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Journal of Plastic, Reconstructive &... Feb 2022While scaphoid excision combined with Four Corner Arthrodesis (FCA) or Proximal Row Carpectomy (PRC) is a commonly-used salvage procedures to treat type two and type... (Meta-Analysis)
Meta-Analysis Review
While scaphoid excision combined with Four Corner Arthrodesis (FCA) or Proximal Row Carpectomy (PRC) is a commonly-used salvage procedures to treat type two and type three Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC)-induced degenerative arthritis, controversy remains over which treatment intervention provides superior outcomes. We searched for articles comparing a range of motion, grip strength, complications requiring reoperation, conversion to wrist arthrodesis, pain, and disability of shoulder and arm scores between FCA and PRC-treated patients. The risk of bias was assessed using the National Institutes of Health (NIH) quality assessment tool. We performed a meta-analysis using Random-Effects Models. Fifteen articles (10 retrospective, 2 cross-sectional, 1 prospective, and 2 randomized trials) were included. There was no significant difference between PRC and FCA in any of the different outcome measures. The risk of bias was found consistently high across all studies. Despite the lack of high-quality evidence, based on existing literature, we recommend PRC as the preferred choice of treatment because of the simplicity of the surgical procedure, lack of hardware-related complications, and comparable long-term outcomes. Level of evidence: III - Therapeutic.
Topics: Arthrodesis; Carpal Bones; Cross-Sectional Studies; Hand Strength; Humans; Prospective Studies; Range of Motion, Articular; Retrospective Studies; Scaphoid Bone; Treatment Outcome; Wrist Joint
PubMed: 34802951
DOI: 10.1016/j.bjps.2021.09.076 -
Orthopedic Reviews Nov 2020The controversy in surgical management of end-stage tibiotalar arthritis with Total Ankle Arthroplasty (TAA) versus Ankle Arthrodesis (AA) has grown in parallel with the...
The controversy in surgical management of end-stage tibiotalar arthritis with Total Ankle Arthroplasty (TAA) versus Ankle Arthrodesis (AA) has grown in parallel with the evolution of both procedures. No randomized controlled trials exist due to the vast differences in surgical goals, patient expectations, and complication profiles between the two procedures. This makes high quality systematic reviews necessary to compare outcomes between these two treatment options. The aim of this study was to provide a systematic review with meta-analysis of publications reporting outcomes, complications, and revision data following third-generation TAA and/or modern AA published in the past decade. Thirtyfive articles met eligibility criteria, which included 4312 TAA and 1091 AA procedures. This review reports data from a mean follow-up of 4.9 years in the TAA cohort and 4.0 years in the AA cohort. There was no significant difference in overall complication rate following TAA compared to AA (23.6% and 25.7% respectively, P-value 0.31). Similarly, there was no significant difference in revision rate following TAA compared to AA (7.2% and 6.3% respectively, P-value 0.65). Successful treatment of end-stage tibiotalar arthritis requires an understanding of a patients' goals and expectations, coupled with appropriate patient selection for the chosen procedure. The decision to proceed with TAA or AA should be made on a case-by-case basis following an informed discussion with the patient regarding the different goals and complication profiles for each procedure.
PubMed: 33312482
DOI: 10.4081/or.2020.8279 -
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 -
Spine Deformity Nov 2022To assess surgical and safety outcomes associated with different rod materials and diameters in adolescent idiopathic scoliosis (AIS) surgery. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess surgical and safety outcomes associated with different rod materials and diameters in adolescent idiopathic scoliosis (AIS) surgery.
METHODS
A systematic literature review and meta-analysis evaluated the surgical management of AIS patients using pedicle screw fixation systems (i.e., posterior rods and pedicle screws) with rods of different materials and sizes. Postoperative surgical outcomes (e.g., kyphosis and coronal correction) and complications (i.e., hyper/hypo-lumbar lordosis, proximal junctional kyphosis, revisions, reoperations, and infections) were assessed. Random-effects models (REMs) pooled data for outcomes reported in ≥ 2 studies.
RESULTS
Among 75 studies evaluating AIS surgery using pedicle screw fixation systems, 46 described rod materials and/or diameters. Two studies directly comparing titanium (Ti) and cobalt-chromium (CoCr) rods found that CoCr rods provided significantly better postoperative kyphosis angle correction vs. Ti rods during a shorter follow-up (0-3 months, MD = - 2.98°, 95% CI - 5.79 to - 0.17°, p = 0.04), and longer follow-up (≥ 24 months, MD = - 3.99°, 95% CI - 6.98 to - 1.00, p = 0.009). Surgical infection varied from 2% (95% CI 1.0-3.0%) for 5.5 mm rods to 4% (95% CI 2.0-7.0%) for 6 mm rods. Reoperation rates were lower with 5.5 mm rods 1% (95% CI 0.0-3.0%) vs. 6 mm rods [6% (95% CI 2.0-9.0%); p = 0.04]. Differences in coronal angle, lumbar lordosis, proximal junctional kyphosis, revisions, and infections did not differ significantly (p > 0.05) among rods of different materials or diameters.
CONCLUSION
For AIS, CoCr rods provided better correction of thoracic kyphosis compared to Ti rods. Patients with 5.5 mm rods had fewer reoperations vs. 6.0 and 6.35 mm diameter rods.
LEVEL OF EVIDENCE
III.
Topics: Humans; Adolescent; Scoliosis; Lordosis; Titanium; Spinal Fusion; Kyphosis; Cobalt; Chromium
PubMed: 35737287
DOI: 10.1007/s43390-022-00537-1 -
Journal of Foot and Ankle Research Apr 2022First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end-stage hallux rigidus. It has been postulated to produce good results in the... (Review)
Review
BACKGROUND
First metatarsophalangeal joint arthrodesis is commonly performed for symptomatic end-stage hallux rigidus. It has been postulated to produce good results in the literature. Various fixation techniques offer differences in union rates, complications and functional outcomes, stirring debates about which produces the best outcomes for patients. Therefore, this review aims to synthesise and compare the outcomes of modern fixation techniques used for first metatarsophalangeal joint (FMPJ) arthrodesis.
METHODS
The electronic database searched were PubMed, CINAHL, Cochrane Library, and Google Scholar. The critical appraisal skills programme tool for cohort study was used. The interventions consisted of screw(s), plate(s), and staple(s). Studies comprising outdated fixation techniques such as suture, metallic wire, external fixation, Rush rods or Steinmann pins were excluded. Participants were adults over 18 years, undergoing FMPJ arthrodesis in the UK. Studies with the population consisting primarily of revision cases, patients with rheumatoid arthritis or diabetes were excluded.
RESULTS
Seven UK studies included 277 feet and a 95.7% overall union rate at a mean union time of 83.5 days. Staples had the highest union rate of 98.2% at mean union time of 84 days, followed by plates (95.2%, 92 days), and finally screws (94.9%, 71 days). The overall complication incidence is 5.8%. All of the fixation techniques produced good functional outcomes postoperatively.
CONCLUSIONS
Whilst staple techniques showed the highest union rate, plating techniques are preferable over screws or staples for better results across several outcome measures, including reduced complication incidence, stability, early ambulation, and good functional outcome. The Manchester-Oxford Foot Questionnaire and EuroQol-5Dimensional are recommended as measurement tools to assess functional outcomes following FMPJ arthrodesis.
Topics: Adult; Arthrodesis; Cohort Studies; Hallux Valgus; Humans; Metatarsophalangeal Joint; Retrospective Studies; Treatment Outcome
PubMed: 35468802
DOI: 10.1186/s13047-022-00540-9 -
European Journal of Orthopaedic Surgery... Feb 2024The number of patients undergoing total hip arthroplasty (THA) surgery after previous lumbar arthrodesis (LA) is rising. Literature suggests that LA may significantly... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The number of patients undergoing total hip arthroplasty (THA) surgery after previous lumbar arthrodesis (LA) is rising. Literature suggests that LA may significantly impact pelvic biomechanics and potentially compromise the success of prosthetic hip replacement. This study aims to evaluate complication rates, dislocation rates, and revision rates in patients with prior LA undergoing THA surgery compared to those undergoing THA surgery without prior LA.
METHODS
A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A PICOS template was developed to ensure a structured approach. The search for relevant studies was performed across five databases, including Pubmed, Scopus, Embase, Medline, and Cochrane. The selected articles were evaluated based on the Levels of Evidence (LoE) criteria. The Coleman Methodology Score (mCMS) was employed to analyze the retrospective studies. This systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO). For the outcomes that allowed for a meta-analysis performed using R software, a p < 0.05 was considered statistically significant.
RESULTS
The final analysis included seventeen studies comprising a total of 3,139,164 cases of THA. Among these cases, 3,081,137 underwent THA surgery alone, while 58,027 patients underwent THA with a previous LA. The study investigated various factors, including dislocation rates, revision rates, and complication, as well as the surgical approach and type of implant used, for both the THA-only group and the group of patients who underwent THA with prior LA. The analysis revealed a statistically significant difference (p < 0.05) for all variables studied, favoring the group of patients who underwent THA alone without prior LA.
CONCLUSIONS
This systematic review and meta-analysis demonstrated a statistically significant superiority in all analyzed outcomes for patients who underwent THA-only without prior LA. Specifically, patients with isolated THA implants experienced significantly lower incidences of THA dislocation, wound complications, periprosthetic joint infection, revision, and mechanical complications.
LEVEL OF EVIDENCE
Level IV.
Topics: Humans; Arthroplasty, Replacement, Hip; Retrospective Studies; Postoperative Complications; Joint Dislocations; Arthrodesis; Reoperation; Hip Dislocation
PubMed: 37847406
DOI: 10.1007/s00590-023-03761-1 -
Clinical Orthopaedics and Related... Nov 2014A two-stage reimplantation procedure is a well-accepted procedure for management of first-time infected total knee arthroplasty (TKA). However, there is a lack of... (Review)
Review
BACKGROUND
A two-stage reimplantation procedure is a well-accepted procedure for management of first-time infected total knee arthroplasty (TKA). However, there is a lack of consensus on the treatment of subsequent reinfections.
QUESTIONS/PURPOSES
The purpose of this study was to perform a decision analysis to determine the treatment method likely to yield the highest quality of life for a patient after a failed two-stage reimplantation.
METHODS
We performed a systematic review to estimate the expected success rates of a two-stage reimplantation procedure, chronic suppression, arthrodesis, and amputation for treatment of infected TKA. To determine utility values of the various possible health states that could arise after two-stage revision, we used previously published values and methods to determine the utility and disutility tolls for each treatment option and performed a decision tree analysis using the TreeAgePro 2012 software suite (Williamstown, MA, USA). These values were subsequently varied to perform sensitivity analyses, determining thresholds at which different treatment options prevailed.
RESULTS
Overall, the composite success rate for two-stage reimplantation was 79.1% (range, 33.3%-100%). The utility (successful outcome) and disutility toll (cost for treatment) for two-stage reimplantation were determined to be 0.473 and 0.20, respectively; the toll for undergoing chronic suppression was set at 0.05; the utility for arthrodesis was 0.740 and for amputation 0.423. We set the utilities for subsequent two-stage revision and other surgical procedures by subtracting the disutility toll from the utility each time another procedure was performed. The two-way sensitivity analysis varied the utility status after an additional two-stage reimplantation (0.47-0.99) and chance of a successful two-stage reimplantation (45%-95%). The model was then extended to a three-way sensitivity analysis twice: once by setting the variable arthrodesis utility at a value of 0.47 and once more by setting utility of two-stage reimplantation at 0.05 over the same range of values on both axes. Knee arthrodesis emerged as the treatment most likely to yield the highest expected utility (quality of life) after initially failing a two-stage revision. For a repeat two-stage revision to be favored, the utility of that second two-stage revision had to substantially exceed the published utility of primary TKA of 0.84 and the probability of achieving infection control had to exceed 90%.
CONCLUSIONS
Based on best available evidence, knee arthrodesis should be strongly considered as the treatment of choice for patients who have persistent infected TKA after a failed two-stage reimplantation procedure. We recognize that particular circumstances such as severe bone loss can preclude or limit the applicability of fusion as an option and that individual clinical circumstances must always dictate the best treatment, but where arthrodesis is practical, our model supports it as the best approach.
Topics: Amputation, Surgical; Analysis of Variance; Arthroplasty, Replacement, Knee; Decision Support Techniques; Decision Trees; Humans; Prosthesis-Related Infections; Quality of Life; Recurrence; Reoperation; Replantation; Treatment Failure
PubMed: 24488752
DOI: 10.1007/s11999-014-3482-4 -
Clinical Orthopaedics and Related... Jun 2016Although Lisfranc injuries are uncommon, representing approximately 0.2% of all fractures, they are complex and can result in persistent pain, degenerative arthritis,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Although Lisfranc injuries are uncommon, representing approximately 0.2% of all fractures, they are complex and can result in persistent pain, degenerative arthritis, and loss of function. Both open reduction and internal fixation (ORIF) and primary fusion have been proposed as treatment options for these injuries, but debate remains as to which approach is better.
QUESTIONS/PURPOSES
We asked whether ORIF or primary fusion led to (1) fewer reoperations for hardware removal; (2) less frequent revision surgery; (3) higher patient outcome scores; and (4) more frequent anatomic reduction.
METHODS
A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Three trials met the criteria for inclusion within the meta-analysis. Qualifying articles for the meta-analysis had data extracted independently by two authors (NS, AF). The quality of each study was assessed using the Center for Evidence Based Medicine's evaluation strategy; data were extracted from articles rated as good and fair: two and one article, respectively.
RESULTS
The risk ratio for hardware removal was 0.23 (95% confidence interval [CI], 0.11-0.45; p < 0.001) indicating more hardware removal for ORIF than fusion. For other revision surgery, the risk ratio for ORIF was 0.36 (95% CI, 0.08-1.59; p = 0.18) favoring neither. Similarly, neither was favored using patient-reported outcomes; the standard mean difference was calculated to be 0.50 (95% CI, -2.13 to 3.12; p = 0.71). When considering the risk of nonanatomic alignment, neither was favored (risk ratio, 1.48; 95% CI, 0.34-6.38; p = 0.60).
CONCLUSIONS
The surgeon should consider the increased risk of hardware removal along with its associated morbidity and discuss this with the patient preoperatively when considering ORIF of Lisfranc injuries. Because no new trials have been performed since 2012, further randomized controlled trials will be needed improve our understanding of these interventions.
LEVEL OF EVIDENCE
Level I, therapeutic study.
Topics: Arthrodesis; Chi-Square Distribution; Device Removal; Foot Bones; Foot Injuries; Fracture Fixation, Internal; Fracture Healing; Fractures, Bone; Humans; Ligaments, Articular; Odds Ratio; Open Fracture Reduction; Postoperative Complications; Reoperation; Risk Factors; Treatment Outcome
PubMed: 26022112
DOI: 10.1007/s11999-015-4366-y -
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 -
Journal of Orthopaedics and... Oct 2022Robotic surgery (RS) may offer benefits compared with freehand/conventional surgery (FS) in the treatment of patients with spinal disease. The aim of this study was to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Robotic surgery (RS) may offer benefits compared with freehand/conventional surgery (FS) in the treatment of patients with spinal disease. The aim of this study was to evaluate the efficacy and safety of RS versus FS in spinal fusion.
METHODS
A systematic review and meta-analysis was performed. Data analysis and risk of bias assessment were analysed using REVMAN V5.3.
RESULTS
We found 11 randomised clinical trials involving 817 patients (FS: 408, RS: 409). The main diagnosis was degenerative spine disease. SpineAssist, Renaissance (Mazor Robotics), Tianji Robot and TiRobot robots (TINAVI Medical Technologies) were used. Pedicle screw placement within the safety zone (grades A + B according to the Gertzbein and Robbins scale) ranged from 93% to 100% in FS versus 85-100% in RS (relative risk 1.01, 95% CI 1.00-1.03, p = 0.14). Regarding intervention time, the meta-analysis showed a mean difference (MD) of 6.45 min (95% CI -13.59 to 26.49, p = 0.53). Mean hospital stay was MD of -0.36 days (95% CI -1.03 to 0.31, p = 0.30) with no differences between groups. Contradictory results were found regarding fluoroscopy time, although there seems to be a lower radiation dose in RS versus FS (p < 0.05). Regarding safety, the studies included surgical revision frequency.
CONCLUSIONS
No conclusive results were found suggesting that there are benefits in using RS over FS for spinal fusion. Further research with adequate patient selection, robot type and quality-of-life variables is needed.
LEVEL OF EVIDENCE
level 1.
Topics: Humans; Lumbar Vertebrae; Pedicle Screws; Retrospective Studies; Robotic Surgical Procedures; Robotics; Spinal Diseases; Spinal Fusion; Spine
PubMed: 36242652
DOI: 10.1186/s10195-022-00669-0