RESUMO
PURPOSE: Ankle arthrodesis (AA) has traditionally been the surgical standard for patients with an end-stage ankle osteoarthritis, with total ankle arthroplasty (TAA) recently becoming an alternative. The aim of this study was to update evidence in terms of functional outcomes, complications, and quality of life between AA and TAA by analyzing comparative studies. METHODS: PubMed, MEDLINE, Scopus, and Cochrane Central databases were used to search keywords. A total of 21 studies entered our qualitative and quantitative analysis. Demographics, functional outcomes, and complications were extracted. Random and fixed-effect models were used for the meta-analysis of standardized mean differences (SMDs) and odds ratios (ORs). RESULTS: A total of 18,448 patients were identified, with a mean age of 57.3 ± 11.3 years. TAA showed significantly greater post-operative range of motion (SMD - 0.883, 95% CI - 1.175 to - 0.590; I2 < 0.001) and Ankle Osteoarthritis Scale scores (SMD - 1.648, 95% CI - 3.177 to - 0.118; I2 = 97.67), but no differences in other patient-reported outcome scores were found. Patients undergoing TAA showed higher post-operative SF-36 (SMD - 0.960, 95% CI - 1.584 to - 0.336; I2 = 68.77). The total complication rate was similar between the two procedures (OR 0.936, 95% CI 0.826 to 1.060; I2 = 87.44), including the incidence of re-operations (OR 1.720, 95% CI 0.892 to 3.316; I2 = 77.65). CONCLUSION: While TAA and AA showed no differences in most post-operative functional outcomes, our review demonstrates that patients undergoing TAA show better health-related quality of life than AA. We found no evidence to suggest that TAA carries a higher risk of complications and re-operations compared to AA.
Assuntos
Artroplastia de Substituição do Tornozelo , Osteoartrite , Idoso , Tornozelo , Articulação do Tornozelo/cirurgia , Artrodese/efeitos adversos , Artroplastia de Substituição do Tornozelo/efeitos adversos , Humanos , Pessoa de Meia-Idade , Osteoartrite/epidemiologia , Osteoartrite/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: A growing number of patients continue to receive total knee replacement (TKR) surgery. Nevertheless, such surgeries result in moderate to severe postoperative pain and difficulty in managing it. Musical interventions are regarded as a type of multimodal analgesia, achieving beneficial results in other clinical treatments. This study aims to evaluate the effect of musical interventions in improving short-term pain outcomes following TKR in order to determine a more reasonable and standard way of delivering musical intervention. METHODS: A systematic search was conducted to identify available and relevant randomized controlled trials (RCTs) regarding musical interventions compared against non-musical interventions in patients treated with TKR in Embase, MEDLINE, Cochrane Library, Web of Science, CNKI, and Wanfang Med Online up to 8 January 2020. The authors independently assessed study eligibility and risk of bias and collected the outcomes of interest to analyze. The statistical analysis was conducted using the Review Manager (RevMan) version 5.30 software. RESULTS: Eight RCTs comprised of 555 patients satisfied the inclusion criteria and were enrolled in the present study. The results showed no significant difference between the music and control groups in pain of the visual analog scale (VAS), during postoperative recovery room, back to the ward after surgery; anxiety degree of VAS; heart rate; respiratory rate; oxygen saturation; blood pressure, systolic blood pressure, and diastolic blood pressure. Nevertheless, significant differences were observed between the two groups in average increase in continuous passive motion (CPM) angles and LF/HF ratio (one kind index of heart rate variability). CONCLUSIONS: Musical interventions fail to demonstrate an obvious effect in improving short-term pain outcomes following TKR. A reasonable standardization of musical interventions, including musical type, outcome measures used, outcomes measured, duration, timing and headphones or players, may improve pain outcomes with certain advantages and should be further explored after TKR.
Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Musicoterapia/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/terapia , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Musicoterapia/normas , Manejo da Dor/normas , Dor Pós-Operatória/psicologia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do TratamentoRESUMO
Soft tissue coverage and tension-free closure can often be challenging in patients with ankle arthropathy being considered for total ankle arthroplasty. We present 2 patients with severe posttraumatic ankle arthropathy who underwent placement of a soft tissue expander to assist with soft tissue coverage prior to total ankle arthroplasty. LEVELS OF EVIDENCE: Level IV.
Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Osteoartrite/cirurgia , Complicações Pós-Operatórias/cirurgia , Terapia de Tecidos Moles/métodos , Dispositivos para Expansão de Tecidos/estatística & dados numéricos , Adulto , Artroplastia de Substituição do Tornozelo/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/etiologia , Complicações Pós-Operatórias/diagnóstico , Cuidados Pré-Operatórios/métodos , Amplitude de Movimento Articular/fisiologia , Procedimentos de Cirurgia Plástica/métodos , Recuperação de Função Fisiológica , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Estudos de Amostragem , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Post-operative complications after total hip or knee replacement can delay recovery, prolong hospitalisation, increase rates of re-admission and, in the most severe cases, lead to long-term disability or even death. In this analysis of pooled data from four large, randomised, phase III clinical trials that compared the oral, direct Factor Xa inhibitor rivaroxaban with subcutaneous enoxaparin for the prevention of venous thromboembolism after total hip or knee replacement (n = 12,729), the incidence of complications, including bleeding and adverse events related to surgery (such as wound infection, wound dehiscence and haemarthrosis) are reported. Interventions and procedures relating to surgery are also compared between the groups. Bleeding events, including excessive wound haematoma and surgical-site bleeding, occurred at similar rates in the rivaroxaban and enoxaparin groups. Over the total study duration, adverse surgical events occurred at a similar rate in the rivaroxaban group compared with the enoxaparin group after total knee replacement (2.26% vs. 2.69%, respectively) and total hip replacement (1.48% vs. 1.65%, respectively). Blood loss, wound drainage and transfusion requirements were also similar between the two groups. This analysis shows that the incidence of adverse surgical events with rivaroxaban was similar to enoxaparin.