Outcome after total ankle arthroplasty with a minimum of five years follow-up: A systematic review and meta-analysis

The controversy in surgical management of end-stage tibiotalar arthritis with Total Ankle Arthroplasty (TAA) versus Ankle Arthrodesis (AA) has grown in parallel with the evolution of both procedures. No randomized controlled trials exist due to the vast differences in surgical goals, patient expectations, and complication profiles between the two procedures. This makes high quality systematic reviews necessary to compare outcomes between these two treatment options. The aim of this study was to provide a systematic review with meta-analysis of publications reporting outcomes, complications, and revision data following third-generation TAA and/or modern AA published in the past decade. Thirtyfive articles met eligibility criteria, which included 4312 TAA and 1091 AA procedures. This review reports data from a mean follow-up of 4.9 years in the TAA cohort and 4.0 years in the AA cohort. There was no significant difference in overall complication rate following TAA compared to AA (23.6% and 25.7% respectively, P-value 0.31). Similarly, there was no significant difference in revision rate following TAA compared to AA (7.2% and 6.3% respectively, P-value 0.65). Successful treatment of end-stage tibiotalar arthritis requires an understanding of a patients’ goals and expectations, coupled with appropriate patient selection for the chosen procedure. The decision to proceed with TAA or AA should be made on a case-by-case basis following an informed discussion with the patient regarding the different goals and complication profiles for each procedure.

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A 27-year Meta-analysis of Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00233 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0023 ◽

Cited By ~ 2

Author(s):

Christopher Gross ◽

Steven Haddad ◽

Jesse Morris ◽

Elizabeth Durante ◽

Philip Kirn

Keyword(s):

Systematic Review ◽

Second Generation ◽

Revision Rate ◽

Meta Analysis ◽

Total Ankle Arthroplasty ◽

Complication Rates ◽

Third Generation ◽

Early Generation ◽

Previous Systematic Review ◽

Ankle Arthroplasty

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty is an alternative to ankle arthrodesis for the treatment of end-stage arthritis while maintaining greater ankle motion and functionality. Early generation implants had unacceptably high complication rates. However, increasing surgical experience and newer third-generation designs have the potential to offer better outcomes. A previous systematic review reported results from studies published between 1990 and 2005, focusing on second-generation implants. We performed a systematic review of the literature addressing the intermediate-long-term outcomes of interest in total ankle arthroplasty studies published since 2006, and we compared our findings to those from earlier generation implants. Methods: A comprehensive search of MEDLINE for all articles published from 3/25/2006 to 2/1/2017 was conducted with a minimum two-year follow-up. Two reviewers evaluated each study to determine whether it was eligible for inclusion and abstracted the data of interest. Meta-analytic pooling of group results across studies was performed. The analysis focused on third-generation ankle implants. Results: The previous systematic review identified 10 studies (n=852), whereas we identified 40 studies (n=4835). The prior study showed a five and ten-year survival rate of 78% and 77%, respectively; respective rates were 86% (p=0.001) and 76% (p=0.53) in ours and similar to the previous study. The revision rate following TAR was 7% in the earlier review (loosening/subsidence, 28%). In ours, the revision rate following TAR was 9.6% (p=0.10) (component loosening, 37%); 3.4% (p=0.02) of ankles were converted to arthrodesis. The mean post-operative Ankle-Hindfoot score was 78.2 points in the prior review and 80.1 (p=0.20) points for ours. There is significant (p<0.0001) heterogeneity (I2=92.94%) between the studies; a meta-analysis of proportions showed that 81.6%of subjects had good outcomes while 46.6% had an excellent outcome. Conclusion: Based on these findings, the outcomes for third-generation total ankle arthroplasty have no significant differences in survival rates when compared to second-generation implants. However, functional scores, range of motion, and overall patient outcomes were significantly higher in the third-generation implants. However, data from early generation studies were sparse in comparison, so direct comparative studies are needed to strengthen this conclusion.

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Heterotopic Ossification in Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00029 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0002

Author(s):

Thomas Bemenderfer ◽

Robert Anderson ◽

Mario Escudero ◽

Feras Waly ◽

Kevin Wing ◽

...

Keyword(s):

Systematic Review ◽

Range Of Motion ◽

Functional Outcome ◽

Heterotopic Ossification ◽

Functional Outcomes ◽

Total Ankle Arthroplasty ◽

Minimal Clinical Important Difference ◽

Ankle Arthroplasty ◽

Wide Range

Category: Ankle Arthritis Introduction/Purpose: Heterotopic ossification (HO) following total ankle arthroplasty (TAA) is a known sequela and has been reported to contribute to reduced postoperative range of motion and poor patient functional outcomes. However, conflicting results have been reported in the literature with respect to the correlation between HO and clinical outcome. As new strategies and implants continue to be designed, it is important to understand what instruments for measuring the outcome of treatment are important to assess when evaluating outcome measures in TAA. The present study documents the incidence of HO and functional outcome for the novel 2 component fixed bearing Infinity Total Ankle System prosthesis at minimum of two year follow up and reports a systematic review of the literature. Methods: We reviewed the incidence, degree of severity, and functional outcome in 67 consecutive patients who underwent primary Infinity TAA at two North American tertiary medical centers between 2013 and 2015 in a prospective observational study. Radiographic and functional outcome data was collected preoperatively, at 6 to 12 months postoperatively, and annually thereafter. In addition, we conducted a systematic review of studies reporting the incidence of HO following TAA. We included peer-reviewed studies reporting on at least 20 TAAs with minimum follow up of two years. Results: While the incidence of HO was 68% at 2.4 years in the 67 patients who underwent primary Infinity TAA, there was no association between HO and AOFAS (HO 73.9, no HO 55.0), SF36-PCS (HO 50.1, no HO 45.2), FFI (HO 22.1, no HO 26.4), and VAS (HO 2.6, no HO 2.3). Fourteen studies with 1201 TAAs were included. The overall incidence of HO following TAA was approximately 56.6% at average 3.8 years with a wide range (range, 22.2-100%). Four studies (299 ankles) did not address functional outcomes. Nine studies (822 ankles) reported no association between functional outcomes and HO. One study (80 ankles) reported a statistically significant difference in range of motion of 7 degrees of dorsiflexion and a 7-point difference in AOFAS score. Conclusion: There was no association between HO and functional outcome in our observational cohort. Only one study demonstrated statistically significant differences in range of motion and functional outcome due to HO. Although the minimal clinical important difference in ankle dorsiflexion and AOFAS has not been established in TAA, these differences are below the minimal clinical important difference established in other foot and ankle procedures. Available data, including the results in our 67 patients, suggests that clinical function is independent of the presence of HO.

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Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.5.peds19126 ◽

2019 ◽

Vol 24 (5) ◽

pp. 558-571 ◽

Cited By ~ 3

Author(s):

Kartik Bhatia ◽

Hans Kortman ◽

Christopher Blair ◽

Geoffrey Parker ◽

David Brunacci ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Case Reports ◽

Meta Analysis ◽

Case Series ◽

Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

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Faculty Opinions recommendation of Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: systematic review and meta-analysis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1161782.623384 ◽

2009 ◽

Author(s):

Anthony Harries

Keyword(s):

Systematic Review ◽

Antiretroviral Treatment ◽

Meta Analysis ◽

Resource Limited Settings ◽

Resource Limited ◽

Lost To Follow Up

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Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-102525 ◽

2020 ◽

pp. bjsports-2020-102525

Author(s):

Stefanos Karanasios ◽

Vasileios Korakakis ◽

Rod Whiteley ◽

Ioannis Vasilogeorgis ◽

Sarah Woodbridge ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Risk Of Bias ◽

Short Term ◽

Lateral Elbow ◽

Long Term Follow Up ◽

Wait And See ◽

Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

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349 Cognitive Behavioral Therapy for Insomnia in Patients with Chronic Pain - A Systematic Review and Meta-Analysis

SLEEP ◽

10.1093/sleep/zsab072.348 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A139-A140

Author(s):

Janannii Selvanathan ◽

Chi Pham ◽

Mahesh Nagappa ◽

Philip Peng ◽

Marina Englesakis ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Behavioral Therapy ◽

Cancer Pain ◽

Behavioral Therapy ◽

Meta Analysis ◽

Post Treatment ◽

Cognitive Behavioral ◽

Comorbid Insomnia ◽

Patient Reported

Abstract Introduction Patients with chronic non-cancer pain often report insomnia as a significant comorbidity. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first line of treatment for insomnia, and several randomized controlled trials (RCTs) have examined the efficacy of CBT-I on various health outcomes in patients with comorbid insomnia and chronic non-cancer pain. We conducted a systematic review and meta-analysis on the effectiveness of CBT-I on sleep, pain, depression, anxiety and fatigue in adults with comorbid insomnia and chronic non-cancer pain. Methods A systematic search was conducted using ten electronic databases. The duration of the search was set between database inception to April 2020. Included studies must be RCTs assessing the effects of CBT-I on at least patient-reported sleep outcomes in adults with chronic non-cancer pain. Quality of the studies was assessed using the Cochrane risk of bias assessment and Yates quality rating scale. Continuous data were extracted and summarized using standard mean difference (SMD) with 95% confidence intervals (CIs). Results The literature search resulted in 7,772 articles, of which 14 RCTs met the inclusion criteria. Twelve of these articles were included in the meta-analysis. The meta-analysis comprised 762 participants. CBT-I demonstrated a large significant effect on patient-reported sleep (SMD = 0.87, 95% CI [0.55–1.20], p < 0.00001) at post-treatment and final follow-up (up to 9 months) (0.59 [0.31–0.86], p < 0.0001); and moderate effects on pain (SMD = 0.20 [0.06, 0.34], p = 0.006) and depression (0.44 [0.09–0.79], p= 0.01) at post-treatment. The probability of improving sleep and pain following CBT-I at post-treatment was 81% and 58%, respectively. The probability of improving sleep and pain at final follow-up was 73% and 57%, respectively. There were no statistically significant effects on anxiety and fatigue. Conclusion This systematic review and meta-analysis showed that CBT-I is effective for improving sleep in adults with comorbid insomnia and chronic non-cancer pain. Further, CBT-I may lead to short-term moderate improvements in pain and depression. However, there is a need for further RCTs with adequate power, longer follow-up periods, CBT for both insomnia and pain, and consistent scoring systems for assessing patient outcomes. Support (if any):

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Long-term outcomes of psychological treatment for posttraumatic stress disorder: a systematic review and meta-analysis

Psychological Medicine ◽

10.1017/s003329172100163x ◽

2021 ◽

pp. 1-11

Author(s):

Maxi Weber ◽

Sarah Schumacher ◽

Wiebke Hannig ◽

Jürgen Barth ◽

Annett Lotzin ◽

...

Keyword(s):

Systematic Review ◽

Depressive Symptoms ◽

Stress Disorder ◽

Psychological Treatment ◽

Meta Analysis ◽

Effect Sizes ◽

Long Term Outcomes ◽

Psychological Treatments

Abstract Several types of psychological treatment for posttraumatic stress disorder (PTSD) are considered well established and effective, but evidence of their long-term efficacy is limited. This systematic review and meta-analysis aimed to investigate the long-term outcomes across psychological treatments for PTSD. MEDLINE, Cochrane Library, PTSDpubs, PsycINFO, PSYNDEX, and related articles were searched for randomized controlled trials with at least 12 months of follow-up. Twenty-two studies (N = 2638) met inclusion criteria, and 43 comparisons of cognitive behavioral therapy (CBT) were available at follow-up. Active treatments for PTSD yielded large effect sizes from pretest to follow-up and a small controlled effect size compared with non-directive control groups at follow-up. Trauma-focused treatment (TFT) and non-TFT showed large improvements from pretest to follow-up, and effect sizes did not significantly differ from each other. Active treatments for comorbid depressive symptoms revealed small to medium effect sizes at follow-up, and improved PTSD and depressive symptoms remained stable from treatment end to follow-up. Military personnel, low proportion of female patients, and self-rated PTSD measures were associated with decreased effect sizes for PTSD at follow-up. The findings suggest that CBT for PTSD is efficacious in the long term. Future studies are needed to determine the lasting efficacy of other psychological treatments and to confirm benefits beyond 12-month follow-up.

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