scholarly journals Is Knee Joint Distraction a Viable Treatment Option for Knee OA?—A Literature Review and Meta-Analysis

2018 ◽  
Vol 32 (08) ◽  
pp. 788-795 ◽  
Author(s):  
Tsuneari Takahashi ◽  
Thomas G. Baboolal ◽  
Jonathan Lamb ◽  
Thomas W. Hamilton ◽  
Hemant G. Pandit
Keyword(s):  
Systematic Review ◽  
Knee Joint ◽  
Structural Parameters ◽  
Meta Analysis ◽  
Tibial Osteotomy ◽  
Knee Oa ◽  
Pain Scores ◽  
Joint Distraction ◽  
Total Knee ◽  
Level I

AbstractKnee joint distraction (KJD) is a new application of an established technique to regenerate native cartilage using an external fixator. The purpose of this study is to perform a systematic review and meta-analysis of the literature to determine whether KJD is beneficial for knee osteoarthritis and how results compare with established treatments. Studies assessing the outcomes of KJD were retrieved, with three studies (one cohort and two randomized controlled trials), 62 knees, meeting the inclusion criteria. The primary outcome was functional outcome, assessed using a validated outcome score, at 1 year. Secondary outcomes included pain scores, structural assessment of the joint, and adverse events. KJD is associated with improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from baseline to 1 year as well as reductions in pain scores and improvements in structural parameters assessed radiographically and by magnetic resonance imaging. KJD is not associated with decreased knee flexion, but is associated with a high risk of pin site infection. In patients aged 65 years or under at 1 year, no differences in WOMAC or pain scores was detected between patients managed with KJD compared with high tibial osteotomy or total knee arthroplasty. KJD may represent a potential treatment for knee arthritis, though further trials with longer term follow-up are required to establish its efficacy compared with contemporary treatments. This is a Level I (systematic review and meta-analysis) study.

scholarly journals Knee Joint Distraction as Treatment for Osteoarthritis Results in Clinical and Structural Benefit: A Systematic Review and Meta-Analysis of the Limited Number of Studies and Patients Available

Cartilage ◽  
2020 ◽  
pp. 194760352094294
Author(s):  
Mylène P. Jansen ◽  
Tim A.E.J. Boymans ◽  
Roel J.H. Custers ◽  
Rutger C.I. Van Geenen ◽  
Ronald J. Van Heerwaarden ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Joint ◽  
Structural Parameters ◽  
Meta Analysis ◽  
Tibial Osteotomy ◽  
Control Groups ◽  
Joint Distraction ◽  
Short And Long Term

Objective Knee joint distraction (KJD) is a joint-preserving osteoarthritis treatment that may postpone a total knee arthroplasty (TKA) in younger patients. This systematic review and meta-analysis evaluates short- and long-term clinical benefit and tissue structure changes after KJD. Design MEDLINE, EMBASE, and Web of Science were searched for eligible clinical studies evaluating at least one of the primary parameters: WOMAC, VAS-pain, KOOS, EQ5D, radiographic joint space width or MRI cartilage thickness after KJD. Random effects models were applied on all outcome parameters and outcomes were compared with control groups found in the included studies. Results Eleven articles reporting on 7 different KJD cohorts with in total 127 patients and 5 control groups with multiple follow-up moments were included, of which 2 were randomized controlled trials. Significant improvements in all primary parameters were found and benefit lasted up to at least 9 years. Overall, outcomes were comparable with control groups, including high tibial osteotomy, although TKA showed better clinical response. Conclusions Current, still limited, evidence shows KJD causes clear benefit in clinical and structural parameters, both short- and long-term. Longer follow-up with more patients is necessary, to validate outcome and to potentially improve patient selection for this intensive treatment. Thus far, for younger knee osteoarthritis patients, KJD may be an option to consider.

Unicompartmental knee arthroplasty versus High tibial osteotomy in treatment of isolated medial compartment Osteoarthritis of knee: A Systematic Review and MetaAnalysis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ibrahim Mostafa El-Ganzoury ◽  
Zeiad Mohamed Zakaria ◽  
Ahmed Elsayed ◽  
Abd Ellah Elwarwary
Keyword(s):  
Systematic Review ◽  
Total Knee Arthroplasty ◽  
High Tibial Osteotomy ◽  
Knee Arthroplasty ◽  
Unicompartmental Knee Arthroplasty ◽  
Meta Analysis ◽  
Medial Compartment ◽  
Tibial Osteotomy ◽  
Medial Compartment Osteoarthritis ◽  
Total Knee

Abstract Background Several surgical procedures have been mentioned to treat medial compartment osteoarthritis (OA), as total knee arthroplasty (TKA), unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO). Objectives The aim of the study is a systematic review & meta analysis conducted to compare the outcomes between UKA & HTO in different types of patients diagnosed as an isolated medial compartment OA who treated with UKA or HTO and statistically compare between their results of pain, range of motion, complications, and i ncidence of revision to TKA using studies published between 2009 to 2019 from any country. Patients and Methods The review will be restricted to Randomized controlled trials (RCTs), clinical trials, and comparative studies, either prospective or retrospective, which studied the outcome of HTO versus UKA of isolated medial compartment osteoarthritis patients, articles published in English &published during 2009 to 2019. Results About 150 articles were found using search keywords. By filtration and screening of the title and exclusion of unrelated articles, about 60 articles were found. By applications of all inclusion and exclusion criteria, only 12 articles were fit to undergo this meta-analysis. Conclusion In conclusion, there were no significant differences in the pain score, knee score, complication rate and revision rate to TKA between HTO and UKA, while the HTO group manifested superior ROM compared to the UKA group. So, HTO may be convenient for patients with high activity requirements. Over time, both groups exhibited increased revision rates with the deteriorated clinical outcomes. Therefore when deciding on a therapeutic plan, the ability to revise these failed choices of treatment to a total knee arthroplasty should be a major consideration. This may assist surgeons in their choice. Based on the findings of current meta-analysis, it appears that the two groups have the same efficiency and safety in the treatment of medial knee OA.

scholarly journals Knee joint distraction as treatment for osteoarthritis: a systematic review and meta-analysis

2020 ◽  
Vol 28 ◽  
pp. S386-S387
Author(s):  
M. Jansen ◽  
T.A. Boymans ◽  
R.J. Custers ◽  
R.C. Van Geenen ◽  
R.J. Van Heerwaarden ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Joint ◽  
Meta Analysis ◽  
Joint Distraction

A historical cohort of temporal lobe surgery for medically refractory epilepsy: a systematic review and meta-analysis to guide future nonrandomized controlled trial studies

2020 ◽  
Vol 133 (1) ◽  
pp. 71-78 ◽  
Author(s):  
Anthony T. Lee ◽  
John F. Burke ◽  
Pranathi Chunduru ◽  
Annette M. Molinaro ◽  
Robert Knowlton ◽  
...  
Keyword(s):  
Systematic Review ◽  
Temporal Lobe ◽  
Epilepsy Surgery ◽  
Refractory Epilepsy ◽  
Meta Analysis ◽  
Small Sample ◽  
Seizure Freedom ◽  
Level I ◽  
Study Designs ◽  
Medically Refractory Epilepsy

OBJECTIVERecent trials for temporal lobe epilepsy (TLE) highlight the challenges of investigating surgical outcomes using randomized controlled trials (RCTs). Although several reviews have examined seizure-freedom outcomes from existing data, there is a need for an overall seizure-freedom rate estimated from level I data as investigators consider other methods besides RCTs to study outcomes related to new surgical interventions.METHODSThe authors performed a systematic review and meta-analysis of the 3 RCTs of TLE in adults and report an overall surgical seizure-freedom rate (Engel class I) composed of level I data. An overall seizure-freedom rate was also collected from level II data (prospective cohort studies) for validation. Eligible studies were identified by filtering a published Cochrane meta-analysis of epilepsy surgery for RCTs and prospective studies, and supplemented by searching indexed terms in MEDLINE (January 1, 2012–April 1, 2018). Retrospective studies were excluded to minimize heterogeneity in patient selection and reporting bias. Data extraction was independently reverified and pooled using a fixed-effects model. The primary outcome was overall seizure freedom following surgery. The historical benchmark was applied in a noninferiority study design to compare its power to a single-study cohort.RESULTSThe overall rate of seizure freedom from level I data was 72.4% (55/76 patients, 3 RCTs), which was nearly identical to the overall seizure-freedom rate of 71.7% (1325/1849 patients, 18 studies) from prospective cohorts (z = 0.134, p = 0.89; z-test). Seizure-freedom rates from level I and II studies were consistent over the years of publication (R2< 0.01, p = 0.73). Surgery resulted in markedly improved seizure-free outcomes compared to medical management (RR 10.82, 95% CI 3.93–29.84, p < 0.01; 2 RCTs). Noninferiority study designs in which the historical benchmark was used had significantly higher power at all difference margins compared to using a single cohort alone (p < 0.001, Bonferroni’s multiple comparison test).CONCLUSIONSThe overall rate of seizure freedom for temporal lobe surgery is approximately 70% for medically refractory epilepsy. The small sample size of the RCT cohort underscores the need to move beyond standard RCTs for epilepsy surgery. This historical seizure-freedom rate may serve as a useful benchmark to guide future study designs for new surgical treatments for refractory TLE.

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