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Knee Surgery, Sports Traumatology,... Mar 2022There are contentious data about the role calcium pyrophosphate (CPP) crystals and chondrocalcinosis (CC) play in the progression of osteoarthritis (OA), as well as in... (Review)
Review
PURPOSE
There are contentious data about the role calcium pyrophosphate (CPP) crystals and chondrocalcinosis (CC) play in the progression of osteoarthritis (OA), as well as in the outcomes after knee arthroplasty. Hence, the purpose of this systematic review was to analyse the clinical and functional outcome, progression of OA and prosthesis survivorship after unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in patients with CC compared to patients without CC.
METHODS
A systematic review of the literature in PubMed, Medline, Embase and Web of Science was performed using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis" (PRISMA) guidelines. Articles which reported the outcome and survival rates of prosthesis after TKA or UKA in patients with CC were included.
RESULTS
A total of 3718 patient knees were included in eight selected publications, with a median sample sizes of 234 knees (range 78-1000) and 954 knees (range 408-1500) for publications including UKA and TKA, respectively. At time of surgery, the mean age was 69 years and the prevalence for CC ranged from 12.6 to 36%. Chondrocalcinosis did not significantly influence the functional and clinical outcome, the implant survival as well as the radiologic progression of OA disease after UKA and TKA.
CONCLUSION
The presence of CPP crystals in tissue samples, synovial fluid or evidence of calcifications on preoperative radiographs did not significantly influence the postoperative functional and activity scores. It also had no significant influence on prosthesis survival rate, whether it was a UKA or a TKA. This study shows that the impact of a subclinical form of chondrocalcinosis may not be of clinical relevance in the context of arthroplasty.
LEVEL OF EVIDENCE
IV.
Topics: Aged; Arthroplasty, Replacement, Knee; Chondrocalcinosis; Humans; Knee Joint; Knee Prosthesis; Osteoarthritis, Knee; Prosthesis Failure; Treatment Outcome
PubMed: 33677614
DOI: 10.1007/s00167-021-06519-6 -
International Journal of Surgery... May 2018The debate over the use of cemented or cementless fixation in total knee arthroplasty (TKA) has never stopped since cementless fixation was introduced. We undertook a... (Meta-Analysis)
Meta-Analysis Review
No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: A systematic review and meta-analysis.
BACKGROUND
The debate over the use of cemented or cementless fixation in total knee arthroplasty (TKA) has never stopped since cementless fixation was introduced. We undertook a systematic review and meta-analysis to evaluate the optimal mode of fixation (full-cementless vs. full-cemented) in TKA.
METHODS
PubMed, Embase, and the Cochrane Library databases up to July 2017 were searched to identify randomised controlled trials (RCTs) and quasi-RCTs comparing full-cementless TKA and full-cemented TKA. The primary outcome was implant survivorship. Secondary outcomes included radiological outcomes (maximum total point-motion [MTPM], radiolucent line, rotation degree) and clinical outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] score, Knee Society Score [KSS] score, postoperative range of movement, blood loss and complications).
RESULTS
Seven studies were included in the systematic review and meta-analysis. The mean follow-up was 7.1 years (range from 2 to 16.6 years). There was no difference in implant survivorship (RR, 0.98; 95% CI, 0.95-1.01; p = 0.25; I = 0%), MTPM (weighted mean difference [WMD], 0.13 mm; 95% CI, -0.69-0.95; p = 0.75; I = 89.3%) and radiolucent line (RR, 1.36; 95% CI, 0.57-3.23; p = 0.48; I = 54%) between the cementless and cemented methods. There was a mean 0.22° more rotation in the full-cementless fixation group (95% CI, 0.13-0.32; p < 0.01; I = 28.5%). There were no significant differences relating to clinical outcomes (WOMAC score, KSS score, postoperative range of movement, blood loss and complications) between the two fixation groups.
CONCLUSIONS
Although more overall component rotation is found in full-cementless fixation, the implant survivorship and clinical efficacy are likely similar between full-cementless and full-cemented fixation. However, future RCTs with similar cementless prosthetic coating and longer-term follow-up are still needed to confirm our findings.
Topics: Arthroplasty, Replacement, Knee; Bone Cements; Humans; Knee Joint; Knee Prosthesis; Prosthesis Design; Prosthesis Failure
PubMed: 29656129
DOI: 10.1016/j.ijsu.2018.04.015 -
BMC Musculoskeletal Disorders May 2023Periprosthetic joint infection (PJI) is a serious complication with total joint arthroplasty (TJA), that necessitates reoperation. Pre-closure irrigation with dilute... (Meta-Analysis)
Meta-Analysis
PURPOSE
Periprosthetic joint infection (PJI) is a serious complication with total joint arthroplasty (TJA), that necessitates reoperation. Pre-closure irrigation with dilute povidone-iodine (PI) is among the preventive measures, but its efficiency is still controversial. As a result, the focus of this systematic review and meta-analysis is on the effect of dilute PI wound irrigation in the prevention of PJI following TJA.
METHODS
We systematically reviewed and analyzed articles that compared PI with other agents in terms of PJI rate after TJA, searching Medline, Scopus, Web of science, and Cochrane databases. A number of 13 papers including 63,950 patients in total, were finally considered in qualitative and quantitative assessments. We have also further assessed review articles.
RESULTS
In comparison with normal saline (NS), PI reduced post-operative infection rate (OR: 0.44; CI 95%: 0.34-0.56). However, there was no difference between PI and chlorhexidine (CHG) (OR: 1.61; CI 95%: 0.83-3.09)) or undetermined comparators (OR: 1.08; CI 95%: 0.67-1.76).
CONCLUSION
PI irrigation seems an efficient preventive measure for post-operative PJI and would seem to be the most feasible for TJA protocol.
Topics: Humans; Povidone-Iodine; Arthroplasty, Replacement, Hip; Prosthesis-Related Infections; Arthritis, Infectious; Surgical Wound Infection; Retrospective Studies
PubMed: 37231378
DOI: 10.1186/s12891-023-06548-x -
Journal of Shoulder and Elbow Surgery May 2022The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral... (Review)
Review
BACKGROUND
The use of reverse total shoulder arthroplasty and stemless anatomic total shoulder replacement has been increasing in the United States every year. Stemless humeral components in reverse total shoulder arthroplasty are only approved for clinical trials in the United States with an investigational device exception with limited data.
METHODS
A systematic review on stemless reverse total shoulder arthroplasty was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A search was conducted on November 25, 2020, using the MEDLINE/PubMed, Cochrane, and Embase databases. All articles were reviewed by 2 independent evaluators, with any conflicts or issues resolved by consensus or a final decision by the senior author. The primary outcomes extracted were complications, radiographic results, and outcome scores.
RESULTS
We evaluated 10 studies that used either the Total Evolutive Shoulder System (TESS) or Verso implant. There were 430 total patients and 437 total procedures; 266 patients in the TESS group underwent a total of 272 procedures, and 164 patients in the Verso group underwent a total of 165 procedures. The mean age at the time of surgery was 73.8 years (range, 38-93 years). The mean follow-up period ranged from 6.4 to 101.6 months per study. There was an overall trend of improved clinical outcome scores, a 0.2% humeral component loosening rate, and an 11.2% complication rate.
CONCLUSIONS
This review shows that the clinical and functional outcomes following stemless or metaphyseal reverse total shoulder arthroplasty are quite promising, especially with the low rate of humeral-sided complications. There continues to be a need for additional long-term studies and randomized clinical trials.
Topics: Arthroplasty, Replacement, Shoulder; Humans; Prosthesis Design; Shoulder Joint; Shoulder Prosthesis; Treatment Outcome
PubMed: 35051541
DOI: 10.1016/j.jse.2021.12.017 -
The Bone & Joint Journal Apr 2017The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which... (Meta-Analysis)
Meta-Analysis Review
AIMS
The aim of this study was to investigate the outcomes of Vancouver type B2 and B3 fractures by performing a systematic review of the methods of surgical treatment which have been reported.
MATERIALS AND METHODS
A systematic search was performed in Ovid MEDLINE, Embase and the Cochrane Central Register of Controlled Trials. For inclusion, studies required a minimum of ten patients with a Vancouver type B2 and/or ten patients with a Vancouver type B3 fracture, a minimum mean follow-up of two years and outcomes which were matched to the type of fracture. Studies were also required to report the rate of re-operation as an outcome measure. The protocol was registered in the PROSPERO database.
RESULTS
A total of 22 studies were included based on the eligibility criteria, including 343 B2 fractures and 167 B3 fractures. The mean follow-up ranged from 32 months to 74 months. Of 343 Vancouver B2 fractures, the treatment in 298 (86.8%) involved revision arthroplasty and 45 (12.6%) were treated with internal fixation alone. A total of 37 patients (12.4%) treated with revision arthroplasty and six (13.3%) treated by internal fixation only underwent further re-operation. Of 167 Vancouver B3 fractures, the treatment in 160 (95.8%) involved revision arthroplasty and eight (4.8%) were treated with internal fixation without revision. A total of 23 patients (14.4%) treated with revision arthroplasty and two (28.6%) treated only with internal fixation required re-operation.
CONCLUSION
A significant proportion, particularly of B2 fractures, were treated without revision of the stem. These were associated with a higher rate of re-operation. The treatment of B3 fractures without revision of the stem resulted in a high rate of re-operation. This demonstrates the importance of careful evaluation and accurate characterisation of the fracture at the time of presentation to ensure the correct management. There is a need for improvement in the reporting of data in case series recording the outcome of the surgical treatment of periprosthetic fractures. We have suggested a minimum dataset to improve the quality of data in studies dealing with these fractures. Cite this article: 2017;99-B(4 Supple B):17-25.
Topics: Arthroplasty, Replacement, Hip; Femoral Fractures; Fracture Fixation, Internal; Hip Prosthesis; Humans; Periprosthetic Fractures; Prosthesis Design; Prosthesis Failure; Reoperation
PubMed: 28363890
DOI: 10.1302/0301-620X.99B4.BJJ-2016-1311.R1 -
Danish Medical Journal May 2014Severely painful or dysfunctional destroyed wrists can be reconstructed by fusion, interposition of soft-tissue or by arthroplasty using artificial materials. Total and... (Review)
Review
INTRODUCTION
Severely painful or dysfunctional destroyed wrists can be reconstructed by fusion, interposition of soft-tissue or by arthroplasty using artificial materials. Total and partial wrist arthroplasty (T/PWA) has been used on a regular basis since the 1960's. The objective of this study was to review the literature on second, third and fourth generation implants.
METHODS
The review was conducted according to the PRISMA-guidelines. A search was made using a protocolled strategy and well-defined criteria in PubMed, in the Cochrane Library and by screening reference lists.
RESULTS
37 publications describing a total of 18 implants were selected for analysis. 16 of the publications were useful for the evaluation of implant longevity. Despite methodological shortcomings in many of the source documents, a summary estimate was possible.
CONCLUSION
It seems that T/PWA has a good potential to improve function through pain reduction and preservation of mobility. The risk of severe complications - deep infection and instability problems - is small with the available implants. Implant survival of 90-100% at five years are reported in most series - if not all - using newer second generation and third generation implants, but declines from five to eight years. Periprosthetic osteolysis/radiolucency is frequently reported. Its causes and consequences are not clarified.
Topics: Arthroplasty, Replacement; Hand Strength; Humans; Joint Prosthesis; Radiography; Range of Motion, Articular; Wrist Joint
PubMed: 24814740
DOI: No ID Found -
Acta Orthopaedica Et Traumatologica... Mar 2018The aim of this systematic review was to analyze the results of published treatment options in Brucella infection following total joint arthroplasty (TJA). (Review)
Review
INTRODUCTION
The aim of this systematic review was to analyze the results of published treatment options in Brucella infection following total joint arthroplasty (TJA).
METHODS
We performed a systematic review of the literature regarding outcomes of Brucella infection after TJA (hip and knee). We searched multiple databases for articles in the area published from 1950 to 2016.
RESULTS
A total of 18 patients (12 male and 6 female; mean age 59 years) from 14 published studies were identified. The minimum follow-up time was 6 months (range, 6-120 months). Seven patients were treated with debridement or antibrucella treatment only. Eleven patients (61%) underwent removal of the prosthesis and were treated with one or two-stage exchange arthroplasty. The mean duration of antibiotic therapy was 5.8 months. There was no relapse of infection.
CONCLUSIONS
In the absence of loosening of the components of the prosthesis, an attempt to treat Brucella infection medically might be a reasonable choice. One or two-stage exchange arthroplasty could provide successful results without relapse of infection when combined with appropriate antibiotherapy.
LEVEL OF EVIDENCE
Level III, therapeutic study.
Topics: Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Clinical Decision-Making; Female; Humans; Male; Middle Aged; Prosthesis-Related Infections; Reoperation
PubMed: 29223445
DOI: 10.1016/j.aott.2017.11.003 -
BMC Musculoskeletal Disorders Apr 2024Obesity represents an epidemic of rising numbers worldwide year after year. In the Orthopedic field, obesity is one of the major causes leading to osteoarthritis needing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Obesity represents an epidemic of rising numbers worldwide year after year. In the Orthopedic field, obesity is one of the major causes leading to osteoarthritis needing Total Joint Arthroplasty (TJA). Still, contextually, it represents one of the most significant risk factors for joint replacement complications and failures. So, bariatric Surgery (BS) is becoming a valuable option for weight control and mitigating obesity-related risk factors. This review of the literature and meta-analysis aims to evaluate periprosthetic joint infections (PJI) and surgical site infections (SSI) rates in patients who underwent TKA after BS compared to obese patients without BS.
METHODS
Systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines up to October 2023. We included longitudinal studies comparing obese patients who underwent total knee arthroplasty after bariatric surgery (study group) and obese patients who underwent TKA (control group). The surgical site infection and Periprosthetic joint infection rate were compared among groups using a meta-analytical approach.
RESULTS
The online database and references investigation identified one hundred and twenty-five studies. PJI rate differed significantly among groups, (z = -21.8928, p < 0.0001), with a lower risk in the BS group (z = -10.3114, p < 0.0001), for SSI, instead, not statistically significance were recorded (z = -0.6784, p = 0.4975).
CONCLUSIONS
The current Literature suggests that Bariatric Surgery can reduce infectious complications in TKA, leading to better outcomes and less related costs treating of knee osteoarthritis in obese patients.
Topics: Humans; Arthroplasty, Replacement, Knee; Surgical Wound Infection; Bariatric Surgery; Obesity; Osteoarthritis, Knee; Arthritis, Infectious; Prosthesis-Related Infections; Retrospective Studies; Arthroplasty, Replacement, Hip
PubMed: 38561717
DOI: 10.1186/s12891-024-07288-2 -
The Bone & Joint Journal Jan 2018Patients with neuromuscular imbalance who require total hip arthroplasty (THA) present particular technical problems due to altered anatomy, abnormal bone stock,... (Review)
Review
Patients with neuromuscular imbalance who require total hip arthroplasty (THA) present particular technical problems due to altered anatomy, abnormal bone stock, muscular imbalance and problems of rehabilitation. In this systematic review, we studied articles dealing with THA in patients with neuromuscular imbalance, published before April 2017. We recorded the demographics of the patients and the type of neuromuscular pathology, the indication for surgery, surgical approach, concomitant soft-tissue releases, the type of implant and bearing, pain and functional outcome as well as complications and survival. Recent advances in THA technology allow for successful outcomes in these patients. Our review suggests excellent benefits for pain relief and good functional outcome might be expected with a modest risk of complication. Cite this article: 2018;100-B(1 Supple A):17-21.
Topics: Arthroplasty, Replacement, Hip; Humans; Neuromuscular Diseases; Osteoarthritis, Hip; Postoperative Complications; Postural Balance; Treatment Outcome
PubMed: 29292335
DOI: 10.1302/0301-620X.100B1.BJJ-2017-0571.R1 -
Clinical Orthopaedics and Related... Apr 2011With the trend toward pay-for-performance standards plus the increasing incidence and prevalence of periprosthetic joint infection (PJI), orthopaedic surgeons must... (Review)
Review
BACKGROUND
With the trend toward pay-for-performance standards plus the increasing incidence and prevalence of periprosthetic joint infection (PJI), orthopaedic surgeons must reconsider all potential infection control measures. Both airborne and nonairborne bacterial contamination must be reduced in the operating room.
QUESTIONS/PURPOSES
Analysis of airborne bacterial reduction technologies includes evaluation of (1) the effectiveness of laminar air flow (LAF) and ultraviolet light (UVL); (2) the financial and potential health costs of each; and (3) an examination of current national and international standards, and guidelines.
METHODS
We systematically reviewed the literature from Ovid, PubMed (Medline), Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA, NHSEED, CINAHLPLUS, and Google Scholar published until June 2010 focusing on ultraclean air, ultraviolet light, and laminar air.
RESULTS
High-level data demonstrating substantial PJI reduction of any infection control method may not be feasible as a result of the relatively low rates of occurrence and the expense and difficulty of conducting a large enough study with adequate power. UVL has potentially unacceptable health costs and the Centers for Disease Control and Prevention (CDC) recommends against its use. European countries have standardized LAF and it is used by the majority of American joint surgeons.
CONCLUSIONS
Both LAF and UVL reduce PJI. The absence of a high level of evidence from randomized trials is not proof of ineffectiveness. The historically high cost of LAF has decreased substantially. Only LAF has been standardized by several European countries. The CDC recommends further study of LAF but recommends UVL not be used secondary to documented potential health risks to personnel.
Topics: Air Microbiology; Arthroplasty, Replacement; Environment, Controlled; Evidence-Based Medicine; Health Care Costs; Humans; Infection Control; Joint Prosthesis; Operating Rooms; Practice Guidelines as Topic; Prosthesis-Related Infections; Risk Assessment; Sterilization; Ultraviolet Rays
PubMed: 21161744
DOI: 10.1007/s11999-010-1688-7