RESUMO
This Technology Overview was prepared using systematic review methodology and summarizes the findings of studies published as of July 15, 2011, on modern metal-on-metal hip implants. Analyses conducted on outcomes by two joint registries indicate that patients who receive metal-on-metal total hip arthroplasty (THA) and hip resurfacing are at greater risk for revision than are patients who receive THA using a different bearing surface combination. Data from these registries also indicate that larger femoral head components have higher revision rates and risk of revision and that older age is associated with increased revision risks of large-head metal-on-metal THA. Several studies noted a correlation between suboptimal hip implant positioning and higher wear rates, local metal debris release, and consequent local tissue reactions to metal debris. In addition, several studies reported elevated serum metal ion concentrations in patients with metal-on-metal hip articulations, although the clinical significance of these elevated ion concentrations remains unknown.
Assuntos
Artroplastia de Quadril , Prótese de Quadril , Desenho de Prótese , Artroplastia de Quadril/efeitos adversos , Humanos , Metais , ReoperaçãoRESUMO
Based on the best current evidence and a systematic review of published studies, 14 recommendations have been created to guide clinical practice and management of supracondylar fractures of the humerus in children. Two each of these recommendations are graded Weak and Consensus; eight are graded Inconclusive. The two Moderate recommendations include nonsurgical immobilization for acute or nondisplaced fractures of the humerus or posterior fat pad sign, and closed reduction with pin fixation for displaced type II and III and displaced flexion fractures.
Assuntos
Fixação de Fratura , Fraturas do Úmero/terapia , Criança , Medicina Baseada em Evidências , Humanos , ImobilizaçãoAssuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Tromboembolia Venosa/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Humanos , Guias de Prática Clínica como Assunto , Ultrassonografia , Tromboembolia Venosa/diagnóstico por imagem , Tromboembolia Venosa/etiologiaRESUMO
This guideline supersedes a prior one from 2007 on a similar topic. The work group evaluated the available literature concerning various aspects of patient screening, risk factor assessment, and prophylactic treatment against venous thromboembolic disease (VTED), as well as the use of postoperative mobilization, neuraxial agents, and vena cava filters. The group recommended further assessment of patients who have had a previous venous thromboembolism but not for other potential risk factors. Patients should be assessed for known bleeding disorders, such as hemophilia, and for the presence of active liver disease. Patients who are not at elevated risk of VTED or for bleeding should receive pharmacologic prophylaxis and mechanical compressive devices for the prevention of VTED. The group did not recommend specific pharmacologic agents and/or mechanical devices. The work group recommends, by consensus opinion, early mobilization for patients following elective hip and knee arthroplasty. The use of neuraxial anesthesia can help limit blood loss but was not found to affect the occurrence of VTED. No clear evidence was established regarding whether inferior vena cava filters can prevent pulmonary embolism in patients who have a contraindication to chemoprophylaxis and/or known VTED.
Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Tromboembolia Venosa/prevenção & controle , Anestesia Epidural , Perda Sanguínea Cirúrgica , Comorbidade , Deambulação Precoce , Procedimentos Cirúrgicos Eletivos , Hemofilia A/epidemiologia , Humanos , Dispositivos de Compressão Pneumática Intermitente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , Ultrassonografia Doppler Dupla , Filtros de Veia Cava , Tromboembolia Venosa/epidemiologia , Trombose Venosa/diagnóstico por imagemAssuntos
Fraturas por Compressão/terapia , Fraturas Espontâneas/terapia , Osteoporose/complicações , Guias de Prática Clínica como Assunto/normas , Fraturas da Coluna Vertebral/terapia , Feminino , Consolidação da Fratura/fisiologia , Fraturas por Compressão/diagnóstico por imagem , Fraturas por Compressão/etiologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Humanos , Masculino , Ortopedia/normas , Osteoporose/diagnóstico , Prognóstico , Radiografia , Medição de Risco , Sociedades Médicas , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/etiologia , Resultado do Tratamento , Estados UnidosAssuntos
Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Antibacterianos/administração & dosagem , Sedimentação Sanguínea , Proteína C-Reativa/análise , Humanos , Contagem de Leucócitos , Imageamento por Ressonância Magnética , Infecções Relacionadas à Prótese/cirurgia , Medição de Risco , Líquido Sinovial/citologia , Tomografia Computadorizada por Raios XRESUMO
Of the 31 recommendations made by the work group, 19 were determined to be inconclusive because of the absence of definitive evidence. Of the remaining recommendations, four were classified as moderate grade, six as weak, and two as consensus statements of expert opinion. The four moderate-grade recommendations include suggestions that exercise and nonsteroidal anti-inflammatory drugs be used to manage rotator cuff symptoms in the absence of a full-thickness tear, that routine acromioplasty is not required at the time of rotator cuff repair, that non-cross-linked, porcine small intestine submucosal xenograft patches not be used to manage rotator cuff tears, and that surgeons can advise patients that workers' compensation status correlates with less favorable outcomes after rotator cuff surgery.
Assuntos
Artropatias/terapia , Lesões do Manguito Rotador , Manguito Rotador/cirurgia , Articulação Acromioclavicular/cirurgia , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Artroscopia/métodos , Terapia por Exercício , Humanos , Artropatias/cirurgia , Lesões do Ombro , Articulação do Ombro/cirurgia , Traumatismos dos Tendões/terapiaRESUMO
This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of osteochondritis dissecans of the knee. None of the 16 recommendations made by the work group is graded as strong; most are graded inconclusive; two are graded weak; and four are consensus statements. Both of the weak recommendations are related to imaging evaluation. For patients with knee symptoms, radiographs of the joint may be obtained to identify the lesion. For patients with radiographically apparent lesions, MRI may be used to further characterize the osteochondritis dissecans lesion or identify other knee pathology.
Assuntos
Articulação do Joelho , Osteocondrite Dissecante/diagnóstico , Osteocondrite Dissecante/terapia , Terapia por Estimulação Elétrica , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética , Procedimentos Ortopédicos , Aparelhos Ortopédicos , RadiografiaAssuntos
Fixação de Fratura/métodos , Fraturas do Rádio/cirurgia , Artroscopia , Transplante Ósseo , Fios Ortopédicos , Moldes Cirúrgicos , Descompressão Cirúrgica , Medicina Baseada em Evidências , Humanos , Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/reabilitação , ContençõesRESUMO
This clinical practice guideline is based on a series of systematic reviews of published studies on the treatment of symptomatic osteoporotic spinal compression fractures. Of 11 recommendations, one is strong; one, moderate; three, weak; and six, inconclusive. The strong recommendation is against the use of vertebroplasty to treat the fractures; the moderate recommendation is for the use of calcitonin for 4 weeks following the onset of fracture. The weak recommendations address the use of ibandronate and strontium ranelate to prevent additional symptomatic fractures, the use of L2 nerve root blocks to treat the pain associated with L3 or L4 fractures, and the use of kyphoplasty to treat symptomatic fractures in patients who are neurologically intact.
Assuntos
Fraturas por Compressão/terapia , Fraturas por Osteoporose/terapia , Fraturas da Coluna Vertebral/terapia , Conservadores da Densidade Óssea/uso terapêutico , Calcitonina/uso terapêutico , Terapia Combinada , Difosfonatos/uso terapêutico , Medicina Baseada em Evidências , Humanos , Ácido Ibandrônico , Bloqueio Nervoso , Compostos Organometálicos/uso terapêutico , Medição da Dor , Tiofenos/uso terapêutico , Vertebroplastia/métodosRESUMO
No preferred test for diagnosis of periprosthetic joint infection exists, and the algorithm for the workup of patients suspected of infection remains unclear. The work group evaluated the available literature to determine the role of each diagnostic modality and devise a practical algorithm that allows physicians to reach diagnosis of periprosthetic joint infection. Ten of the 15 recommendations have strong or moderate evidence in support. These include matters involving erythrocyte sedimentation rate and C-reactive protein level testing, knee and hip aspiration, and stopping the use of antibiotics prior to obtaining intra-articular cultures. The group recommends against the use of intraoperative Gram stain but does recommend the use of frozen sections of peri-implant tissues in reoperation patients in whom infection has not been established, as well as multiple cultures in reoperation patients being assessed for infection. The group recommends against initiating antibiotic treatment in patients with suspected infection until after joint cultures have been obtained, but recommends that prophylactic preoperative antibiotics not be withheld in patients at lower probability for infection.
Assuntos
Algoritmos , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Antibioticoprofilaxia , Biópsia por Agulha Fina , Sedimentação Sanguínea , Proteína C-Reativa/análise , Diagnóstico por Imagem , Humanos , Infecções Relacionadas à Prótese/tratamento farmacológico , ReoperaçãoRESUMO
This technology overview addressed four questions that compared the difference in outcomes between patients undergoing cervical disc arthroplasty with patients undergoing anterior cervical diskectomy fusion. Most studies did not either report or conduct the appropriate statistical analyses to examine predictive characteristics in patients with successful clinical outcomes. Most studies were inconclusive or unreliable regarding clinical outcomes and revision and/or complication rates in patients who present with neck and/or arm pain. No significant difference in the length of hospital stay was reported; however, two studies included in the overview reported that patients treated with cervical disc arthroplasty returned to work in significantly fewer days (range, 14 to 16 days) than did patients treated with anterior cervical diskectomy fusion.
Assuntos
Artroplastia/métodos , Vértebras Cervicais/cirurgia , Discotomia/métodos , Disco Intervertebral/cirurgia , Cervicalgia/cirurgia , Artroplastia/economia , Avaliação da Deficiência , Discotomia/economia , Humanos , Medição da Dor , Seleção de PacientesRESUMO
For this technology overview, the tools of evidence-based medicine were used to summarize information on the effectiveness and clinical outcomes related to the usage of bone void fillers- specifically, synthetic graft materials. Comprehensive literature searches were conducted to address five key questions, which the task force that prepared the report posed as follows. Question 1 addressed the use of synthetic bone void fillers alone. Question 2 was designed to determine whether synthetic bone void fillers could successfully serve as graft extenders and eliminate the need for iliac crest bone graft. Questions 3, 4, and 5 addressed the use of allografts as a comparison with synthetic fillers because clinical results with allografts are perceived as being much closer to autografts in these areas of the spine.
Assuntos
Substitutos Ósseos , Transplante Ósseo/tendências , Medicina Baseada em Evidências , Transplante Ósseo/métodos , Humanos , Fusão Vertebral/métodos , Resultado do TratamentoRESUMO
This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. None of the 16 recommendations made by the work group was graded as strong; most are graded inconclusive; four are graded weak; two are graded as moderate strength; and two are consensus statements. The two moderate-strength recommendations include the suggestions for early postoperative protective weight bearing and for the use of protective devices that allow for postoperative mobilization.
Assuntos
Tendão do Calcâneo/lesões , Traumatismos dos Tendões/diagnóstico , Traumatismos dos Tendões/cirurgia , Humanos , Modalidades de Fisioterapia , Cuidados Pós-Operatórios , Ruptura , Traumatismos dos Tendões/reabilitação , Suporte de CargaRESUMO
This clinical practice guideline is based on a systematic review of published studies on the treatment of glenohumeral osteoarthritis in the adult patient population. Of the 16 recommendations addressed, nine are inconclusive. Two were reached by consensus-that physicians use perioperative mechanical and/or chemical venous thromboembolism prophylaxis for shoulder arthroplasty patients and that total shoulder arthroplasty not be performed in patients with glenohumeral osteoarthritis who have an irreparable rotator cuff tear. Four options were graded as weak: the use of injectable viscosupplementation; total shoulder arthroplasty and hemiarthroplasty as treatment; avoiding shoulder arthroplasty by surgeons who perform fewer than two shoulder arthroplasties per year (to reduce the risk of immediate postoperative complications); and the use of keeled or pegged all-polyethylene cemented glenoid components. The single moderate-rated recommendation was for the use of total shoulder arthroplasty rather than hemiarthroplasty. Management of glenohumeral osteoarthritis remains controversial; the scientific evidence on this topic can be significantly improved.