The impact of retaining the femoral stem in revision total hip arthroplasty: a systematic review, meta-analysis, and meta-regression.

INTRODUCTION: The management of well-fixed femoral stems in revision total hip arthroplasty (rTHA) remains a subject of debate, with concerns over potential complications arising from stem retention. This study aimed to investigate the re-revision rates due to aseptic loosening of the stem, overall re-revision rates, dislocation rates, and factors influencing these outcomes in rTHA with a retained well-fixed femoral stem. MATERIALS AND METHODS: A systematic search was conducted across several databases including PubMed, EMBASE, and CENTRAL to identify pertinent publications from their inception through 2023. We specifically focused on studies that reported outcomes of rTHA with retained well-fixed femoral stems. The study designs incorporated in our research encompassed both cohort studies and case series studies. Thirty-five studies involving isolated acetabular revision and retaining the stem were included, representing a total of 3497 patients. Data extraction was tailored to the study questions. Meta-analyses, meta-regression, and subgroup analyses were conducted to evaluate the outcomes and their relationship with various factors. Pooled results, meta-regression, and subgroup analyses were performed using random-effects models. To assess and reduce bias, we employed Egger's test and the trim and fill method. RESULTS: The meta-analysis included 3497 patients with a mean follow-up of 9.28 years. The 10-year risk of re-revision after retaining femoral stem using highly cross-linked polyethylene was 1.7% (95% CI 1.1%-2.3%; I2: 60%) for stem aseptic loosening and 8.8% (95% CI 6.2%-11.4%; I2: 78%) overall re-revision. Dislocation risk was 5.7% (95% CI 4.1-7.0%; I2: 61%). Ceramic heads showed lower stem failure risk than metal heads in long-term follow-ups (P < 0.001). The posterolateral approach in revision surgery resulted in better long-term outcomes compared to the direct lateral approach (P < 0.001). Follow-up duration, timeline of study, Harris Hip Score, type of stem fixation, femoral head material, BMI, age, stem age, and surgical approach were evaluated as influential factors on these outcomes. CONCLUSION: The re-revision rate due to aseptic loosening of the retained stem during rTHA was found to be significantly low, supporting the idea of retaining well-fixed stems during rTHA. The overall re-revision and dislocation rates also presented comparable or better outcomes to prior studies. A range of factors, including the use of highly cross-linked polyethylene and ceramic femoral heads, was found to influence these outcomes. LEVEL OF EVIDENCE: IV. PROSPERO REGISTRATION NUMBER: CRD42022351157.

Hamstring Injury Treatments and Management in Athletes: A Systematic Review of the Current Literature.

BACKGROUND: The field of sports medicine presents a varied landscape of research on hamstring injuries in athletes, characterized by inconclusive and sometimes conflicting findings on effective treatment and rehabilitation strategies. This discordance prompted the current systematic investigation. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for conducting the systematic review. Multiple international bibliometric databases (Scopus, PubMed, Web of Science, and Embase) were searched to identify studies evaluating any treatment option for the management of hamstring injuries in athletes. Eligible studies were appraised for quality using Joanna Briggs Institute and Risk of Bias 2 tools. RESULTS: A total of 30 studies with 1,195 participants were included. Of the reviewed studies, treatments varied from aggressive rehabilitation, platelet-rich plasma (PRP) injections, manual techniques, various exercise protocols to modalities like high-power laser and nonsteroidal anti-inflammatory drugs. Evidence suggested benefits from treatments like extensive muscle lengthening during eccentric actions, progressive agility, and trunk stabilization. PRP injections produced mixed results regarding return to sport and reinjury rates. Stretching exercises, sometimes combined with cryotherapy, showed benefits. CONCLUSION: Treatments for hamstring injuries exhibit varied efficacy. Although rest, ice, compression, and elevation remains essential for acute management, rehabilitation focusing on muscle strengthening and flexibility is crucial. The potential benefits of PRP injections, especially for chronic cases, require more conclusive research. A comprehensive approach, combining evidence-based practices and patient-centric factors, is vital for effective management and recovery. LEVEL OF EVIDENCE: Level IV. See Instructions for Authors for a complete description of levels of evidence.

Prediction of In-Hospital Outcomes in Patients with Traumatic Brain Injury Using Computed Tomographic Scoring Systems: A Comparison Between Marshall, Rotterdam, and Neuroimaging Radiological Interpretation Systems.

OBJECTIVE: This study aimed to compare the prognostic value of Marshall, Rotterdam, and Neuroimaging Radiological Interpretation Systems (NIRIS) in predicting the in-hospital outcomes of patients with traumatic brain injury. METHODS: We identified 250 patients with traumatic brain injury in a retrospective single-center cohort from 2019 to 2020. Computed tomography (CT) scans were reviewed by two radiologists and scored according to three CT scoring systems. One-month outcomes were evaluated, including hospitalization, intensive care unit admission, neurosurgical procedure, and mortality. Logistic regression analysis was performed to identify scoring systems and outcome relationships. The best cutoff value was calculated using the receiver operating characteristic curve model. RESULTS: Eighteen patients (7.2%) died in the 1-month follow-up. The mean age and Glasgow Coma Scale of survivors differed significantly from nonsurvivors. Subarachnoid hemorrhage and compressed/absent cisterns were dead patients' most frequent CT findings. All three scoring systems had good discrimination power in mortality prediction (area under the receiver operating characteristic curve of the Marshall, Rotterdam, and NIRIS was 0.78, 0.86, and 0.84, respectively). Regarding outcome, three systems directly correlated with unfavorable outcome prediction. CONCLUSIONS: The Marshall, Rotterdam, and NIRIS are good predictive models for mortality and outcome prediction, with slight superiority of the Rotterdam in mortality prediction and the Marshall in intensive care unit admission and neurosurgical procedures.

Predictive Utility of the Glasgow Coma Scale and the Head Abbreviated Injury Scale in Traumatic Brain Injury: Results from the National Trauma Registry of Iran.

BACKGROUND: Trauma severity indices are commonly used to describe the severity of sustained injuries in a quantitative manner perceivable by healthcare providers in different settings. In this study, we aimed to assess the predictive utility of the Glasgow Coma Scale (GCS) and the 2015 revision of the head Abbreviated Injury Scale (head AIS) as two of the most widely used severity indices for traumatic brain injury (TBI). METHODS: In this cross-sectional study, we used data from the National Trauma Registry of Iran. The area under the receiver operating characteristic curve (AUROC) was calculated to assess the utility of GCS and head AIS scores in predicting patients' outcomes. RESULTS: A total of 321 patients, predominantly males (81.9%) with an average age of 41.9 (±19.5) years were enrolled in the study. The most common cause of injury was road traffic accidents (73.5%) followed by falls (20.2%). The mean admission GCS and head AIS scores were 13.5 (±3.2) and 2.5 (±1.0), respectively. AUROC of the GCS was significantly higher than the head AIS for all outcome variables (P<0.05). AUROC of both severity scoring systems for predicting in-hospital mortality was significantly higher in the 15-44 age group than the 65 or older age group (P<0.05). CONCLUSION: Based on our study results, GCS had better performance in predicting patients' outcomes than the head AIS. Also, we found that age significantly affected the ability of these indices in predicting in-hospital mortality of TBI patients.