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Ng MK, Magruder ML, Heckmann ND, Delanois RE, Piuzzi NS, Krebs VE, Mont MA. How-To Create an Orthopaedic Systematic Review: A Step-by-Step Guide. Part III: Executing a Meta-Analysis. J Arthroplasty 2024:S0883-5403(24)00242-0. [PMID: 38493965 DOI: 10.1016/j.arth.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 03/19/2024] Open
Abstract
At the top of the evidence-based pyramid, systematic reviews stand out as the most powerful, synthesizing findings from numerous primary studies. Specifically, a quantitative systematic review, known as a meta-analysis, combines results from various studies to address a specific research question. This review serves as a guide on how to: (1) design; (2) perform; and (3) publish an orthopedic arthroplasty systematic review. In Part III, we focus on how to design and perform a meta-analysis. We delineate the advantages and disadvantages of meta-analyses compared to systematic reviews, acknowledging their potential challenges due to time constraints and the complexities posed by study heterogeneity and data availability. Despite these obstacles, a well-executed meta-analysis contributes precision and heightened statistical power, standing at the apex of the evidence-based pyramid. The design of a meta-analysis closely mirrors that of a systematic review, but necessitates the inclusion of effect sizes, variability measures, sample sizes, outcome measures, and overall study characteristics. Effective data presentation involves the use of forest plots, along with analyses for heterogeneities and subgroups. Widely-used software tools are common in this domain, and there is a growing trend toward incorporating artificial intelligence software. Ultimately, the intention is for these papers to act as foundational resources for individuals interested in conducting systematic reviews and meta-analyses in the context of orthopaedic arthroplasty, where applicable.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Nathanael D Heckmann
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Viktor E Krebs
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland; Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
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Youn EJ, Shin C, Haratian R, Guzman A, Kim JY, McGahan P, Chen JL. Income and Insurance Status Impact Access to Health Care for Hip Osteoarthritis. Arthrosc Sports Med Rehabil 2023; 5:100747. [PMID: 37645390 PMCID: PMC10461205 DOI: 10.1016/j.asmr.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/18/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To explore differences in the affordability of and accessibility to health care among adults with hip osteoarthritis with respect to race/ethnicity, income, and insurance status. Methods This cross-sectional retrospective study was conducted using 2016 National Health Interview Survey (NHIS) data. NHIS data collection occurred continuously from January to December 2016. Individuals belonging to households and noninstitutionalized groups were included in the study. Because NHIS randomized surveys are conducted face-to-face on an annual basis, follow-up data are not collected. Results Answers from 38,158,634 weighted respondents with a mean age of 58.33 ± 0.33 years were assessed. Among adults with hip osteoarthritis, those with public insurance had increased odds of delaying care owing to lack of transportation and had decreased odds of delaying care and follow-up care owing to cost. Individuals who were uninsured or who belonged to lower income brackets were associated with increased odds of being unable to afford or utilize health care. Conclusions In this study, we found that income bracket and insurance status affect the accessibility to health care among adults with hip osteoarthritis in the United States. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- Erin J. Youn
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
- Williams College, Williamstown, Massachusetts, U.S.A
| | - Caleb Shin
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Ryan Haratian
- Department of Orthopaedic Surgery, Sports Medicine & Rehabilitation, Wright State University Boonshoft School of Medicine, Dayton, Ohio, U.S.A
| | - Alvarho Guzman
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Joo Yeon Kim
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - Patrick McGahan
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
| | - James L. Chen
- Advanced Orthopedics and Sports Medicine, San Francisco, California, U.S.A
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Nham FH, Court T, Zalikha AK, El-Othmani MM, Shah RP. Assessing the predictive capacity of machine learning models using patient-specific variables in determining in-hospital outcomes after THA. J Orthop 2023; 41:39-46. [PMID: 37304653 PMCID: PMC10248727 DOI: 10.1016/j.jor.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/13/2023] Open
Abstract
Background Machine learning is a subset of artificial intelligence using algorithmic modeling to progressively learn and create predictive models. Clinical application of machine learning can aid physicians through identification of risk factors and implications of predicted patient outcomes. Aims The aim of this study was to compare patient-specific and situation perioperative variables through optimized machine learning models to predict postoperative outcomes. Methods Data from 2016 to 2017 from the National Inpatient Sample was used to identify 177,442 discharges undergoing primary total hip arthroplasty, which were included in the training, testing, and validation of 10 machine learning models. 15 predictive variables consisting of 8 patient-specific and 7 situational specific variables were utilized to predict 3 outcome variables: length of stay, discharge, and mortality. The machine learning models were assessed in responsiveness via area under the curve and reliability. Results For all outcomes, Linear Support Vector Machine had the highest responsiveness among all models when using all variables. When utilizing patient-specific variables only, responsiveness of the top 3 models ranged between 0.639 and 0.717 for length of stay, 0.703-0.786 for discharge disposition, and 0.887-0.952 for mortality. The top 3 models utilizing situational variables only produced responsiveness of 0.552-0.589 for length of stay, 0.543-0.574 for discharge disposition, and 0.469-0.536 for mortality. Conclusions Linear Support Vector Machine was the most responsive machine learning model of the 10 algorithms trained, while decision list was most reliable. Responsiveness was observed to be consistently higher with patient-specific variables than situational variables, emphasizing the predictive capacity and value of patient-specific variables. The current practice in machine learning literature generally deploys a single model, it is suboptimal to develop optimized models for application into clinical practice. The limitation of other algorithms may prohibit potential more reliable and responsive models.Level of Evidence III.
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Affiliation(s)
- Fong H. Nham
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Tannor Court
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Abdul K. Zalikha
- Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, Detroit, MI, 48201, USA
| | - Mouhanad M. El-Othmani
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, 10032, USA
| | - Roshan P. Shah
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, 10032, USA
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Makabe S, Kume Y, Akagawa Y, Wakasa M, Ito K, Kijima H. Discharge Planning and Challenges for Patients With Asian Lifestyles Following Total Hip Arthroplasty: National Survey Design in Japan. Orthop Nurs 2023; 42:115-122. [PMID: 36944207 DOI: 10.1097/nor.0000000000000930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
This study examined discharge planning and challenges for patients following total hip arthroplasty in Japan. A cross-sectional national survey of 500 hospitals was conducted in May 2019. Discharge planning education tended to include content on dislocation prevention, including prevention while using a squat toilet and crouching down to sit on the floor or sleep on a futon on the floor-activities common in many Asian communities that require a maximum flexion of the hip joint. The challenges of discharge planning included diverse lifestyles, aging issues, lack of assistance at home, lack of consensus on dislocation prevention intervention, limitation of standardized care, interprofessional collaboration, and lack of time to educate family. Tailored discharge planning can be challenging, particularly for aged patients who practice "floor culture", i.e., sleeping, sitting and eating on the floor. Discharge planning needs to be task shifted from the surgeon to the nurse to enhance nurses' empowerment in Japan.
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Affiliation(s)
- Sachiko Makabe
- Sachiko Makabe, PhD, RN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Yu Kume, PhD, OT, Department of Occupational Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Yuko Akagawa, RN, PHN, MSN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Masahiko Wakasa, PhD, PT, Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Kaina Ito, RN, PHN, Children's Mirai Center, Akita, Japan
- Hiroaki Kijima, MD, PhD, Department of Orthopedic, Akita University Hospital, Akita, Japan
| | - Yu Kume
- Sachiko Makabe, PhD, RN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Yu Kume, PhD, OT, Department of Occupational Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Yuko Akagawa, RN, PHN, MSN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Masahiko Wakasa, PhD, PT, Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Kaina Ito, RN, PHN, Children's Mirai Center, Akita, Japan
- Hiroaki Kijima, MD, PhD, Department of Orthopedic, Akita University Hospital, Akita, Japan
| | - Yuko Akagawa
- Sachiko Makabe, PhD, RN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Yu Kume, PhD, OT, Department of Occupational Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Yuko Akagawa, RN, PHN, MSN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Masahiko Wakasa, PhD, PT, Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Kaina Ito, RN, PHN, Children's Mirai Center, Akita, Japan
- Hiroaki Kijima, MD, PhD, Department of Orthopedic, Akita University Hospital, Akita, Japan
| | - Masahiko Wakasa
- Sachiko Makabe, PhD, RN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Yu Kume, PhD, OT, Department of Occupational Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Yuko Akagawa, RN, PHN, MSN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Masahiko Wakasa, PhD, PT, Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Kaina Ito, RN, PHN, Children's Mirai Center, Akita, Japan
- Hiroaki Kijima, MD, PhD, Department of Orthopedic, Akita University Hospital, Akita, Japan
| | - Kaina Ito
- Sachiko Makabe, PhD, RN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Yu Kume, PhD, OT, Department of Occupational Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Yuko Akagawa, RN, PHN, MSN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Masahiko Wakasa, PhD, PT, Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Kaina Ito, RN, PHN, Children's Mirai Center, Akita, Japan
- Hiroaki Kijima, MD, PhD, Department of Orthopedic, Akita University Hospital, Akita, Japan
| | - Hiroaki Kijima
- Sachiko Makabe, PhD, RN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Yu Kume, PhD, OT, Department of Occupational Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Yuko Akagawa, RN, PHN, MSN, Department of Nursing, Akita University Graduate School of Health Sciences, Akita, Japan
- Masahiko Wakasa, PhD, PT, Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
- Kaina Ito, RN, PHN, Children's Mirai Center, Akita, Japan
- Hiroaki Kijima, MD, PhD, Department of Orthopedic, Akita University Hospital, Akita, Japan
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Sorial AK, Anjum SA, Cook MJ, Board TN, O'Neill TW. Statins, bone biology and revision arthroplasty: review of clinical and experimental evidence. Ther Adv Musculoskelet Dis 2020; 12:1759720X20966229. [PMID: 33403020 PMCID: PMC7747105 DOI: 10.1177/1759720x20966229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 09/14/2020] [Indexed: 12/27/2022] Open
Abstract
Osteoarthritis is a painful, disabling condition which is increasing in
prevalence as a result of an ageing population. With no recognized
disease-limiting therapeutics, arthroplasty of the hip and knee is the most
common and effective treatment for lower limb osteoarthritis, however lower limb
arthroplasty has a finite life-span and a proportion of patients will require
revision arthroplasty. With increasing life expectancy and an increasing
proportion of younger (<65 years) patients undergoing arthroplasty, the
demand for revision arthroplasty after implant failure is also set to
increase. Statins are cholesterol-modulating drugs widely used for cardiovascular risk
reduction which have been noted to have pleiotropic effects including
potentially influencing arthroplasty survival. In vitro studies
have demonstrated pleiotropic effects in human bone cells, including enhancement
of osteoblastogenesis following simvastatin exposure, and in
vivo studies have demonstrated that intraperitoneal simvastatin can
increase peri-implant bone growth in rats following titanium tibial implant
insertion. There is evidence that statins may also influence osseointegration,
enhancing bone growth at the bone–implant interface, subsequently improving the
functional survival of implants. Data from the Danish Hip Arthroplasty Registry
and the Clinical Practice Research Datalink in the UK suggest a reduction in the
risk of lower limb revision arthroplasty in statin ever-users
versus never-users, and a time-dependent effect of statins
in reducing the risk of revision. In this article we review the clinical and
experimental evidence linking statins and risk of revision arthroplasty.
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Affiliation(s)
- Antony K Sorial
- Newcastle University, Biosciences Institute, International Centre for Life, Newcastle upon Tyne, NE1 3BZ, UK
| | | | - Michael J Cook
- Centre for Epidemiology versus Arthritis, University of Manchester, Manchester, UK
| | - Tim N Board
- The Centre for Hip Surgery, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Terence W O'Neill
- Centre for Epidemiology versus Arthritis, University of Manchester, Manchester, UK, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Neck-sparing short femoral stems: A meta-analysis. Orthop Traumatol Surg Res 2020; 106:1481-1494. [PMID: 32703717 DOI: 10.1016/j.otsr.2020.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neck sparing short femoral stems are supposed to ease restoration of the proximal femoral anatomy and physiological hip biomechanics. This stem design is of particular interest as they have the potential to generate prosthetic hips that have higher functional performance with an improved lifespan, and revise more easily. Unlike previously published meta-analysis, this meta-analysis was initiated to determine if neck sparing short femoral stems compared to conventional stems: (1) resulted in improved functional performance; (2) reduced risk of thigh pain; (3) reduced risk of reoperation/revision, and 4) reduced stress shielding related bone loss in the proximal femur. MATERIAL AND METHODS Literature databases were searched between 1st January 2005 and 30th March 2019. The primary search was conducted using the electronic databases MEDLINE, EMBASE, PubMed, Open Grey, Trip Pro, Evidence Search, and Cochrane. Eligible studies were assessed for homogeneity, with continuous outcomes expressed as standardized mean difference with 95% confidence interval and dichotomous data as odds-ratio with 95% confidence interval. RESULTS Ten randomised clinical trials were eligible; these trials included 1259 total hip arthroplasty procedures, inclusive of 616 neck sparing short stems and 643 conventional stems. We were not able to find a significant functional advantage of using neck sparing short stems based on Harris Hip scores (0.0850; 95% CI: -0.03 to 0.20 [p=0.40]) and WOMAC scores (-0.0605; 95% CI: -0.03 to 0.15 [p=0.87]). We found a trend in favour of neck sparing short stems to reduce the risk of thigh pain but this was non significant (odds ratio of 0.11; 95% CI: 0.03 to 0.43 [p=0.178]). Neck sparing short stems were associated with similar early- to mid-term dislocation and revision rates compared to conventional stems with odds ratio of 1.435 (95% CI: 0.545 to 3.780 [p=0.968]) and of 0.581 (95% CI: 0.220 to 1.532 [p=0.972]), respectively. Neck sparing short stems were found to have less bone loss in both Gruen zones 1 and 7 (3.324; 95% CI: -7.683 to 1.036 [p<0.001], and of -4.632; 95% CI: -9682 to 0.418 [p<0.001], respectively). DISCUSSION/CONCLUSION Neck sparing short femoral stems achieve excellent early to mid-term outcomes in both clinical and radiological outcome scores that are in keeping with conventional stems functionally. Hitherto, results from this meta-analysis suggest that neck-sparing stems may achieve better maintenance of bone mineral density than their conventional counterparts, in addition to fewer cases of thigh pain. LEVEL OF EVIDENCE I; meta-analysis.
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Grottoli CF, Cingolani A, Zambon F, Ferracini R, Villa T, Perale G. Simulated Performance of a Xenohybrid Bone Graft (SmartBone ®) in the Treatment of Acetabular Prosthetic Reconstruction. J Funct Biomater 2019; 10:E53. [PMID: 31766685 PMCID: PMC6963854 DOI: 10.3390/jfb10040053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 02/06/2023] Open
Abstract
Total hip arthroplasty (THA) is a surgical procedure for the replacement of hip joints with artificial prostheses. Several approaches are currently employed in the treatment of this kind of defect. Overall, the most common method involves using a quite invasive metallic support (a Burch-Schneider ring). Moreover, valid alternatives and less invasive techniques still need to be supported by novel material development. In this work, we evaluated the performance of SmartBone®, a xenohybrid bone graft composed of a bovine bone matrix reinforced with biodegradable polymers and collagen, as an effective support in acetabular prosthesis reconstruction. Specifically, the material's mechanical properties were experimentally determined (E = ~1.25 GPa, Ef = ~0.34 GPa, and Et = ~0.49 GPa) and used for simulation of the hip joint system with a SmartBone® insert. Moreover, a comparison with a similar case treated with a Burch-Schneider ring was also conducted. It was found that it is possible to perform THA revision surgeries without the insertion of an invasive metal support and it can be nicely combined with SmartBone®'s osteointegration characteristics. The material can withstand the loads independently (σmax = ~12 MPa) or be supported by a thinner titanium plate in contact with the bone in the worst cases. This way, improved bone regeneration can be achieved.
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Affiliation(s)
| | - Alberto Cingolani
- Industrie Biomediche Insubri SA, 6805 Mezzovico-Vira, Switzerland; (C.F.G.); (A.C.)
| | - Fabio Zambon
- Politecnico di Milano, Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, 20133 Milan, Italy; (F.Z.); (T.V.)
| | - Riccardo Ferracini
- Department of Surgical Sciences and Integrated Diagnostics, University of Genova, Largo R. Benzi 10, 16132 Genova, Italy;
- IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132 Genova, Italy
| | - Tomaso Villa
- Politecnico di Milano, Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering “G. Natta”, 20133 Milan, Italy; (F.Z.); (T.V.)
| | - Giuseppe Perale
- Industrie Biomediche Insubri SA, 6805 Mezzovico-Vira, Switzerland; (C.F.G.); (A.C.)
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Donaueschingenstrasse 13, 1200 Vienna, Austria
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De Lucia O, Pierannunzii LM, Pregnolato F, Verduci E, Crotti C, Valcamonica E, Pisoni L, Comi D, Lonati PA, Meroni PL, Murgo A. Effectiveness and Tolerability of Repeated Courses of Viscosupplementation in Symptomatic Hip Osteoarthritis: A Retrospective Observational Cohort Study of High Molecular Weight vs. Medium Molecular Weight Hyaluronic Acid vs. No Viscosupplementation. Front Pharmacol 2019; 10:1007. [PMID: 31616292 PMCID: PMC6768944 DOI: 10.3389/fphar.2019.01007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 08/08/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Nonsurgical management of symptomatic hip osteoarthritis needs real-world evidence. We evaluated the effectiveness and tolerability of US-guided intra-articular treatment of two hyaluronic acids (HAs) commercially available in Italy and investigated predictors of response. Methods: Outpatient records including three cohorts: 122 subjects treated with medium (1,500–3,200 kDa; Hyalubrix®) molecular weight (MW) or high (hylan G-F20; Synvisc®) MW HAs and 20 controls taking NSAIDs/analgesics on demand were retrospectively analyzed. Pain VAS score, WOMAC, NSAID/analgesic consumption, and causes of suspension were available at 1, 6, 12, and 24 months after first administration. As selection bias usually affects observational retrospective studies, a quasi-randomization process was attained by performing propensity score approach. Results: Propensity score adjustment successfully allowed comparisons among balanced groups of treatments. VAS and WOMAC considerably decreased over time in treated groups independently of the radiological grade (p<0.001). On the other hand, the control group showed only a slight and rather uneven variation in VAS. Mean score changes were comparable in both HA cohorts from the earliest stages (ΔVAS(HA1,500–3,200kDa)T1vsT0 = −20%; ΔVAS(hylan G-F20)T1vsT0 = −23%/ΔWOMAC(HA1,500–3,200kDa)T1vsT0 = −17%; ΔWOMAC(hylan G-F20)T1vsT0 = −19%), reaching a further substantial reduction after 12 months (ΔVAS(HA1,500–3,200kDa)T12vsT0 = −52%; ΔVAS(hylan G-F20)T12vsT0 = −53%/ΔWOMAC(HA1,500–3,200kDa)T12vsT0 = −45%; and ΔWOMAC(hylan G-F20)T12vsT0 = −47%). Almost 11% (=13/122) of ineffectiveness and few moderate local side effects 3% (=4/122) were detected. Conclusions: Viscosupplementation in a real-life setting seems to provide a sound alternative in pain management in comparison to oral NSAIDs/analgesics, guaranteeing a reduced intake of pain killer medications. Analgesic effectiveness, functional recovery, and reduced joint stiffness extend and improve over 12 and 24 months, suggesting that repeated administrations achieve an additive effect.
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Affiliation(s)
- Orazio De Lucia
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy
| | - Luca Massimo Pierannunzii
- Department of Orthopedics, Sports Traumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy
| | - Francesca Pregnolato
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milano, Italy
| | - Elisa Verduci
- Department of Clinical and Experimental Medicine, Unit of Rheumatology, University of Messina, Messina, Italy
| | - Chiara Crotti
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy.,DISCCO-Department of Clinical Science and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Elisabetta Valcamonica
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy.,Division of Internal Medicine and Cardiological Rehabilitation, Angelo Bellini Hospital - ASST Valle Olona, Somma Lombardo, Italy
| | - Laura Pisoni
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy.,Rheumatology Outpatient Clinic, ASST Nord Milano, Milano, Italy
| | - Daniela Comi
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy.,Department of Rehabilitation, ASST Lecco, Lecco, Italy
| | - Paola Adele Lonati
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milano, Italy
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Milano, Italy
| | - Antonella Murgo
- Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milano, Italy
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Oo WM, Yu SPC, Daniel MS, Hunter DJ. Disease-modifying drugs in osteoarthritis: current understanding and future therapeutics. Expert Opin Emerg Drugs 2018; 23:331-347. [PMID: 30415584 DOI: 10.1080/14728214.2018.1547706] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Osteoarthritis (OA) is a leading cause of pain and disability among adults with a current prevalence of around 15% and a predicted prevalence of 35% in 2030 for symptomatic OA. It is increasingly recognized as a heterogeneous multi-faceted joint disease with multi-tissue involvement of varying severity. Current therapeutic regimens for OA are only partially effective and often have significant associated toxicities. There are no disease-modifying drugs approved by the regulatory bodies. Areas covered: We reviewed the opportunities within key OA pathogenetic mechanism: cartilage catabolism/anabolism, pathological remodeling of subchondral bone and synovial inflammation to identify targeted disease-modifying osteoarthritis drugs, based on compounds currently in Phase II and III stages of clinical development in which x-ray and/or MRI was used as the structural outcome with/without symptomatic outcomes according to regulatory requirements. Expert opinion: Given the heterogeneity of the OA disease process and complex overlapping among these phenotypes, a 'one size fits all' approach used in most clinical trials would unlikely be practical and equally effective in all patients, as well as in all anatomical OA sites. On the other hand, it is a challenge to develop a targeted drug with high activity, specificity, potency, and bioavailability in the absence of toxicity for long-term use in this chronic disease of predominantly older adults. Further research and insight into evaluation methods for drug-targeted identification of early OA and specific characterization of phenotypes, improvement of methodological designs, and development/refinement of sensitive imaging and biomarkers will help pave the way to the successful discovery of disease-modifying drugs and the optimal administration strategies in clinical practice.
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Affiliation(s)
- Win Min Oo
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
| | - Shirley Pei-Chun Yu
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
| | - Matthew Sean Daniel
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
| | - David John Hunter
- a Rheumatology Department, Royal North Shore Hospital, and, Institute of Bone and Joint Research, Kolling Institute , University of Sydney , Sydney , Australia
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10
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Goodman SB, Mihalko WM, Anderson PA, Sale K, Bozic KJ. Introduction of New Technologies in Orthopaedic Surgery. JBJS Rev 2018; 4:01874474-201605000-00005. [PMID: 27490218 DOI: 10.2106/jbjs.rvw.o.00067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The introduction of new devices, biologics, and combination products to the orthopaedic marketplace is increasing rapidly. The majority of these new technologies obtain clearance to market by demonstrating substantial equivalence to a predicate (previously approved device) according to the U.S. Food and Drug Administration (FDA) 510(k) process. Surgeons play a critical role in the introduction of new technologies to patients and must take a leadership role in promoting safe, efficacious, appropriate, and cost-effective care, especially for operative procedures. Surgeons should monitor and document their patients' clinical outcomes and adverse events when using new technology, to ensure that the new technology is performing as desired.
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Affiliation(s)
- Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - William M Mihalko
- Department of Orthopaedic Surgery & Biomedical Engineering, Campbell Clinic, Memphis, Tennessee
| | - Paul A Anderson
- Department of Orthopaedic Surgery, University of Wisconsin, Madison, Wisconsin
| | - Katherine Sale
- Department of Research and Scientific Affairs, American Academy of Orthopaedic Surgeons, Rosemont, Illinois
| | - Kevin J Bozic
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, Texas
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11
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Li D, Wang H, Li Z, Wang C, Xiao F, Gao Y, Zhang X, Wang P, Peng J, Cai G, Zuo B, Shen Y, Qi J, Qian N, Deng L, Song W, Zhang X, Shen L, Chen X. The inhibition of RANKL expression in fibroblasts attenuate CoCr particles induced aseptic prosthesis loosening via the MyD88-independent TLR signaling pathway. Biochem Biophys Res Commun 2018; 503:1115-1122. [DOI: 10.1016/j.bbrc.2018.06.128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 06/22/2018] [Indexed: 01/04/2023]
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12
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Li D, Wang C, Li Z, Wang H, He J, Zhu J, Zhang Y, Shen C, Xiao F, Gao Y, Zhang X, Li Y, Wang P, Peng J, Cai G, Zuo B, Yang Y, Shen Y, Song W, Zhang X, Shen L, Chen X. Nano-sized Al 2O 3 particle-induced autophagy reduces osteolysis in aseptic loosening of total hip arthroplasty by negative feedback regulation of RANKL expression in fibroblasts. Cell Death Dis 2018; 9:840. [PMID: 30082761 PMCID: PMC6079072 DOI: 10.1038/s41419-018-0862-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 06/30/2018] [Accepted: 07/06/2018] [Indexed: 12/25/2022]
Abstract
Aseptic loosening is mainly caused by wear debris generated by friction that can increase the expression of receptor activation of nuclear factor (NF)-κB (RANKL). RANKL has been shown to support the differentiation and maturation of osteoclasts. Although autophagy is a key metabolic pathway for maintaining the metabolic homeostasis of cells, no study has determined whether autophagy induced by Al2O3 particles is involved in the pathogenesis of aseptic loosening. The aim of this study was to evaluate RANKL levels in patients experiencing aseptic loosening after total hip arthroplasty (THA) and hip osteoarthritis (hOA) and to consequently clarify the relationship between RANKL and LC3II expression. We determined the levels of RANKL and autophagy in fibroblasts treated with Al2O3 particles in vitro while using shBECN-1 interference lentivirus vectors to block the autophagy pathway and BECN-1 overexpression lentivirus vectors to promote autophagy. We established a novel rat model of femoral head replacement and analyzed the effects of Al2O3 particles on autophagy levels and RANKL expression in synovial tissues in vivo. The RANKL levels in the revision total hip arthroplasty (rTHA) group were higher than those in the hOA group. In patients with rTHA with a ceramic interface, LC3II expression was high, whereas RANKL expression was low. The in vitro results showed that Al2O3 particles promoted fibroblast autophagy in a time- and dose-dependent manner and that RANKL expression was negatively correlated with autophagy. The in vivo results further confirmed these findings. Al2O3 particles induced fibroblast autophagy, which reduced RANKL expression. Decreasing the autophagy level promoted osteolysis and aseptic prosthetic loosening, whereas increasing the autophagy level reversed this trend.
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Affiliation(s)
- De Li
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenglong Wang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhuokai Li
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiye He
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junfeng Zhu
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehui Zhang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Shen
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Xiao
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Gao
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Zhang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Li
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Wang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianping Peng
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guiquan Cai
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Zuo
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Yang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Shen
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weidong Song
- Department of Orthopedic Surgery, Sun Yat-Sen memorial hospital affiliated to Sun Yat-Sen university, Guangzhou, China
| | - Xiaoling Zhang
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Lei Shen
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xiaodong Chen
- Department of Orthopedic Surgery, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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13
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de Steiger R, Lorimer M, Graves SE. Cross-Linked Polyethylene for Total Hip Arthroplasty Markedly Reduces Revision Surgery at 16 Years. J Bone Joint Surg Am 2018; 100:1281-1288. [PMID: 30063590 DOI: 10.2106/jbjs.17.01221] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is an effective operation for the management of end-stage hip osteoarthritis, but long-term success can be limited by wear of the polyethylene bearing surface. Cross-linking conventional polyethylene has resulted in lower wear rates and a reduction in bone lysis in both laboratory and clinical studies. The aim of this study was to compare the rates of revision between cross-linked polyethylene (XLPE) and conventional non-cross-linked polyethylene (CPE) at 16 years after THAs performed for the treatment of osteoarthritis. METHODS We performed an observational study of data, from a national registry, on all patients who underwent THA for osteoarthritis in Australia from 1999 through December 31, 2016. The outcomes of THAs performed with CPE were compared with those of THAs performed with XLPE, along with an analysis of the effect of age, sex, femoral head size, the method of acetabular and femoral component fixation, and the reasons and types of revision. The principal outcome measure was the time to the first revision, determined using Kaplan-Meier estimates of survivorship. RESULTS CPE was used in 41,171 procedures, and XLPE was used in 199,131. The mean ages of the men and women treated with CPE were 70.0 years (standard deviation [SD] = 9.9 years) and 72.5 years (SD = 9.7 years), respectively, whereas the men and women who received XLPE were slightly younger (mean age, 68.6 years [SD = 10.3 years] and 70.7 years [SD = 9.9 years], respectively. XLPE was associated with a lower rate of revision than CPE at 6 months, and this difference became more apparent with time. The 16-year cumulative percentage of revisions of the primary THAs was 11.7% (95% confidence interval [CI] = 11.1% to 12.3%]) in the CPE group and 6.2% (95% CI = 5.7% to 6.7%) in the XLPE group. The hazard ratio at 9 years was 3.02 (p = 0.001). CONCLUSIONS The use of XLPE has resulted in a significant reduction in the rate of revision at 16 years following THA for osteoarthritis. This evidence suggests that the longevity of THA is likely to be improved, which may enable younger patients to undergo surgery, confident of a reduced need for revision in the long term. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- R de Steiger
- Australian Orthopaedic Association National Joint Replacement Registry, SAHMRI, Adelaide, South Australia, Australia.,School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - M Lorimer
- Australian Orthopaedic Association National Joint Replacement Registry, SAHMRI, Adelaide, South Australia, Australia
| | - S E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, SAHMRI, Adelaide, South Australia, Australia
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Schwarz E, Reinisch G, Brandauer A, Aharinejad S, Scharf W, Trieb K. Load transfer and periprosthetic fractures after total hip arthoplasty: Comparison of periprosthetic fractures of femora implanted with cementless distal-load or proximal-load femoral components and measurement of the femoral strain at the time of implantation. Clin Biomech (Bristol, Avon) 2018; 54:137-142. [PMID: 29587147 DOI: 10.1016/j.clinbiomech.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 01/07/2018] [Accepted: 03/16/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the causes and mechanisms underlying periprosthetic fractures around femoral components particularly in relation to the stem design. In an in vitro study 20 pairs of fresh cadaveric femora were loaded to fracture axially and transversally. FINDINGS When proximal femoral strain was measured at the time of impaction of cementless stems the load transfer was determined by the underlying anatomy rather than by the shape of the stem, so that the so-called "load transfer" properties - proximal or distal - ascribed to stem designs are a myth. The axial-load and the transverse-load model were then exposed to loads to failure (fracture) and showed a biphasic pattern throughout independent of the impact direction. In the second phase, the fracture phase proper, the bone behaved like a brittle solid. Failure occurred very rapidly within less than 5 milliseconds. The forces to failure were between 2 and 11 kN. Most of the fractures (82.5%) occurred above the stem tip. INTERPRETATION Note that the study was confined to early preosteointegration fractures. Neither the stem design nor the impact direction, i.e. on the knee or on the side of the hip, was related to the fracture morphology.
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Affiliation(s)
- E Schwarz
- Trauma Unit, Hanusch-Krankenhaus, Vienna, Austria
| | - G Reinisch
- Biomechanische Forschungs-Gesellschaft m.b.H., Vienna, Austria; Department of Micro-Technique and Precision Engineering, Vienna University of Technology, Austria
| | - A Brandauer
- Department of Micro-Technique and Precision Engineering, Vienna University of Technology, Austria
| | - S Aharinejad
- Anatomy and Cellular Biology Division, Vienna Medical School, Austria
| | - W Scharf
- Trauma Unit, Hanusch-Krankenhaus, Vienna, Austria
| | - K Trieb
- Department of Orthopedics, Klinikum Wels-Grieskirchen, Austria.
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15
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Vijaysegaran P, Knibbs LD, Morawska L, Crawford RW. Surgical Space Suits Increase Particle and Microbiological Emission Rates in a Simulated Surgical Environment. J Arthroplasty 2018; 33:1524-1529. [PMID: 29317156 DOI: 10.1016/j.arth.2017.12.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/07/2017] [Accepted: 12/08/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The role of space suits in the prevention of orthopedic prosthetic joint infection remains unclear. Recent evidence suggests that space suits may in fact contribute to increased infection rates, with bioaerosol emissions from space suits identified as a potential cause. This study aimed to compare the particle and microbiological emission rates (PER and MER) of space suits and standard surgical clothing. METHODS A comparison of emission rates between space suits and standard surgical clothing was performed in a simulated surgical environment during 5 separate experiments. Particle counts were analyzed with 2 separate particle counters capable of detecting particles between 0.1 and 20 μm. An Andersen impactor was used to sample bacteria, with culture counts performed at 24 and 48 hours. RESULTS Four experiments consistently showed statistically significant increases in both PER and MER when space suits are used compared with standard surgical clothing. One experiment showed inconsistent results, with a trend toward increases in both PER and MER when space suits are used compared with standard surgical clothing. CONCLUSION Space suits cause increased PER and MER compared with standard surgical clothing. This finding provides mechanistic evidence to support the increased prosthetic joint infection rates observed in clinical studies.
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Affiliation(s)
- Praveen Vijaysegaran
- Faculty of Built Environment and Engineering, School of Engineering Systems, Queensland University of Technology, Brisbane, Australia
| | - Luke D Knibbs
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Ross W Crawford
- Faculty of Built Environment and Engineering, School of Engineering Systems, Queensland University of Technology, Brisbane, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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16
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Wu X, Sun H, Zhou X, Wang J, Li J. Quality assessment of systematic reviews on total hip or knee arthroplasty using mod-AMSTAR. BMC Med Res Methodol 2018; 18:30. [PMID: 29548276 PMCID: PMC5857117 DOI: 10.1186/s12874-018-0488-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 02/28/2018] [Indexed: 02/05/2023] Open
Abstract
Background Increasing numbers of systematic reviews (SRs) on total knee arthroplasty (TKA) and total hip arthroplasty (THA) have been published in recent years, but their quality has been unclear. The purpose of this study is to evaluate the methodological quality of SRs on TKA and THA. Methods We searched Ovid-Medline, Ovid-Embase, Cochrane Databases (including HTA, DARE, and CDSR), CBM, CNKI, Wang Fang, and VIP, from January 2014 to December 2015 for THA and TKA. The quality of SRs was assessed using the modified 25-item “Assessment of Multiple Systematic Reviews” (mod-AMSTAR) tool, which was based on the AMSTAR scale. A T-test, nonparametric test, and linear regression were conducted to assess the relationship between bibliographical characteristics and methodological quality. Results Sixty-three SRs were included, from which the majority of SRs (50, 79.4%) were conducted in Asia. Only 4 reviews were rated as high quality, and most were weak in providing a priori design (6, 9.5%), not limiting the publication type (8, 13%), providing an excluded primary studies list (4, 6.3%) and reporting support for the included primary studies (1, 1.6%). Reviews published in English journals performed better than did Chinese journals in duplicate data extraction (81.3% vs 46.7%, p = 0.017; 70.8% vs 33.3%, p = 0.009) and providing source of support for the SR (87.5% vs 33.3%, P < 0.001). Reviews published in journals with a higher impact factor were associated with a higher mod-AMSTAR score (regression coefficient: 0.38, 95%CI: 0.11–0.65; P = 0.006). Conclusion The methodological quality of the included SRs is far from satisfactory. Authors of SRs should conform to the recommendations outlined in the mod-AMSTAR items. Areas needing improvement were providing a priori design, not limiting the publication type, providing an excluded primary studies list, and reporting conflicts of interest. Electronic supplementary material The online version of this article (10.1186/s12874-018-0488-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xinyu Wu
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Huan Sun
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoqin Zhou
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ji Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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17
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Teoh KH, Whitham RDJ, Golding DM, Wong JF, Lee PYF, Evans AR. R3 Cup Does Not Have a High Failure Rate in Conventional Bearings: A Minimum of 5-Year Follow-Up. J Arthroplasty 2018; 33:460-463. [PMID: 29107497 DOI: 10.1016/j.arth.2017.09.059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 09/11/2017] [Accepted: 09/21/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The R3 cementless acetabular system was first marketed in Australia and Europe in 2007. Previous papers have shown high failure rates of the R3 cup with up to 24% with metal-on-metal bearing. There are currently no medium term clinical results on this cup. The aim of the study is to review our results of the R3 acetabular cup with conventional bearings with a minimum of 5-year follow-up. METHODS Patients who were implanted with the R3 acetabular cup were identified from our center's arthroplasty database. A total of 293 consecutive total hip arthroplasties were performed in 286 patients. The primary outcome was revision. The secondary outcomes were the Oxford Hip Scores (OHS) and radiographic evaluation. RESULTS The mean age of the patients was 69.4 years. The mean preoperative OHS was 23 (range 10-34) and the mean OHS was 40 (range 33-48) at the final follow-up. Radiological evaluation showed an excellent ARA score in all patients at 5 years. None of the R3 cups showed osteolysis at the final follow-up. There were 3 revisions in our series, of which 2 R3 cups were revised. The risk of revision was 1.11% at 5 years. CONCLUSION Our experience of using the R3 acetabular system with conventional bearings showed high survivorship and is consistent with the allocated Orthopaedic Data Evaluation Panel rating of 5A* as rated in 2015 in the United Kingdom.
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Affiliation(s)
- Kar H Teoh
- The Hip Arthroplasty Unit, Royal Gwent Hospital, Newport, Wales, United Kingdom; South Wales Orthopaedic Research Network, WelshBone, Trauma and Orthopaedics, Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | - Robert D J Whitham
- South Wales Orthopaedic Research Network, WelshBone, Trauma and Orthopaedics, Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | - David M Golding
- South Wales Orthopaedic Research Network, WelshBone, Trauma and Orthopaedics, Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | - Jenny F Wong
- South Wales Orthopaedic Research Network, WelshBone, Trauma and Orthopaedics, Princess of Wales Hospital, Bridgend, Wales, United Kingdom
| | - Paul Y F Lee
- South Wales Orthopaedic Research Network, WelshBone, Trauma and Orthopaedics, Princess of Wales Hospital, Bridgend, Wales, United Kingdom; Grantham and District Hospital, Lincolnshire, United Kingdom
| | - Aled R Evans
- The Hip Arthroplasty Unit, Royal Gwent Hospital, Newport, Wales, United Kingdom
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18
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López-López JA, Humphriss RL, Beswick AD, Thom HHZ, Hunt LP, Burston A, Fawsitt CG, Hollingworth W, Higgins JPT, Welton NJ, Blom AW, Marques EMR. Choice of implant combinations in total hip replacement: systematic review and network meta-analysis. BMJ 2017; 359:j4651. [PMID: 29097396 PMCID: PMC5683044 DOI: 10.1136/bmj.j4651] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 01/29/2023]
Abstract
Objective To compare the survival of different implant combinations for primary total hip replacement (THR). Design Systematic review and network meta-analysis. Data sources Medline, Embase, The Cochrane Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, and the EU Clinical Trials Register.Review methods Published randomised controlled trials comparing different implant combinations. Implant combinations were defined by bearing surface materials (metal-on-polyethylene, ceramic-on-polyethylene, ceramic-on-ceramic, or metal-on-metal), head size (large ≥36 mm or small <36 mm), and fixation technique (cemented, uncemented, hybrid, or reverse hybrid). Our reference implant combination was metal-on-polyethylene (not highly cross linked), small head, and cemented. The primary outcome was revision surgery at 0-2 years and 2-10 years after primary THR. The secondary outcome was the Harris hip score reported by clinicians.Results 77 studies were included in the systematic review, and 15 studies (3177 hips) in the network meta-analysis for revision. There was no evidence that the risk of revision surgery was reduced by other implant combinations compared with the reference implant combination. Although estimates are imprecise, metal-on-metal, small head, cemented implants (hazard ratio 4.4, 95% credible interval 1.6 to 16.6) and resurfacing (12.1, 2.1 to 120.3) increase the risk of revision at 0-2 years after primary THR compared with the reference implant combination. Similar results were observed for the 2-10 years period. 31 studies (2888 patients) were included in the analysis of Harris hip score. No implant combination had a better score than the reference implant combination.Conclusions Newer implant combinations were not found to be better than the reference implant combination (metal-on-polyethylene (not highly cross linked), small head, cemented) in terms of risk of revision surgery or Harris hip score. Metal-on-metal, small head, cemented implants and resurfacing increased the risk of revision surgery compared with the reference implant combination. The results were consistent with observational evidence and were replicated in sensitivity analysis but were limited by poor reporting across studies.Systematic review registration PROSPERO CRD42015019435.
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Affiliation(s)
- José A López-López
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rachel L Humphriss
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew D Beswick
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Learning and Research Building (Level 1), Bristol BS10 5NB, UK
| | - Howard H Z Thom
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Linda P Hunt
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Learning and Research Building (Level 1), Bristol BS10 5NB, UK
| | - Amanda Burston
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Learning and Research Building (Level 1), Bristol BS10 5NB, UK
| | - Christopher G Fawsitt
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - William Hollingworth
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Julian P T Higgins
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nicky J Welton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Learning and Research Building (Level 1), Bristol BS10 5NB, UK
| | - Elsa M R Marques
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Learning and Research Building (Level 1), Bristol BS10 5NB, UK
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19
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Liao Y, Su R, Zhang P, Yuan B, Li L. Cortisol inhibits mTOR signaling in avascular necrosis of the femoral head. J Orthop Surg Res 2017; 12:154. [PMID: 29047405 PMCID: PMC5648506 DOI: 10.1186/s13018-017-0656-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ANFH is a major health problem, to which long lasting and definitive treatments are lacking. The aim of this study is to study RNA alterations attributed to cortisol-induced ANFH. METHODS Rat models were stratified into three groups: in vitro group (n = 20) for molecular biological assays, control group (n = 3), and ANFH group induced using lipopolysaccharide and dexamethasone (n = 3). Bone marrow-derived endothelial progenitor cells (BM-EPCs) were extracted from the rats. An RNA expression array was performed on BM-EPCs, and enriched genes were subject to pathway analysis. In vitro studies following findings of array results were also performed using the isolated BM-EPCs. RESULTS Significant alterations in mammalian target of rapamycin (mTOR) and HIF signaling pathways were identified in BM-EPCs of ANFH. By applying cortisol and dexamethasone to BM-EPCs, significant changes in mTOR and HIF elements were identified. The alteration of HIF pathways appeared to be downstream of mTOR signaling. Glucocorticoid receptor (GR) expression was related to glucocorticoid-dependent mRNA expression of mTOR/HIF genes. mTOR-dependent angiogenesis but not anabolism was the target of GR in ANFH. Inhibition of mTOR signaling also induced apoptosis of BM-EPCs via CHOP-dependent DR5 induction in response to GR stimulation. CONCLUSION Decreased mTOR signaling in response to GR stimulation leading to downregulated HIF pathway as well as increased apoptosis could be the pathophysiology.
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Affiliation(s)
- Yun Liao
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.,Department of Pharmacy, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, China
| | - Rui Su
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Ping Zhang
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Bo Yuan
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China
| | - Ling Li
- Department of Pharmacy, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200336, China.
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20
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van Oldenrijk J, Scholtes VAB, van Beers LWAH, Geerdink CH, Niers BBAM, Runne W, Bhandari M, Poolman RW. Better early functional outcome after short stem total hip arthroplasty? A prospective blinded randomised controlled multicentre trial comparing the Collum Femoris Preserving stem with a Zweymuller straight cementless stem total hip replacement for the treatment of primary osteoarthritis of the hip. BMJ Open 2017; 7:e014522. [PMID: 29042371 PMCID: PMC5652481 DOI: 10.1136/bmjopen-2016-014522] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Primary aim was to compare the functional results at 3 months and 2 years between short and conventional cementless stem total hip arthroplasty (THA). Secondary aim was to determine the feasibility of a double-blind implant-related trial. DESIGN A prospective blinded randomised controlled multicentre trial in patients with osteoarthritis of the hip. All patients, research assistants, clinical assessors, investigators and data analysts were blinded to the type of prosthesis. POPULATION 150 patients between 18 and 70 years with osteoarthritis of the hip, 75 in the short stem and 75 in the conventional stem group. Mean age: 60 years (SD 7). INTERVENTIONS the Collum Femoris Preserving short stem versus the Zweymuller Alloclassic conventional stem. MAIN OUTCOME MEASURES The Dutch version of the Hip Disability and Osteoarthritis Outcome Score (HOOS). Secondary outcomes measures: Harris Hip Score, the Physical Component Scale of the SF12, the Timed Up and Go test, Pain and the EQ-5D. Feasibility outcomes: continued blinding, protocol adherence and follow-up success rate. RESULTS No significant difference between the two groups. Mean HOOS total score in the short stem group increased 32.7 points from 36.6 (95% CI 32.9 to 40.2) preoperatively to 69.3 (95% CI 66.4 to 72.1) at 3 months follow-up. Mean HOOS total score in the conventional straight stem group increased 36.3 points from 37.1 (95% CI 33.9 to 40.3) preoperatively to 73.4 (95% CI 70.3 to 76.4) at 3 months follow-up. 91.2% of patients remained blinded at 2 years follow-up. Both protocol adherence and follow-up success rate were 98%. CONCLUSIONS Functional result at 3 months and 2 years after short stem THA is not superior to conventional cementless THA. There were more perioperative and postoperative complications in the short stem group. Direct comparison of two hip implants in a double-blinded randomised controlled trial is feasible. TRIAL REGISTRATION NUMBER NTR1560.
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Affiliation(s)
- Jakob van Oldenrijk
- Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vanessa A B Scholtes
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Loes W A H van Beers
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Carel H Geerdink
- Department of Orthopaedic surgery, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Bob B A M Niers
- Department of Orthopaedic surgery, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Wouter Runne
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Mohit Bhandari
- Department of Surgery, Mcmaster University, Hamilton, Ontario, Canada
| | - Rudolf W Poolman
- Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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21
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Baert IAC, Lluch E, Van Glabbeek F, Nuyts R, Rufai S, Tuynman J, Struyf F, Meeus M. Short stem total hip arthroplasty: Potential explanations for persistent post-surgical thigh pain. Med Hypotheses 2017; 107:45-50. [PMID: 28915961 DOI: 10.1016/j.mehy.2017.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/14/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022]
Abstract
Short stem uncemented femoral implants were developed with the aim of preserving proximal bone stock for future revisions, improving biomechanical reconstruction, aiding insertion through smaller incisions and potentially decreasing or limiting the incidence of thigh pain. Despite all the advantages of short stem designs, it remains unclear whether they are able to limit post-surgical thigh pain. In patients with short stem hip arthroplasty and persistent thigh pain, it is of the utmost importance to understand the potential etiologies of this chronic pain for selecting the appropriate treatment strategy. Therefore, this manuscript explores the hypothetical etiologies of persistent thigh pain in short stem total hip arthroplasty, including both peripheral factors (structural or biomechanical causes) and central factors (involvement of the central nervous system). First, intrinsic causes (e.g. aseptic femoral loosening and prosthetic joint infection) and extrinsic sources (e.g. muscle pathology or spinal pathology) of persistent thigh pain related to hip arthroplasty are explained. In addition, other specific peripheral causes for thigh pain related to the short stem prosthetic reconstruction (e.g. stem malalignment and micro-motion) are unraveled. Second, the etiology of persistent thigh pain after short stem hip arthroplasty is interpreted in a broader concept than the biomechanical approach where peripheral structural injury is believed to be the sole driver of persistent thigh pain. Over the past decades evidence has emerged of the involvement of sensitization of central nervous system nociceptive pathways (i.e. central sensitization) in several chronic pain disorders. In this manuscript it is explained that there might be a relevant role for altered central nociceptive processing in patients with persistent pain after joint arthroplasty or revision surgery. Recognition of a potential role for centrally-mediated changes in pain processing in total hip replacement surgery has important implications for treatment. Comprehensive treatment addressing peripheral factors as well as neurophysiological changes occurring in the nervous system may help to improve outcomes in patients with short stem hip arthroplasty and chronic thigh pain. Working within a biopsychosocial approach in orthopaedic surgery, specifically in relation to total hip arthroplasty, could be very important and may lead to more satisfaction. Further research is warranted.
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Affiliation(s)
- Isabel A C Baert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Pain in Motion Research Group, Belgium(1).
| | - Enrique Lluch
- Pain in Motion Research Group, Belgium(1); Departments of Human Physiology and Rehabilitation Sciences, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium; Department of Physical Therapy, University of Valencia, Valencia, Spain
| | - Francis Van Glabbeek
- Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Rudy Nuyts
- Department of Orthopaedic Surgery and Traumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Salim Rufai
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joanna Tuynman
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Pain in Motion Research Group, Belgium(1); Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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22
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Schnell-Inderst P, Iglesias CP, Arvandi M, Ciani O, Matteucci Gothe R, Peters J, Blom AW, Taylor RS, Siebert U. A bias-adjusted evidence synthesis of RCT and observational data: the case of total hip replacement. HEALTH ECONOMICS 2017; 26 Suppl 1:46-69. [PMID: 28139089 DOI: 10.1002/hec.3474] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/02/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Abstract
Evaluation of clinical effectiveness of medical devices differs in some aspects from the evaluation of pharmaceuticals. One of the main challenges identified is lack of robust evidence and a will to make use of experimental and observational studies (OSs) in quantitative evidence synthesis accounting for internal and external biases. Using a case study of total hip replacement to compare the risk of revision of cemented and uncemented implant fixation modalities, we pooled treatment effect estimates from OS and RCTs, and simplified existing methods for bias-adjusted evidence synthesis to enhance practical application. We performed an elicitation exercise using methodological and clinical experts to determine the strength of beliefs about the magnitude of internal and external bias affecting estimates of treatment effect. We incorporated the bias-adjusted treatment effects into a generalized evidence synthesis, calculating both frequentist and Bayesian statistical models. We estimated relative risks as summary effect estimates with 95% confidence/credibility intervals to capture uncertainty. When we compared alternative approaches to synthesizing evidence, we found that the pooled effect size strongly depended on the inclusion of observational data as well as on the use bias-adjusted estimates. We demonstrated the feasibility of using observational studies in meta-analyses to complement RCTs and incorporate evidence from a wider spectrum of clinically relevant studies and healthcare settings. To ensure internal validity, OS data require sufficient correction for confounding and selection bias, either through study design and primary analysis, or by applying post-hoc bias adjustments to the results. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Petra Schnell-Inderst
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, Hall i.T., Austria
| | - Cynthia P Iglesias
- Department of Health Sciences, University of York, Heslington, UK
- Centre for Health Economics, University of York, UK
- Hull and York Medical School, University of York, UK
- Luxemboug Institute of Health, Luxembourg
| | - Marjan Arvandi
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, Hall i.T., Austria
| | - Oriana Ciani
- Institute of Health Services Research, University of Exeter Medical School, Exeter, UK
- Centre for Research on Health and Social Care Management, Bocconi University, Milan, Italy
| | - Raffaella Matteucci Gothe
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, Hall i.T., Austria
| | - Jaime Peters
- Institute of Health Services Research, University of Exeter Medical School, Exeter, UK
| | - Ashley W Blom
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Rod S Taylor
- Institute of Health Services Research, University of Exeter Medical School, Exeter, UK
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, Hall i.T., Austria
- Center for Health Decision Science, Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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23
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Xu X, Wen H, Hu Y, Liu Z, Pan X. Efficacy of intra-articular magnesium for postoperative analgesia in total hip arthroplasty. Biomed Rep 2017; 6:232-236. [PMID: 28357078 DOI: 10.3892/br.2017.837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/17/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to compare the efficacy of intra-articular magnesium sulphate and a saline placebo for postoperative pain control following total hip arthroplasty (THA). Sixty patients underwent THA and were randomly allocated into two groups to receive intra-articular injections of either 10 ml magnesium sulphate (100 mg/ml; magnesium group, n=30) or 10 ml normal saline solution (control group, n=30). Postoperative analgesia was maintained by intravenous morphine injection. The outcome measurements were visual analogue score (VAS), morphine consumption and Harris hip score (HHS). The two groups were well matched. The outcome of VAS at rest was significantly lower at postoperative hours 6 and 12 in the magnesium group as compared with the control group, although the difference was insignificant preoperatively and at postoperative hours 2, 4, 24 and 48, and days 3, 7 and 14. This indicator during activity was also lower in the magnesium group at postoperative hour 24 than that of the control group, although the difference was insignificant preoperatively and at hour 48, and days 7 and 14. The consumption of morphine (the total quantity) at 0-6, 6-12 and 0-48 h in the magnesium group was significantly lower than in the control group, although no significant differences were observed at 12-24 and 24-48 h between the groups. The improvements of HHS from preoperative to postoperative scores were statistically significant, however, no significant differences were identified between groups. Thus, the findings indicate that intra-articular magnesium sulphate injections provided improved pain control and reduced the need for morphine when compared with a saline placebo following THA.
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Affiliation(s)
- Xinxian Xu
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Hong Wen
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yuezheng Hu
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhongtang Liu
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiaoyun Pan
- Department of Osteopathy, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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24
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Chen Q, Huang C, Zhang YJ. The effect of intravertebral anesthesia on bone cement implantation syndrome in aged patients: A single-center 5-year retrospective study. Medicine (Baltimore) 2016; 95:e4775. [PMID: 27603378 PMCID: PMC5023901 DOI: 10.1097/md.0000000000004775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The aim of the study was to assess the effect of commonly used intravertebral anesthesia on bone cement implantation syndrome (BCIS) in aged patients undergoing hemiarthroplasty.The medical records of 1210 aged patients receiving hemiarthroplasty under intravertebral anesthesia were retrospectively reviewed. Anesthesia charts for all patients were reviewed for central venous pressure, mean arterial pressure, arterial oxygen saturation, and heart rate before, during, and after cementation. Each patient was classified into no BCIS (grade 0) or BCIS grade 1, 2, or 3 according to the degree of hypotension, arterial desaturation, or loss of consciousness around cementation. Changes in these grades after cementation were compared according to the ways of intravertebral anesthesia used.Among all included patients, 72.2% (874/1210) showed grade 1 or higher grade of BCIS after cementation. Compared with spinal-epidural anesthesia, single epidural anesthesia showed adjusted odds ratios (95% confidence interval) of 1.25 (1.13-1.43) for grade 1, 1.36 (0.83-2.06) for grade 2, and 3.55 (1.52-7.06) for marked postoperatively grade 3 of BCIS versus grade 0 (Type III P < 0.0001).Single epidural anesthesia was associated with increased odds for elevation of these grades after cementation compared with spinal-epidural anesthesia.
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Affiliation(s)
| | | | - Ya-Jun Zhang
- Department of Anesthesiology, East branch, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, Chengdu 610110, China
- Correspondence: Ya-Jun Zhang, Department of Anesthesiology, Sichuan Provincial People's Hospital (east branch), Sichuan Academy of Medical Science, north Da Mian Hong HeAve, Long Quan district, Chengdu, China (e-mail: )
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25
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Pennington MW, Grieve R, van der Meulen JH. Lifetime cost effectiveness of different brands of prosthesis used for total hip arthroplasty: a study using the NJR dataset. Bone Joint J 2015; 97-B:762-70. [PMID: 26033055 DOI: 10.1302/0301-620x.97b6.34806] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There is little evidence on the cost effectiveness of different brands of hip prostheses. We compared lifetime cost effectiveness of frequently used brands within types of prosthesis including cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed) and hybrid (Exeter V40 Trilogy, Exeter V40 Trident, and CPT Trilogy). We used data from three linked English national databases to estimate the lifetime risk of revision, quality-adjusted life years (QALYs) and cost. For women with osteoarthritis aged 70 years, the Exeter V40 Elite Plus Ogee had the lowest risk of revision (5.9% revision risk, 9.0 QALYs) and the CPT Trilogy had the highest QALYs (10.9% revision risk, 9.3 QALYs). Compared with the Corail Pinnacle (9.3% revision risk, 9.22 QALYs), the most commonly used brand, and assuming a willingness-to-pay of £20,000 per QALY gain, the CPT Trilogy is most cost effective, with an incremental net monetary benefit of £876. Differences in cost effectiveness between the hybrid CPT Trilogy and Exeter V40 Trident and the cementless Corail Pinnacle and Taperloc Exceed were small, and a cautious interpretation is required, given the limitations of the available information. However, it is unlikely that cemented brands are among the most cost effective. Similar patterns of results were observed for men and other ages. The gain in quality of life after total hip arthroplasty, rather than the risk of revision, was the main driver of cost effectiveness. Cite this article: Bone Joint J 2015;97-B:762-70.
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Affiliation(s)
- M W Pennington
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - R Grieve
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - J H van der Meulen
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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