Hyaluronate Acid Plus Platelet-Rich Plasma Is Superior to Steroids for Pain Relief Less Than 6 Months Using Injection Therapy of Partial Rotator Cuff Tears: A Systematic Review and Network Meta-analysis.

PURPOSE: To compare the efficacy of steroid injections to other injectable therapies in partial-thickness rotator cuff (RC) tears. METHODS: A systematic literature search was performed until October 25, 2021, in 3 databases (Cochrane Central Register of Controlled Trials, Embase, MEDLINE). Eligible studies compared the efficacy of steroid, hyaluronic acid (HA), platelet-rich plasma (PRP), the combination of HA and PRP (HA + PRP), and adipose-derived regenerative cells in RC tears. The primary outcomes were the visual analog scale (VAS), Constant-Murley Shoulder Outcome Score (CMS) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. Using paired and network meta-analysis, we calculated pooled mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: We included a total of 7 articles in the quantitative synthesis. In shorter periods, the HA + PRP combination was superior to the other substances we investigated (HA + PRP: VAS [0-4 weeks]: MD: -0.99 [95% CI, -1.62 to -0.36]; CMS [0-3 months]: 20.56 [95% CI, 16.18 to 24.94]. This combination was followed by the use of HA or PRP alone, depending on the duration of follow-up and the outcome being studied. In our study, short-term results suggest that saline is superior to steroids for partial tears, but this trend is reversed at 6-month follow-up. CONCLUSIONS: The HA and PRP combination is currently the most effective in partial RC tear treatment in the short term. After 6 months, there is no meaningful difference, so the benefits of the combination are short term. LEVEL OF EVIDENCE: Level II, including Level I to II studies.

Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis.

BACKGROUND: The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA. METHODS: We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups). RESULTS: Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group. CONCLUSION: Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis's survival.

One-stage bilateral hip arthroplasty / Egy ülésben végzett kétoldali csípoprotézis-beültetés

Introduction: The unilateral total hip arthroplasty is a routine surgical intervention, but in the mean time in several institutions over the world, they perform also bilateral total hip arthroplasty as a one-stage surgery, with different indications. Objective: The aim of this study is to present through our cases and through the international literature the indication criteria, the absolute and relative contraindications, and the potential difficulties of one-stage bilateral hip arthroplasty, showing also the real state of this intervention in our healthcare and financial situation. Method: In this publication, we review - in relation to our five cases - the possibilities of bilateral total hip arthroplasty, their indications and differences compared to the unilateral intervention, and also its financial background. Results: We had neither surgical nor internal medicine complications. Comparing to unilateral hip arthroplasty, patients needed no higher quantity of blood transfusion, but the hospitalization period was 1,5-2 times longer in our cases. Difficulties of mobilization were according more to their internal medical status. Conclusion: According to our experience, the one-stage bilateral hip arthroplasty, with well considered indication range, can be performed safely in adequate internal medicine state of the patient, involving the cardiology and reumatology specialist, with careful anesthesia preparation. The financial side of this intervention is not yet solved at the National Health Insurance Fund of Hungary.

Effect of the surgical exposure on the early postoperative period after total knee arthroplasty / A feltárás módjának hatása a közvetlen posztoperatív idoszakra teljes felszínpótló térdprotézis beültetése esetén

INTRODUCTION: Total knee arthroplasty has become one of the most successful and safest surgical procedures in orthopedic surgery. Of the many different types of surgical exposure, the most common, so-called medial parapatellar (MP) incision is the cut of the quadriceps tendon, which impairs extensor function. In contrast, subvastus (S) exposure, which spares the extensor apparatus, may promise better healing. AIM: The purpose of our prospective observational study at the Orthopedic Clinic of Semmelweis University is to compare the effects of the MP and the S excision on the early postoperative period. METHOD: The 60 patients enrolled were randomly assigned to two different groups according to the type of intervention. In the study, we measured the effects of the two different methods of surgical exposure on homogeneous patient groups in the early postoperative period based on international literature and the parameters we defined. RESULTS: Visual analog scale (VAS) measured resting and active pain levels for the first 10 days, suggesting a more pronounced difference in active VAS values for the S group. In the case of active VAS, patients in the S group also had significantly less pain on days 2, 3, and 10 than in the MP group. Taking into account the results of the other days, it is in favour of preserving the integrity of the extensor apparatus for improved postoperative functionality. Patients' knee joint range of motion was also measured. On day 1, those in the S group were significantly larger. As the days progress, MP group members catch up with S group during their rehabilitation. Group S patients had an average of 1.944 days to extended leg elevation, which is nearly two days shorter compared to the MP group (p<0.0001). CONCLUSIONS: After statistical analysis of data, subvastus exposure appears to be more beneficial in the rehabilitation of the early postoperative period. However, large-scale, multicentre observational studies are required to establish evidence. Orv Hetil. 2020; 161(29): 1208-1214.

[Prevalence of blood transfusion after primary total hip arthroplasty]. / A vértranszfúzió gyakorisága primer csípoprotézis-beültetés után.

Introduction: Total hip arthroplasty is one of the most common surgical procedures that requires blood transfusion, with the possible risk of significant complications. Aim: A retrospective study was performed to analyze the predictors of blood transfusion after primary total hip arthroplasty. Method: We collected the data of 210 consecutive patients undergoing total hip arthroplasty. Patient's data, preoperative hemoglobin and hematocrit level, the type of the prosthesis, the use of a suction drain, tranexamic acid or anticoagulants and the type and amount of blood transfusion were recorded. Results: A total of 41% of our patients required transfusion, 8.6% receiving allogenic blood. Significant predictors of allogenic blood transfusion were preoperative hemoglobin and hematocrit levels, the type of prosthesis, the use of suction drainage and the use of tranexamic acid. Patients with pre-donated autologous blood did not require allogenic blood transfusion. Conclusion: Based on our study, total hip arthroplasty necessitates allogenic blood transfusion in 8.6%. Major predictors associated with the need for transfusion are preoperative hemoglobin and hematocrit levels, the type of prosthesis, the use of suction drainage and the use of tranexamic acid. Pre-donated autologous blood helps to reduce allogenic transfusion rate. Orv Hetil. 2020; 161(8): 290-294.

[The role of multimodal postoperative analgesia after primary hip arthroplasty]. / A multimodális posztoperatív fájdalomcsillapítás szerepe primer csípoízületi arthroplasticában.

Introduction: Due to the increasing number of arthroplasties, the number of post-operative hospital days was reduced and the rate of rehabilitation accelerated. For this, proper postoperative analgesia is essential and the multimodal pain relief is an excellent tool. Aim: The aim of our study was to compare postoperative functional results, postoperative pain levels, and opioid analgesic needs of patients who received conventional and novel analgesic treatments. Method: In our prospective study, 81 patients were enrolled who underwent primary hip prosthesis surgery in our institution between February 2017 and January 2018. Of the randomized patients, 38 were in the control group and 43 in the multimodal pain group. We have tested their analgesic needs and the subjective pain levels of patients with the help of the visual analog scale (VAS). Results: Patients receiving multimodal pain relief had significantly lower opioid analgesic requirements and significantly lower VAS values assessed at 6 hours, and 3 and 4 days postoperatively. In addition, the patients in this group stayed in the hospital for a significantly shorter time after surgery. Conclusions: Based on our experience, multimodal pain relief in one-sided primary hip joint arthroplasty significantly reduced the patients' postoperative subjective pain sensation and pain killer consumptions. Orv Hetil. 2019; 160(52): 2054-2060.

[Is suction drainage necessary in elective total hip arthroplasty?]. / Szükség van szívódrénre elektív csípoprotézis-mutétek során?

INTRODUCTION: Several studies have been published which questioned the use of suction drain during elective hip arthroplasty. AIM: In this prospective study the authors examined how the use of suction drainage affected complications related to perioperative blood loss and hemorrhage in patients undergoing elective hip arthroplasty. METHOD: Eighty-six patients undergoing elective hip arthroplasty were divided into two groups. In 54 patients ("drain" group) suction drains were used during operation, whereas in 32 patients no suction drain was applied. Perioperative blood loss, use of tranexamic acid, method of thrombosis prophylaxis, transfusion requirement, incidental postoperative hemorrhage, septic complications, and all other postoperative complications were recorded. RESULTS: Perioperative blood loss was affected with the use of tranexamic acid but not with the use of drainage (p = 0.94). Patients without the use of drain showed a tendency of lower transfusion requirement (p = 0.08). There was no correlation between any complications and the use of drainage. CONCLUSION: In accordance with published results the authors conclude that the routine use of suction drainage during elective hip arthroplasty is not definitely necessary. Orv. Hetil., 2016, 157(29), 1171-1176.

Impact of the method of exposure in total hip arthroplasty on the variability of gait in the first 6months of the postoperative period.

INTRODUCTION, OBJECTIVE: Gait analysis has provided important information about the variability of gait for patients prior to and after total hip arthroplasty (THA). The objective of this research was to clarify how the method of exposure in total hip arthroplasty affects the variability of gait. MATERIALS AND METHOD: Gait analysis was performed at 0.8m/s, 1.0m/s, and 1.2m/s on 25 patients with direct-lateral exposure (DL), 22 with antero-lateral exposure (AL) and 25 with posterior exposure (P) during total hip arthroplasty. The control group was represented by 45 healthy subjects of identical age. Gait analysis was performed pre-operatively and 3 and 6months after the surgery. Gait parameter variability was characterized by the coefficient of variance (CV) of spatial-temporal parameters and by the mean coefficient of variance (MeanCV) of angular parameters. RESULTS: The variability of gait tends to reach control values during the first 6months of the postoperative period in all three patient groups. Six months after THA, in patients operated with DL and AL exposure the variability of gait differs significantly from control values; however, in patients operated with P exposure, the variability of spatial-temporal and angular parameters - except the rotation of pelvis - was similar to that of controls. DISCUSSION, CONCLUSION: The type of surgical technique significantly influences the variability of gait. Difference in the variability of angular parameters predicts gait instability and increased risk of falling after THA without the joint capsule preserved. Joint capsule preservation ensures a recovery of gait variability. It should be taken into account when compiling rehabilitation protocols. Differences related to the method of exposure should be considered when abandoning therapeutic aids.

Impact of the method of exposure in total hip arthroplasty on balancing ability in response to sudden unidirectional perturbation in the first six months of the postoperative period.

INTRODUCTION AND OBJECTIVE: Total hip arthroplasty affects 3-5% of the elderly population. Therefore, the effectiveness of surgery and the ensuing rehabilitation is of great significance. This study investigated balancing ability in response to sudden unidirectional perturbation changes during the first 6months of the postoperative period with respect to different methods of joint exposure during the operation (antero-lateral, direct-lateral and posterior to preserve the joint capsule). Our hypothesis is that the results may provide a tool to improve the rehabilitation procedures. MATERIALS AND METHODS: The dynamic balancing ability of 25 patients with direct-lateral exposure, 22 with antero-lateral exposure and 25 with posterior exposure during a total hip arthroplasty was examined using ultrasound-based provocation tests prior to and at 6weeks, 12weeks and 6months after total hip arthroplasty. The control group was represented by 45 healthy subjects of identical age. The dynamic balancing ability after unidirectional perturbation was characterised by Lehr's damping ratio calculated from the results of tests performed with the patient standing on both limbs, standing on the affected limb and standing on the non-affected limb. RESULTS: In the case of direct-lateral and antero-lateral exposure, Lehr's damping ratio significantly decreased compared to the preoperative values at 6weeks postoperatively, but it increased steadily afterwards. Lehr's damping ratio while standing on the affected limb was significantly lower - even at 6months postoperatively - than that of the control group. In the case of posterior exposure, Lehr's damping ratio continuously increased in the postoperative period and corresponded to that of the control group at 6months after total hip arthroplasty. DISCUSSION AND CONCLUSION: For patients operated on using direct-lateral and antero-lateral exposure methods, the dynamic balancing ability continuously improved in the first 6months of the postoperative period, but the dynamic balancing ability of the affected limb differed from that of the control group. In the case of posterior exposure to preserve the joint capsule the dynamic balancing ability evaluated a more rapidly compared to the other two exposure methods. There was no significant difference in the balancing ability of the control group at 6months after total hip arthroplasty with posterior exposure. The increasing range of joint motion, muscle development, and the development of the dynamic balancing ability should be taken into account when compiling rehabilitation protocols. Differences related to the method of exposure should be considered when developing the dynamic balancing ability and abandoning therapeutic aids.