not using TXA in pelvic and acetabular fracture surgery, especially in terms of EBL reduction, transfusion rates, and the risk of postoperative complications.
Topics: Antifibrinolytic Agents; Blood Loss, Surgical; Fracture Fixation, Internal; Hip Fractures; Humans; Postoperative Complications; Spinal Fractures; Tranexamic Acid
PubMed: 35866801
DOI: 10.1097/MD.0000000000029574 -
Journal of Orthopaedics and... Jul 2022To evaluate the effectiveness of pelvic packing (PP) in pelvic fracture patients with hemodynamic instability. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the effectiveness of pelvic packing (PP) in pelvic fracture patients with hemodynamic instability.
MATERIALS AND METHODS
Three databases-PubMed, Embase and the Cochrane Library-were systematically searched to identify studies presenting comparisons between a protocol including PP and a protocol without PP. Mortality, transfusion requirement and length of hospitalization were extracted and pooled for meta-analysis. Relative risk (RR) and standard mean difference (SMD), along with their confidence intervals (CIs), were used as the pooled statistical indices.
RESULTS
Eight studies involving 480 patients were identified as being eligible for meta-analysis. PP usage was associated with significantly reduced overall mortality (RR = 0.61, 95% CI = 0.47-0.79, p < 0.01) as well as reduced mortality within 24 h after admission (RR = 0.42, 95% CI = 0.26-0.69, p < 0.01) and due to hemorrhage (RR = 0.26, 95% CI = 0.14-0.50, p < 0.01). The usage of PP also decreased the need for pre-operative transfusion (SMD = - 0.44, 95% CI = - 0.69 to - 0.18, p < 0.01), but had no influence on total transfusion during the first 24 h after admission (SMD = 0.05, 95% CI = - 0.43-0.54, p = 0.83) and length of hospitalization (ICU stay and total stay).
CONCLUSIONS
This meta-analysis indicates that a treatment protocol including PP could reduce mortality and transfusion requirement before intervention in pelvic fracture patients with hemodynamic instability vs. angiography and embolization. This latter technique could be used as a feasible and complementary technique afterwards.
Topics: Attention; Fractures, Bone; Hemorrhage; Humans; Pelvic Bones; Pelvis
PubMed: 35799073
DOI: 10.1186/s10195-022-00647-6 -
International Journal of Surgery... Jun 2022
Meta-Analysis
A commentary on "Trabecular metal versus non-trabecular metal acetabular components for acetabular revision surgery: A systematic review and meta-analysis" (Int J Surg 2022;100:106597).
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Reoperation
PubMed: 35642828
DOI: 10.1016/j.ijsu.2022.106687 -
Acta Bio-medica : Atenei Parmensis Mar 2022There is no consensus about the best treatment for acetabular fracture in older patients. The purpose of this study was to review the current literature looking for...
Is non-operative management of acetabular fracture a viable option for older patients? A systematic review of the literature for indication, treatments, complications and outcome.
There is no consensus about the best treatment for acetabular fracture in older patients. The purpose of this study was to review the current literature looking for indication, perioperative information and outcome of nonoperative management for acetabular fractures in elderly.A systematic review of literature was performed on different research database by using various combination of the keywords "acetabular fracture", "elderly patients", "60 years", "nonoperative", "nonsurgical" and "conservative treatment".Six articles met our inclusion criteria, 315 patients aged 60 or more treated nonoperatively for acetabular fracture were included in the analysis. The average age was 78.1 years, the average follow-up length was 48.7 months. The main criteria for indication of nonoperative management for acetabular fractures were, old age (75 years or more), two or more important medical comorbidities, and minimally or undisplaced fracture. The most frequent fracture pattern was anterior column in 25.3% of cases. Fall from standard height was the most frequent causative mechanism in 80% of patients. A conversion total hip arthroplasty was performed after 8.3% of cases. A 1-year mortality of 18% was reported, an overall mortality of 33.1% at last follow-up was reported.The management of acetabular fractur in elderly is a challenging problem and there is no consensus about the best treatment. Currently, multiple treatment options have been suggested, depending on fracture pattern and patients' general conditions. Although operatively treatment allow for an early recovery, there is not an high level of evidence about the superiority in terms or complications and mortality rate compared to nonoperative treatment.
Topics: Acetabulum; Aged; Arthroplasty, Replacement, Hip; Fracture Fixation, Internal; Fractures, Bone; Hip Fractures; Humans; Spinal Fractures; Treatment Outcome
PubMed: 35604268
DOI: 10.23750/abm.v92iS3.12544 -
International Journal of Surgery... Jul 2022
Meta-Analysis
A commentary on "Trabecular metal versus non-trabecular metal acetabular components for acetabular revision surgery: A systematic review and meta-analysis" (Int J Surg 2022;100:106597).
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Hip Prosthesis; Humans; Reoperation
PubMed: 35568307
DOI: 10.1016/j.ijsu.2022.106660