Risk factors associated with osteonecrosis of femoral head after internal fixation of femoral neck fracture:a systematic review and meta-analysis.

BACKGROUND: Although the risk factors associated with osteonecrosis of femoral head (ONFH) after internal fixation of femoral neck fracture (IFFNF) have been frequently reported, the results remain controversial. Therefore, its related risk factors were systematically evaluated and meta-classified in this study. METHODS: Literature on risk factors of ONFH caused by IFFNF was retrieved in PubMed, Embase and Cochrane Library due June 2019. Review Manager 5.3 software was applied to data synthesis, and Stata 13.0 software was adopted for analyses of publication bias and sensitivity. RESULTS: A total of 17 case-control studies with 2065 patients were included. The risk of ONFH after IF was 0.40-fold higher in patients with Garden III-IV FNF than that in patients with Garden I-II (OR: 0.40, 95%CI: 0.29-0.55). The risk of OFNH with retained IF was uplifted by 0.04 times (OR: 0.04, 95%CI: 0.02-0.07). There was nonsignificant relationship between gender and ONFH after IFFNF (OR: 1.27, 95%CI: 0.84-1.94). Moreover, ONFH after IFFNF presented no association with age (OR:1.66, 95%CI: 0.89-3.11), injury-operation interval (OR:1.29, 95%CI: 0.82-2.04), fracture reduction mode (OR:1.98, 95%CI: 0.92-4.26), preoperative traction (OR:1.69, 95%CI: 0.29-9.98) and mechanism of injury (OR:0.53, 95%CI: 0.06-4.83). Egger's and Begg's tests indicated a publication bias (P = 0.001). CONCLUSION: It was demonstrated that Garden classification and retained IF were important influencing factors of ONFH after IFFNF. Gender, age, injury-operation interval, fracture reduction mode, preoperative traction and the mechanism of ONFH were irrelevant to the complication.

Correlation between Body Mass Index and Periprosthetic Joint Infection following Total Joint Arthroplasty: A protocol for systematic review and meta analysis.

BACKGROUND: Despite rapid reports on the correlation between body mass index (BMI) and periprosthetic joint infection (PJI) after total joint arthroplasty, some have conducted regression tests or meta-analyses with controversial results. In this study, we systematically meta-analyzed relevant trials and carefully evaluated the correlation for verification. METHODS: Literature on the correlation between BMI and PJI following total joint arthroplasty was retrieved in PubMed, Embase and Cochrane Library due September 2019. Stata 13.0 software was adopted for data synthesis and analyses of publication bias and sensitivity. Random-effect models were used to summary the overall estimate of the multivariate adjusted odds ratio (OR)/hazard ratio/rate ratio with 95% confidence intervals (CIs). RESULTS: A total of 29 observational studies representing 3,204,887 patients were included. The meta-analysis revealed that the risk of postoperative PJI significantly increased by 1.51 times in the obese group (OR = 1.51; 95% CI = 1.30-1.74 for the obese group vs. the non-obese group), and by 3.27 times in the morbid obese group (OR = 3.27; 95% CI = 2.46-4.34 for the morbid obese group vs the non-morbid obese group). A significant association remained consistent, as indicated by subgroup analyses and sensitivity analyses. CONCLUSION: Our findings demonstrate that postoperative PJI is positively correlated with BMI, with obese patients showing a greater risk of developing PJI than non-obese patients. Similarly, morbid obese patients present a higher risk of PJI than non-morbid obese patients. However, this conclusion needs to be corroborated by more prospective studies.