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Martijn HA, Sierevelt IN, Wassink S, Nolte PA. Fifth Metatarsal Osteotomies for Treatment of Bunionette Deformity: A Meta-Analysis of Angle Correction and Clinical Condition. J Foot Ankle Surg 2018; 57:140-148. [PMID: 29268897 DOI: 10.1053/j.jfas.2017.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Indexed: 02/03/2023]
Abstract
We assessed which type of osteotomy would be most suited for correcting an increased fourth to fifth intermetatarsal angle (IMA) and metatarsophalangeal angle (MPA) and would have the best results regarding the clinical condition and satisfaction. The study design was a systematic review and meta-analysis. The main outcome measures were the IMA, MPA, and American Orthopaedic Foot and Ankle Society Lesser Metatarsophalangeal-Interphalangeal scale and satisfaction scores. A systematic search was performed in Medline, Embase, Cochrane, SPORTdiscus, and CINAHL up to September 2016. Prospective and retrospective studies that had evaluated the outcomes of fifth metatarsal osteotomies to correct a bunionette deformity at all patient ages were included. The outcomes were determined from clinical or radiographic evaluations. The search yielded 28 studies suitable for inclusion in our meta-analysis. All groups of osteotomies achieved significant IMA changes, with proximal osteotomies resulting in significantly greater changes than diaphyseal or distal osteotomies. The overall effect of osteotomies on the MPA was of a significant reduction. Proximal and diaphyseal osteotomies both resulted in significant differences in MPA correction compared with distal osteotomies. The incidence of major complications was the least in the distal osteotomy group. The overall mean success rate of bunionette surgery was 93%. The patients were most satisfied with proximal osteotomies, followed by distal and diaphyseal osteotomies (100% and 92%, respectively). In conclusion, every type of osteotomy has the capability of significantly reducing the fourth to fifth IMA and MPA. The fewest complications occurred with distal osteotomies, and the greatest satisfaction score was achieved with proximal osteotomies. However, only 1 study evaluated these results for proximal osteotomies. Distal osteotomies resulted in a high satisfaction rate and were the most represented osteotomy in our meta-analysis. Thus, when major IMA and MPA reduction is not required, the distal osteotomy could be the treatment of choice owing to its low complication rate.
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Affiliation(s)
- Hugo A Martijn
- Orthopaedic Resident, Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands.
| | - Inger N Sierevelt
- Clinical Epidemiologist, Department of Orthopaedic Research and the Linnaeus Research Institute, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Sander Wassink
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
| | - Peter A Nolte
- Orthopaedic Surgeon, Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, The Netherlands
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Shigemura T, Yamamoto Y, Murata Y, Sato T, Tsuchiya R, Wada Y. Total hip arthroplasty after a previous pelvic osteotomy: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2018; 104:455-463. [PMID: 29581068 DOI: 10.1016/j.otsr.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND There are several reports regarding total hip arthroplasty (THA) after a previous pelvic osteotomy (PO). However, to our knowledge, until now there has been no formal systematic review and meta-analysis published to summarize the clinical results of THA after a previous PO. Therefore, we conducted a systematic review and meta-analysis of results of THA after a previous PO. We focus on these questions as follows: does a previous PO affect the results of subsequent THA, such as clinical outcomes, operative time, operative blood loss, and radiological parameters. METHODS Using PubMed, Web of Science, and Cochrane Library, we searched for relevant original papers. The pooling of data was performed using RevMan software (version 5.3, Cochrane Collaboration, Oxford, UK). A p-value<0.05 was judged as significant. Standardized mean differences (SMD) were calculated for continuous data with a 95% confidence interval (CI) was reported. Statistical heterogeneity was assessed based on I2 using standard χ2 test. When I2>50%, significant heterogeneity was assumed and a random-effects model was applied for the meta-analysis. A fixed-effects model was applied in the absence of significant heterogeneity. RESULTS Eleven studies were included in this meta-analysis. The pooled results indicated that there was no significant difference in postoperative Merle D'Aubigne-Postel score (I2=0%, SMD=-0.15, 95% CI: -0.36 to 0.06, p=0.17), postoperative Harris hip score (I2=60%, SMD=-0.23, 95% CI: -0.50 to 0.05, p=0.10), operative time (I2=86%, SMD=0.37, 95% CI: -0.09 to 0.82, p=0.11), operative blood loss (I2=82%, SMD=0.23, 95% CI: -0.17 to 0.63, p=0.25), and cup abduction angle (I2=43%, SMD=-0.08, 95% CI: -0.25 to 0.09, p=0.38) between THA with and without a previous PO. However, cup anteversion angle of THA with a previous PO was significantly smaller than that of without a previous PO (I2=77%, SMD=-0.63, 95% CI: -1.13 to -0.13, p=0.01). CONCLUSION Systematic review and meta-analysis of results of THA after a previous PO was performed. A previous PO did not affect the results of subsequent THA, except for cup anteversion. Because of the low quality evidence currently available, high-quality randomized controlled trials are required. LEVEL OF EVIDENCE Level III, meta-analysis of case-control studies.
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Affiliation(s)
- T Shigemura
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan.
| | - Y Yamamoto
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
| | - Y Murata
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
| | - T Sato
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
| | - R Tsuchiya
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
| | - Y Wada
- Department of orthopaedic surgery, Teikyo university, Chiba Medical Center, 3426-3 Anesaki, 2990111 Ichihara, Chiba, Japan
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Berstock JR, Murray JR, Whitehouse MR, Blom AW, Beswick AD. Medial subvastus versus the medial parapatellar approach for total knee replacement: A systematic review and meta-analysis of randomized controlled trials. EFORT Open Rev 2018; 3:78-84. [PMID: 29657848 PMCID: PMC5890136 DOI: 10.1302/2058-5241.3.170030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Twenty randomized controlled trials comprising 1893 primary total knee replacements were included in this review. The subvastus approach conferred superior results for mean difference (MD) in time to regain an active straight leg raise (1.7 days, 95% confidence interval [CI] 1.0 to 2.3), visual analogue score for pain on day one (0.8 points on a scale out of 10, 95% CI 0.2 to 1.4) and total range of knee movement at one week (7°, 95% CI 3.2 to 10.7). The subvastus approach also resulted in fewer lateral releases (odds ratio 0.4, 95% CI 0.2 to 0.7) and less peri-operative blood loss (MD 57 mL, 95% CI 10.5 to 106.4) but prolonged surgical times (MD 9.7 min, 95% CI 3.9 to 15.6). There was no difference in Knee Society Score at six weeks or one year, or the rate of adverse events including superficial or deep infection, deep vein thrombosis or knee stiffness requiring manipulation under anaesthesia. This review demonstrates evidence of early post-operative benefits following the subvastus approach with equivalence between approaches thereafter.
Cite this article: EFORT Open Rev 2018;3:78-84. DOI: 10.1302/2058-5241.3.170030.
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Affiliation(s)
| | - James R Murray
- Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | | | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, UK
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Weir CJ, Butcher I, Assi V, Lewis SC, Murray GD, Langhorne P, Brady MC. Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review. BMC Med Res Methodol 2018; 18:25. [PMID: 29514597 PMCID: PMC5842611 DOI: 10.1186/s12874-018-0483-0] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rigorous, informative meta-analyses rely on availability of appropriate summary statistics or individual participant data. For continuous outcomes, especially those with naturally skewed distributions, summary information on the mean or variability often goes unreported. While full reporting of original trial data is the ideal, we sought to identify methods for handling unreported mean or variability summary statistics in meta-analysis. METHODS We undertook two systematic literature reviews to identify methodological approaches used to deal with missing mean or variability summary statistics. Five electronic databases were searched, in addition to the Cochrane Colloquium abstract books and the Cochrane Statistics Methods Group mailing list archive. We also conducted cited reference searching and emailed topic experts to identify recent methodological developments. Details recorded included the description of the method, the information required to implement the method, any underlying assumptions and whether the method could be readily applied in standard statistical software. We provided a summary description of the methods identified, illustrating selected methods in example meta-analysis scenarios. RESULTS For missing standard deviations (SDs), following screening of 503 articles, fifteen methods were identified in addition to those reported in a previous review. These included Bayesian hierarchical modelling at the meta-analysis level; summary statistic level imputation based on observed SD values from other trials in the meta-analysis; a practical approximation based on the range; and algebraic estimation of the SD based on other summary statistics. Following screening of 1124 articles for methods estimating the mean, one approximate Bayesian computation approach and three papers based on alternative summary statistics were identified. Illustrative meta-analyses showed that when replacing a missing SD the approximation using the range minimised loss of precision and generally performed better than omitting trials. When estimating missing means, a formula using the median, lower quartile and upper quartile performed best in preserving the precision of the meta-analysis findings, although in some scenarios, omitting trials gave superior results. CONCLUSIONS Methods based on summary statistics (minimum, maximum, lower quartile, upper quartile, median) reported in the literature facilitate more comprehensive inclusion of randomised controlled trials with missing mean or variability summary statistics within meta-analyses.
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Affiliation(s)
- Christopher J. Weir
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Isabella Butcher
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Valentina Assi
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Stephanie C. Lewis
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Gordon D. Murray
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marian C. Brady
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
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105
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Zhao F, Wang Y, Liu L, Bian M. Erythropoietin for cancer-associated malignant anemia: A meta-analysis. Mol Clin Oncol 2017; 6:925-930. [PMID: 28588792 DOI: 10.3892/mco.2017.1254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/23/2017] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to evaluate the effectiveness of erythropoietin (EPO) for improving cancer-associated malignant anemia. A search was performed for randomized clinical trials, conducted according to the Cochrane manual, using electronic databases including PubMed, EMBASE, the Cochrane Library and ClinicalTrails.gov up to 15 August 2015. A total of 6 eligible studies from 5 articles enrolling a total of 453 patients were entered into the current meta-analysis. Upon EPO treatment, there were significant differences in the change in hemoglobin (HB) levels compared with the placebo at short-term follow-up [mean difference (MD)=0.66; 95% confidence interval (CI), 0.14-1.18; I2=Not applicable; P=0.01) and long-term follow-up (MD=0.10; 95% CI, 0.02-0.18; I2=Not applicable; P=0.01) under the random effects model. For changes in hematocrit (HCT) compared with the placebo, the results revealed there were significant differences at short-term follow-up (MD=2.47; 95% CI, 0.75-4.19; I2=Not applicable; P=0.005) and long-term follow-up (MD=7.60; 95% CI, 6.15-9.05; I2=Not applicable; P<0.00001) under the random effects model. Compared with the placebo in short-term follow-up under the fixed effects model with homogeneity, the result was a significant difference for the transfusion ratio [relative risk (RR)=0.81; 95% CI, 0.67- 0.97; I2=34%; P=0.02) and the transfusion requirements (MD=-0.45; 95% CI, -0.92, 0.03; I2=6%; P=0.07). Funnel plots did not detect any publication bias. These results suggest that EPO was beneficial to alleviate cancer-associated anemia and improve survival outcomes for patients with cancer.
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Affiliation(s)
- Feng Zhao
- Department of Blood Transfusion Medicine, Linzi District People's Hospital, Binzhou Medical University, Zibo, Shandong 255400, P.R. China
| | - Yijuan Wang
- Department of Blood Transfusion Medicine, Linzi District People's Hospital, Binzhou Medical University, Zibo, Shandong 255400, P.R. China
| | - Lin Liu
- Medical Intensive Care Unit, PKU Care Luzhong Hospital, Zibo, Shandong 255400, P.R. China
| | - Meiling Bian
- Department of Internal Medicine, Linzi District People's Hospital, Binzhou Medical University, Zibo, Shandong 255400, P.R. China
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106
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Ye CY, Liu A, Xu MY, Nonso NS, He RX. Arthroplasty versus Internal Fixation for Displaced Intracapsular Femoral Neck Fracture in the Elderly: Systematic Review and Meta-analysis of Short- and Long-term Effectiveness. Chin Med J (Engl) 2017; 129:2630-2638. [PMID: 27779172 PMCID: PMC5125344 DOI: 10.4103/0366-6999.192788] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is conflicting evidence as to whether the femoral head should be preserved or replaced in elderly patients with displaced intracapsular femoral neck fractures. In this article, we performed a systematic review and meta-analysis to compare the short- and long-term effectiveness of arthroplasty (AR) and internal fixation (IF). METHODS PubMed, Embase, and the Cochrane Library were searched systematically up to January 2016. All randomized controlled trials directly comparing the effectiveness of AR and IF for displaced intracapsular fracture were retrieved with no limitation on language or publication year. RESULTS In total, eight prospective randomized studies involving 2206 patients were included. The results of our study showed that patients in the AR group reported significantly lower complication (risk ratio: 0.56, 95% confidence interval [CI] = 0.38-0.80), re-operation (risk ratio: 0.17, 95% CI = 0.13-0.22), revision rates (risk ratio: 0.11, 95% CI: 0.08-0.16), and better function compared with their IF counterparts, and they were less likely to suffer postoperative pain. No statistically significant differences for the rates of mortality, infection, and/or deep vein thrombosis between AR and IF were found. CONCLUSIONS Based on our analysis, we recommend that AR should be used as the primary treatment for displaced intracapsular femoral neck fractures in the elderly. However, IF may be appropriate for those who are very frail.
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Affiliation(s)
- Chen-Yi Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - An Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Ming-Yuan Xu
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Nwofor Samuel Nonso
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Rong-Xin He
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
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107
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Shao H, Chen CL, Maltenfort MG, Restrepo C, Rothman RH, Chen AF. Bilateral Total Hip Arthroplasty: 1-Stage or 2-Stage? A Meta-Analysis. J Arthroplasty 2017; 32:689-695. [PMID: 27776901 DOI: 10.1016/j.arth.2016.09.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 09/15/2016] [Accepted: 09/19/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is one of the most successful orthopedic surgeries performed in the last 50 years. However, controversies still exist between conducting 1- or 2-stage bilateral THA. METHODS Using PubMed, Ovid, Embase, and Cochrane library databases, we searched for papers written between January 1995 and October 2015 that contained the following search terms: "one-stage or two-stage" or "simultaneous or staged," and "hip" and "arthroplasty or replacement." A meta-analysis was conducted with the collected pooled data about major and minor systemic complications, surgical complications, and other perioperative data associated with 1- and 2-stage bilateral THA. Statistical analysis was performed by the Mantel-Haenszel method, and the fixed effect model was used to analyze data. RESULTS There were 13 studies with 17,762 patients who underwent 1-stage bilateral THA and 46,147 patients who underwent 2-stage bilateral THA. One-stage bilateral THA had a lower risk of major systemic complications, less deep venous thrombosis, and shorter operative time compared with 2-stage bilateral THA. There were no significant differences in death, pulmonary embolism, cardiovascular complication, infections, minor complications, and other surgical complications between procedures. CONCLUSION One-stage bilateral THA was superior to 2-stage bilateral THA in terms of major systemic complication, deep venous thrombosis, and surgical time compared with 2-stage bilateral THA. However, this study does not encourage performing 1-stage over 2-stage bilateral THA. Higher evidence level studies are necessary for further analysis.
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Affiliation(s)
- Hongyi Shao
- Orthopedics Department, Beijing Jishuitan Hospital, Beijing, China
| | - Chi-Lung Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Mitchell G Maltenfort
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Camilo Restrepo
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Richard H Rothman
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Antonia F Chen
- Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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108
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Gurnani N, van Deurzen DFP, Janmaat VT, van den Bekerom MPJ. Tenotomy or tenodesis for pathology of the long head of the biceps brachii: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2016; 24:3765-3771. [PMID: 25975753 DOI: 10.1007/s00167-015-3640-6] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 05/05/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this meta-analysis is to compare clinical outcomes of tenotomy and tenodesis in the surgical treatment of long head of the biceps brachii (LHB). METHODS A literature search was conducted in Embase and PubMed from 2000 to April 2014. All studies comparing the clinical outcomes between LHB tenotomy and tenodesis were included. The quality assessment was done by utilizing the Coleman score. We included nine studies comprising 650 patients undergoing LHB tenotomy or tenodesis, mostly with concomitant shoulder pathology. RESULTS No significant difference in post-operative Constant score (mean difference 1.77), elbow flexion strength (mean difference 0), and forearm supination strength (mean difference 0.01) in favour of tenodesis was observed. A Popeye deformity (odds ratio 0.17) and cramping pain (odds ratio 0.38) in the bicipital groove muscle were less frequently seen in patients treated with tenodesis. The Coleman score ranged between 45 and 100 in the included studies. CONCLUSION Based on this meta-analysis, no differences in post-operative functional outcome between tenotomy and tenodesis for the treatment of LHB lesions were observed. A Popeye deformity and cramping pain in the bicipital groove are more frequently observed in patients treated with tenotomy. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Navin Gurnani
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - Derek F P van Deurzen
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Vincent T Janmaat
- Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Ye C, Zhang W, Wu W, Xu M, Nonso NS, He R. Influence of the Infrapatellar Fat Pad Resection during Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0163515. [PMID: 27706208 PMCID: PMC5051736 DOI: 10.1371/journal.pone.0163515] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 09/10/2016] [Indexed: 12/27/2022] Open
Abstract
Background To enhance surgical exposure, resection of the infrapatellar fat pad (IPFP) is usually a routine procedure in total knee arthroplasty (TKA). However, there is conflicting evidence regarding whether IPFP resection during TKA impairs clinical outcome. We performed a systematic review and meta-analysis to clarify the influence of IPFP resection on primary TKA. Methods Embase, PubMed, and the Cochrane Library were systematically searched up to August 2016 to identify relevant studies. All clinical studies comparing IPFP resection (IPFP-R) and IPFP preservation (IPFP-P) in patients undergoing primary TKA were obtained. The meta-analysis was performed with Revman 5.3 and STATA 12.0 software. The weighted mean was estimated by using random effects (RE) models with 95% CIs, heterogeneity was assessed using the H statistic and the inconsistency index (I2). Results Seven studies involving 2,734 patients (3,258 knees) were included. IPFP resection trended to increase the incidence of postoperative anterior knee pain within 2 months postoperatively, compared with patients in whom the IPFP was preserved (odds ratio [OR]s 2.12[0.95, 4.73], p = 0.07). An increased incidence of anterior knee pain was observed in the IPFP resection group > 12 months postoperatively, but the difference was not significant (OR, 3.69 [0.81, 16.82], p = 0.07). In addition, a trend towards more shortening of the patellar tendon was also observed in the IPFP-R group. No significant results were found regarding postoperative knee function. Conclusion These results suggest that preserving the IPFP may be superior to IPFP resection in patients undergoing primary TKA, due to the relatively lower rate of anterior knee pain after short-term follow-up.
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Affiliation(s)
- Chenyi Ye
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Wei Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Weigang Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Mingyuan Xu
- Department of Plastic Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Nwofor Samuel Nonso
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Rongxin He
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
- * E-mail:
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110
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Functional outcomes of total hip arthroplasty in patients aged 30 years or less: a systematic review and meta-analysis. Hip Int 2016; 26:424-431. [PMID: 27174066 DOI: 10.5301/hipint.5000376] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Young adult hip surgery is a growing subspecialty. Increasingly total hip arthroplasty (THA) is offered to patients aged 30 or less suffering from end-stage hip arthropathy from a variety of congenital, developmental and acquired conditions. There is a paucity of evidence to advise such patients and surgeons alike on the functional outcomes of THA in this age group, as individual studies tend to include small cohorts. METHODS A systematic review and meta-analysis was performed to assess whether THA in patients aged 30 years or less provides significant functional improvement. The primary outcome measure was change in Harris Hip Score. Secondary outcome measures were implant survivorship and the effect of fixation type and bearing surface. RESULTS The results of 743 primary THA procedures were included. Weighted mean patient age was 22.7 years. Harris Hip Score improved by a weighted mean difference of 42.17 points out of 100 (95% confidence interval, 36.48-47.86 points, p<0.001) after THA at a weighted mean follow-up of 8.4 years. Pooled revision rate was 5.0% for the same time period. CONCLUSIONS This is the largest review to date of THA in patients aged 30 or less. The results show significant functional improvement measured by Harris Hip Score. The revision rate of 5% at 8.4 years is comparable to the general THA population. This contrasts high revision rates reported in older reviews of the literature, suggesting adoption of improved techniques and implants in the more recent literature.
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111
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Blom AW, Artz N, Beswick AD, Burston A, Dieppe P, Elvers KT, Gooberman-Hill R, Horwood J, Jepson P, Johnson E, Lenguerrand E, Marques E, Noble S, Pyke M, Sackley C, Sands G, Sayers A, Wells V, Wylde V. Improving patients’ experience and outcome of total joint replacement: the RESTORE programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2016. [DOI: 10.3310/pgfar04120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BackgroundTotal hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsearch STudies into the ORthopaedic Experience (RESTORE) programme, we explored the care and experiences of patients with osteoarthritis after being listed for THR and TKR up to the time when an optimal outcome should be expected.ObjectiveTo undertake a programme of research studies to work towards improving patient outcomes after THR and TKR.MethodsWe used methodologies appropriate to research questions: systematic reviews, qualitative studies, randomised controlled trials (RCTs), feasibility studies, cohort studies and a survey. Research was supported by patient and public involvement.ResultsSystematic review of longitudinal studies showed that moderate to severe long-term pain affects about 7–23% of patients after THR and 10–34% after TKR. In our cohort study, 10% of patients with hip replacement and 30% with knee replacement showed no clinically or statistically significant functional improvement. In our review of pain assessment few research studies used measures to capture the incidence, character and impact of long-term pain. Qualitative studies highlighted the importance of support by health and social professionals for patients at different stages of the joint replacement pathway. Our review of longitudinal studies suggested that patients with poorer psychological health, physical function or pain before surgery had poorer long-term outcomes and may benefit from pre-surgical interventions. However, uptake of a pre-operative pain management intervention was low. Although evidence relating to patient outcomes was limited, comorbidities are common and may lead to an increased risk of adverse events, suggesting the possible value of optimising pre-operative management. The evidence base on clinical effectiveness of pre-surgical interventions, occupational therapy and physiotherapy-based rehabilitation relied on small RCTs but suggested short-term benefit. Our feasibility studies showed that definitive trials of occupational therapy before surgery and post-discharge group-based physiotherapy exercise are feasible and acceptable to patients. Randomised trial results and systematic review suggest that patients with THR should receive local anaesthetic infiltration for the management of long-term pain, but in patients receiving TKR it may not provide additional benefit to femoral nerve block. From a NHS and Personal Social Services perspective, local anaesthetic infiltration was a cost-effective treatment in primary THR. In qualitative interviews, patients and health-care professionals recognised the importance of participating in the RCTs. To support future interventions and their evaluation, we conducted a study comparing outcome measures and analysed the RCTs as cohort studies. Analyses highlighted the importance of different methods in treating and assessing hip and knee osteoarthritis. There was an inverse association between radiographic severity of osteoarthritis and pain and function in patients waiting for TKR but no association in THR. Different pain characteristics predicted long-term pain in THR and TKR. Outcomes after joint replacement should be assessed with a patient-reported outcome and a functional test.ConclusionsThe RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving THR and TKR. Issues relating to their evaluation and the assessment of patient outcomes are highlighted. Potential interventions at key times in the patient pathway were identified and deserve further study, ultimately in the context of a complex intervention.Study registrationCurrent Controlled Trials ISRCTN52305381.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 4, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Neil Artz
- School of Health Professions, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Paul Dieppe
- Medical School, University of Exeter, Exeter, UK
| | - Karen T Elvers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jeremy Horwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Paul Jepson
- School of Sport, Exercise and Rehabilitation Sciences, Birmingham, UK
| | - Emma Johnson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Elsa Marques
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Mark Pyke
- North Bristol NHS Trust, Bristol, UK
| | | | - Gina Sands
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Victoria Wells
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Ye C, Xu M, Wang S, Jiang S, Chen X, Zhou X, He R. Decreased Bone Mineral Density Is an Independent Predictor for the Development of Atherosclerosis: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0154740. [PMID: 27149062 PMCID: PMC4858264 DOI: 10.1371/journal.pone.0154740] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/18/2016] [Indexed: 01/11/2023] Open
Abstract
Background There is conflicting evidence regarding the association between decreased bone mineral density (BMD) and atherosclerosis. To this end, we performed a systematic review and meta-analysis to clarify the association. Methods To identify relevant studies, PubMed, Embase, and the Cochrane Library were systematically searched up to November 2015. All observational and comparative studies directly investigating the relationship between decreased BMD and clinical consequences of atherosclerotic vascular abnormalities, including carotid artery calcification (CAC), cardiovascular disease (CAD), and coronary artery disease (CAD) were obtained, without limitation of language or publication year. Results A total of 25 studies involving 10,299 patients were included. The incidence of atherosclerotic vascular abnormalities was significantly increased in low BMD patients, compared to patients with normal BMD (OR, 1.81, 95% CI [1.01, 2.19], p<0.00001)). Similar results were also observed for postmenopausal women (OR, 2.23, 95% CI [1.72, 2.89], p<0.00001). Subgroup analyses of osteopenia, osteoporosis, and normal BMD also revealed that the combined ORs for the incidence of atherosclerotic vascular abnormalities increased as BMD decreased. Of note, after adjusting for age, sex, body mass index (BMI) and other vascular risk factors, decreased BMD remained significantly associated with the incidence of atherosclerotic vascular abnormalities (OR, 2.96, 95% CI [2.25, 3.88], p < 0.00001). Conclusions Based on the results of this study, decreased BMD is an independent predictor for the development of atherosclerosis in elderly individuals. Moreover, the risk of atherosclerotic vascular abnormalities increased as BMD decreased. Future studies focusing on individuals with different severities of atherosclerosis and comorbidities are of interest.
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Affiliation(s)
- Chenyi Ye
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Mingyuan Xu
- Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Shengdong Wang
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Shuai Jiang
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xi Chen
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Xiaoyu Zhou
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Rongxin He
- Department of Orthopedics, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
- * E-mail:
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Is a ceramic-on-ceramic bearing really superior to ceramic-on-polyethylene for primary total hip arthroplasty? A systematic review and meta-analysis of randomised controlled trials. Hip Int 2016; 25:191-8. [PMID: 25684252 DOI: 10.5301/hipint.5000223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2014] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The outcomes of using a ceramic-on-ceramic (CoC) vs ceramic-on-polyethylene (CoP) bearing surface for primary total hip arthroplasty (THA) are much debated. We performed a systematic review and meta-analysis of randomised controlled trials (RCTs) to compare and evaluate the outcomes of these 2 bearing surfaces. MATERIALS AND METHODS Electronic databases (PubMed/Medline, CENTRAL, Embase and Web of Science) were systematically searched for RCTs investigating the association between bearing surfaces and outcomes following primary THA. Two investigators independently reviewed studies for eligibility, assessed the risk of bias, extracted and analysed the data. RESULTS In total, 13 RCTs including a total of 2,488 THAs were identified. The Harris Hip Score appeared to be similar between CoC and CoP THAs. The acetabular liner wear rate was lower in CoC than CoP THA, but the meta-analysis showed that the incidence of component-related noise and overall ceramic fracture in CoC group were 14.73 times and 6.02 times higher than CoP THA, respectively. There were no statistically significant differences in rates of radiolucent line formation (>1 mm), osteolysis, loosening, revision with follow-up ≥ 5 years, intraoperative femoral fracture, dislocation, deep infection, deep venous thrombosis and leg length discrepancy between CoC and CoP THAs. CONCLUSIONS There appears to be no clear evidence favouring the use of either a CoC or CoP bearing surfaces in primary THA, further studies with high-quality and longer term follow-up to provide more evidence on this topic are still required.
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Weel H, Mallee WH, van Dijk CN, Blankevoort L, Goedegebuure S, Goslings JC, Kennedy JG, Kerkhoffs GMMJ. The effect of concentrated bone marrow aspirate in operative treatment of fifth metatarsal stress fractures; a double-blind randomized controlled trial. BMC Musculoskelet Disord 2015; 16:211. [PMID: 26290323 PMCID: PMC4546041 DOI: 10.1186/s12891-015-0649-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 07/27/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Fifth metatarsal (MT-V) stress fractures often exhibit delayed union and are high-risk fractures for non-union. Surgical treatment, currently considered as the gold standard, does not give optimal results, with a mean time to fracture union of 12-18 weeks. In recent studies, the use of bone marrow cells has been introduced to accelerate healing of fractures with union problems. The aim of this randomized trial is to determine if operative treatment of MT-V stress fractures with use of concentrated blood and bone marrow aspirate (cB + cBMA) is more effective than surgery alone. We hypothesize that using cB + cBMA in the operative treatment of MT-V stress fractures will lead to an earlier fracture union. METHODS/DESIGN A prospective, double-blind, randomized controlled trial (RCT) will be conducted in an academic medical center in the Netherlands. Ethics approval is received. 50 patients will be randomized to either operative treatment with cB + cBMA, harvested from the iliac crest, or operative treatment without cB + cBMA but with a sham-treatment of the iliac crest. The fracture fixation is the same in both groups, as is the post-operative care.. Follow up will be one year. The primary outcome measure is time to union in weeks on X-ray. Secondary outcome measures are time to resumption of work and sports, functional outcomes (SF-36, FAOS, FAAM), complication rate, composition of osteoprogenitors in cB + cBMA and cost-effectiveness. Furthermore, a bone biopsy is taken from every stress fracture and analysed histologically to determine the stage of the stress fracture. The difference in primary endpoint between the two groups is analysed using student's t-test or equivalent. DISCUSSION This trial will likely provide level-I evidence on the effectiveness of cB + cBMA in the operative treatment of MT-V stress fractures. TRIAL REGISTRATION Netherlands Trial Register (reg.nr NTR4377 ).
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Affiliation(s)
- Hanneke Weel
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, G4-264, 1105, AZ, Amsterdam, The Netherlands.
| | - Wouter H Mallee
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, G4-264, 1105, AZ, Amsterdam, The Netherlands.
| | - C Niek van Dijk
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, G4-264, 1105, AZ, Amsterdam, The Netherlands.
| | - Leendert Blankevoort
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, G4-264, 1105, AZ, Amsterdam, The Netherlands.
| | - Simon Goedegebuure
- The Sport Physician Group, Saint Lucas Andreas Hospital department of Sports Medicine, Jan Tooropstraat 164, 1061, AE, Amsterdam, The Netherlands.
| | - J Carel Goslings
- Department of Surgery, Trauma Unit, Academical Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - John G Kennedy
- Orthopaedic Surgery, Hospital for Special Surgery, 523 East 72nd Street, 5th Floor Rm 514, New York, NY, 10021, USA.
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, Meibergdreef 9, G4-264, 1105, AZ, Amsterdam, The Netherlands.
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Si HB, Zeng Y, Shen B, Yang J, Zhou ZK, Kang PD, Pei FX. The influence of body mass index on the outcomes of primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2015; 23:1824-32. [PMID: 25217315 DOI: 10.1007/s00167-014-3301-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/02/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE The body mass index (BMI) is widely recognized as a prognostic factor in multiple operations; however, the relationship between the BMI and outcomes following total knee arthroplasty (TKA) is extensively debated. We aimed to evaluate the effect of the BMI at different cutoff values on the outcomes following primary TKA. METHODS Electronic databases (PubMed/Medline, CENTRAL, Embase and Web of Science) were systematically searched for studies investigating the association between the BMI and outcomes following primary TKA. Two investigators independently reviewed studies for eligibility, assessed the study quality using the Newcastle-Ottawa Scale and extracted the data. A meta-analysis was performed using Review Manager software. RESULTS Twenty-eight articles including a total of 20,988 TKAs were identified. The postoperative Knee Society Score appeared to trend lower in obese (BMI ≥ 30 kg/m(2)) patients than in non-obese (BMI < 30 kg/m(2)) patients. The meta-analysis showed that revision with follow-up ≥5 years, any infection, superficial infection and deep vein thrombosis occurred statistically more frequently in obese patients, whereas a deep infection occurred statistically more frequently in morbidly obese (BMI ≥ 40 kg/m(2)) patients than in non-obese patients. No differences in aseptic loosening with follow-up ≥5 years, pulmonary embolism and perioperative mortality rates were found between obese and non-obese patients. CONCLUSIONS Patients with a BMI ≥ 30 kg/m(2) are at a higher risk of lower functional scores and developing complications following primary TKA. It appears reasonable to encourage obese patients to lose weight before selective TKA. LEVEL OF EVIDENCE Prognostic study, Level III.
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Affiliation(s)
- Hai-bo Si
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, 37# Guoxue Road, Chengdu, 610041, People's Republic of China,
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Liu W, Wahafu T, Cheng M, Cheng T, Zhang Y, Zhang X. The influence of obesity on primary total hip arthroplasty outcomes: A meta-analysis of prospective cohort studies. Orthop Traumatol Surg Res 2015; 101:289-96. [PMID: 25817907 DOI: 10.1016/j.otsr.2015.01.011] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/13/2015] [Accepted: 01/27/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Whether or not, obesity negatively influencing the outcomes of primary total hip arthroplasty (THA) remains a controversial issue. Though observational studies focused on this topic, the reported conclusions remain inconsistent. Therefore, we performed a meta-analysis of prospective cohort studies to evaluate if obesity negatively affects: (1) the overall complication rate (incidence of dislocation, deep infection and osteolysis); (2) functional outcome; (3) operative time and stay duration in hospital for the primary THA. METHODS We searched the PubMed, Embase, Web of Science, and the Cochrane Library until July 2014 to identify the eligible prospective studies. The Newcastle Ottawa Scale (NOS) was used for quality assessment of the included studies. We extracted and pooled the data. As for continuous data, mean difference (MD) was calculated; for dichotomous variables, we calculated a weighted relative risk (RR) with its 95% confidence interval. Heterogeneity was evaluated using I(2) statistics. P ≤ 0.05 was thought to be significant. RESULTS Fifteen studies were eligible for data extraction, which involved 11,271 total hip arthroplasties. The pooled data of complication rate demonstrated that obese patients suffered higher rates of complication (RR: 1.68, 95% CI 1.23 to 2.30, P = 0.0004), dislocation (RR: 2.08, 95% CI 1.54 to 2.81, P < 0.0001) and deep infection (RR: 2.92, 95% CI 0.74 to 11.49, P = 0.13). For the functional result, obese patients acquired relatively lower Harris Hip Score than non-obese patients (MD: -2.75, 95% CI -4.77 to -0.6), no difference was found regarding Oxford Hip Score (MD: -0.46, 95% CI -2.18 to 1.26, P = 0.60). Obese patients compared to non-obese patients showed an increase duration of operation (MD: 10.67, 95% CI 3.00 to 18.35, P = 0.006). However, no significant difference was found in the length of stay in hospital between obese and non-obese patients (MD: -0.16, 95% CI -0.34 to 0.02, P = 0.08). CONCLUSIONS This meta-analysis of prospective cohort studies demonstrates that obesity negatively influences the overall complication rate, dislocation rate, functional outcome and operative time of primary total hip arthroplasty.
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Affiliation(s)
- W Liu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China
| | - T Wahafu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China
| | - M Cheng
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China
| | - T Cheng
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China
| | - Y Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China
| | - X Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, 200233 Shanghai, China.
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Pharmacologic agents for the prevention and treatment of delirium in patients undergoing cardiac surgery: systematic review and metaanalysis. Crit Care Med 2015; 43:194-204. [PMID: 25289932 DOI: 10.1097/ccm.0000000000000673] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Postcardiac surgery delirium is associated with increased risks of morbidity, cognitive decline, poor health-related quality of life and mortality, and higher healthcare costs. We performed a systematic review of randomized controlled trials to examine the effect of pharmacologic agents for the prevention and the treatment of delirium after cardiac surgery. DATA SOURCES Electronic search on PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, ISI Web of Science, and CINAHL up to December 2013. STUDY SELECTION Randomized controlled trials of pharmacologic agents used for the prevention and the treatment of delirium after emergency or elective cardiac surgery in adults. DATA EXTRACTION We extracted data on patient population, pharmacologic agents, delirium characteristics, rescue treatment, length of stays in the ICU and hospital, and mortality. For each trial, we assessed the risk of bias domains and rated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. DATA SYNTHESIS Of the 13 studies (10 prevention and three treatment) involving 5,848 patients, one multicentered randomized controlled trial on prophylactic dexamethasone made up 77% of the total sample size. The use of pharmacologic agents (dexamethasone, rivastigmine, risperidone, ketamine, dexmedetomidine, propofol, and clonidine) reduced the risk of delirium (relative risk, 0.57; 95% CI, 0.40-0.80) with quality of evidence rated as moderate. There was high quality of evidence for no increased risk of mortality (relative risk, 0.89; 95% CI, 0.57-1.38) associated with the use of prophylactic pharmacologic agents. Metaanalysis of treatment trials was not undertaken because of high heterogeneity. In two small trials (total number of patients = 133), haloperidol did not appear to be effective in treating delirium. CONCLUSIONS Moderate to high-quality evidence supports the use of pharmacologic agents for the prevention of delirium, but results are based largely on one randomized controlled trial. The evidence for treating postcardiac surgery delirium with pharmacologic agents is inconclusive.
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Gillespie JA, Patil SR, Meek RDM. Clinical outcome scores for arthroscopic femoral osteochondroplasty in femoroacetabular impingement: a quantitative systematic review. Scott Med J 2014; 60:13-22. [PMID: 25428942 DOI: 10.1177/0036933014560300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Femoroacetabular impingement is the abnormal contact of the proximal femur and acetabulum during motion. It causes hip pain and joint degeneration in young patients. This systematic review aims to clarify the clinical effect of arthroscopic femoral osteochondroplasty for cam lesions and to review the available literature for the general medical readership, including providers of primary and secondary care. METHODS AND RESULTS Electronic databases were searched for studies of arthroscopic femoral osteochondroplasty in primary femoroacetabular impingement. A total of 2618 article titles, 242 abstracts and 33 full text articles were considered. Ultimately nine studies with clinical outcome scores met the inclusion criteria and were included in the qualitative systematic review. Six studies were suitable for meta-analysis using an inverse variance, random effects model (RevMan software). In the nine studies, improvements were seen in Western Ontario and McMaster Universities Osteoarthritis index, Non-arthritic Hip Score and Modified Harris Hip Scores. Across the six studies suitable for meta-analysis (537 patients), a 24-point weighted mean improvement in Non-arthritic hip score was seen. This yielded a large overall effect size of 1.6. CONCLUSION Arthroscopic femoral osteochondroplasty appears to be a beneficial treatment for primary femoroacetabular impingement, with a large effect size seen across six eligible studies.
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Affiliation(s)
- J A Gillespie
- Orthopaedic Registrar, Southern General Hospital, UK
| | - S R Patil
- Consultant Orthopaedic Surgeon, Southern General Hospital, UK
| | - R D M Meek
- Consultant Orthopaedic Surgeon, Southern General Hospital, UK
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Berstock JR, Blom AW, Beswick AD. A systematic review and meta-analysis of the standard versus mini-incision posterior approach to total hip arthroplasty. J Arthroplasty 2014; 29:1970-82. [PMID: 25023783 DOI: 10.1016/j.arth.2014.05.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/27/2014] [Accepted: 05/22/2014] [Indexed: 02/01/2023] Open
Abstract
The mini-incision posterior approach may appeal to surgeons comfortable with the standard posterior approach to the hip. We present the first systematic review and meta-analysis of these two approaches. Twelve randomised controlled trials and four non-randomised trials comprising of 1498 total hip arthroplasties were included. The mini-incision posterior approach was associated with an early improvement in Harris hip score of 1.8 points (P<0.001), reduced operating time (5minutes, P<0.001), length of hospital stay (14hours, P<0.001), intraoperative and total blood loss (63ml, P<0.001 and 119ml, P<0.001 respectively). There were no statistically significant differences in the incidence of dislocation, nerve injury, infection or venous thromboembolic events. The minimally invasive posterior approach appears to provide a safe and acceptable alternative to the standard incision posterior approach.
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Affiliation(s)
- James R Berstock
- University of Bristol Musculoskeletal Research Unit, AOC (Lower Level), Southmead Hospital, Bristol, UK
| | - Ashley W Blom
- University of Bristol Musculoskeletal Research Unit, AOC (Lower Level), Southmead Hospital, Bristol, UK
| | - Andrew D Beswick
- University of Bristol Musculoskeletal Research Unit, AOC (Lower Level), Southmead Hospital, Bristol, UK
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Graudal N, Hubeck-Graudal T, Tarp S, Christensen R, Jürgens G. Effect of combination therapy on joint destruction in rheumatoid arthritis: a network meta-analysis of randomized controlled trials. PLoS One 2014; 9:e106408. [PMID: 25244021 PMCID: PMC4171366 DOI: 10.1371/journal.pone.0106408] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/05/2014] [Indexed: 01/05/2023] Open
Abstract
Background Despite significant cost differences, the comparative effect of combination treatments of disease modifying anti-rheumatic drugs (DMARDs) with and without biologic agents has rarely been examined. Thus we performed a network meta-analysis on the effect of combination therapies on progression of radiographic joint erosions in patients with rheumatoid arthritis (RA). Methods and Findings The following combination drug therapies compared versus single DMARD were investigated: Double DMARD: 2 DMARDs (methotrexate, sulfasalazine, leflunomide, injectable gold, cyclosporine, chloroquine, azathioprin, penicillamin) or 1 DMARD plus low dose glucocorticoid (LDGC); triple DMARD: 3 DMARDs or 2 DMARDs plus LDGC; biologic combination: 1 DMARD plus biologic agent (tumor necrosis factor α inhibitor (TNFi) or abatacept or tocilizumab or CD20 inhibitor (CD20i)). Randomized controlled trials were identified in a search of electronic archives of biomedical literature and included in a star-shaped network meta-analysis and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. Effects are reported as standardized mean differences (SMD). The effects of data from 39 trials published in the period 1989–2012 were as follows: Double DMARD: −0.32 SMD (CI: −0.42, −0.22); triple DMARD: −0.46 SMD (CI: −0.60, −0.31); 1 DMARD plus TNFi: −0.30 SMD (CI: −0.36, −0.25); 1 DMARD plus abatacept: −0.20 SMD (CI: −0.33, −0.07); 1 DMARD plus tocilizumab: −0.34 SMD (CI: −0.48, −0.20); 1 DMARD plus CD20i: −0.32 SMD (CI: −0.40, −0.24). The indirect comparisons showed similar effects between combination treatments apart from triple DMARD being significantly better than abatacept plus methotrexate (−0.26 SMD (CI: −0.45, −0.07)) and TNFi plus methotrexate (−0.16 SMD (CI: −0.31, −0.01)). Conclusion Combination treatment of a biologic agent with 1 DMARD is not superior to 2–3 DMARDs including or excluding LDGC in preventing structural joint damage. Future randomized studies of biologic agents should be compared versus a combination of DMARDs.
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Affiliation(s)
- Niels Graudal
- Department of Rheumatology IR4242, Copenhagen University Hospital, Rigshospitalet, Denmark
- * E-mail:
| | | | - Simon Tarp
- Musculoskeletal Statistics Unit, the Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg, Denmark
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Frederiksberg, Denmark
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Gesche Jürgens
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg, Denmark
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Louwerens JKG, Sierevelt IN, van Noort A, van den Bekerom MPJ. Evidence for minimally invasive therapies in the management of chronic calcific tendinopathy of the rotator cuff: a systematic review and meta-analysis. J Shoulder Elbow Surg 2014; 23:1240-9. [PMID: 24774621 DOI: 10.1016/j.jse.2014.02.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Revised: 01/30/2014] [Accepted: 02/10/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND This meta-analysis assessed the short-term to midterm effectiveness of minimally invasive treatments in the management of calcifying tendinopathy of the shoulder cuff, a common source of chronic shoulder pain that leads to pain, a decreased active range of motion, and loss of muscular strength. When conservative therapies fail, minimally invasive treatment options can be considered before resulting to surgery. MATERIALS AND METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to conduct this review. A systematic literature search was conducted in May 2013 to identify all studies that examined the short-term to midterm effectiveness of minimally invasive treatments for chronic calcifying tendinopathy. The primary end points were identified as function, pain, and total resorption rates. Grades of Recommendation Assessment, Development and Evaluation (GRADE) was used to assess the quality of evidence. RESULTS Included were 20 studies (1544 participants). Common methodological flaws were related to randomization. In general, there is moderate-quality GRADE evidence that high-energy extracorporeal shockwave therapy has a significant effect on pain relief and functional status compared with other interventions. There is variable-quality GRADE evidence on the efficiency of other interventions. CONCLUSION High-energy extracorporeal shockwave therapy is the most thoroughly investigated minimally invasive treatment option in the short-term to midterm and has proven to be a safe and effective treatment. Ultrasound-guided needling is safe but has not been proven to be more effective than an ultrasound-guided subacromial corticosteroid injection in recent level I research, and further research will have to prove its effectiveness.
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Affiliation(s)
- Jan K G Louwerens
- Centre for Orthopaedic Research, Spaarne Ziekenhuis, Hoofddorp, The Netherlands.
| | - Inger N Sierevelt
- Centre for Orthopaedic Research, Spaarne Ziekenhuis, Hoofddorp, The Netherlands
| | - Arthur van Noort
- Department of Orthopaedic Surgery, Spaarne Ziekenhuis, Hoofddorp, The Netherlands
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Marques EMR, Jones HE, Elvers KT, Pyke M, Blom AW, Beswick AD. Local anaesthetic infiltration for peri-operative pain control in total hip and knee replacement: systematic review and meta-analyses of short- and long-term effectiveness. BMC Musculoskelet Disord 2014; 15:220. [PMID: 24996539 PMCID: PMC4118275 DOI: 10.1186/1471-2474-15-220] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 06/30/2014] [Indexed: 12/17/2022] Open
Abstract
Background Surgical pain is managed with multi-modal anaesthesia in total hip replacement (THR) and total knee replacement (TKR). It is unclear whether including local anaesthetic infiltration before wound closure provides additional pain control. Methods We performed a systematic review of randomised controlled trials of local anaesthetic infiltration in patients receiving THR or TKR. We searched MEDLINE, Embase and Cochrane CENTRAL to December 2012. Two reviewers screened abstracts, extracted data, and contacted authors for unpublished outcomes and data. Outcomes collected were post-operative pain at rest and during activity after 24 and 48 hours, opioid requirement, mobilisation, hospital stay and complications. When feasible, we estimated pooled treatment effects using random effects meta-analyses. Results In 13 studies including 909 patients undergoing THR, patients receiving local anaesthetic infiltration experienced a greater reduction in pain at 24 hours at rest by standardised mean difference (SMD) -0.61 (95% CI -1.05, -0.16; p = 0.008) and by SMD -0.43 (95% CI -0.78 -0.09; p = 0.014) at 48 hours during activity. In TKR, diverse multi-modal regimens were reported. In 23 studies including 1439 patients undergoing TKR, local anaesthetic infiltration reduced pain on average by SMD -0.40 (95% CI -0.58, -0.22; p < 0.001) at 24 hours at rest and by SMD -0.27 (95% CI -0.50, -0.05; p = 0.018) at 48 hours during activity, compared with patients receiving no infiltration or placebo. There was evidence of a larger reduction in studies delivering additional local anaesthetic after wound closure. There was no evidence of pain control additional to that provided by femoral nerve block. Patients receiving local anaesthetic infiltration spent on average an estimated 0.83 (95% CI 1.54, 0.12; p = 0.022) and 0.87 (95% CI 1.62, 0.11; p = 0.025) fewer days in hospital after THR and TKR respectively, had reduced opioid consumption, earlier mobilisation, and lower incidence of vomiting. Few studies reported long-term outcomes. Conclusions Local anaesthetic infiltration is effective in reducing short-term pain and hospital stay in patients receiving THR and TKR. Studies should assess whether local anaesthetic infiltration can prevent long-term pain. Enhanced pain control with additional analgesia through a catheter should be weighed against a possible infection risk.
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Affiliation(s)
- Elsa M R Marques
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
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Abstract
INTRODUCTION Obesity represents a significant risk factor in the pathophysiology of degenerative changes in coxarthrosis. OBJECTIVE The study aims to investigate obesity as a risk factor in the examined sample comprising 136 patients who underwent hip endoprothesis implantation. MATERIAL AND METHODS The series comprised 136 patients with a hip endoprosthesis implanted, where the patients' BMI, amount of blood used, duration of surgery, number of assistants, and type of anaesthesia were observed. Wounds and late post-operative complications, infections, haemorrhage, vein thrombosis, endoprosthesis dislocations, length of inpatient stay, start of physical therapy and full weight-bearing were also observed. The observation period lasted six months on average. DISCUSSION In simple terms, the three greatest factors when implanting a hip endoprosthesis are as follows: properties of the endoprosthesis, the orthopaedic surgeon's skill and experience, and individual characteristics of the patient, i.e. age, sex, health condition, body weight, BMI, adequate physical therapy. CONCLUSION We believe that the implantation of a hip endoprosthesis should be postponed for patients with a BMI exceeding 29.99. Such patients should receive endocrine treatment, they should undergo a weight loss programme in order to reduce their body weight and in order to reduce their BMI to under 29.99.
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Affiliation(s)
- Predrag Grubor
- Clinic of Traumatology, Clinical Centre, University of Banja Luka, Bosnia and Herzegovina
| | - Slavko Manojlovic
- Institute for Physical Medicinu”dr Miroslav Zotovic” of Banja Luka, Bosnia and Herzegovina
| | | | - Milan Grubor
- School of Medicine, University of Banja Luka, Bosnia and Herzegovina
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Olanzapine: a systematic review and meta-regression of the relationships between dose, plasma concentration, receptor occupancy, and response. J Clin Psychopharmacol 2013; 33:329-35. [PMID: 23609380 DOI: 10.1097/jcp.0b013e31828b28d5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To conduct a systematic review examining the relationships between olanzapine dose, clinical outcome, dopamine occupancy, and plasma concentration; and to evaluate the potential for therapeutic drug monitoring. METHODS A search using Embase, Medline, and Pubmed was conducted; and the literature was systematically reviewed. Studies meeting inclusion criteria were examined. The relationships between olanzapine dose, response, dopamine occupancy, and concentration were analyzed using statistical regression. RESULTS Ten studies were included in the analysis for dose-response. The effect size-dose relationship showed a typical dose-response curve with minimal rise in slope for doses higher than 10 mg/d. For the dose-occupancy relationship, 6 studies were included. Doses more than approximately 12 mg/d were sufficient to block 65% of striatal D2 receptors. Doses higher than 20 mg led to minimally higher receptor occupancies. Fifteen studies were included in the meta-regression of olanzapine mean concentrations. A linear relationship between mean plasma concentration and mean dose was observed. CONCLUSIONS Our review suggests that the likelihood of a favorable response with olanzapine is maximized at doses of 10 to 15 mg/d (perhaps lower in nonsmoking females). Higher doses may be considered if 15 mg is ineffective and if plasma level is less than 20 ng/mL on that dose. There is a direct linear relationship between olanzapine dose and plasma concentration. Therapeutic drug monitoring may be useful in patients who are suspected of nonadherence, where there is potential for a drug interaction, and in patients taking 15 mg/d or more and who have not reached clinical response.
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Kerkhoffs GM, Servien E, Dunn W, Dahm D, Bramer JA, Haverkamp D. The influence of obesity on the complication rate and outcome of total knee arthroplasty: a meta-analysis and systematic literature review. J Bone Joint Surg Am 2012; 94:1839-44. [PMID: 23079875 PMCID: PMC3489068 DOI: 10.2106/jbjs.k.00820] [Citation(s) in RCA: 357] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The increase in the number of individuals with an unhealthy high body weight is particularly relevant in the United States. Obesity (body mass index ≥ 30 kg/m2) is a well-documented risk factor for the development of osteoarthritis. Furthermore, an increased prevalence of total knee arthroplasty in obese individuals has been observed in the last decades. The primary aim of this systematic literature review was to determine whether obesity has a negative influence on outcome after primary total knee arthroplasty. METHODS A search of the literature was performed, and studies comparing the outcome of total knee arthroplasty in different weight groups were included. The methodology of the included studies was scored according to the Cochrane guidelines. Data extraction and pooling were performed. The weighted mean difference for continuous data and the weighted odds ratio for dichotomous variables were calculated. Heterogeneity was calculated with use of the I2 statistic. RESULTS After consensus was reached, twenty studies were included in the data analysis. The presence of any infection was reported in fourteen studies including 15,276 patients (I2, 26%). Overall, infection occurred more often in obese patients, with an odds ratio of 1.90 (95% confidence interval [CI], 1.46 to 2.47). Deep infection requiring surgical debridement was reported in nine studies including 5061 patients (I2, 0%). Deep infection occurred more often in obese patients, with an odds ratio of 2.38 (95% CI, 1.28 to 4.55). Revision of the total knee arthroplasty, defined as exchange or removal of the components for any reason, was documented in eleven studies including 12,101 patients (I2, 25%). Revision for any reason occurred more often in obese patients, with an odds ratio of 1.30 (95% CI, 1.02 to 1.67). CONCLUSIONS Obesity had a negative influence on outcome after total knee arthroplasty.
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Affiliation(s)
- Gino M.M.J. Kerkhoffs
- Department of Orthopedic Surgery, Orthotrauma Research Center Amsterdam, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail address for G.M.M.J. Kerkhoffs:
| | - Elvire Servien
- Centre Albert Trillat, Hôpital de la Croix-Rousse, Groupement Hospitalier Nord, 103 Grande rue de la Croix-Rousse, 69004 Lyon, France
| | - Warren Dunn
- Department of Orthopaedic Surgery, Vanderbilt Orthopaedic Institute, 1215 21st Avenue South, Suite 4200, Nashville, TN 37232
| | - Diane Dahm
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
| | - Jos A.M. Bramer
- Department of Orthopedic Surgery, Orthotrauma Research Center Amsterdam, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail address for G.M.M.J. Kerkhoffs:
| | - Daniel Haverkamp
- Department of Orthopedic Surgery, Orthotrauma Research Center Amsterdam, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail address for G.M.M.J. Kerkhoffs:
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Moullec G, Gour-Provencal G, Bacon SL, Campbell TS, Lavoie KL. Efficacy of interventions to improve adherence to inhaled corticosteroids in adult asthmatics: impact of using components of the chronic care model. Respir Med 2012; 106:1211-25. [PMID: 22770682 DOI: 10.1016/j.rmed.2012.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2012] [Revised: 05/31/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Adherence to inhaled corticosteroids (ICS) remains poor among asthmatics, yet little is known about the efficacy of interventions to improve adherence. Implementing the Chronic Care Model (CCM) components among patients with respiratory disorders has been associated with an improvement in outcomes, yet little is known about its effects on ICS adherence in asthmatics. OBJECTIVE We conducted a systematic review to assess the efficacy of interventions to improve ICS adherence among adult-asthmatics, and whether the use of CCM components (i.e., teaching self-management skills, providing decision support, delivery system design, and clinical information systems) resulted in greater ICS adherence. METHODS All English language articles testing the efficacy of an intervention including ICS medication on outcome from MEDLINE and PsychINFO databases through Aug-2010 were reviewed. Interventions were categorized based on the inclusion of CCM components. We standardized treatment effects to obtain effect-size's (ES's) and we combined the ES's of studies according to the number of CCM components included in their interventions. RESULTS Eighteen studies met inclusion criteria. Inclusion of a greater number of CCM components within interventions was associated with stronger effects on ICS adherence outcomes, with interventions featuring one, two, and four CCM components having medium (ES = 0.29; 95%CI, 0.16-0.42), large (0.53; 0.40-0.66), and very-large (0.83; 0.69-0.98) effects respectively. CONCLUSIONS Findings provide support for using the CCM as a framework for the design and implementation of interventions to improve adherence among adult-asthmatics.
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Affiliation(s)
- Gregory Moullec
- Montreal Behavioural Medicine Centre, Montreal, Quebec, Canada
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Robinson SA, Lajeunesse MJ, Forbes MR. Sex differences in mercury contamination of birds: testing multiple hypotheses with meta-analysis. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2012; 46:7094-7101. [PMID: 22668132 DOI: 10.1021/es204032m] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The sex of a bird can, in principle, affect exposure and accumulation of mercury. One conventional explanation for sex differences in mercury burden suggests female birds should have lower concentrations than conspecific males, because breeding females can depurate methylmercury to their eggs. However, sex differences in body burden of mercury among birds are not consistent. We used meta-analysis to synthesize 123 male-female comparisons of mercury burden from 50 studies. For breeding birds, males had higher concentrations of mercury than did females, supporting egg depuration as a mechanism. However, the percentage of female body mass represented by a clutch did not significantly predict the magnitude of the sex difference in mercury contamination, as predicted. Furthermore, whether species were semialtrical or altrical versus semiprecocial or precocial also did not explain sex differences in mercury burden. Foraging guild of a species did explain near significant variation in sex differences in mercury burden where piscivores and invertivores showed significant sex differences, but sex differences were not detected for carnivores, herbivores, insectivores, and omnivores. The magnitude and direction of sexual size dimorphism did not explain variation in sex differences in mercury burden among breeding birds. We reveal targeted research directions on mechanisms for sex differences in mercury and confirm that sex is important to consider for environmental risk assessments based on breeding birds.
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Affiliation(s)
- Stacey A Robinson
- Department of Biology, Carleton University, 209 Nesbitt Building, 1125 Colonel By Drive, Ottawa, Ontario K1S 5B6, Canada.
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Haverkamp D, Klinkenbijl MN, Somford MP, Albers GHR, van der Vis HM. Obesity in total hip arthroplasty--does it really matter? A meta-analysis. Acta Orthop 2011; 82:417-22. [PMID: 21657972 PMCID: PMC3237030 DOI: 10.3109/17453674.2011.588859] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 03/11/2011] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Discussion persists as to whether obesity negatively influences the outcome of hip arthroplasty. We performed a meta-analysis with the primary research question of whether obesity has a negative effect on short- and long-term outcome of total hip arthroplasty. METHODS We searched the literature and included studies comparing the outcome of hip arthroplasty in different weight groups. The methodology of the studies included was scored according to the Cochrane guidelines. We extracted and pooled the data. For continuous data, we calculated a weighted mean difference and for dichotomous variables we calculated a weighted odds ratio (OR). Heterogeneity was calculated using I(2) statistics. RESULTS 15 studies were eligible for data extraction. In obese patients, dislocation of the hip (OR = 0.54, 95% CI: 0.38-0.75) (10 studies, n = 8,634), aseptic loosening (OR = 0.64, CI: 0.43-0.96) (6 studies, n = 5,137), infection (OR = 0.3, CI: 0.19-0.49) (10 studies, n = 7,500), and venous thromboembolism (OR = 0.56, CI: 0.32-0.98) (7 studies, n = 3,716) occurred more often. Concerning septic loosening and intraoperative fractures, no statistically significant differences were found, possibly due to low power. Subjective outcome measurements did not allow pooling because of high heterogeneity (I(2) = 68%). INTERPRETATION Obesity appears to have a negative influence on the outcome of total hip replacement.
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Affiliation(s)
- Daniël Haverkamp
- Department of Orthopaedic Surgery, Tergooi Ziekenhuizen, Hilversum, the Netherlands.
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Haverkamp D, van den Bekerom MPJ, Harmse I, Schafroth MU. One stage bilateral total hip arthroplasty, is it safe? A meta-analysis. Hip Int 2011; 20:440-6. [PMID: 21157747 DOI: 10.1177/112070001002000405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2010] [Indexed: 02/04/2023]
Abstract
Controversy has prevailed for many years relating to the safety of one-stage and two-stage total hip arthroplasty (THA) for bilateral disease. We performed a meta-analysis of 1460 studies of which 5 prospective studies met our inclusion criteria. A total of 579 patients had two-stage procedures and 334 had one-stage surgery. The studies showed a low heterogeneity (I2 =0%) allowing pooling of data. No differences were found in the incidence of major complications (odds ratio 0.72 95%CI: 0.45-1.15). One-stage bilateral THA may therefore be a safe procedure.
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Affiliation(s)
- Daniël Haverkamp
- Academic Medical Centre, Department of Orthopaedic Surgery, Amsterdam, The Netherlands.
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Wamper KE, Sierevelt IN, Poolman RW, Bhandari M, Haverkamp D. The Harris hip score: Do ceiling effects limit its usefulness in orthopedics? Acta Orthop 2010; 81:703-7. [PMID: 21110703 PMCID: PMC3216080 DOI: 10.3109/17453674.2010.537808] [Citation(s) in RCA: 177] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The Harris hip score (HHS), a disease-specific health status scale that is frequently used to measure the outcome of total hip arthroplasty, has never been validated properly. A questionnaire is suitable only when all 5 psychometric properties are of sufficient quality. We questioned the usefulness of the HHS by investigating its content validity. METHODS We performed a systematic review based on a literature search in PubMed, Embase, and the Cochrane Library for descriptive studies published in 2007. 54 studies (59 patient groups) met our criteria and were included in the data analysis. To determine the content validity, we calculated the ceiling effect (percentage) for each separate study and we pooled data to measure the weighted mean. A subanalysis of indications for THA was performed to differentiate the populations for which the HHS would be suitable and for which it would not. A ceiling effect of 15% or less was considered to be acceptable. RESULTS Over half the studies (31/59) revealed unacceptable ceiling effects. Pooled data across the studies included (n = 6,667 patients) suggested ceiling effects of 20% (95%CI: 18-22). Ceiling effects were greater (32%, 95%CI:12-52) in those patients undergoing hip resurfacing arthroplasty. INTERPRETATION Although the Harris hip score is widely used in arthroplasty research on outcomes, ceiling effects are common and these severely limit its validity in this field of research.
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Affiliation(s)
- Kim E Wamper
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam
| | - Inger N Sierevelt
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, Departments of Surgery and of Clinical Epidemiology and Biostatistics, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Daniël Haverkamp
- Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam
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Steroid avoidance or withdrawal after renal transplantation increases the risk of acute rejection but decreases cardiovascular risk. A meta-analysis. Transplantation 2010; 89:1-14. [PMID: 20061913 DOI: 10.1097/tp.0b013e3181c518cc] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The morbidity related to long-term steroid therapy has led to continued interest in withdrawal of steroids from immunosuppressant regimens after renal transplantation. A number of recent trials have provided long-term information regarding the risks and benefits of steroid avoidance or withdrawal (SAW). METHODS A literature search was performed using Ovid Medline, Embase, the Cochrane Library, and the Transplant Library. Randomized controlled trials comparing a maintenance steroid group with complete avoidance or withdrawal of steroids were selected. All studies were assessed for methodological quality. Trials were pooled by meta-analysis to provide summary effects (relative risk [RR] or weighted mean difference) with 95% confidence intervals (CI). RESULTS Thirty-four studies including 5,637 patients met the inclusion criteria. SAW regimens significantly increased the risk of acute rejection (AR) over maintenance steroids (RR 1.56, CI 1.31-1.87, P<0.0001). No significant differences in corticosteroid resistant AR, patient survival, or graft survival were observed. Serum creatinine was increased and creatinine clearance was reduced with SAW. Cardiovascular risk factors including incidence of hypertension (RR 0.90, CI 0.85-0.94, P<0.0001), new onset diabetes (RR 0.64, CI 0.50-0.83, P=0.0006), and hypercholesterolemia (RR 0.76, CI 0.67-0.87, P<0.0001) were reduced significantly by SAW. CONCLUSION Despite an increase in the risk of AR with SAW protocols, there is only a small effect on graft function with no measurable effect on graft or patient survival. There are significant benefits in cardiovascular risk profiles after SAW. SAW protocols would seem justified with current immunosuppressive protocols in low-risk recipients.
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Mycophenolate mofetil decreases acute rejection and may improve graft survival in renal transplant recipients when compared with azathioprine: a systematic review. Transplantation 2009; 87:785-94. [PMID: 19300178 DOI: 10.1097/tp.0b013e3181952623] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Mycophenolate mofetil (MMF) has increasingly replaced azathioprine (AZA) as the antimetabolite of choice in immunosuppressive protocols. Initial trials comparing MMF with AZA in patients receiving cyclosporine A sandimmune showed a clinical benefit in reducing the incidence of acute rejections. It has been questioned whether this benefit remains significant when using newer formulations of cyclosporine A (neoral) and tacrolimus. METHODS Literature searches were performed using the Transplant Library, Cochrane library, Medline, and Embase for all randomized controlled trials directly comparing MMF with AZA in renal transplant recipients. Trials were assessed for quality using the Jadad scoring system. Trials were pooled using meta-analysis software. Confidence intervals were set at 95%. RESULTS Nineteen relevant studies were identified, including a total of 3143 patients. MMF significantly reduces the risk of acute rejection when used in combination with any calcineurin inhibitor (relative risk 0.62, 0.55-0.87, P<0.00001). The hazard for graft loss, including death with a functioning graft, is also significantly reduced in patients treated with MMF (hazard ratio 0.76, 0.59-0.98, P=0.037). There is no significant difference in patient survival or renal transplant function between groups. Risk of adverse events, including cytomegalovirus infection, anemia, leukopenia or rates of malignancy, does not differ significantly. A greater risk of diarrhea is seen in MMF-treated patients. CONCLUSIONS We have shown that MMF used with a calcineurin inhibitor does indeed confer a clinical benefit over AZA by reducing the risk of acute rejection and also possibly reducing graft loss. This effect is independent of whether MMF is used in combination with sandimmune, neoral or tacrolimus.
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Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth 2009; 102:408-17. [PMID: 19174373 DOI: 10.1093/bja/aen384] [Citation(s) in RCA: 297] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M S Abrahams
- Department of Anesthesiology and Perioperative Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239-3098, USA.
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