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Gouveia K, Hache P, Johal H. Plating as a reduction aid prior to intramedullary nailing of tibia fractures: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2024; 34:1259-1267. [PMID: 38145978 DOI: 10.1007/s00590-023-03801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE The purpose of this meta-analysis is to analyse the literature on plate-assisted reduction during intramedullary nailing of tibial shaft fractures and to compare the rates of infection and nonunion. METHODS The databases Medline, Embase, and Web of Science were searched from inception to February 2022 for literature comparing plate-assisted reduction during intramedullary nailing of extra-articular tibia fractures to standard, closed means of reduction. Data were extracted and pooled in a random effects meta-analysis for the primary outcomes of nonunion and infection risk. RESULTS Five comparative studies were identified including 520 total patients, of which 151 underwent tibial nailing with the use of plate-assisted reduction with an average follow-up time of 17.9 months. Approximately two-thirds of patients retained the plate used to assist reduction during intramedullary nailing (102 of 151). Pooled analysis of the infection rates found no significant difference with plate-assisted intramedullary nailing (Risk Ratio [RR] 0.90, 95% CI 0.49-1.65, p = 0.72), and for nonunion rates, there was also no significant difference with plate-assisted intramedullary nailing (Risk Ratio [RR] 0.80, 95% CI 0.40-1.60, p = 0.53). CONCLUSIONS Plate-assisted reduction during intramedullary nailing of tibia shaft fractures was not associated with an increased risk for nonunion or infection, and can be safely applied as an adjunct for reduction in challenging fracture patterns, without the need for later removal. However, evidence is quite limited and further investigation into the use of provisional plating as a technique is needed as its use in intramedullary nailing continues to expand.
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Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Philip Hache
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Centre for Evidence-Based Orthopaedics, Hamilton, ON, Canada
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2
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Gouveia K, Sprague S, Gallant J, Del Fabbro G, Leonard J, Bzovsky S, McKay P, Busse JW. In-person cognitive behavioural therapy vs. usual care after surgical management of extremity fractures: an unsuccessful feasibility trial. Pilot Feasibility Stud 2024; 10:2. [PMID: 38184642 PMCID: PMC10770933 DOI: 10.1186/s40814-023-01430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Extremity fractures are common, and most are managed operatively; however, despite successful reduction, up to half of patients report persistent post-surgical pain. Furthermore, psychological factors such as stress, distress, anxiety, depression, catastrophizing, and fear-avoidance behaviors have been associated with the development of chronic pain. The purpose of this pilot study was to examine the feasibility of a randomized controlled trial to determine the effect of in-person cognitive behavioral therapy (CBT) vs. usual care on persistent post-surgical pain among patients with a surgically managed extremity fracture. METHODS Eligible patients were randomized to either in-person CBT or usual care. We used four criteria to judge the composite measure of feasibility: 1) successful implementation of CBT at each clinical site, 2) 40 patients recruited within 6 months, 3) treatment compliance in a minimum 36 of 40 participants (90%), and 4) 32 of 40 participants (80%) achieving follow-up at one year. The primary clinical outcome was persistent post-surgical pain at one year after surgery. RESULTS Only two of the four participating sites were able to implement the CBT regimen due to difficulties with identifying certified therapists who had the capacity to accommodate additional patients into their schedule within the required timeframe (i.e., 8 weeks of their fracture). Given the challenges associated with CBT implementation, only one site was able to actively recruit patients. This site screened 86 patients and enrolled 3 patients (3.5%) over a period of three months. Participants were unable to comply with the in-person CBT, with no participants attending an in-person CBT session. Follow-up at one year could not be assessed as the pilot study was stopped early, three months into the study, due to failure to achieve the other three feasibility criteria. CONCLUSION Our pilot trial failed to demonstrate the feasibility of a trial of in-person CBT versus usual care to prevent persistent pain after surgical repair of traumatic long-bone fractures and re-enforces the importance of establishing feasibility before embarking on definitive trials. Protocol modifications to address the identified barriers include the delivery of our intervention as a therapist-guided, remote CBT program. TRIAL REGISTRATION ClinicalTrials.gov (Identifier NCT03196258); Registered June 22, 2017, https://clinicaltrials.gov/ct2/show/NCT03196258.
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Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Sheila Sprague
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Jodi Gallant
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Gina Del Fabbro
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Jordan Leonard
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Sofia Bzovsky
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Paula McKay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 293 Wellington St. N, Suite 110, Hamilton, ON, L8L 8E7, Canada
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Gouveia K, Harbour E, Gazendam A, Bhandari M. Fixation of Distal Radius Fractures Under Wide-Awake Local Anesthesia: A Systematic Review. Hand (N Y) 2024; 19:58-67. [PMID: 35880346 PMCID: PMC10786102 DOI: 10.1177/15589447221109632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this systematic review was to analyze the available literature on fixation of distal radius fractures (DRFs) under wide-awake local anesthesia no-tourniquet (WALANT), and to examine postoperative pain scores and functional outcomes, operative data including operative time and blood loss, and the frequency of adverse events. METHODS Embase, MEDLINE, Web of Science, and SCOPUS were searched from inception until May 2022 for relevant studies. Studies were screened in duplicate, and data on pain scores, functional outcomes, and adverse events were recorded. Due to methodological and statistical heterogeneity, the results are presented in a descriptive fashion. RESULTS Ten studies were included comprising 456 patients with closed, unilateral DRFs, of whom 226 underwent fixation under WALANT. These patients had a mean age of 52.8 ± 8.3 years, were 48% female, and had a mean follow-up time of 11.6 months (range: 6-24). Operative time for WALANT patients averaged 60.4 ± 6.5 minutes, with mean postoperative pain scores of 1.4 ± 0.6 on a 10-point scale. Studies that compared WALANT to general anesthesia found shorter hospital stays with most WALANT patients being sent home the same day, decreased postoperative pain scores, and decreased costs to the healthcare system. No adverse events were reported for WALANT patients. CONCLUSIONS A growing body of literature reports that for closed, unilateral DRF, surgical fixation under WALANT is a safe and effective option. It allows patients to have surgery sooner, with improved pain scores and good functional outcomes, with a very low incidence of adverse events.
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Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Eric Harbour
- School of Medicine, University of Limerick, Ireland
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
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Masud S, Momtaz D, Betsch M, Migliorini F, Ghali A, Popa A, Gouveia K, Leroux T, Degen R, Khan M. A comprehensive comparison and evaluation of surgical techniques for anterior shoulder instability: a Bayesian network meta-analysis. J Shoulder Elbow Surg 2023; 32:e531-e547. [PMID: 37541334 DOI: 10.1016/j.jse.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Anterior shoulder instability is a common clinical problem; however, conflicting evidence exists regarding optimal treatment algorithms. We perform a comparative analysis of stabilization techniques used for recurrent anterior shoulder instability to identify the one associated with the lowest rate of recurrent instability. We additionally explore how glenoid bone loss and osseus lesions affect recurrence rates. METHODS PubMed, MEDLINE, Embase, and Cochrane databases were searched for clinical studies comparing surgical techniques for anterior shoulder instability. Two team members independently assessed all potential studies for eligibility and extracted data. Each included study underwent a risk of bias assessment using the Cochrane risk of bias summary tool. The primary outcome of interest was the rate of recurrent instability, which underwent a Bayesian network meta-analysis. Additional analyses were performed relating to the degree of glenoid bone loss and the presence of osseous lesions. RESULTS Of 2699 studies screened, 52 studies with 4209 patients were included. Patients who underwent open Latarjet demonstrated the overall lowest rate of recurrent instability [log odds ratio (LOR) 1.93], whereas patients who underwent arthroscopic Bankart repair demonstrated the highest (LOR 2.87). When glenoid bone loss was 10% to 20%, open Latarjet had significantly lower recurrent instability (P = .0016) compared to arthroscopic Bankart repair. When glenoid bone loss increased from 0%-10% to 10%-20%, arthroscopic Bankart repair had a significantly increased rate of recurrence (P = .021). In the presence of an engaging Hill-Sachs lesion, both open Latarjet (P = .01) and arthroscopic Bankart with remplissage (P = .029) had significantly reduced recurrence rates compared to arthroscopic Bankart repair. Finally, regardless of procedure, the presence of a Hill-Sachs or bony Bankart lesion was associated with an increased risk of recurrent instability (r = 0.44, P = .0003, and r = 0.40, P = .006, respectively). CONCLUSION The open Latarjet has the overall lowest recurrent instability and significantly lower compared to arthroscopic Bankart repair in the setting of increasing glenoid bone loss. Bone loss between 0% and 10% results in similar outcomes across all procedures.
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Affiliation(s)
- Saad Masud
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Marcel Betsch
- Department of Orthopaedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty of the University Heidelberg, Mannheim, BW, Germany
| | - Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, University Hospital RWTH Aachen, Aachen, NW, Germany
| | - Abdullah Ghali
- Department of Orthopaedics, Baylor College of Medicine, Houston, TX, USA
| | | | - Kyle Gouveia
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
| | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Ryan Degen
- Division of Orthopaedic Surgery, University of Western Ontario, London, ON, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.
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Gouveia K, Harbour E, Athwal GS, Khan M. Return to Sport After Arthroscopic Bankart Repair With Remplissage: A Systematic Review. Arthroscopy 2023; 39:1046-1059.e3. [PMID: 36646363 DOI: 10.1016/j.arthro.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To determine the return-to-sport rate following arthroscopic Bankart repair with remplissage (ABR), including overall rate of return to sport, rate of return to preinjury level of sport, and the rate of return for specific subgroups such as contact or throwing athletes. METHODS EMBASE, PubMed, and MEDLINE were searched from database inception until February 2022. Studies were screened by 2 reviewers independently and in duplicate for data regarding rates of return to sport following ABR. Data on return to sport and functional outcomes were recorded. Data are presented in a descriptive fashion. RESULTS Overall, 20 studies were included with a total of 736 patients (738 shoulders) who underwent ABR. These patients had a mean age of 28 years (range 14-72 years) and were 83% male. Mean follow-up time after surgery was 45 months (range 12-127 months). The rate of return to any level of sport ranged from 60% to 100%, whereas the rate of return to the preinjury level ranged from 63% to 100%. When we excluded those who underwent ABR as a revision procedure, the rate of return to any level of sport was 68% to 100%. Lastly, the return to sport rates for contact or collision athletes ranged from 80% to 100%, whereas for overhead or throwing athletes it was 46% to 79%. The rate of recurrence of instability postoperatively ranged from 0% to 20% in included studies. CONCLUSIONS For athletes with anterior shoulder instability, ABR led to a high rate of return to sport along with a low rate of recurrence of instability. Although most athletes are able to return to the same level of sport, certain groups such as throwing athletes may face greater difficulty. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Eric Harbour
- School of Medicine, University of Limerick, Limerick, Ireland
| | - George S Athwal
- Hand and Upper Limb Centre, Western University, London, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Gormley J, Gouveia K, Sakha S, Stewart V, Emmanuel U, Shehata M, Tushinski D, Shanthanna H, Madden K. Reduction of opioid use after orthopedic surgery: a scoping review. Can J Surg 2022; 65:E695-E715. [PMID: 36265899 PMCID: PMC9592092 DOI: 10.1503/cjs.023620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The opioid epidemic is one of the biggest public health crises of our time, and overprescribing of opioids after surgery has the potential to lead to long-term use. The purpose of this review was to identify and summarize the available evidence on interventions aimed at reducing opioid use after orthopedic surgery. Methods: We searched CENTRAL, Embase and Medline from inception until August 2019 for studies comparing interventions aimed at reducing opioid use after orthopedic surgery to a control group. We recorded demographic data and data on intervention success, and recorded or calculated percent opioid reduction compared to control. Results: We included 141 studies (20 963 patients) in the review, of which 113 (80.1%) were randomized controlled trials (RCTs), 6 (4.3%) were prospective cohort studies, 16 (11.4%) were retrospective cohort studies, 5 (3.6%) were case reports, and 1 (0.7%) was a case series. The majority of studies (95 [67.4%]) had a follow-up duration of 2 days or less. Interventions included the use of local anesthetics and/or nerve blocks (42 studies [29.8%]), nonsteroidal anti-inflammatory drugs (31 [22.0%]), neuropathic pain medications (9 [6.4%]) and multimodal analgesic combinations (25 [17.7%]. In 127 studies (90.1%), a significant decrease in postoperative opioid consumption compared to the control intervention was reported; the median opioid reduction in these studies was 39.7% (range 5%–100%). Despite these reductions in opioid use, the effect on pain scores and on incidence of adverse effects was inconsistent. Conclusion: There is a large body of evidence from randomized trials showing the promise of a variety of interventions for reducing opioid use after orthopedic surgery. Rigorously designed RCTs are needed to determine the ideal interventions or combination of interventions for reducing opioid use, for the good of patients, medicine and society.
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Affiliation(s)
- Jessica Gormley
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden)
| | - Kyle Gouveia
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden)
| | - Seaher Sakha
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden)
| | - Veronica Stewart
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden)
| | - Ushwin Emmanuel
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden)
| | - Michael Shehata
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden)
| | - Daniel Tushinski
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden)
| | - Harsha Shanthanna
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden)
| | - Kim Madden
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ont. (Gormley, Gouveia, Stewart, Shehata); the Faculty of Science, McMaster University, Hamilton, Ont. (Sakha, Emmanuel); the Department of Surgery, McMaster University, Hamilton, Ont. (Tushinski, Madden); the Hamilton Health Sciences - Juravinski Hospital, Hamilton, Ont. (Tushinski); the Department of Anesthesia, McMaster University, Hamilton, Ont. (Shanthanna); and St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Shanthanna, Madden)
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Kruse C, Gouveia K, Thornley P, Yan JR, McCarthy C, Chan T, Kishta W, Khanna V. COVID-19 and the transition to virtual teaching sessions in an orthopaedic surgery training program: a survey of resident perspectives. BMC Med Educ 2022; 22:655. [PMID: 36050706 PMCID: PMC9434512 DOI: 10.1186/s12909-022-03703-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND COVID-19 has had a tremendous impact on medical education. Due to concerns of the virus spreading through gatherings of health professionals, in-person conferences and rounds were largely cancelled. The purpose of this study is the evaluate the implementation of an online educational curriculum by a major Canadian orthopaedic surgery residency program in response to COVID-19. METHODS A survey was distributed to residents of a major Canadian orthopaedic surgery residency program from July 10th to October 24th, 2020. The survey aimed to assess residents' response to this change and to examine the effect that the transition has had on their participation, engagement, and overall educational experience. RESULTS Altogether, 25 of 28 (89%) residents responded. Respondents generally felt the quality of education was superior (72%), their level of engagement improved (64%), and they were able to acquire more knowledge (68%) with the virtual format. Furthermore, 88% felt there was a greater diversity of topics, and 96% felt there was an increased variety of presenters. Overall, 76% of respondents felt that virtual seminars better met their personal learning objectives. Advantages reported were increased accessibility, greater convenience, and a wider breadth of teaching faculty. Disadvantages included that the virtual sessions felt less personal and lacked dynamic feedback to the presenter. CONCLUSIONS Results of this survey reveal generally positive attitudes of orthopaedic surgery residents about the transition to virtual learning in the setting of an ongoing pandemic. This early evaluation and feedback provides valuable guidance on how to grow this novel curriculum and bring the frontier of virtual teaching to orthopaedic education long-term.
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Affiliation(s)
- Colin Kruse
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, ON, Hamilton, Canada.
| | - Kyle Gouveia
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, ON, Hamilton, Canada
| | - Patrick Thornley
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, ON, Hamilton, Canada
| | - James R Yan
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, ON, Hamilton, Canada
| | - Colm McCarthy
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, ON, Hamilton, Canada
| | - Teresa Chan
- Department of Medicine, Division of Emergency Medicine, McMaster University, ON, Hamilton, Canada
| | - Waleed Kishta
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, ON, Hamilton, Canada
| | - Vickas Khanna
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, ON, Hamilton, Canada
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8
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Gouveia K, Rizvi SFH, Dagher D, Leroux T, Bedi A, Khan M. Assessing Bone Loss in the Unstable Shoulder: a Scoping Review. Curr Rev Musculoskelet Med 2022; 15:369-376. [PMID: 35788508 DOI: 10.1007/s12178-022-09773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW The aim of this scoping review is to identify and summarize findings published in the literature over the past 5 years related to methods for assessment of bone loss in anterior shoulder instability. RECENT FINDINGS Of the 113 clinical studies included in this review, 76 reported a cutoff for glenoid bone loss when determining the patients indicated for one of the many stabilization procedures investigated. Bone loss on the glenoid side was evaluated most commonly with three-dimensional computed tomography (3D CT), and either linear or surface area-based methods were employed with the use of a best-fit circle. When combined with plain CT, the two methods comprise up to 70% of the reported measurement techniques for glenoid bone loss (79 of 113 studies). On the humeral side, Hill-Sachs lesions were assessed more heterogeneously, though plain CT or 3D CT remained the methods of choice in the majority of studies (43 of 68, 63.2%). Lastly, the glenoid track was assessed by 27 of 113 studies (23.9%), again most commonly with 3D CT (13 studies) and plain CT (seven studies). The assessment of glenoid and humeral bone loss is essential to treatment decisions for patient with recurrent anterior shoulder instability. Glenoid bone loss is most commonly assessed using cross-sectional imaging, most often 3D CT, and some variation of a best-fit circle applied to the inferior portion of the glenoid. Hill-Sachs lesion assessment was also commonly done using three-dimensional imaging; however, there was more variability in assessment methods across studies and there is an obvious need to unify the approach to humeral bone loss assessment for the purposes of improving treatment decisions and to better assess on-track and off-track lesions.
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Affiliation(s)
- Kyle Gouveia
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Syed Fayyaz H Rizvi
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Danielle Dagher
- Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Asheesh Bedi
- Northshore Orthopedic and Spine Institute, Chicago, IL, USA
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Gouveia K, Kay J, Memon M, Simunovic N, Bedi A, Ayeni OR. Return to Sport After Surgical Management of Posterior Shoulder Instability: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:845-857. [PMID: 33974810 DOI: 10.1177/03635465211011161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterior shoulder instability accounts for a small proportion of all shoulder instability, although it can affect athletes of all types, from contact to overhead athletes. Surgical treatment is quite successful in these patients; however, the literature reports a wide range of rates of return to sport. PURPOSE/HYPOTHESIS The purpose was to determine the return-to-sport rates after surgical stabilization for posterior shoulder instability. It was hypothesized that patients would experience a high rate of return to sport. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 4. METHODS Embase, PubMed, and MEDLINE were searched for relevant literature from database inception until April 2020, and studies were screened by 2 reviewers independently and in duplicate for studies reporting rates of return to sport after surgical management of posterior shoulder instability. Demographic data as well as data on return to sport and functional outcomes were recorded. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias was assessed for all included studies. RESULTS Overall, 32 studies met inclusion criteria and comprised 1100 patients (1153 shoulders) with a mean age of 22.8 years (range, 11-65) and a mean follow-up of 43.2 months (range, 10-228). The pooled rate of return to any level of sport was 88% (95% CI, 84%-92%; I2 = 68.7%). In addition, the pooled rate of return to the preinjury level was 68% (95% CI, 60%-76%; I2 = 79%). Moreover, the pooled return-to-sport rate for contact athletes was 94% (95% CI, 90%-97%; I2 = 0%), while for throwing athletes it was 88% (95% CI, 83%-92%; I2 = 0%). CONCLUSION Surgical management of posterior shoulder instability resulted in a high rate of return to sport, as well as significant pain reduction and functional improvement in most patients. However, only two-thirds of athletes can return to their preinjury levels of sport.
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Affiliation(s)
- Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Asheesh Bedi
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
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10
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Nairn L, Gyemi L, Gouveia K, Ekhtiari S, Khanna V. The learning curve for the direct anterior total hip arthroplasty: a systematic review. Int Orthop 2021; 45:1971-1982. [PMID: 33629172 DOI: 10.1007/s00264-021-04986-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The direct anterior approach (DAA) for total hip arthroplasty (THA) is a muscle-sparing approach thought to have less post-operative pain and quicker recovery, with similar functional outcomes to other approaches. However, it is technically challenging and transitioning surgeons may experience increased complication rates. The purpose of this systematic review is to identify reported learning curves associated with the DAA. METHODS Three databases (MEDLINE, Embase, and Web of Science) were searched using terms including "total hip arthroplasty," "direct anterior approach," and "learning curve." Study characteristics, patient demographics, learning curve analyses, and complications were abstracted. RESULTS Twenty-one studies met inclusion criteria, with a total of 9738 patients (60% female), an average age of 63.7 years (range: 13-94), body mass index of 27.0 kg/m2 (range: 16.8-58.9), and follow-up of 19 months (range: 1.5-100). There were five retrospective cohort studies and 13 case series representing fair methodological quality. Six studies depicted a true learning curve, with mean operative time of 156.59 ± 41.71 minutes for the first case, 93.18 ± 14.68 minutes by case 30, and 80.45 ± 12.28 minutes by case 100. Mean complication rate was 20.8 ± 12.7% in early groups and decreased to 7.6 ± 7.1% in late groups. CONCLUSION This review demonstrated a substantial learning curve associated with the DAA to THA. Operative time plateaued after approximately 100 cases. Complication rates decreased substantially from early to late groups.
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Affiliation(s)
- Leah Nairn
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
| | - Lauren Gyemi
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Seper Ekhtiari
- Division of Orthopaedic Surgery, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Vickas Khanna
- Division of Orthopaedic Surgery, McMaster University, 1200 Main Street West, Hamilton, ON, L8N 3Z5, Canada
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11
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Abstract
CONTEXT Snapping scapula syndrome (SSS) is commonly misdiagnosed and underreported due to lack of awareness. OBJECTIVE This scoping review aims to summarize the current evidence related to SSS diagnosis and treatment to aid clinicians in managing the condition more effectively. DATA SOURCES PubMed, Medline, and Embase databases were searched for studies related to the etiology, diagnosis, or treatment of SSS (database inception to March 2020). STUDY SELECTION Databases were searched for available studies related to the etiology, diagnosis, or treatment of SSS. STUDY DESIGN A scoping review study design was selected to explore the breadth of knowledge in the literature regarding SSS diagnosis and treatment. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Primary outcomes abstraction included accuracy of diagnostic tests, functional outcomes, and pain relief associated with various nonoperative and operative treatment options for SSS. RESULTS A total of 1442 references were screened and 40 met the inclusion criteria. Studies commonly reported SSS as a clinical diagnosis and relied heavily on a focused history and physical examination. The most common signs reported were medial scapular border tenderness, crepitus, and audible snapping. Three-dimensional computed tomography had high interrater reliability of 0.972, with a 100% success rate in identifying symptomatic incongruity of the scapular articular surface. Initial nonoperative treatment was reported as successful in most symptomatic patients, with improved visual analogue scale (VAS) scores (7.7 ± 0.5 pretreatment, to 2.4 ± 0.6). Persistently symptomatic patients underwent surgical intervention most commonly involving bursectomy, superomedial angle resection, or partial scapulectomy. High satisfaction rates of surgery were reported in VAS (6.9 ± 0.7 to 1.9 ± 0.9), American Shoulder and Elbow Surgeons scores (50.3 ± 12.2 to 80.6 ± 14.9), and mean simple shoulder test scores (5.6 ± 1.0 to 10.2 ± 1.1). CONCLUSION Focused history and physical examination is the most crucial initial step in the diagnostic process, with supplemental imaging used to assess for structural etiologies when nonoperative management fails. Nonoperative management is as effective as surgical management in pain relief and is advised for 3 to 6 months before operative treatment.
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Affiliation(s)
- Hassan Baldawi
- Moin Khan, MD, MSc, FRCSC, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Mary Grace Wing, Room G807, Hamilton, Ontario, L8N 4A6, Canada () (Twitter: @moinkhan_md)
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12
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Gouveia K, Zhang K, Kay J, Memon M, Simunovic N, Garrigues GE, Pollock JW, Ayeni OR. The Use of Elbow Arthroscopy for Management of the Pediatric Elbow: A Systematic Review of Indications and Outcomes. Arthroscopy 2021; 37:1958-1970.e1. [PMID: 33539972 DOI: 10.1016/j.arthro.2021.01.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this review was to systematically examine the literature surrounding elbow arthroscopy for pediatric patients and to assess indications, functional outcomes, and complication rates. METHODS This systematic review was carried out in accordance with PRISMA guidelines. EMBASE, PubMed, and MEDLINE were searched for relevant literature from inception until December 2019, and studies were screened by 2 reviewers independently and in duplicate for those investigating elbow arthroscopy in a pediatric population (<18 years). Editorials, review articles, and case reports were excluded. Demographic data and data on surgical indications, treatment outcomes, and complications were recorded. A methodological quality assessment was performed for all included studies using the Methodological Index for Non-Randomized Studies. RESULTS Overall, 19 studies, all of level IV evidence, were identified with a total of 492 patients (513 elbows). The patient population was 22.3% female with a mean age of 14.0 years (range, 4.0-15.7) and a mean follow-up time of 33.0 months (range, 7.4-96 months). Twelve studies (263 patients) exclusively recruited patients with osteochondritis dissecans (OCD), although other indications for elbow arthroscopy included arthrofibrosis (50 patients), elbow fracture (37 patients), medial ulnar collateral ligament injury (31 patients), and posterior impingement (17 patients). All 13 reporting studies showed a significant improvement in the elbow flexion-extension arc, and 4 of 5 that reported a functional outcome score before and after surgery demonstrating a significant improvement. Last, the overall complication rates ranged from 0% to 23.8%, with a total of 8 instances of neurological injury (5 ulnar, 2 radial, 1 unspecified), all being transient and resolving within 3 to 6 months. CONCLUSION Although elbow arthroscopy is primarily being performed for OCD in children and adolescents, there is evidence surrounding several other potential indications. Case series published to date have demonstrated significant improvements in functional outcomes and low rates of major complications. LEVEL OF EVIDENCE Level IV, systematic review of level IV studies.
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Affiliation(s)
- Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kailai Zhang
- Department of Physical Medicine and Rehabilitation, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - J W Pollock
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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13
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Shahzad U, Taccone MS, Kumar SA, Okura H, Krumholtz S, Ishida J, Mine C, Gouveia K, Edgar J, Smith C, Hayes M, Huang X, Derry WB, Taylor MD, Rutka JT. Modeling human brain tumors in flies, worms, and zebrafish: From proof of principle to novel therapeutic targets. Neuro Oncol 2021; 23:718-731. [PMID: 33378446 DOI: 10.1093/neuonc/noaa306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
For decades, cell biologists and cancer researchers have taken advantage of non-murine species to increase our understanding of the molecular processes that drive normal cell and tissue development, and when perturbed, cause cancer. The advent of whole-genome sequencing has revealed the high genetic homology of these organisms to humans. Seminal studies in non-murine organisms such as Drosophila melanogaster, Caenorhabditis elegans, and Danio rerio identified many of the signaling pathways involved in cancer. Studies in these organisms offer distinct advantages over mammalian cell or murine systems. Compared to murine models, these three species have shorter lifespans, are less resource intense, and are amenable to high-throughput drug and RNA interference screening to test a myriad of promising drugs against novel targets. In this review, we introduce species-specific breeding strategies, highlight the advantages of modeling brain tumors in each non-mammalian species, and underscore the successes attributed to scientific investigation using these models. We conclude with an optimistic proposal that discoveries in the fields of cancer research, and in particular neuro-oncology, may be expedited using these powerful screening tools and strategies.
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Affiliation(s)
- Uswa Shahzad
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Michael S Taccone
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Sachin A Kumar
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Hidehiro Okura
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Stacey Krumholtz
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Joji Ishida
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Coco Mine
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Kyle Gouveia
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Julia Edgar
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Christian Smith
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada
| | - Madeline Hayes
- Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Canada
| | - Xi Huang
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Developmental and Stem Cell Biology, Hospital for Sick Children, Toronto, Canada
| | - W Brent Derry
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Michael D Taylor
- Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - James T Rutka
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada.,Arthur and Sonia Labatt Brain Tumor Research Center, Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
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14
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Gouveia K, Shah A, Kay J, Memon M, Simunovic N, Cakic JN, Ranawat AS, Ayeni OR. Iliopsoas Tenotomy During Hip Arthroscopy: A Systematic Review of Postoperative Outcomes. Am J Sports Med 2021; 49:817-829. [PMID: 32628861 DOI: 10.1177/0363546520922551] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic iliopsoas tendon release is a surgical treatment option for painful snapping hips, although it has been associated with controversy surrounding potential complications including decreased hip flexion strength, iatrogenic hip instability, and iliopsoas atrophy. PURPOSE To systematically assess the efficacy and safety of arthroscopic iliopsoas tenotomy during hip arthroscopic surgery as an intervention for painful snapping hips. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A total of 3 online databases (Embase, PubMed, and MEDLINE) were searched from database inception until September 2019 for studies investigating iliopsoas tenotomy during hip arthroscopic surgery. Studies were screened by 2 reviewers independently and in duplicate, and studies investigating arthroscopic iliopsoas tendon release were included. Demographic data as well as data on treatment success, functional outcome scores, and radiological outcomes were recorded. A risk of bias assessment was performed for all included studies. RESULTS Overall, 21 studies were identified with a total of 824 patients (875 hips). These patients were 82.5% female (680/824), with a mean age of 28.1 years (range, 12-62 years) and mean follow-up of 32.1 months (range, 3-73 months). Arthroscopic iliopsoas tenotomy was performed at the level of the labrum in 811 hips (92.7%) or the lesser trochanter in 64 hips (7.3%). The overall reported success rate of the procedure in resolving snapping hips was 93.0% (266/286), and all studies reported an improvement in functional outcome scores. Only 6 studies (93 hips) discussed postoperative hip flexion strength, with complete recovery of strength reported in 4 studies (47 hips) and mild decreases reported in the other 2 studies (46 hips). Iliopsoas atrophy was evaluated radiologically (3 studies; 66 hips) and was found postoperatively in 92.4% (61/66) of hips. No major complications were reported. CONCLUSION Arthroscopic release of the iliopsoas tendon was effective in alleviating pain and persistent clicking associated with a snapping hip. Although patients demonstrated some early postoperative weakness and iliopsoas atrophy on radiological imaging, the results from studies to date showed satisfactory clinical function and return to sports/activities. High-quality comparative studies are needed to further assess arthroscopic iliopsoas tendon release to determine the optimal technique and location of tendon release.
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Affiliation(s)
- Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Josip N Cakic
- Centre for Sports Medicine and Orthopaedics, Johannesburg, South Africa
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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15
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Gouveia K, Abidi SK, Shamshoon S, Gohal C, Madden K, Degen RM, Leroux T, Alolabi B, Khan M. Arthroscopic Bankart Repair With Remplissage in Comparison to Bone Block Augmentation for Anterior Shoulder Instability With Bipolar Bone Loss: A Systematic Review. Arthroscopy 2021; 37:706-717. [PMID: 32911004 DOI: 10.1016/j.arthro.2020.08.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this systematic review is to examine the rates of postoperative recurrence of instability, functional outcomes, and complications after treatment with bone augmentation procedures or arthroscopic Bankart repair with remplissage for recurrent anterior shoulder instability in the setting of subcritical glenoid bone loss. METHODS EMBASE, PubMed, and MEDLINE were searched from database inception until June 2019 for articles examining either bone block augmentation to the glenoid or Bankart repair with remplissage (BRR) in the setting of subcritical glenoid bone loss. Search and data extraction were performed by 2 reviewers independently and in duplicate. A separate analysis was done for comparative studies. RESULTS Overall, 145 studies were identified, including 4 comparative studies. Across all studies, postoperative recurrence rates ranged from 0% to 42.8% for bone block augmentation and 0% to 15% for Bankart repair with remplissage. In comparative studies reporting subcritical glenoid bone loss, rates were 5.7% to 11.6% in the Latarjet group and 0% to 13.3% in the Bankart repair with remplissage group. However, in all studies reporting 10% to 15% mean glenoid bone loss, there was an increased rate of recurrent instability with arthroscopic soft tissue repair (6.1% to 13.2%) in comparison with bony augmentation (0% to 8.2%). Lastly, complication rates ranged from 0% to 66.7% for the bone block group and 0% to 2.3% for arthroscopic Bankart repair with remplissage. CONCLUSION Both bone block augmentation and Bankart repair with remplissage are effective treatment options for recurrent anterior shoulder instability in patients with bipolar bone loss but subcritical glenoid bone loss. Both have comparable functional outcomes, albeit bone block procedures carry an increased risk of complications. Arthroscopic BRR may be associated with a higher failure rate for preoperative glenoid bone loss >10%. Therefore, it may represent a stabilization procedure best suited for cases of recurrent anterior instability with glenoid bone loss <10% and the presence of a significant, off-track Hill-Sachs lesion. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
- Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Saif Shamshoon
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Chetan Gohal
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kim Madden
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ryan M Degen
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Ontario, Canada
| | - Timothy Leroux
- Division of Orthopedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bashar Alolabi
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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16
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Woolnough T, Axelrod D, Bozzo A, Koziarz A, Koziarz F, Oitment C, Gyemi L, Gormley J, Gouveia K, Johal H. What Is the Relative Effectiveness of the Various Surgical Treatment Options for Distal Radius Fractures? A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Clin Orthop Relat Res 2021; 479:348-362. [PMID: 33165042 PMCID: PMC7899542 DOI: 10.1097/corr.0000000000001524] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/14/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many acceptable treatment options exist for distal radius fractures (DRFs); however, a simultaneous comparison of all methods is difficult using conventional study designs. QUESTIONS/PURPOSES We performed a network meta-analysis of randomized controlled trials (RCTs) on DRF treatment to answer the following questions: Compared with nonoperative treatment, (1) which intervention is associated with the best 1-year functional outcome? (2) Which intervention is associated with the lowest risk of overall complications? (3) Which intervention is associated with the lowest risk of complications requiring operation? METHODS Ten databases were searched from inception to July 25, 2019. Search and analysis reporting adhered to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Included studies were English-language RCTs that assessed at least one surgical treatment arm for adult patients with displaced DRFs, with less than 20% loss to follow-up. We excluded RCTs reporting on patients with open fractures, extensive bone loss, or ipsilateral upper extremity polytrauma. Seventy RCTs (n = 4789 patients) were included. Treatments compared were the volar locking plate, bridging external fixation, nonbridging external fixation, dynamic external fixation, percutaneous pinning, intramedullary fixation, dorsal plating, fragment-specific plating, and nonoperative treatment. Subgroup analyses were conducted for intraarticular fractures, extraarticular fractures, and patients with an average age greater than 60 years. Mean (range) patient age was 59 years (56 to 63) and was similar across all treatment groups except for dynamic external fixation (44 years) and fragment-specific plating (47 years). Distribution of intraarticular and extraarticular fractures was approximately equal among the treatment groups other than that for intramedullary fixation (73% extraarticular), fragment-specific plating (66% intraarticular) [13, 70], and dorsal plating (100% intraarticular). Outcomes were the DASH score at 1 year, total complications, and reoperation. The minimum clinically important different (MCID) for the DASH score was set at 10 points. The analysis was performed using Bayesian methodology with random-effects models. Rank orders were generated using surface under the cumulative ranking curve values. Evidence quality was assessed using Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology. Most studies had a low risk of bias due to randomization and low rates of incomplete follow-up, unclear risk of bias due to selective reporting, and high risk of bias due to lack of patient and assessor blinding. Studies assessing bridging external fixation and/or nonoperative treatment arms had a higher overall risk of bias while studies with volar plating and/or percutaneous pinning treatment arms had a lower risk of bias. RESULTS Across all patients, there were no clinically important differences in terms of the DASH score at 1 year; although differences were found, all were less than the MCID of 10 points. Volar plating was ranked the highest for DASH score at 1 year (mean difference -7.34 [95% credible interval -11 to -3.7) while intramedullary fixation, with low-quality evidence, also showed improvement in DASH score (mean difference -7.75 [95% CI -14.6 to -0.56]). The subgroup analysis revealed that only locked volar plating was favored over nonoperative treatment for patients older than 60 years of age (mean difference -6.4 [95% CI -11 to -2.1]) and for those with intraarticular fractures (mean difference -8.4 [95% CI -15 to -2.0]). However, its clinical importance was uncertain as the MCID was not met. Among all patients, intramedullary fixation (odds ratio 0.09 [95% CI 0.02 to 0.84]) and locked volar plating (OR 0.14 [95% CI 0.05 to 0.39]) were associated with a lower complication risk compared with nonoperative treatment. For intraarticular fractures, volar plating was the only treatment associated with a lower risk of complications than nonoperative treatment (OR 0.021 [95% CI < 0.01 to 0.50]). For extraarticular fractures, only nonbridging external fixation was associated with a lower risk of complications than nonoperative treatment (OR 0.011 [95% CI < 0.01 to 0.65]), although the quality of evidence was low. Among all patients, the risk of complications requiring operation was lower with intramedullary fixation (OR 0.06 [95% CI < 0.01 to 0.85) than with nonoperative treatment, but no treatment was favored over nonoperative treatment when analyzed by subgroups. CONCLUSION We found no clinically important differences favoring any surgical treatment option with respect to 1-year functional outcome. However, relative to the other options, volar plating was associated with a lower complication risk, particularly in patients with intraarticular fractures, while nonbridging external fixation was associated with a lower complication risk in patients with extraarticular fractures. For patients older than 60 years of age, nonoperative treatment may still be the preferred option because there is no reliable evidence showing a consistent decrease in complications or complications requiring operation among the other treatment options. Particularly in this age group, the decision to expose patients to even a single surgery should be made with caution. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Taylor Woolnough
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Daniel Axelrod
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Anthony Bozzo
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Alex Koziarz
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Frank Koziarz
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Colby Oitment
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Lauren Gyemi
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Jessica Gormley
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Kyle Gouveia
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
| | - Herman Johal
- T. Woolnough, L. Gyemi, J. Gormley, K. Gouveia, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- D. Axelrod, A. Bozzo, C. Oitment, H. Johal, Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada
- A. Bozzo, H. Johal, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- A. Koziarz, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- F. Koziarz, McMaster University, Hamilton, ON, Canada
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Gazendam A, Nucci N, Gouveia K, Abdel Khalik H, Rubinger L, Johal H. Cannabinoids in the Management of Acute Pain: A Systematic Review and Meta-analysis. Cannabis Cannabinoid Res 2020; 5:290-297. [PMID: 33381643 PMCID: PMC7759255 DOI: 10.1089/can.2019.0079] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: To synthesize the best evidence surrounding the efficacy of cannabinoids for acute pain in the clinical setting based on subjective pain scores and observed adverse effects. Design: Systematic review with meta-analysis. Data Sources: PubMed, Embase, Cochrane Databases, and Google Scholar. Eligibility Criteria: English-language randomized-controlled clinical trials comparing cannabinoids with placebo in patients with acute pain. Data Extraction and Synthesis: Study quality was assessed using the Cochrane risk of bias tool. All stages were conducted independently by a team of three reviewers. Data were pooled through meta-analysis and stratified by route of administration. Primary Outcomes and Measures: Patient-reported pain and adverse events (AEs). Results: Six trials (678 participants) were included examining oral (5 trials) and intramuscular (1 trial) cannabinoids. Overall, there was a small but statistically significant treatment effect favoring the use of cannabinoids over placebo (-0.90, 95% confidence interval [CI] -1.69 to -0.1, i 2=65%, p=0.03). When stratified by route of administration, intramuscular cannabinoids were found to have a significant reduction in pain relative to placebo (-2.98, 95% CI -4.09 to -1.87, i 2=0%, p<0.0001). No difference in effect was observed between oral cannabinoids and placebo (-0.21, 95% CI -0.64 to 0.22, i 2=3%, p=0.34). Serious AEs were rare, and similar across the cannabinoid (14/374, 3.7%) and placebo groups (8/304, 2.6%). Conclusions: There is low-quality evidence indicating that cannabinoids may be a safe alternative for a small but significant reduction in subjective pain score when treating acute pain, with intramuscular administration resulting in a greater reduction relative to oral. Higher quality, long-term randomized-controlled trials examining whether there may be a role for cannabinoids in treating acute pain are required.
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Affiliation(s)
- Aaron Gazendam
- Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Nicholas Nucci
- Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Canada
| | - Kyle Gouveia
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Hassaan Abdel Khalik
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Luc Rubinger
- Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Herman Johal
- Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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18
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Nucci N, Gazendam A, Gouveia K, Ghert M, Wilson D. Management of infected extremity endoprostheses: a systematic review. Eur J Orthop Surg Traumatol 2020; 30:1139-1149. [PMID: 32405759 DOI: 10.1007/s00590-020-02699-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endoprosthetic reconstructions have become increasingly common in the setting of significant bone loss. Indications include revision arthroplasty, trauma, and reconstruction in the setting of primary malignancies or bony metastases. Although the use of endoprostheses has several advantages, they carry a high risk of infection. The purpose of this review is to determine the success rates of surgical management of infected endoprostheses. METHODS The authors searched databases for relevant studies and screened in duplicate. Data extracted included overall infection rate, timing of infection, follow-up, isolated pathogen and operative treatment strategy, and subsequent failure rate. The overall quality of the evidence with the Methodological Index for non-randomized studies criteria. RESULTS A total of 16 studies and 647 patients met the inclusion criteria. 400 patients had operative management and reported outcomes. Failure rates of patients undergoing debridement, antibiotics, and implant retention (DAIR) were 55.1%. Failure rates of patients who underwent one-stage revision were 45.5%. Failure rates of patients undergoing two-stage revision were 27.3%. Failure occurred at 31.4 months (range, 0-228) postoperatively. CONCLUSIONS Rates of periprosthetic joint infection remain high in endoprosthetic reconstructions. Although DAIR procedures were found to have a low success rate, they remain a reasonable option in acute infections given the morbidity of staged revisions. There is a lack of comparative data in the current literature and the heterogeneity and low level of evidence does not allow for between group comparisons of results.
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Affiliation(s)
- Nicholas Nucci
- Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Aaron Gazendam
- Division of Orthopaedics, Department of Surgery, Center for Evidence-Based Orthopaedics, St. Joseph's Hospital, McMaster University, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada.
| | - Kyle Gouveia
- Michael G. Degroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Michelle Ghert
- Division of Orthopaedics, Department of Surgery, Center for Evidence-Based Orthopaedics, St. Joseph's Hospital, McMaster University, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
| | - David Wilson
- Division of Orthopaedics, Department of Surgery, Center for Evidence-Based Orthopaedics, St. Joseph's Hospital, McMaster University, Room G522, 50 Charlton Avenue East, Hamilton, ON, L8N 4A6, Canada
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Loshon CA, Beary KE, Gouveia K, Grey EZ, Santiago-Lara LM, Setlow P. Nucleotide sequence of the sspE genes coding for gamma-type small, acid-soluble spore proteins from the round-spore-forming bacteria Bacillus aminovorans, Sporosarcina halophila and S. ureae. Biochim Biophys Acta 1998; 1396:148-52. [PMID: 9540829 DOI: 10.1016/s0167-4781(97)00204-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The single sspE genes coding for gamma-type small, acid-soluble spore proteins (SASP) of three round-spore-forming bacteria, Bacillus aminovorans, Sporosarcina halophila and S. ureae, have been cloned and sequenced. While the deduced amino acid sequences of these three gamma-type SASP show clear homology to those from six Bacillus species that do not form round spores, there are no residues conserved completely among the 9 sequences known. In addition, the 139 residue B. aminovorans protein is 35 residues larger than any other while the 60 residue S. halophila protein is one of the smallest. These data suggest that the sspE genes have been under little selective pressure in recent evolutionary time.
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Affiliation(s)
- C A Loshon
- Department of Biochemistry, University of Connecticut Health Center, Farmington 06030, USA
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