ABSTRACT
Background: Recent evidence on the cost-effectiveness of technology in total knee arthroplasty (TKA) demonstrated that navigated computer-assisted methods (N-TKA) is likely to be most cost-effective in the clinical setting. The aim of the current meta-analysis is to compare radiographic, clinical and functional outcomes between conventional TKA (C-TKA) and N-TKA methods. Methods: All prospective randomized controlled trials (pRCTs) comparing primary TKA performed using C-TKA and N-TKA techniques were eligible for inclusion. Radiographic outcomes included postoperative coronal, sagittal and axial component alignment. Clinical outcomes included all-cause revision and aseptic revision. Functional outcomes were analyzed when reported. A random-effects meta-analysis of all available cases was performed. This allowed for all missing data. Results: Normal coronal mechanical alignment of the tibial (p < 0.001) and femoral (p = 0.001) components was achieved more frequently with N-TKA. Normal sagittal mechanical alignment of the tibial component was achieved significantly more with N-TKA (p < 0.010). There was no difference in short-term clinical survivorship (all-cause, p = 0.649; aseptic, p = 0.79) or in functional outcomes reported between groups. There was a clinically significant reduction in the mean C-TKA operative time (87 min, σ = 16.6, 95% CI 76.4-98.8) compared N-TKA (97.6 min, σ = 16.9, 95% CI 86.2-109.1) (p = 0.17). Conclusion: Navigated TKA achieves superior radiographic alignment for femoral and tibial components in both the coronal and sagittal plane. Operative times are 10 min longer in the N-TKA group. Functional outcomes are similar between navigated and conventional groups. Clinical outcomes reported in Level I studies are limited to short-term follow-up so future prospective studies are required.
ABSTRACT
Vestibular rehabilitation therapy is an established treatment for patients with vestibular dysfunction. Virtual reality (VR) and augmented reality (AR) can be utilised in vestibular rehabilitation. Evidence of the efficacy of VR and AR delivered rehabilitation in patients with peripheral vestibular disorders is reviewed. MEDLINE, EMBASE, CENTRAL, CINAHL, PsychInfo, PsychBITE, OTSeeker, Ei Compendex, IEE, Clinical trials.gov and WebofScience databases were searched. Reduction in vestibular dysfunction symptoms 0-3 months post-intervention was the primary outcome. Secondary outcomes included long-term symptom improvement and side effects. Risk of bias assessment and meta analyses were planned. Five studies meeting eligibility criteria were included. Dizziness Handicap Inventory (DHI) scores 0-3 months post-intervention were reported by four studies. Meta-analysis identified a 1.13 (95% CI, - 1.74, - 0.52) standardized mean difference reduction in DHI in VR and AR treated patients compared to controls. Side effects reported by two studies were reduced by week four of VR intervention. Bias assessment identified DHI scores and side effects to be at high risk or of some concern. Adjunct VR interventions reduced patient DHI significantly more than vestibular rehabilitation alone 0-3 months post-intervention in adult patients diagnosed with unilateral vestibular disease. High quality studies are needed.
