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Lin Z, Chen T, Chen G, Pan W, Xu W. Effects of tourniquet on surgical site wound infection and pain after total knee arthroplasty: A meta-analysis. Int Wound J 2023; 21:e14414. [PMID: 37779328 PMCID: PMC10824622 DOI: 10.1111/iwj.14414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
The application of a tourniquet (TNQ) for haemostasis in total knee arthroplasty (TKA) is controversial and lacking systematic evaluation. This meta-analysis assessed relevant international data to quantitatively evaluate the implications of using TNQ in TKA, further guide clinical diagnosis and treatment, and improve postoperative outcomes. A comprehensive computerised search of PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, VIP, and Wanfang databases was conducted to retrieve randomised controlled trials on the application of TNQ in TKA published from database inception to August 2023. The included data, ultimately comprising 1482 patients in 16 studies, were collated and subjected to meta-analysis using Stata 17.0 software. The results showed that the use of TNQ during TKA led to significantly higher rates of postoperative surgical site wound infection (3.96% vs. 1.79%, odds ratio: 2.15, 95% confidence intervals [CIs]: 1.11-4.16, p = 0.023) and wound pain scores on the first (standardised mean difference [SMD]: 0.65, 95% CI: 0.35-0.94, p < 0.001), second (SMD: 0.66, 95% CI: 0.01-1.31, p = 0.045), and third (SMD: 0.68, 95% CI: 0.31-1.05, pP < 0.001) day after the procedure. In conclusion, the application of TNQ in TKA increases the risk of postoperative surgical site wound infection and worsens short-term postoperative wound pain; therefore, TNQ should be used sparingly during TKA, or its use should be decided in conjunction with the relevant clinical indications and the surgeon's experience.
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Affiliation(s)
- Zhengwu Lin
- Department of OrthopedicsTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Te Chen
- Department of Special Requirements WardTaizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical UniversityTaizhouChina
- Enze Hospital, Taizhou Enze Medical Center (Group)TaizhouChina
| | - Guofu Chen
- Department of OrthopedicsTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhouChina
| | - Wenjun Pan
- Department of OrthopedicsTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhouChina
- Enze Hospital, Taizhou Enze Medical Center (Group)TaizhouChina
| | - Wei Xu
- Department of OrthopedicsTaizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical UniversityTaizhouChina
- Enze Hospital, Taizhou Enze Medical Center (Group)TaizhouChina
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Deconstruction of the Prevention of Knee Osteoarthritis by Swimming Based on Data Mining Technology. BIOMED RESEARCH INTERNATIONAL 2022; 2022:1001686. [PMID: 36017389 PMCID: PMC9398800 DOI: 10.1155/2022/1001686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022]
Abstract
With the continuous development of big data and the continuous improvement of people's living standards, increasingly attention is paid to physical health. Swimming in this sport is effective in preventing the occurrence of arthritis. This paper analyzes the prevention and exploration of arthritis and relies on the traditional method of retrieving clinical literature on the treatment of knee osteoarthritis with traditional Chinese medicine and internal medicine, which requires a lot of manpower and material resources. At this time, the role of data mining technology is brought into play. This article analyzes the prevention of arthritis by swimming. If you rely on the traditional retrieval of clinical literature on the treatment of knee osteoarthritis with traditional Chinese medicine and internal medicine, you will find a lot of disordered data. It takes a lot of manpower and material resources to sort out the summary, and at this time, the role of data mining (DM) technology is brought into play. In this paper, the relevant information of the literature that meets the requirements is established in an Excel database, and the data of the relevant information is entered. Through sorting and analysis, the TCM syndrome types of knee osteoarthritis are summarized. Then, DM technology was used to carry out statistical analysis of frequency and prescription, to summarize the distribution characteristics of the corresponding knee osteoarthritis, TCM syndrome types, and the weight of each syndrome type, and to make a preliminary discussion at the same time. Finally, it is concluded that there are better prevention methods for arthritis in the research methods of traditional Chinese medicine. DM technology has been increasingly applied to all aspects of traditional Chinese medicine. DM technology has improved its research efficiency by 38% and achieved great results, which will play a greater role in promoting the research process of TCM syndrome.
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Barker KL, Room J, Knight R, Dutton S, Toye F, Leal J, Kenealy N, Maia Schlüssel M, Collins G, Beard D, Price AJ, Underwood M, Drummond A, Lamb S. Home-based rehabilitation programme compared with traditional physiotherapy for patients at risk of poor outcome after knee arthroplasty: the CORKA randomised controlled trial. BMJ Open 2021; 11:e052598. [PMID: 34452970 PMCID: PMC8404435 DOI: 10.1136/bmjopen-2021-052598] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate whether a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty offers superior outcomes to traditional outpatient physiotherapy. DESIGN A prospective, single-blind, two-arm randomised controlled superiority trial. SETTING 14 National Health Service physiotherapy departments in the UK. PARTICIPANTS 621 participants identified at high risk of a poor outcome after knee arthroplasty using a bespoke screening tool. INTERVENTIONS A multicomponent home-based rehabilitation programme delivered by rehabilitation assistants with supervision from qualified therapists versus usual care outpatient physiotherapy. MAIN OUTCOME MEASURES The primary outcome was the Late-Life Function and Disability Instrument (LLFDI) at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function), Knee injury and Osteoarthritis Outcome Score Quality of Life subscale, Physical Activity Scale for the Elderly, 5 dimension, 5 level version of Euroqol (EQ-5D-5L) and physical function assessed using the Figure of 8 Walk test, 30 s Chair Stand Test and Single Leg Stance. RESULTS 621 participants were randomised between March 2015 and January 2018. 309 were assigned to CORKA (Community Rehabilitation after Knee Arthroplasty) home-based rehabilitation, receiving a median five treatment sessions (IQR 4-7). 312 were assigned to usual care, receiving a median 4 sessions (IQR 2-6). The primary outcome, LLFDI function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference=0.49 points; 95% CI -0.89 to 1.88; p=0.48). There were no statistically significant differences between the groups on any of the patient-reported or physical secondary outcome measures at 6 or 12 months.There were 18 participants in the intervention group reporting a serious adverse event (5.8%), only one directly related to the intervention, all other adverse events recorded throughout the trial related to underlying chronic medical conditions. CONCLUSIONS The CORKA intervention was not superior to usual care. The trial detected no significant differences, clinical or statistical, between the two groups on either primary or secondary outcomes. CORKA offers an evaluation of an intervention utilising a different service delivery model for this patient group. TRIAL REGISTRATION NUMBER ISRCTN13517704.
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Affiliation(s)
- Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jonathan Room
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Ruth Knight
- Oxford Clinicial Trials Research Unit (OCTRU), Centre Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Susan Dutton
- Oxford Clinicial Trials Research Unit (OCTRU), Centre Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Francine Toye
- Nuffield Orthopaedic Centre Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Jose Leal
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Nicola Kenealy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Michael Maia Schlüssel
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Gary Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Avril Drummond
- Div of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
- NDORMS, University of Oxford, Oxford, UK
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Barker KL, Room J, Knight R, Dutton SJ, Toye F, Leal J, Kent S, Kenealy N, Schussel MM, Collins G, Beard DJ, Price A, Underwood M, Drummond A, Cook E, Lamb SE. Outpatient physiotherapy versus home-based rehabilitation for patients at risk of poor outcomes after knee arthroplasty: CORKA RCT. Health Technol Assess 2020; 24:1-116. [PMID: 33250068 DOI: 10.3310/hta24650] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Over 100,000 primary knee arthroplasty operations are undertaken annually in the UK. Around 15-30% of patients do not report a good outcome. Better rehabilitation strategies may improve patient-reported outcomes. OBJECTIVES To compare the outcomes from a traditional outpatient physiotherapy model with those from a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty. DESIGN An individually randomised, two-arm controlled trial with a blinded outcome assessment, a parallel health economic evaluation and a nested qualitative study. SETTING The trial took place in 14 NHS physiotherapy departments. PARTICIPANTS People identified as being at high risk of a poor outcome after knee arthroplasty. INTERVENTIONS A multicomponent home-based rehabilitation package delivered by rehabilitation assistants with supervision from qualified therapists compared with usual-care outpatient physiotherapy. MAIN OUTCOME MEASURES The primary outcome was the Late Life Function and Disability Instrument at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function); Knee injury and Osteoarthritis Outcome Score; Quality of Life subscale; Physical Activity Scale for the Elderly; EuroQol-5 Dimensions, five-level version; and physical function assessed using the Figure-of-8 Walk Test, 30-Second Chair Stand Test and Single Leg Stance. Data on the use of health-care services, time off work and informal care were collected using participant diaries. RESULTS In total, 621 participants were randomised. A total of 309 participants were assigned to the COmmunity based Rehabilitation after Knee Arthroplasty (CORKA) home-based rehabilitation programme, receiving a median of five treatment sessions (interquartile range 4-7 sessions). A total of 312 participants were assigned to usual care, receiving a median of four sessions (interquartile range 2-6 sessions). The primary outcome, Late Life Function and Disability Instrument function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual-care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference 0.49 points, 95% confidence interval -0.89 to 1.88 points; p = 0.48). There were no statistically significant differences between the groups in any of the patient-reported or physical secondary outcome measures at 6 or 12 months post randomisation. The health economic analysis found that the CORKA intervention was cheaper to provide than usual care (£66 less per participant). Total societal costs (combining health-care costs and other costs) were lower for the CORKA intervention than usual care (£316 less per participant). Adopting a societal perspective, CORKA had a 75% probability of being cost-effective at a threshold of £30,000 per quality-adjusted life-year. Adopting the narrower health and social care perspective, CORKA had a 43% probability of being cost-effective at the same threshold. LIMITATIONS The interventions were of short duration and were set within current commissioning guidance for UK physiotherapy. Participants and treating therapists could not be blinded. CONCLUSIONS This randomised controlled trial found no important differences in outcomes when post-arthroplasty rehabilitation was delivered using a home-based, rehabilitation assistant-delivered rehabilitation package or a traditional outpatient model. However, the health economic evaluation found that when adopting a societal perspective, the CORKA home-based intervention was cost-saving and more effective than, and thus dominant over, usual care, owing to reduced time away from paid employment for this group. Further research could look at identifying the risk of poor outcome and further evaluation of a cost-effective treatment, including the workforce model to deliver it. TRIAL REGISTRATION Current Controlled Trials ISRCTN13517704. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jon Room
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ruth Knight
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Susan J Dutton
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Fran Toye
- Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Seamus Kent
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nicola Kenealy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Michael M Schussel
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Gary Collins
- Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - David J Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Sarah E Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,School of Medicine and Health, University of Exeter, Exeter, UK
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