Impact of preoperative anemia on patients undergoing total joint replacement of lower extremity: a systematic review and meta-analysis.

PURPOSE: Preoperative anemia increases postoperative morbidity, mortality, and the risk of allogeneic transfusion. However, the incidence of preoperative anemia in patients undergoing total hip arthroplasty and total knee arthroplasty (TKA) and its relationship to postoperative outcomes has not been previously reported. METHODS: We conducted a comprehensive literature search through PubMed, Cochrane Library, Web of Sincien, and Embase from inception to July 2023 to investigate the prevalence of preoperative anemia in patients undergoing Total Joint Arthroplasty, comorbidities between anemic and non-anemicpatients before surgery, and postoperative outcomes. postoperative outcomes were analyzed. Overall prevalence was calculated using a random-effects model, and heterogeneity between studies was examined by Cochran's Q test and quantified by the I2 statistic. Subgroup analyses and meta-regression analyses were performed to identify sources of heterogeneity. Publication bias was assessed by funnel plots and validated by Egger's test. RESULTS: A total of 21 studies with 369,101 samples were included, all of which were retrospective cohort studies. 3 studies were of high quality and 18 studies were of moderate quality. The results showed that the prevalence of preoperative anemia was 22% in patients awaiting arthroplasty; subgroup analyses revealed that the prevalence of preoperative anemia was highest in patients awaiting revision of total knee arthroplasty; the highest prevalence of preoperative anemia was found in the Americas; preoperative anemia was more prevalent in the female than in the male population; and preoperative anemia with a history of preoperative anemia was more common in the female than in the male population. patients with a history of preoperative anemia; patients with joint replacement who had a history of preoperative anemia had an increased risk of infection, postoperative blood transfusion rate, postoperative blood transfusion, Deep vein thrombosis of the lower limbs, days in hospital, readmission within three months, and mortality compared with patients who did not have preoperative anemia. CONCLUSION: The prevalence of preoperative anemia in patients awaiting total joint arthroplasty is 22%, and is higher in TKA and female patients undergoing revision, while preoperative anemia is detrimental to the patient's postoperative recovery and will increase the risk of postoperative complications, transfusion rates, days in the hospital, readmission rates, and mortality.

The safety and efficacy of unicompartmental knee arthroplasty in outpatient surgical centers: A systematic review and meta-analysis.

BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an effective treatment method for knee osteoarthritis. With the development and implementation of enhanced recovery after surgery, UKA is now increasingly performed in outpatient surgical centers. However, there is ongoing debate regarding the safety and effectiveness of performing UKA in outpatient settings. METHODS: The search was performed to retrieve randomized controlled trials and cohort studies on outpatient UKA from PubMed, Cochrane Library, EMbase, CNKI, and WanFangData databases. The search was conducted from the inception of the databases until August 31, 2023. After independent screening, data extraction, and risk of bias evaluation by two researchers, meta-analysis was performed using RevMan 5.4 software. RESULTS: A total of eight studies involving 18,411 patients were included. The results showed that the postoperative transfusion rate in the outpatient group was lower than that in the inpatient group [OR = 0.36, 95%CI (0.24, 0.54), p < 0.00001], and the difference was statistically significant. However, there was no significant difference between the two groups in terms of readmission rate, reoperation rate, surgical site infection, and periprosthetic fracture. The differences were not statistically significant. CONCLUSION: Compared to the traditional inpatient route, the blood transfusion rate for single-condyle replacement in the outpatient operation center is lower, and there is no significant difference in readmission rate, reoperation rate, surgical site infection, and periprosthesis fracture. The outpatient approach to UKA is safe, feasible, and highly satisfactory for patients. However, the results have certain limitations, and a rigorous preoperative complication risk assessment can minimize the risk of UKA in outpatient surgery centers. TRIAL REGISTRATION: PROSPERO number CRD42023405373.

Systematic evaluation of the degree of joint amnesia in patients after total hip arthroplasty with direct anterior approach (DAA) compared with posterior approach (PA).

OBJECTIVE: A comparative study of joint amnesia in patients undergoing total hip arthroplasty with the direct anterior approach and posterior approach was conducted through a comprehensive evaluation. METHODS: The literature on joint amnesia in postoperative patients who underwent total hip arthroplasty by the direct anterior approach and the posterior approach was systematically searched in PubMed, Embase, Web of Science, Cochrane Library, CNKI, CBM, Wanfang, and VIP databases from the time of library construction until February 13, 2023. Meta-analysis was performed using RevMan 5.3 software after independent searching, screening of the literature, data extraction, and quality assessment of the included studies by two investigators in strict accordance with the guidelines for conducting meta-analyses. RESULTS: A total of one RCT and six cohort studies were included in this meta-analysis. Meta-analysis results indicated that at 1 month postoperatively (MD = 2.08, 95% CI (0.20, 3.96), P = 0.03), 3 months (MD = 10.08, 95% CI (1.20, 18.96), P = 0.03), and 1 year (MD = 6.74, 95% CI (1.30, 12.19), P = 0.02), DAA total hip arthroplasty was associated with better FJS compared to PA at 1 year postoperatively. However, there was no statistical significance in FJS between the two groups at 5 years postoperatively (MD = 1.35, 95% CI (- 0.58, 3.28), P = 0.17). CONCLUSION: Current evidence suggests that the degree of joint amnesia after THA for DAA was not found to be superior to that of PA. Further, these findings require confirmation by including a larger number of high-quality randomized controlled studies. STUDY DESIGN: Systematic review; Level of evidence, 3.

Meta-analysis of outcomes after total knee arthroplasty in patients with rheumatoid arthritis and osteoarthritis.

The purpose of this study was to compare the difference in functional scores and the incidence of complications after TKA between RA and osteoarthritis. The PubMed, MedLine, The Cochrane Library, Embase and Web of Science databases were searched for all clinical studies up to 15 March 2023 comparing outcomes after total knee replacement in patients with RA and OA, with two review authors independently screening the literature. A total of 7,820,115 (knee-counted) cases were included in 34 studies. The results of meta-analysis showed that the scores of the RA group were lower than that of the osteoarthritis group in the postoperative knee joint score [MD=-2.72,95%CI(-5.06,-0.38),P=0.02] and the postoperative knee joint function score [MD=-11.47,95%CI(-16.55,-6.39),P<0.00001], and the difference was statistically significant. The incidence of deep venous thrombosis (OR=0.84,95%CI(0.79,0.90),P<0.00001) and pulmonary embolism (OR=0.84,95%CI(0.78,0.91),P<0.00001) were significantly lower in RA than in osteoarthritis (P<0.00001). Compared with patients with osteoarthritis, patients with rheumatoid arthritis have lower knee society scores and functional scores after total knee arthroplasty, and a higher risk of prosthetic infection, loosening, and revision, but TKA can still effectively reduce pain in RA patients, Improve function and quality of life without increasing the risk of lower extremity venous thrombosis and pulmonary embolism. Therefore, total knee replacement can be used as a treatment option for patients with rheumatoid arthritis who have not responded to conservative treatment. Patients should fully understand the benefits and possible risks of total knee replacement and develop an individualized treatment plan.

Rheumatoid arthritis is a protective factor against Alzheimer's disease: a bidirectional two-sample Mendelian randomization study.

BACKGROUND: Epidemiological evidence suggests that there is an association between rheumatoid arthritis (RA) and Alzheimer's disease (AD). However, the causal relationship between RA and AD remains unclear. Therefore, this study aimed to investigate the causal relationship between RA and AD. METHODS: Using publicly available genome-wide association study datasets, bidirectional two-sample Mendelian randomization (TSMR) was performed using the inverse-variance weighted (IVW), weighted median, MR‒Egger regression, simple mode, and weighted mode methods. RESULTS: The results of MR for the causal effect of RA on AD (IVW, odds ratio [OR] = 0.959, 95% confidence interval [CI]: 0.941-0.978, P = 2.752E-05; weighted median, OR = 0.960, 95% CI: 0.937-0.984, P = 0.001) revealed a causal association between genetic susceptibility to RA and an increased risk of AD. The results of MR for the causal effect of AD on RA (IVW, OR = 0.978, 95% CI: 0.906-1.056, P = 0.576; weighted median, OR = 0.966, 95% CI: 0.894-1.043, P = 0.382) indicated that there was no causal association between genetic susceptibility to AD and an increased risk of RA. CONCLUSIONS: The results of this two-way two-sample Mendelian randomization analysis revealed a causal association between genetic susceptibility to RA and a reduced risk of AD but did not reveal a causal association between genetic susceptibility to AD and an increased or reduced risk of RA.

[Research progress of functional alignment robot assisted knee replacement].

The correct alignment of the knee joint is considered to be one of the most influential factors in determining the long-term prognosis after total knee arthroplasty(TKA). In order to achieve the correct alignment goal, many different alignment concepts and surgical techniques have been established. For example, mechanical alignment(MA), kinematic alignment(KA) and functional alignment(FA) have their own characteristics. MA focuses on achieving neutral alignment of the limbs, parallel and equal bone gaps during stretching and flexion. KA aims to restore the patient 's natural joint line, make the joint level and angle normal and improve the physiological soft tissue balance, and strive to reproduce the normal knee function;among them, functional alignment(FA) developed with robot-assisted surgery technology is a relatively new alignment concept. It not only considers the alignment of the body, but also aims to achieve flexion and extension balance, while respecting the native soft tissue capsule. It not only restores the plane and slope of the in situ joint line accurately during the operation, but also takes into account the balance of soft tissue, which is a better alignment method. Therefore, it is of great significance to correctly construct the lower limb force line of patients, which is helpful to restore knee joint function, relieve pain symptoms and prolong the service life of prosthesi. However, compared with traditional TKA, the operation time of robot-assisted FA-TKA is prolonged, which means that the probability of postoperative infection will be greater. At present, most studies of FA technology report short-term results, and the long-term efficacy of patients is not clear. Therefore, long-term research results are needed to support the application of this technology. Therefore, the author makes a review on the research status of functional alignment.

The efficacy and safety of direct superior approach (DSA) for total hip arthroplasty: a systematic review and meta-analysis.

OBJECTIVE: To systematically evaluate the clinical safety and efficacy of the direct superior approach and the conventional surgical approach. DATE SOURCES: From PubMed, Embase, the Cochrane Library, and China Knowledge Network up to January 30, 2023. MAIN RESULTS: A total of 7 case series involving 4306 patients undergoing total hip arthroplasty were included, including 679 patients with direct superior approach. All outcome measures: Oxford Hip Score [MD = 0.30, 95% CI (- 0.87, 1.47), P = 0.62], Hip Harris Score [MD = - 0.18, 95% CI (- 0.86, 0.49), P = 0.59], intraoperative blood loss [MD = - 54.14, 95% CI (- 102.75,-5.52), P = 0.03], transfusion rate [MD = 0.49, 95% CI (0.29, 0.83), P = 0.008], Limb Length Differences [MD = - 0.21, 95% CI (0.02, 0.39), P = 0.03], Length of Stay [MD = - 0.61, 95% CI (- 0.69, - 0.52), P < 0.00001]. CONCLUSIONS: The DSA was superior to conventional access in terms of incision length, bleeding, postoperative transfusion rate, and early postoperative HHS. In addition, our study found that because the DSA has less tissue damage, it has the potential advantages of accelerating patient recovery after surgery, shortening hospitalization time, and reducing patient economic pressure, which can significantly improve patient quality of life and satisfaction.

Minimally invasive medial femoral approach to total knee arthroplasty improves short-term outcomes compared to the standard medial parapatellar approach: a systematic review and meta-analysis.

OBJECTIVE: The aim of this study is to conduct a comprehensive evaluation of the effectiveness of the medial parapatellar approach via the vastus medialis obliquus muscle in comparison with the standard medial parapatellar approach for total knee arthroplasty, using a systematic approach. METHODS: A computer search was conducted on PubMed, EMBASE, Medline, Cochrane libraries, and Web of Science databases to comprehensively collect randomized controlled studies on minimally invasive (MMV) approaches for knee arthroplasty, specifically the vastus and medial parapatellar (MP) approaches. Two authors independently screened the literature based on inclusion and exclusion criteria, evaluated the quality of the included studies using the Cochrane systematic review method, and performed a meta-analysis using RevMan 5.3 software. RESULTS: A total of twelve randomized controlled studies were ultimately included, comprising 788 knees. The small incision medial femoral muscle approach (MMV) group consisted of 398 cases, while the traditional parapatellar approach (MP) group consisted of 390 cases. Data analysis showed that in the comparison of KSS, VAS, and ROM score at 3 months after surgery, MMV approach was superior to MP approach [MD = 2.89, 95%CI (0.33, 5.46), P = 0.03], [MD = - 0.22, 95%CI (- 0.36, - 0.09), P = 0.001], and [MD = 1.08, 95%CI (0.04, 2.12), P = 0.04]. However, there was no significant difference in the postoperative KSS, VAS, and ROM score between the MMV and MP approaches at 6 and 12 months after surgery. The operation time of the MMV group was longer than that of the MP group [MD = 8.98, 95%CI (4.64, 13.32), P < 0.0001], and the number of days of straight leg raising after surgery was shorter in the MMV group than in the MP group [MD = - 1.91, 95%CI (- 3.45, - 0.37), P = 0.01], with statistically significant differences. There was no significant difference in the lateral support band release rate [OR = 0.72, 95%CI (0.23, 2.28), P = 0.58], length of hospital stay [MD = 0.07, 95%CI (- 0.18, 0.31), P = 0.58], postoperative complications [MD = 0.62, 95%CI (0.33, 1.18), P = 0.15], and intraoperative blood loss [MD = 70.50, 95%CI (- 57.51, 198.72), P = 0.28]. CONCLUSION: Most of the approaches have similar length of stay and incidence of complications compared to standard approaches. However, the minimally invasive midvastus approach has shown potential to improve short-term outcomes. STUDY REGISTRATION: PROSPERO registration number CRD42023410583.

Efficacy and safety of single- and double-dose intravenous tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis.

OBJECTIVE: With the increasing prevalence of osteoarthritis of the hip and knee, total joint replacement, the end-stage treatment, provides pain relief and restoration of function, but is often associated with massive blood loss. Tranexamic acid (TXA) has been reported to reduce perioperative blood loss in hip or knee arthroplasty. However, the optimal dose of TXA administration remains controversial. Therefore, we performed a meta-analysis combining data from 5 trials comparing the efficacy and safety of one fixed dose of 1 g intravenously administered TXA with two doses of 1 g each administered intravenously for hip or knee arthroplasty. METHODS: PubMed, Medline, Embase, Web of Science, and The Cochrane Library were searched from January 2000 to February 2023. Our meta-analysis included randomized controlled trials and cohort studies comparing the efficacy and safety of different doses of intravenous TXA (IV-TXA) for THA or TKA. The observation endpoints included total blood loss, postoperative hemoglobin drop, blood transfusion rate, length of hospital stay, incidence of deep venous thrombosis (DVT), and incidence of pulmonary embolism (PE). Meta-analysis was performed according to Cochrane's guidelines and PRISMA statement. The Danish RevMan5.3 software was used for data merging. RESULTS: Five cohort studies involving 5542 patients met the inclusion criteria. Our meta-analysis showed that the two groups were significantly higher in total blood loss (mean difference (MD) = - 65.60, 95% confidence interval (CI) [- 131.46, 0.26], P = 0.05); blood transfusion rate (risk difference (RD) = 0.00, 95% CI [- 0.01, 0.02], P = 0.55); postoperative hemoglobin (MD = 0.02, 95% CI [- 0.09, 0.13], P = 0.31); postoperative hospital stay days (MD = - 0.13), 95% CI [- 0.35, 0.09], P = 0.25); DVT (RD = 0.00, 95% CI [- 0.00, 0.01], P = 0.67); PE (RD = 0.00, 95% CI [- 0.01, 0.00], P = 0.79). There was some inherent heterogeneity due to variance in sample size across each major study. CONCLUSION: 1 dose of 1 g and 2 doses of 1 g IV-TXA each time have similar effects on reducing blood loss, blood transfusion rate, postoperative hemoglobin level, and postoperative hospital stay after TKA or THA, without increasing the risk of postoperative complications risk. For patients at high risk of thromboembolic events, one dose of 1 g TXA throughout surgery may be preferred. However, higher-quality RCT is needed to explore the optimal protocol dose to recommend the widespread use of TXA in total joint arthroplasty. Trial registration We conducted literature selection, eligibility criteria evaluation, data extraction and analysis on the research program registered in Prospero (CRD42023405387) on March 16, 2023.

The effects of total hip arthroplasty in treating hip bony fusion in young and middle-aged patients with ankylosing spondylitis.

BACKGROUND: This study aims to investigate the curative effects of total hip arthroplasty (THA) in treating hip bony fusion for young and middle-aged patients with ankylosing spondylitis (AS). METHODS: The clinical data of 26 young and middle-aged patients with AS (31 coxae), who were treated with THA and followed-up for more than 3 years in the period between February 1998 and May 2013, were retrospectively analyzed. Among these patients, 22 patients were male (25 coxae) and 4 patients were female (6 coxae). Patients' age ranged within 19-50 years old, with an average of 31.5 years old. The intervals from arthroplasty to the occurrence of hip joint lesions caused by AS ranged within 2-26 years, with an average of 11.2 years. The average Harris score before the surgery was 19.0 ± 11.5 points. RESULTS: Femoral proximal cleavage fracture occurred in one coxa during the surgery and was fixed by the steel wire cerclage. Sciatic nerve traction injury occurred in one coxa after the surgery, which recovered after 6 months. Posterior hip dislocation occurred in one coxa and was immediately treated with manual reduction. All patients were followed-up, and follow-up duration ranged within 36-123 months, with an average of 46.5 months. In the last follow-up, the average Harris score was 87.1 ± 13.1 points, total passive range of motion was 215.0 ± 22.0°, and passive range of flexion was 90.8 ± 9.3°. All these indexes significantly increased compared with pretreatment (P < 0.01). A periacetabular radiolucent line occurred in one coxa with a width of < 2 mm, and no femoral radiolucent line was found during follow-ups in any patient. Heterotopic ossification occurred in four coxae. CONCLUSION: THA treatment for hip bony fusion caused by AS can achieve satisfactory hip function recovery and excellent prosthesis survival rate.

MODIFIED STOPPA APPROACH FOR PELVIC AND ACETABULAR FRACTURE TREATMENT.

OBJECTIVE: A retrospective review aims to investigate the operative methods and therapeutic effects of the modified Stoppa approach for treating pelvic and acetabular fractures. METHODS: 18 patients with acetabular fracture of the anterior column and pelvic anterior ring fracture underwent surgical treatment using the modified Stoppa approach. Some of the treatment was combined with the iliac fossa approach or rear K-L approach. Fracture reduction and postoperative function were evaluated using the Matta scoring standard and the Majeed scoring system. The Oxford Centre for Evidence-Based Medicine system was used to grade the literature review and create graded B recommendations. RESULTS: Incision length was 6-12 cm (mean, 10 cm), operative duration was 50-150 minutes (mean, 85 minutes), and intraoperative blood loss volume was 400-1,000 ml (mean, 500 ml). 18 patients were followed up for 12-36 months post-operation. In the results of X-ray films, 12 cases were anatomical reductions and the remaining cases were satisfactory reductions. According to Majeed standard, 13 patients were excellent and five patients were good. CONCLUSIONS: Treatment using the modified Stoppa approach was suitable for anterior approaches, in which pelvic and acetabular fractures were sufficiently exposed, the fracture was conveniently reduced, less complications occurred, and curative effect was satisfactory. Level of evidence III, Retrospective comparative study.

OBJETIVO: Uma revisão retrospectiva tem como objetivo investigar os métodos operatórios e efeitos terapêuticos da abordagem modificada de Stoppa para o tratamento de fraturas pélvicas e acetabulares. MÉTODOS: 18 pacientes com fratura acetabular da coluna anterior e fratura do anel anterior pélvico foram submetidos a tratamento cirúrgico utilizando a abordagem de Stoppa modificada. Parte do tratamento foi feita em conjunto com a abordagem da fossa ilíaca ou com a abordagem pelo acesso posterior de K-L. A redução da fratura e a função pós-operatória foram avaliadas pelo padrão de pontuação de Matta e o sistema de pontuação de Majeed. O sistema do Oxford Centre for Evidence-Based Medicine foi usado para classificar a revisão de literatura e criar as recomendações de grau B. RESULTADOS: O comprimento da incisão foi de 6 a 12 cm (média de 10 cm), a duração da cirurgia foi de 50 a 150 minutos (média de 85 minutos) e o volume de perda sanguínea intraoperatória foi de 400 a 1.000 ml (média de 500 ml). 18 pacientes foram acompanhados por 12-36 meses após a operação. Nos resultados dos filmes radiográficos, 12 casos foram de reduções anatômicas e os demais casos foram de reduções satisfatórias. De acordo com o padrão de Majeed, 13 pacientes foram considerados excelentes e cinco pacientes foram considerados bons. CONCLUSÕES: O tratamento que utilizou a abordagem de Stoppa modificada foi adequado para abordagens anteriores, nas quais as fraturas pélvicas e acetabulares estavam suficientemente expostas, a fratura foi convenientemente reduzida, ocorreram menos complicações e o efeito curativo foi satisfatório. Nível de evidencia III, Estudo retrospectivo comparativo.

Modified stoppa approach for pelvic and acetabular fracture treatment / Stoppa modificada para tratamento de fraturas pélvicas e acetabulares

ABSTRACT Objective: A retrospective review aims to investigate the operative methods and therapeutic effects of the modified Stoppa approach for treating pelvic and acetabular fractures. Methods: 18 patients with acetabular fracture of the anterior column and pelvic anterior ring fracture underwent surgical treatment using the modified Stoppa approach. Some of the treatment was combined with the iliac fossa approach or rear K-L approach. Fracture reduction and postoperative function were evaluated using the Matta scoring standard and the Majeed scoring system. The Oxford Centre for Evidence-Based Medicine system was used to grade the literature review and create graded B recommendations. Results: Incision length was 6-12 cm (mean, 10 cm), operative duration was 50-150 minutes (mean, 85 minutes), and intraoperative blood loss volume was 400-1,000 ml (mean, 500 ml). 18 patients were followed up for 12-36 months post-operation. In the results of X-ray films, 12 cases were anatomical reductions and the remaining cases were satisfactory reductions. According to Majeed standard, 13 patients were excellent and five patients were good. Conclusions: Treatment using the modified Stoppa approach was suitable for anterior approaches, in which pelvic and acetabular fractures were sufficiently exposed, the fracture was conveniently reduced, less complications occurred, and curative effect was satisfactory. Level of evidence III, Retrospective comparative study.

RESUMO Objetivo: Uma revisão retrospectiva tem como objetivo investigar os métodos operatórios e efeitos terapêuticos da abordagem modificada de Stoppa para o tratamento de fraturas pélvicas e acetabulares. Métodos: 18 pacientes com fratura acetabular da coluna anterior e fratura do anel anterior pélvico foram submetidos a tratamento cirúrgico utilizando a abordagem de Stoppa modificada. Parte do tratamento foi feita em conjunto com a abordagem da fossa ilíaca ou com a abordagem pelo acesso posterior de K-L. A redução da fratura e a função pós-operatória foram avaliadas pelo padrão de pontuação de Matta e o sistema de pontuação de Majeed. O sistema do Oxford Centre for Evidence-Based Medicine foi usado para classificar a revisão de literatura e criar as recomendações de grau B. Resultados: O comprimento da incisão foi de 6 a 12 cm (média de 10 cm), a duração da cirurgia foi de 50 a 150 minutos (média de 85 minutos) e o volume de perda sanguínea intraoperatória foi de 400 a 1.000 ml (média de 500 ml). 18 pacientes foram acompanhados por 12-36 meses após a operação. Nos resultados dos filmes radiográficos, 12 casos foram de reduções anatômicas e os demais casos foram de reduções satisfatórias. De acordo com o padrão de Majeed, 13 pacientes foram considerados excelentes e cinco pacientes foram considerados bons. Conclusões: O tratamento que utilizou a abordagem de Stoppa modificada foi adequado para abordagens anteriores, nas quais as fraturas pélvicas e acetabulares estavam suficientemente expostas, a fratura foi convenientemente reduzida, ocorreram menos complicações e o efeito curativo foi satisfatório. Nível de evidencia III, Estudo retrospectivo comparativo.

A meta-analysis evaluates the efficacy of intravenous acetaminophen for pain management in knee or hip arthroplasty.

BACKGROUND: The objective of this study was to assess whether intravenous acetaminophen for patients undergoing knee or hip arthroplasty could reduce the opioid consumption and improve pain management. METHOD: Eligible studies were searched from electronic databases including PubMed, Web of Science, Embase (Ovid interface) and Cochrane Library (Ovid interface). The quality assessments were performed according to the Cochrane systematic review method. The assessed outcomes were including opioid consumption, pain scores, length of hospital stays and total occurrence of adverse events. RESULTS: Among 832 records identified, six randomized controlled trials (RCTs) and five non-RCTs were eligible for data extraction and meta-analysis. According to the outcomes, the patients receive intravenous acetaminophen had less total opioid consumption after knee or hip artroplasty (SMD = -0.66; 95%CI, -1.13 to -0.20), but they did not obtain statistical improvement of postoperative pain control at postoperative day 0 (POD0, SMD = -0,15; 95%CI, -0.36 to 0.07), POD1(SMD = 0,12; 95%CI, -0.13 to 0.36), POD2 (SMD = -0,29; 95%CI, -0.70 to 0.12) and POD3 (SMD = -0,04; 95%CI, -0.49 to 0.41). Meanwhile, there were similar outcomes about the length of hospital stays in patients whether or not receiving intravenous acetaminophen (SMD = -0,05; 95%CI, -0.26 to 0.15). And, the total adverse effects occurrence also didn't show any significant difference between the acetaminophen group and control group (OR = 0.87; 95%CI, 0.57 to 1.33). CONCLUSIONS: Perioperative intravenous acetaminophen use in multimodal analgesia could significantly reduce of total opioid consumption, but it did not contribute to decrease the average pain scores and shorten the length of hospital stays in total hip or knee arthroplasty.

Lithium-incorporated deproteinized bovine bone substitute improves osteogenesis in critical-sized bone defect repair.

This study aimed to explore the surface modification of deproteinized bovine bone using lithium-ion and evaluate its efficacy on osteogenesis improvement and critical-sized bone defect repair. Hydrothermal treatment was performed to produce lithium-incorporated deproteinized bovine bone. In vitro study, human osteosarcoma cell MG63 (MG63) was cultured with the bone substitute to evaluate the cell viability and then calcium deposition was measured to analyze the osteogenesis. In vivo studies, male adult goats were chosen to build critical-sized bone defect model and randomly divided into three groups. The goats were treated with autogenous cancellous bone, lithium-incorporated deproteinized bovine bone, and deproteinized bovine bone. Animals were evaluated using radiological analysis including X-ray, computed tomography, and Micro-CT; histological methods involving hematoxylin-eosin dyeing, Masson dyeing, and immunofluorescence detection at 4 and 12 weeks after surgery were carried out. According to the results, lithium-incorporated deproteinized bovine bone produced nano-structured surface layer. The lithium-incorporated deproteinized bovine bone could promote the osteoblast proliferation and increase the calcium deposition. In vivo studies, radiographic results revealed that lithium-incorporated deproteinized bovine bone scaffolds provided better performance in terms of mean gray values of X films, mean pixel values of computed tomography films, and bone volume and trabecular thickness of micro-computed tomography pictures when compared with the deproteinized bovine bone group. In addition, histological analysis showed that the lithium-incorporated deproteinized bovine bone group also significantly achieved larger new bone formation area. At the same time, when the expression of osteogenic factors in vivo was evaluated, runt-related transcription factor 2 (Runx2) and collagen type one (Col-1) were expressed more in lithium-incorporated deproteinized bovine bone group than those in deproteinized bovine bone group. However, the bone defect repair effect using autograft is still a little better than that of lithium-incorporated deproteinized bovine bone substitute based on our results. In conclusion, surface lithium-incorporated deproteinized bovine bone achieved improvement of osteogenesis effect and could enhance the new bone formation in critical-sized bone defects.

[Anterior surgery for fourth lumbar burst fractures].

OBJECTIVE: To evaluate the clinical outcomes of anterior decompression, bone graft and internal fixation in treating fourth lumbar burst fractures with iliac fenestration. METHODS: From February 2001 to May 2006, 8 cases of fourth lumbar burst fractures were treated by anterior decompression, correction, reduction, iliac autograft, Z-plate internal fixation with-iliac fenestration. Of them, there were 7 males and 1 female, aging 24-46 years with an average of 29.3 years, including 3 cases of Denis type A and 5 cases of Denis type B. The decompression, intervertebral height were compared between preoperation and postoperation by CT scanning. According to Frankel assessment for neurological status, 2 cases were at grade C, 5 at grade D and 1 at grade E before operation. Four cases had different degrees of disturbance of sphincter. Time from injury to operation was 8 hours to 11 days. The preoperative height of the anterior border of the L4 vertebral body was (13.8 +/- 2.3) mm, the Cobb angel of fractured vertebral body was (13.2 +/- 2.5) degrees, the vertebral canal sagittal diameter of L4 was (10.6 +/- 3.5) mm. The bone graft volume was (7.5 +/- 1.3) cm3 during operation. RESULTS: Operations were performed successfully. The mean operative time was (142 +/- 25) minutes and the mean amount of blood loss was (436 +/- 39) mL. The incisions obtained healing by first intention after operation. Two cases suffered donor site pain and received no treatment. The follow-up time of 8 cases was from 21 months to 52 months (mean 24.5 months). At one week after operation, the height of the anterior border of the L4 vertebral body was (32.5 +/- 2.6) mm, the Cobb angel of fractured vertebral body was (6.8 +/- 3.7) degrees, and the vertebral canal sagittal diameter of L4 was (19.8 +/- 5.1) mm, showing significant difference when compared with those of preoperation (P < 0.01). At the final follow-up, the results showed that the pressure was reduced sufficiently, all autograft fused well, the neurological status improved at Frankel grade from C to D in 1 patient, from D to E in 3 patients, but the others had no improvement. In 4 patients who had disturbance of sphincter, 3 restored to normal and 1 was better off. CONCLUSION: Clinical outcomes of anterior surgery for fourth lumbar burst fractures with iliac fenestration are satisfactory. It can facilitate operation, reduce the pressure sufficiently, maintenance intervertebral height and recover the neurological function.