RESUMEN
BACKGROUND: It is unclear whether lateral soft tissue release (LSTR) is required as part of percutaneous hallux valgus (PHV) surgery. The primary aim of this systematic review was to assess whether LSTR reduces the risk of recurrence of hallux valgus deformity. The secondary aims were to assess if LSTR increases the risk of complications, improves the clinical outcome and leads to a greater radiographic correction. METHODS: We performed a PRISMA-compliant PROSPERO-registered systematic review, pooling clinical papers reporting results after PHV surgery into two categories (PHV with (Group 1, G1) and without LSTR (Group 2, G2)) and comparing them. Data regarding the study design, demographics, the surgical procedure and the clinical and radiological outcome were extracted and compared. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). RESULTS: Sixteen studies were selected (G1:594 feet; G2:553 feet). The pooled proportion of recurrence at a minimum 21-month follow-up (2%, 95%CI 0-3 vs 2%, 95%CI 0-5; p = 0.70) did not differ in the two groups. Similarly, the pooled proportion of complications (27%, 95%CI 17-38 vs 25%, 95%CI 12-37; p = 0.79) was similar. The pre- (p = 0.23) and post-operative AOFAS scores (p = 0.16), the pre-(HVA: p = 0.23) (IMA: p = 0.94) and post-operative radiological angles (HVA: p = 0.47) (IMA: p = 0.2) and the methodological quality of studies (p = 0.2) did not differ either between G1 and G2. CONCLUSION: There is no evidence that LSTR performed during percutaneous HV surgery reduces the risk of recurrence of the deformity at a mean 4-year follow-up nor improves the clinical and radiological outcome. LEVEL OF EVIDENCE: Level IV systematic review of Level I to IV studies.
Asunto(s)
Hallux Valgus , Huesos Metatarsianos , Humanos , Hallux Valgus/diagnóstico por imagen , Hallux Valgus/cirugía , Resultado del Tratamiento , Osteotomía/métodos , Estudios Retrospectivos , Radiografía , Huesos Metatarsianos/cirugíaRESUMEN
BACKGROUND: Pyrocardan® (Wright Medical-Tornier) is a pyrocarbon implant proposed in the treatment of trapeziometacarpal joint (TMCJ) osteoarthritis. Our aim was to assess the clinical and radiographic results after Pyrocardan® arthroplasty at midterm follow-up. METHODS: In this prospective monocentric study, we enrolled 119 patients treated with Pyrocardan® for TMCJ osteoarthritis and followed up at a minimum of four years. The clinical outcome was assessed through the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Visual Analog Score (VAS) for pain and the Kapandji score collected pre-operatively, at three, six and 12 months, then yearly. Hand radiographs were taken before surgery, at three months and every year. Complications and re-operations were also recorded. RESULTS: The mean follow-up was 5.2 years (range, 4-9). DASH, VAS and Kapandji scores significantly improved at three (p < 0.001 in all cases) and six months (p < 0.001, p = 0.01 and p < 0.001, respectively), remaining stable over time. The dislocation and subluxation rates were 3.3% (4 cases) and 16.8% (20 patients), respectively. The two year, four year and seven year survivorship of the implant was 99%, 98% and 95%, respectively. CONCLUSION: Pyrocardan® arthroplasty provides a satisfactory clinical and radiographic outcome for treating TMCJ osteoarthritis, with a 97% survival rate at four years. We advocate comparative studies with more common techniques (i.e., trapeziectomy) to verify its cost-effectiveness.
Asunto(s)
Articulaciones Carpometacarpianas , Prótesis Articulares , Osteoartritis , Hueso Trapecio , Artroplastia , Articulaciones Carpometacarpianas/cirugía , Estudios de Seguimiento , Humanos , Osteoartritis/cirugía , Estudios Prospectivos , Rango del Movimiento Articular , Hueso Trapecio/cirugíaRESUMEN
INTRODUCTION: Intramedullary locking devices (ILDs) have recently been advocated as a minimally invasive approach to manage displaced intraarticular calcaneal fractures (DIACFs), to minimise complications and improve outcomes. We reviewed clinical and biomechanical studies dealing with commercially available devices to identify their characteristics, efficacy and safety. METHODS: Following a PRISMA checklist, Medline, Scopus and EMBASE databases were searched to identify studies reporting the use of ILDs for treating DIACFs. Biomechanical studies were first evaluated. Cohort studies were then reviewed for demographics, surgical technique, postoperative protocol, clinical and radiographic scores, complications and reoperations. The modified Coleman Methodology Score (CMS) was used to assess the quality of studies. RESULTS: Eleven studies were identified which investigated two devices (Calcanail®, C-Nail®). Three biomechanical studies proved they offered adequate primary stability, stiffness, interfragmentary motion and load to failure. Eight clinical studies (321 feet, 308 patients) demonstrated a positive clinical and radiographic outcome at 16-months average follow-up. Metalware irritation (up to 20%) and temporary nerve entrapment symptoms (up to 30%) were the most common complications, while soft tissue issues (wound necrosis, delayed healing, infection) were reported in 3-5% of cases. Conversion to subtalar fusion was necessary in up to 6% of cases. Four (50%) out of 8 studies were authored by implant designers and in 5 (62%) relevant conflicts of interest were disclosed. Mean (± standard deviation) CMS was 59 ± 9.8, indicating moderate quality. CONCLUSIONS: Treating DIAFCs with ILDs leads to satisfactory clinical outcomes at short-term follow-up, enabling restoration of calcaneal height and improved subtalar joint congruency. Metalware irritation and temporary nerve entrapment symptoms are common complications although wound complications are less frequent than after open lateral approaches. The quality of evidence provided so far is moderate and potentially biased by the conflict of interest, raising concerns about the generalisability of results. LEVEL OF EVIDENCE: Level V - Review of Level III to V studies.
Asunto(s)
Calcáneo , Fracturas Óseas , Fracturas Intraarticulares , Síndromes de Compresión Nerviosa , Calcáneo/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Humanos , Fracturas Intraarticulares/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Although synovial fluid can be used to diagnose periprosthetic joint infections (PJI) effectively, only the cutoff values adopted at the time of PJI diagnosis have been standardized, and few data are currently available about effectiveness of synovial fluid examination before definitive reimplantation. QUESTIONS/PURPOSES: We asked: (1) What are the most appropriate thresholds for synovial fluid leukocyte counts (WBC) and neutrophil percentage (PMN percentage) in a patient group undergoing definitive reimplantation after an uninterrupted course of antibiotic therapy for chronic PJI? (2) What is the predictive value of our synovial WBC and PMN percentage threshold compared with previously proposed thresholds? METHODS: In all, 101 patients with PJI were evaluated for inclusion from January 2016 to December 2018. Nineteen percent (19 of 101) of patients were excluded because of the presence of a chronic inflammatory disease, acute/late hematogenous infection, low amount of synovial fluid for laboratory investigations or infection persistence after spacer placement, and adequate antibiotic therapy. Finally, 81% (82 of 101) of patients with a median (range) age of 74 years (48 to 92) undergoing two-stage revision for chronic TKA infection, who were followed up at our institution for a period 96 weeks or more, were included in this study. The patients did not discontinue antibiotic treatment before reimplantation and were treated for 15 days after reimplantation if intraoperative cultures were negative. No patient remained on suppressive treatment after reimplantation. Synovial fluid was aspirated aseptically with a knee spacer in place to evaluate the cell counts before reimplantation. Thirteen percent (11 of 82) of patients had persistent or recurrent infection, defined as continually elevated erythrocyte sedimentation rate or C-reactive protein levels coupled with local signs and symptoms or positive cultures. The synovial fluid WBC counts and PMN percentage from the 11 patients with persistent or recurrent PJI were compared with the 71 patients who were believed to be free of PJI. Receiver operating characteristic (ROC) curve analyses assessed the predictive value of the parameters, and the areas under the curves (AUCs) were evaluated. The sensitivities, specificities, and positive and negative predictive values were determined for the WBC count and PMN percentage. Patients with persistent or recurrent infection had higher median WBC counts (471 cells/µL versus 1344 cells/µL; p < 0.001) and PMN percentage (36% versus 61%; p < 0.001) than did patients believed to be free of PJI. RESULTS: ROC curve analysis identified the best threshold values to be a WBC count of 934 cells/µL or more (sensitivity 0.82 [95% CI 0.71 to 0.89], specificity 0.82 [95% CI 0.71 to 0.89]) as well as a PMN percentage of at least 52% (sensitivity 0.82 [95% CI 0.71 to 0.89] and specificity 0.78 [95% CI 0.67 to 0.86]. We found no difference between the AUCs for the WBC count and the PMN percentage (0.87 [95% CI 0.79 to 0.96] versus 0.84 [95% CI 0.73 to 0.95]. Comparing the sensitivities and specificities of the synovial fluid WBC count and PMN percentage proposed by other authors, we find that a PMN percentage more than 52% showed better predictive value than previously reported. CONCLUSION: Based on our findings, we believe that patients with WBC counts of at least 934 and PMN percentage of 52% or more should not undergo reimplantation but rather a repeat debridement, as their risk of persistent or recurrent PJI appears prohibitively high. The accuracy of the proposed cutoffs is better than previously reported. LEVEL OF EVIDENCE: Level III, diagnostic study.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Recuento de Células/métodos , Infecciones Relacionadas con Prótesis/cirugía , Reoperación/métodos , Reimplantación/métodos , Líquido Sinovial/citología , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Proteína C-Reactiva/metabolismo , Humanos , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/microbiologíaRESUMEN
PURPOSE: Multiple Level I meta-analyses were conducted comparing traditional static vs. more recently introduced dynamic strategies of fixation for injuries of the distal tibiofibular syndesmosis (TFS). The aim of this review was to assess their robustness and methodological quality, providing support in the choice of a treatment strategy in case of TFS injury using the highest level of evidence. METHODS: In this systematic review, conducted in accordance with the PRISMA guidelines, meta-analyses/systematic reviews comparing static and dynamic fixation methods after acute TFS injury were identified. The robustness of studies was evaluated using the fragility index (FI) for meta-analysis and the fragility quotient (FQ). The risk of bias was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Finally, the Jadad was applied to select the study which provided the highest quality of evidence to develop recommendations for the fixation strategy of these lesions. RESULTS: Out of 1.302 records, four Level I meta-analyses were included in this study. Analyzing the statistically significant dichotomous outcomes, the median FI was 3.5 (IQR, 2 to 5.5; range, 1 to 9), while the median FQ was 1.9% (IQR, 1 to 3.5; range 0.35 to 4.4). In total, 37% had an FI of 2 or less and 75% of outcomes had a FI of 4 or less. According to the AMSTAR score and Jadad algorithm, the largest meta-analysis was selected as the highest evidence provided so far. CONCLUSION: The meta-analyses with statistically significant dichotomous outcomes comparing dynamic and static fixation for treating injuries of the distal tibiofibular syndesmosis are fragile, with a change in less than four patients or less than 2% of the study population sufficient to reverse a significant outcome to nonsignificant. LEVEL OF EVIDENCE: Level I.
Asunto(s)
Traumatismos del Tobillo , Articulación del Tobillo , Traumatismos del Tobillo/cirugía , Articulación del Tobillo/cirugía , Tornillos Óseos , Fijación Interna de Fracturas , Humanos , Metaanálisis como Asunto , Técnicas de Sutura , Resultado del TratamientoRESUMEN
INTRODUCTION: Two methods are currently available for the assay of α-defensin: the enzyme-linked immunosorbent assay (ELISA) and the lateral flow test. We aimed to assess the diagnostic accuracy of synovial fluid α-defensin and to compare the accuracy of the laboratory-based test and the qualitative assessment for the diagnosis of hip and knee prosthetic infection. MATERIALS AND METHODS: We searched (from inception to May 2018) MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane for studies on α-defensin in the diagnosis of periprosthetic joint infection (PJI). Sensitivity, specificity, positive and negative likelihood ratio (LR), and diagnostic odds ratio were analyzed using the bivariate diagnostic random-effects model. The receiver-operating curve for each method was calculated. RESULTS: We included 13 articles in our meta-analysis, including 1170 patients who underwent total hip and knee arthroplasties revision; 368 (31%) had a joint infection according to MSIS and MSIS-modified criteria. Considering the false-positive result rate of 8% and false-negative result rate of 3%, pooled sensitivity and specificity were 0.90 (95% CI 0.83-0.94) and 0.95 (0.92-0.96), respectively. The area under the curve (AUC) was 0.94 (0.92-0.94). No statistical differences in terms of sensitivity and specificity were found between the laboratory-based and qualitative test. The pooled sensitivity and specificity of the two alpha-defensin assessment methods were: laboratory-based test 0.97 (95% CI 0.93-0.99) and 0.96 (95% CI 0.94-0.98), respectively; qualitative test 0.83 (95% CI 0.73-0.91) and 0.94 (95% CI 0.89-0.97), respectively. The diagnostic odds ratio of the α-defensin laboratory based was superior to that of the qualitative test (1126.085, 95% CI 352.172-3600.702 versus 100.9, 95% CI 30.1-338.41; p < 0.001). The AUC for immunoassay and qualitative tests was 0.97 (0.95-0.99) and 0.91 (0.88-0.99), respectively. CONCLUSION: Detection of α-defensin is an accurate test for diagnosis of hip and knee prosthetic infections. The diagnostic accuracy of the two alpha-defensin assessment methods is comparable. The lateral flow assay is a valid, rapid, and more available diagnostic tool, particularly to rule out PJI.
Asunto(s)
Prótesis de Cadera/efectos adversos , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico , Líquido Sinovial/química , alfa-Defensinas/análisis , Biomarcadores/análisis , Articulación de la Cadera/química , Humanos , Articulación de la Rodilla/química , Sensibilidad y EspecificidadRESUMEN
Introduction: Trapeziometacarpal arthritis is a common and disabling condition. There is no evidence in the literature of superiority of one surgical procedure over others. Several prosthetic implants have been introduced to preserve joint mobility. Sourced of data: We searched the on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'artelon', 'thumb', 'carpometacarpal', 'trapeziometacarpal' and 'rhizoarthrosis'; 11 studies were identified. Areas of agreement: The use of Artelon implant is not recommended because of its high revision rate and worse outcomes compared to conventional techniques. Areas of controversy: Inert materials subjected to compressive and shearing forces could produce debris and subsequent inflammatory response. There is debate in the published scientific literature regarding the role of preoperative antibiotic profilaxis and post-surgery inflammatory response. Growing points: Standard techniques such as trapeziectomy alone or combined with interposition or suspensionplasty offer effective treatment for thumb basal joint arthritis. Areas timely for developing research: Several prosthetic implants show promising results in terms of pain relief and functional request, but there is a need of long-term randomized controlled trials to demonstrate their equivalence, and eventually superiority, compared to standard techniques.
Asunto(s)
Artroplastia para la Sustitución de Dedos/métodos , Articulaciones Carpometacarpianas/cirugía , Osteoartritis/fisiopatología , Fuerza de Pellizco/fisiología , Pulgar/patología , Articulaciones Carpometacarpianas/patología , Humanos , Osteoartritis/cirugía , Ensayos Clínicos Controlados Aleatorios como Asunto , Rango del Movimiento Articular , Hueso Trapecio/patología , Hueso Trapecio/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Knee arthrodesis with intramedullary (IM) nail or external fixator (EF) is the most reliable therapeutic option to achieve definitive infection control in patients with septic failure of total knee arthroplasty (TKA). The first aim of this study was to compare re-infection rates following knee arthrodesis for periprosthetic joint infection (PJI) with IM nail or EF. The second aim was to compare rates of radiographic union, complication, and re-operation as well as clinical outcomes. METHODS: A systematic search was performed in electronic databases for longitudinal studies of PJIs (minimum ten patients; minimum follow-up = 1 year) treated by knee arthrodesis with IM nail or EF. Studies were also required to report the rate of re-infection as an outcome measure. Eligible studies were meta-analyzed using random-effect models. RESULTS: The rate (95% confidence intervals) of re-infection was 10.6% (95% CI 7.3 to 14.0) in IM nail arthrodesis studies. The corresponding re-infection rate for EF was 5.4% (95% CI 1.7 to 9.1). This difference was significant (p = 0.009). The use of IM nail resulted in more advantages than EF for frequency of major complications and limb shortening. Other postoperative clinical and radiographic outcomes were similar for both surgical strategies. CONCLUSIONS: The available evidence from the aggregate published data suggests that knee arthrodesis with EF in the specific context of PJI has a reduced risk of re-infection in comparison with the IM nail strategy. The use of IM nail is more effective for the complication rate and shortening of the affected limb.
Asunto(s)
Artrodesis/instrumentación , Artroplastia de Reemplazo de Rodilla/efectos adversos , Clavos Ortopédicos , Fijadores Externos , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Anciano de 80 o más Años , Artrodesis/efectos adversos , Artrodesis/métodos , Artroplastia de Reemplazo de Rodilla/instrumentación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Recurrencia , Reoperación , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Tendoscopy has been proposed in treating several conditions affecting tendons around the ankle. We reviewed literature to investigate the efficacy of Achilles, peroneal and tibialis posterior tendoscopy. METHODS: Following the PRISMA checklist, the Medline, Scopus and EMBASE databases were searched, including studies reporting patients affected by disorders of Achilles, peroneal and tibialis posterior tendons and treated by tendoscopy (or tendoscopic-assisted procedures). The tendoscopic technique, rehabilitation protocol, clinical scores, patient satisfaction, success and failure rates and complications were evaluated. RESULTS: Sixteen studies (319 procedures) dealt with Achilles tendoscopy, nine (108) and six (78) about peroneal and tibialis posterior, respectively. Wound healing, cosmetic results, complication rate, work and sport resumption delay were satisfactory. Clinical scores, classification methods and rehabilitation protocols adopted were heterogeneous. CONCLUSIONS: The recent scientific evidence suggests that tendoscopy and endoscopic-assisted percutaneous procedures are a safe and effective treatment in chronic and acute disorders of tendons around the ankle.
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Tendón Calcáneo/diagnóstico por imagen , Traumatismos del Tobillo/diagnóstico , Endoscopía/métodos , Traumatismos de los Tendones/diagnóstico , Tendón Calcáneo/lesiones , Articulación del Tobillo/diagnóstico por imagen , Humanos , Resultado del TratamientoRESUMEN
INTRODUCTION: In the last few years, the use of collagenase clostridium histolyticum for management of Dupuytren's contracture has increased. The procedure of enzymatic fasciectomy has become popular because it is non-invasive, safe and fast to perform. SOURCES OF DATA: A systematic search was performed on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'Dupuytren collagenase' and 'Dupuytren clostridium histolyticum'. Forty-three studies were identified. The quality of the studies was assessed using the Coleman Methodological Score. AREAS OF AGREEMENT: The use of collagenase clostridium histolyticum provides better outcomes in patients with mild-moderate joint contracture, with lower complications and side effects than open fasciectomy. Manipulation can be performed 2-7 days after the injection. The use of collagenase is cost-effective. AREAS OF CONTROVERSY: Most of the studies did not report patient-related outcomes. The role of dynamic splint has to be investigated with randomized clinical trials. GROWING POINTS: The shorter recovery time and the low incidence of serious or major adverse effects are the main advantages of this new technology. AREAS TIMELY FOR DEVELOPING RESEARCH: There is a need to perform studies with longer follow-up because the recurrence rate seems to increase with time. Further investigations are necessary to assess whether it is safe and effective to inject two or more cords at the same time.
Asunto(s)
Clostridium histolyticum/enzimología , Contractura de Dupuytren/tratamiento farmacológico , Fasciotomía/métodos , Colagenasa Microbiana/uso terapéutico , Análisis Costo-Beneficio , Contractura de Dupuytren/fisiopatología , Contractura de Dupuytren/terapia , Humanos , Inyecciones Intralesiones , Rango del Movimiento Articular , Resultado del TratamientoRESUMEN
INTRODUCTION: Fractures of the distal radius account for 15% of all fractures. The use of arthroscopy is increasingly popular in the last years, with the goal to achieve a better anatomical reduction of the articular fragments. SOURCES OF DATA: We searched the literature on Medline (PubMed), Web of Science and Scopus databases using the combined keywords 'wrist', 'distal radial fracture', 'distal radius fracture' and 'arthroscopy'. Twenty-eight studies were identified. The quality of the studies was assessed using the Coleman Methodological Score. AREAS OF AGREEMENT: Arthroscopy allows to detect intra-articular, ligamentous and triangular fibrocartilage complex injuries in an acute setting with a better prognosis. Arthroscopy increases the quality of the intra-articular reduction compared to fluoroscopy. AREAS OF CONTROVERSY: The main limitation of the selected studies is the short follow-up: the average follow-up in 20 studies was 12 months, a period long enough to assess functional outcomes, but not to assess the occurrence of post-traumatic degenerative changes and their impact on function. Better stratification of the fracture population is needed. GROWING POINTS: The shorter recovery time and the low incidence of adverse effects are the main advantages of this new technology. AREAS TIMELY FOR DEVELOPING RESEARCH: There is need to perform randomized controlled trials reporting on the use of volar locking plates as, at the present time, they are the standard management for these fractures. In addition, the different pattern of fracture should be better classified to manage the patients who will benefit after the management.
Asunto(s)
Artroscopía , Fijación Interna de Fracturas , Fracturas Intraarticulares/cirugía , Ligamentos Articulares/cirugía , Fracturas del Radio/cirugía , Traumatismos de la Muñeca/cirugía , Artroscopía/métodos , Fijación Interna de Fracturas/métodos , Curación de Fractura , Humanos , Fracturas Intraarticulares/diagnóstico por imagen , Fracturas Intraarticulares/fisiopatología , Ligamentos Articulares/lesiones , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/fisiopatología , Resultado del Tratamiento , Traumatismos de la Muñeca/fisiopatologíaRESUMEN
INTRODUCTION: Theoretical advantages of endoscopic cubital tunnel release are the short incision, lower risk of nerve damage, reduced manipulation of the nerve and possible faster recovery. SOURCES OF DATA: We systematically searched Medline (PubMed), Web of Science and Scopus databases using the following keywords: 'endoscopic ulnar nerve', 'endoscopic cubital nerve', 'endoscopic ulnar compression' and 'endoscopic ulnar neuropathy'. Twenty-one studies were included in this review. The quality of the studies was assessed using the Coleman Methodological Score. AREAS OF AGREEMENT: Endoscopic release is effective for cubital tunnel entrapment and allows adequate visualization of the site of entrapment. There is a negative association between the severity of the compression and reported outcomes. Injury to the medial branch of the antebrachial cutaneous nerve is less frequent thanks to the limited dissection. The most frequent complication is the development of a hematoma. AREAS OF CONTROVERSY: It is unclear whether ulnar nerve instability is a contraindication to simple decompression. GROWING POINTS: The shorter time to return to work and the cosmetic appearance of the scar can be considered advantages of the endoscopic technique. AREAS TIMELY FOR DEVELOPING RESEARCH: There is a need to perform randomized clinical trials with common and validated scoring system with a longer duration of follow-up. The literature pertinent to endoscopic cubital tunnel release is lacking in the evaluation of the learning curve. Further investigations are necessary to assess the role of ulnar nerve instability.
Asunto(s)
Síndrome del Túnel Cubital/cirugía , Descompresión Quirúrgica/métodos , Neuroendoscopía/métodos , Descompresión Quirúrgica/efectos adversos , Humanos , Neuroendoscopía/efectos adversos , Procedimientos Neuroquirúrgicos/efectos adversos , Procedimientos Neuroquirúrgicos/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Several arthroscopic glenoid bone augmentation techniques have been introduced to treat patients affected by anterior shoulder instability associated with critical bone loss. The efficacy of the different arthroscopic bony procedures has not been compared yet. PURPOSE: To compare the recurrence, complication, and reoperation rates of the arthroscopic Latarjet (AL) and arthroscopic free bone block (ABB) procedures for anterior shoulder instability. STUDY DESIGN: Meta-analysis and systematic review; Level of evidence, 4. METHODS: A systematic search was conducted in MEDLINE/PubMed, Web of Science, and Embase to identify clinical studies reporting the outcomes of the AL and ABB procedures. The following search phrases were used: "Arthroscopic" AND "Bone Block" OR "Bone Graft," and "Arthroscopic" AND "Glenoid Augmentation" OR "Glenoid Reconstruction," and "Arthroscopic" AND "Latarjet" OR "Coracoid Graft" OR "Coracoid Transfer." Exclusion criteria were <24 months of minimum follow-up, sample size <10 cases, revision after previous glenoid bone grafting, epilepsy, and multidirectional instability. Data regarding the study design, patient characteristics, surgical technique, and outcomes were extracted and analyzed. A proportional meta-analysis was conducted to compare the complication, recurrence, and reoperation rates between the 2 groups. Multiple subgroup analyses were performed to analyze the incidence of each complication and assess the weight of different fixation methods (in the whole cohort) or different graft types (in the ABB group). The modified Coleman Methodology Score was used to assess the risk of bias. RESULTS: Of 5010 potentially relevant studies, 18 studies regarding the AL procedure (908 cases) and 15 studies regarding the ABB procedure (469 cases) were included. The 2 groups were comparable in age (P = .07), sex (P = .14), glenoid bone loss (P = .14), number of preoperative dislocations (P = .62), proportion of primary and revision procedures (P = .95), length of follow-up (P = .81), modified Coleman Methodology Score (P = .21), and level of evidence (P = .49). There was no difference in the recurrence (P = .88), reoperation (P = .79), and complication (P = .08) rates. The subgroup analyses showed a higher rate of hardware-related complications for screw fixation compared with flexible fixation (P = .01). CONCLUSION: The AL and ABB procedures had similar recurrence, reoperation, and complication rates. Screw fixation of the bone graft was related to an increased risk of complications compared with flexible fixation. REGISTRATION: CRD42022368153 (PROSPERO).
Asunto(s)
Artroscopía , Trasplante Óseo , Inestabilidad de la Articulación , Recurrencia , Reoperación , Articulación del Hombro , Humanos , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Reoperación/estadística & datos numéricos , Trasplante Óseo/métodos , Articulación del Hombro/cirugía , Complicaciones Posoperatorias/epidemiología , Luxación del Hombro/cirugíaRESUMEN
BACKGROUND: Culturing of the sonication fluid of removed implants has proven to be more sensitive than conventional periprosthetic tissue culture for the microbiological diagnosis of prosthetic joint infection. Since bacteria surviving on antibiotic-loaded cement spacers used in a two-stage exchange protocol for infected arthroplasties may cause the persistence of infection, in this study we asked whether the sonication also could be used to identify bacteria on antibiotic-loaded cement spacers removed at the second surgical stage during a two-stage exchange procedure to confirm whether or not the prosthetic joint infection had been eradicated. METHODS: We cultured the sonication fluid of cement spacers that had been originally implanted in a two-stage exchange protocol in 21 patients (mean age, 66 years) affected by prosthetic joint infection (16 total knee prostheses and 5 hip prostheses). The cement spacers were vortexed for 30 seconds and then subjected to sonication (frequency 35-40 KHz). The resulting sonicate fluid was cultured for aerobic and anaerobic bacteria. RESULTS: The sonication fluid culture of the removed spacer was positive in six patients (29%), with isolation of methicillin-sensible Staphylococcus Aureus (MSSA) in three cases, methicillin-resistant Staphylococcus Aureus (MRSA) in one case and Pseudomonas Aeruginosa in two cases. In three of these positive cases, the traditional culture of periprosthetic tissue was negative. Two patients with positive sonication culture of the spacer were successfully treated by early debridement of the revision prosthesis and systemic antibiotic therapy. In three patients a knee arthrodesis was planned and performed as the second surgical stage. In two of them the infection was caused by highly resistant Pseudomonas Aeruginosa. The other patient with a MSSA infection had been poorly compliant with the systemic antibiotic therapy due to her mental impairment. The patient originally affected by MRSA infection of his primary hip arthroplasty developed recurrent infection of his revision prosthesis and eventually underwent Girdlestone arthroplasty. CONCLUSIONS: The sonication culture can be used to discover any bacteria on the antibiotic-loaded cement spacer during a two-stage exchange protocol, thus permitting the adoption of timely treatment options, such as the early prosthetic debridment.
Asunto(s)
Antibacterianos/administración & dosificación , Prótesis de Cadera/microbiología , Prótesis de la Rodilla/microbiología , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/prevención & control , Sonicación/métodos , Anciano , Femenino , Prótesis de Cadera/efectos adversos , Humanos , Prótesis de la Rodilla/efectos adversos , Masculino , Persona de Mediana EdadRESUMEN
The suture button (SB) suspension technique has become popular in the treatment of thumb basal joint arthritis, as it works as an internal mean for metacarpal stabilization, demonstrating good results with improvement in function and strength. The aim of our study is to describe a new transosseous suture suspensionplasty technique using a simple Ethibond #2 suture as a substitute for the suture button and to report the postoperative clinical outcomes. In this study, we included a total of 14 patients with 2 years follow-up. We evaluated patients with the use of the Disabilities of the Arm, Shoulder and Hand questionnaire, the Visual Analog Scale, the Kapandji test, and the key pinch strength. Patients treated with transosseous suture suspensionplasty demonstrated clinical improvement at an average follow-up of 24 months. No complications were noted immediately after the procedure or during the 2-year follow-up period.
Asunto(s)
Articulaciones Carpometacarpianas , Osteoartritis , Humanos , Pulgar/cirugía , Osteoartritis/cirugía , Cánula , Mano , Articulaciones Carpometacarpianas/cirugía , SuturasRESUMEN
OBJECTIVE: The purpose of this study was to determine whether the number of cannulated screws used during ankle arthrodesis (AA) might influence the union and complication rate. METHODS: In this Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant PROSPERO-registered systematic review, multiple databases were searched including studies in which patients undergone AA using cannulated screws as exclusive fixation method were followed. Data were harvested regarding the cohort, the study design, the surgical technique, the nonunion, and complication rate at the longest follow-up. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). Two groups were built (arthrodeses fixed with 2 screws [group 1, G1] vs arthrodeses fixed with 3 screws [group 2 G2]) and compared. RESULTS: Fifteen series of patients from 15 studies (667 ankles) were selected (G1 = 458 ankles and G2 = 209). The pooled proportion estimate revealed a similar nonunion rate in the 2-screw group as compared with the 3-screw group (4% vs 3%; P = .68). The pooled proportion of complications was higher in G1 (19%) than in G2 (8%), but it was not significantly different either (P = .45). After exclusion of "symptomatic hardware and screw removal," the difference was still not significant (P = .28) although it resulted lower in G1 than in G2 (4% vs 8%, respectively). CONCLUSIONS: Using 3 cannulated screws during AA as compared with a 2-screw construct does not significantly reduce the risk of nonunion nor the risk of complications. LEVEL OF EVIDENCE: Level IV, Systematic review of level IV.
RESUMEN
Objectives: This study aims to report our experience with Clostridium Histolyticum collagenase (CCH) to support the importance of its clinical use and assess its clinical efficacy, complications, and recurrences. Methods: This prospective observational study of 66 patients with a 2-year follow-up. Patients with an extension lag major of 20° at the metacarpophalangeal joint (MPJ) and/or proximal interphalangeal joint (PIPJ) were included. We collected data on demographic and anamnestic details, MPJ and PIPJ contracture degrees, DASH score, complications, and recurrences. Results: The mean pre-injection contracture was 34° for MPJ and 31° for PIPJ. At the 2-year follow-up, the mean contracture for the MPJ and PIPJ were respectively 3° and 14.5°. The mean DASH score decreased from 21.8 before injection to 10,4 after 2 years. The disease recurrence occurred in 34.8% of the patients, all with PIPJ contracture. The main complication was skin breakage (25.7%). Conclusion: The CCH injections remain a consistent option in treating DD; withdrawal from the European market deprives surgeons and patients of low invasiveness and safe tool for treating DD. Level of evidence IV, Therapeutic study investigating treatment results, Case series .
Objetivos: O objetivo deste estudo é relatar nossa experiência com Clostridium Histolyticum colagenase (CCH) para apoiar a importância de seu uso clínico e para avaliar sua eficácia clínica, complicações e recidivas. Métodos: Estudo observacional prospectivo de acompanhamento por 2 anos em 66 pacientes com um atraso de extensão maior de 20° na articulação metacarpofalângica (MPJ) e/ou articulação interfalângica proximal (PIPJ). Foram coletados dados sobre detalhes demográficos e anamnésicos, graus de contração da MPJ e PIPJ, escore de DASH, complicações e recidivas. Resultados: A média da contração pré-injeção foi de 34° para a MPJ e 31° para a PIPJ. Com 2 anos de acompanhamento, a contração média para a MPJ e PIPJ foi de 3° e 14,5° respectivamente. A pontuação média do DASH diminuiu de 21,8 antes da injeção para 10,4 após 2 anos. A recorrência da doença ocorreu em 34,8% dos pacientes, todos com contração de PIPJ. A principal complicação foi a quebra da pele (25,7%). Conclusão: As injeções de CCH continuam sendo uma opção consistente no tratamento do DD; a retirada do medicamento do mercado europeu priva os cirurgiões e pacientes de uma ferramenta pouco invasiva e segura para o tratamento do DD. Nível de evidência IV, Estudo terapêutico que investiga os resultados do tratamento, série de casos .
RESUMEN
BACKGROUND AND AIM: There is no consensus regarding the most appropriate treatment of scaphoid nonunion. This systematic review aimed to investigate whether wrist arthroscopy exerts a positive influence on bone union and clinical outcomes. METHODS: We searched the literature on Medline (PubMed), Web of Science, Embase and Scopus databases using the combined keywords "scaphoid" AND "arthroscopy" AND "pseudoarthrosis" OR "nonunion". Eighteen studies were finally included in our review. The quality of the studies was assessed using the Coleman Methodological Score. RESULTS: Our systematic review has shown that arthroscopic management of scaphoid nonunion achieves a high rate of union and satisfactory clinical outcomes with minimal complications. CONCLUSIONS: There is need to perform randomized controlled trials reporting on the use of arthroscopy. In addition, the different pattern of pseudoarthrosis should be better classified to manage the patients who will benefit after the management.
Asunto(s)
Fracturas Óseas , Fracturas no Consolidadas , Seudoartrosis , Hueso Escafoides , Humanos , Fracturas Óseas/cirugía , Hueso Escafoides/cirugía , Fracturas no Consolidadas/cirugía , Fijación Interna de Fracturas , Estudios RetrospectivosRESUMEN
Background: Achilles tendon injuries represent one of the most common reasons for referral to orthopaedic surgeons. Purpose: To outline the characteristics, examine trends in publication, and evaluate the correlation between citations and study quality of the 50 most cited articles on Achilles tendon injury. Study Design: Cross-sectional study. Methods: After searching the Web of Science for articles published in orthopaedic journals, we identified the 50 most cited articles on Achilles tendon injury and abstracted their characteristics. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). Multiple bivariate analyses (Pearson or Spearman correlation coefficient) were used to evaluate the association among number of citations, citation rate (citations/year), 2020 journal impact factor (JIF), year of publication, level of evidence (LoE), study type (tendon rupture or chronic tendinopathy), sample size, and mCMS. Results: The top 50 articles were cited 12,194 times. Each article had a mean ± SD 244 ± 88.8 citations (range, 157-657) and a citation rate of 12.6 ± 5.4 per year (range, 3-28). A total of 35 studies (70%) were published between 2000 and 2010. The citation rate of the 16 most recent studies was almost double that of the 16 oldest studies (17.5 vs 9.9; P < .001). Nineteen studies (49%) were classified as having poor quality (mCMS <50 points). The mean JIF of the 9 journals that published the studies was 5.1. The citation rate correlated with the number of citations (r = 0.56; P < .001), publication year (r = 0.60; P < .001), and LoE (r = -0.44; P = .005). The publication year correlated with the LoE (r = -0.40; P = .01). Study quality in terms of mCMS correlated with the JIF (r = 0.35; P = .03) and LoE (r = -0.48; P = .003) but not the citation rate (P = .15). Conclusion: The mean LoE and the citation rate of the most cited articles on Achilles tendon injury both significantly increased over time. Although the JIF was positively correlated with study quality, almost half of the studies had poor-quality methodology.