Does vitamin D deficiency affect functional outcomes in hip fracture patients? A meta-analysis of cohort studies.

BACKGROUND: Vitamin D deficiency is common in patients with hip fractures and may negatively affect functional recovery and quality of life (QOL). OBJECTIVE: This study aimed to conduct a meta-analysis to quantify the effects of vitamin D deficiency on physical function and quality of life after hip fractures. METHODS: The PubMed, EMBASE, Scopus, and Cochrane Library databases were searched for relevant studies. The inclusion criteria were hip fracture, comparison between vitamin D deficiency and normal vitamin D levels in patients with hip fracture, and functional outcome as the primary outcome. The exclusion criteria were case reports, reviews, duplicates, studies with a high risk of bias, and non-comparable or missing data. Two independent reviewers selected studies, extracted data, assessed bias, and performed meta-analyses using the Review Manager. Heterogeneity and publication bias were also assessed. Two independent reviewers selected the studies, extracted data, and assessed the risk of bias. We performed a meta-analysis using Review Manager and assessed heterogeneity and publication bias. RESULTS: Seven studies with 1,972 patients were included. Vitamin D deficiency was defined as a 25(OH)D level < 20 ng/mL. There were no significant differences in the ability to walk (OR 0.68, 95% CI 0.31-1.53, I2 = 69%) or length of hospital stay (MD 2.27 days, 95% CI - 2.47 to 7.01, I2 = 93%) between patients with and without vitamin D deficiency. However, patients with vitamin D deficiency had significantly worse functional ability and quality of life (SMD - 1.50, 95% CI - 2.88 to - 0.12, I2 = 96%). CONCLUSIONS: Despite the limitations of this study, such as small sample size, heterogeneous outcome assessments, and variable vitamin D measurement techniques, the results demonstrated that screening for vitamin D status and optimizing levels through supplementation could facilitate rehabilitation, promote lifestyle changes, aid in the recovery of independence, and help reduce long-term burdens.

The Impact of Hypoalbuminemia on Postoperative Complications in Patients Undergoing Shoulder Arthroplasty: A Meta-Analysis.

OBJECTIVES: The objective of this meta-analysis was to investigate the association between hypoalbuminemia and postoperative complications in patients undergoing shoulder arthroplasty. METHODS: This meta-analysis study was registered in PROSPERO (CRD42023442466) and adhered to the PRISMA guidelines. Studies focused on shoulder arthroplasty that compared hypoalbuminemia and normal albumin levels were included. A systematic literature search was conducted in PubMed, EMBASE, Scopus, and the Cochrane Collaboration database. Seven comparative studies were included, and odds ratios with a 95% confidence interval were calculated for the dichotomous variables. A fixed-effect model was used when there was no statistical evidence of heterogeneity, and a random-effect model was used when significant heterogeneity was observed. Review Manager 5.4 software was used for data analysis. RESULTS: The meta-analysis included a total of 20,290 patients from seven studies. Hypoalbuminemia was significantly associated with a higher risk of readmissions (OR 2.92, 95%CI 1.74 to 4.91), reoperations (OR 3.23, 95%CI 1.98 to 5.27), an increase in hospital stay duration (MD 1.59, 95%CI 0.86 to 2.32), and complications such as death (OR 5.75, 95% CI 2.98 to 11.08; studies = 4), thromboembolic events (OR 2.43, 95% CI 1.46 to 4.06; studies = 4), cardiac events (OR 2.78, 95% CI 1.07 to 7.24; studies = 3), pulmonary infections (OR 3.09, 95% CI 1.54 to 6.20; studies = 3), systemic infections (OR 2.19, 95% CI 1.51 to 3.16; studies = 3), and transfusions (OR 3.16, 95% CI 2.23 to 4.48; studies = 2). However, there was no significant association between hypoalbuminemia and renal complications, surgical site infections, urinary tract infections, wound problems, or cardiovascular events. CONCLUSION: This meta-analysis provides strong evidence that hypoalbuminemia is associated with a higher risk of postoperative complications in patients undergoing shoulder arthroplasty.

[Prevalence and characteristics of complications of Baker cysts by MRI]. / Prevalencia y características de las complicaciones de los quistes de Baker mediante resonancia magnética.

OBJECTIVE: To evaluate the prevalence and describe the findings of complicated Baker cysts observed in a large series of knee MR studies. MATERIALS AND METHODS: A total of 145 Baker cysts were detected out of a series of 382 (38%) consecutive patients with knee MR studies performed. Cysts were classified as simple (smooth walls, homogeneous content, signal intensity similar to that of the synovial fluid and with no changes in the surrounding tissues) or complicated (changes of wall, changes in the intensity of the content signal, presence of free bodies or changes in the surrounding tissues). Complications were detected in ten (6.9%) cysts, which were confirmed by means of direct observation (arthroscopy or surgery, n = 9 cases) or by means of clinical evidence with follow-up (n = 1 case). RESULTS: No differences were detected in sex distribution between simple and complicated cysts (chi 2, p = 0.09), although a statistically significant relationship was indeed detected between the presence of complications with older age (p = 0.003) and presence of meniscal lesions (p = 0.019). In five patients a rupture of the Baker cyst was found, in four intracystic free bodies, and in one case pigmented villonodular synovitis with intracystic foci. Only two out of the five patients with cyst rupture had thrombophlebitis symptoms, the remaining of ruptures being asymptomatic. In three out of the four patients with free intracystic bodies they were considered secondary to degenerative osteochondral lesions, the other case having synovial chondromatosis. CONCLUSIONS: Baker cysts are common and usually are not associated with complications. In our series, a prevalence of 6.8% of complicated cysts was observed, either by their contents or wall changes. The most common complication is rupture (50% of complicated cysts) which can be asymptomatic in up to 80% of cases, followed by free intracystic bodies (40% of complications) usually of degenerative origin. The complication is statistically associated with meniscal ruptures and aged patients.