Computer-Navigated versus Conventional Total Knee Arthroplasty: A Meta-Analysis of Functional Outcomes from Level I and II Randomized Controlled Trials

2019 ◽  
Author(s):  
Brian Zhaojie Chin ◽  
Victor Mun Hin Seck ◽  
Nicholas Li-Xun Syn ◽  
Ian Jun Yan Wee ◽  
Sharon Si Heng Tan ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Change Scores ◽  
Outcome Scores ◽  
Long Term Follow Up ◽  
Level I ◽  
Quality Evidence

AbstractThe main purpose of this article is to provide an up-to-date systematic review and meta-analysis comparing functional outcomes of total knee arthroplasty using either computer navigation (NAV-TKA) or conventional methods (CON-TKA) from the latest assemblage of evidence. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology guidelines. All Level I and II randomized controlled trials (RCTs) in PubMed, EMBASE, and Cochrane that compared functional outcomes after NAV- and CON-TKA were included in the review. Selected end points for random effects, pairwise meta-analysis included Knee Society Knee Score (KSKS), KS Function Score (KSFS), KS Total Score (KSTS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and range of motion at three arbitrary follow-up times. A total of 24 prospective RCTs comprising 3,778 knees were included from the initial search. At long-term follow-up (>5 years), NAV-TKA exhibited significantly better raw KSKS (p = 0.001) (low-quality evidence), contrary to CON-TKA, which reflected significantly better raw KSTS (p = 0.004) (high-quality evidence). While change scores (KSKS, WOMAC) from preoperative values favor CON-TKA at short-term (<6 months) and medium-term follow-up (6–60 months), long-term follow-up change scores in KSKS suggest the superiority of NAV-TKA over CON-TKA (p = 0.02) (very low-quality evidence). Overall, sizeable dispersion of nonstatistically significant functional outcomes in the medium term was observed to eventually converge in the long term, with less differences in functional outcome scores between the two treatment methods in short- and long-term follow-up. While raw functional outcome scores reflect no differences between NAV and CON-TKA, long-term follow-up change scores in KSKS suggest superiority of NAV-TKA over its conventional counterpart. Prospective studies with larger power are required to support the pattern of diminishing differences in functional outcome scores from medium- to long-term follow-up between the two modalities.

scholarly journals Does structural integrity following rotator cuff repair affect functional outcomes and pain scores? A meta-analysis

2017 ◽  
Vol 10 (3) ◽  
pp. 163-169 ◽  
Author(s):  
Aziz Haque ◽  
Harvinder Pal Singh
Keyword(s):  
Rotator Cuff ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Constant Score ◽  
Meta Analysis ◽  
Pain Scores ◽  
Outcome Scores ◽  
Cuff Repair ◽  
Shoulder Score

Background To assess whether the integrity of rotator cuff repairs has an impact on functional outcomes, as well as pain scores, after surgery. Methods Systematic review and meta-analyses performed for Level Ι, ΙΙ and ΙΙΙ studies that presented functional outcome scores and radiological assessment of integrity following rotator cuff repair. Extracted data included patient demographics, functional outcome scores [Constant Score, University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) shoulder score, visual analogue scale (VAS) Pain score], as well as assessment of repair integrity on radiological investigations. A meta-analysis was performed using weighted means and a random effects model. Results Twelve studies were included in the final analysis. Average re-tear rate for the 800 included patients was 22% at a mean follow-up of 27.5 months after surgery. Patients with intact repairs had a significantly higher Constant Score (8.61 points, p < 0.00001), UCLA shoulder score (2.96 points, p < 0.0001) and ASES shoulder score (9.49 points, p < 0.0006). Patients with intact repairs also reported lower pain VAS Pain scores by 0.62 points ( p < 0.0004) Conclusions Our results show better functional outcome and pain scores in patients with intact rotator cuffs at follow-up when compared to those that have re-torn. This difference is equivalent to the published Minimal Clinically Important Difference for the ASES but not Constant Scores. This review has also highlighted that shoulder strength in patients with intact cuff repairs is likely to be greater than in patients with a failed repair.

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

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.

Scaphoid Nonunion Is a Disabling Problem in a Military Population

Hand ◽  
2021 ◽  
pp. 155894472110031
Author(s):  
Nicholas H. Lake ◽  
Rafae Khan ◽  
Kyle W. Mombell ◽  
Mary Fergus ◽  
Dominic Gomez-Leonardelli
Keyword(s):  
Functional Outcome ◽  
Military Service ◽  
Functional Outcomes ◽  
High Rate ◽  
Scaphoid Nonunion ◽  
Military Population ◽  
Outcome Scores ◽  
The Mean ◽  
Return To Duty

Background Scaphoid nonunion can occur in up to 55% of displaced scaphoid fractures. Long-term functional outcomes of this injury are lacking. In addition, no study has published rate of return to active military service after this injury. Our goal was to educate providers and patients on expected functional outcomes and return to duty after treatment of scaphoid nonunion. Methods We conducted a retrospective review of patients who underwent scaphoid nonunion repair at our institution from 2008 to 2017. The primary outcome measures were union rates, return to duty rates, and functional outcome scores obtained by telephone call. A total of 144 patients were included and 40 responded to our call for long-term follow-up. Results A total of 72% of patients achieved union after surgery, 18% required revision surgery, and 74% of patients were able to return to full duty after surgery. However, this number progressively decreased at 1, 2, and 5 years after surgery. At an average of 5.9 years after surgery, the mean Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score was 23.9. The mean qDASH for patients who achieved union (21.9) was significantly lower than those with persistent nonunion (29.2) ( P = .0115). Conclusion Scaphoid nonunion is a difficult problem in the military. We found a high rate of persistent nonunion often requiring revision to partial or full wrist arthrodesis. In addition, our long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. This information can help us better counsel our patients and set expectations after treatment of this injury.

Abstract TP127: Mortality and Recurrence in Atherosclerotic Ischemic Stroke: Long-term Follow-up

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Miguel A Barboza ◽  
Rodrigo Uribe ◽  
Fabiola Serrano ◽  
Luis C Becerra-Pedraza ◽  
D. K Mantilla-Barbosa ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Median Time ◽  
Smoking History ◽  
Stroke Recurrence ◽  
Active Smoking ◽  
Long Term Outcome ◽  
Long Term Follow Up

Background and purpose: Atherosclerotic ischemic stroke is the second most frequent etiology of stroke in the adult population. Functional outcome, mortality and recurrence of stroke rates on the long-term follow-up are poorly studied. This study investigates long-term outcome among patients with ischemic stroke secondary to atherosclerotic causality, and identifies the main factors associated with poor outcome, recurrence, and death. Methods: We analyzed data from our consecutive acute ischemic stroke database, over a period of 25 years (1990-2015). The endpoints were: bad outcome (Modified Rankin Score ≥3), recurrence and mortality at discharge, and final follow-up. Multivariate Cox and Kaplan-Meier analysis were used to estimate the probability of death and recurrence. Results: A total of 946 consecutive atherosclerotic stroke patients were included (571 [60.4%] males, median age 65 years [interquartile range 57-73 years] for the entire population); dyslipidemia (64.2%), hypertension (63.3%), diabetes (35.0%), and active smoking history (31.8%) were the most prevalent risk factors.After a median follow-up of 38 months (IQR 12-75 months), 59.3% patients had a bad outcome at discharge. A result of 26.1% had stroke recurrence (median time until recurrence: 9 months [IQR 12-84 months], with 12.9% cases presenting ≥2 recurrences), and 24.1% were dead (median time to death: 18.5 months [IQR 11-74 months]) at the final follow-up period. After multivariate adjustment, hypertension (HR 4.2, CI 95% 2.8-6.1; p<0.001) was the strongest predictor of recurrence. Additionally, diabetes (HR 2.6, CI 95% 2.0-3.5; p<0.001), bad functional outcome after recurrence (HR 2.3, CI 95% 1.9-2.9; p<0.001), age ≥65 years (HR 2.2, CI 95% 1.7-2.9; p<0.001), and active smoking (HR 1.8, CI 95% 1.3-2.3; p<0.001) were the strongest predictors of mortality. Conclusions: Atherosclerotic ischemic stroke has a high rate of recurrence, associated mainly with hypertension. Mortality is predicted by diabetes, bad functional outcome at recurrence, and older age.

scholarly journals Outcome and Complications of MR Guided Focused Ultrasound for Essential Tremor: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Mohit Agrawal ◽  
Kanwaljeet Garg ◽  
Raghu Samala ◽  
Roopa Rajan ◽  
Vikas Naik ◽  
...  
Keyword(s):  
Essential Tremor ◽  
Focused Ultrasound ◽  
Rating Scale ◽  
Meta Analysis ◽  
Post Procedure ◽  
Standard Mean Difference ◽  
Significant Difference ◽  
Long Term Follow Up

Background: Magnetic resonance guided focused ultrasound (MRgFUS) is a relatively novel technique to treat essential tremor (ET). The objective of this review was to analyze the efficacy and the safety profile of MRgFUS for ET.Methods: A systematic literature review was done. The post procedure changes in the Clinical Rating Scale for Tremor (CRST) score, hand score, disability and quality of life scores were analyzed.Results: We found 29 studies evaluating 617 patients. DTI based targeting was utilized in six cohorts. A significant difference was observed in the pooled standard mean difference between the pre and postoperative total CRST score (p-value &lt; 0.001 and 0.0002), hand score (p-value 0.03 and 0.02); and the disability at 12 months (p-value 0.01). Head pain and dizziness were the most in procedure complications. The immediate pooled proportion of ataxia was 50%, while it was 20% for sensory complications, which, respectively, declined to 31 and 13% on long term follow up. A significant reduction (p = 0.03) in immediate ataxia related complications was seen with DTI targeting.Conclusion: MRgFUS for ET seems to be an effective procedure for relieving unilateral tremor. Use of DTI based targeting revealed a significant reduction in post procedure ataxia related complications as compared to traditional targeting techniques. Analysis of other complications further revealed a decreasing trend on follow up.

Correlation of Neotongue Volume Changes With Functional Outcomes After Long-Term Follow-Up of Total Glossectomy

2010 ◽  
Vol 21 (1) ◽  
pp. 111-116 ◽  
Author(s):  
In Sik Yun ◽  
Dong Won Lee ◽  
Won Jai Lee ◽  
Dae Hyun Lew ◽  
Eun Chang Choi ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Volume Changes ◽  
Long Term Follow Up

Total Knee Replacement in Young, Active Patients. Long-Term Follow-up and Functional Outcome*

1997 ◽  
Vol 79 (4) ◽  
pp. 575-82 ◽  
Author(s):  
DAVID R. DIDUCH ◽  
JOHN N. INSALL ◽  
W. NORMAN SCOTT ◽  
GILES R. SCUDERI ◽  
DAVID FONT-RODRIGUEZ
Keyword(s):  
Total Knee Replacement ◽  
Functional Outcome ◽  
Knee Replacement ◽  
Long Term Follow Up ◽  
Total Knee ◽  
Active Patients

Long-Term Effects of Decompressive Craniectomy on Functional Outcomes after Traumatic Brain Injury: A Multicenter Study

2018 ◽  
Vol 84 (8) ◽  
pp. 1314-1318 ◽  
Author(s):  
Eliza Moskowitz ◽  
Claudia I. Melendez ◽  
Julie Dunn ◽  
Abid D. Khan ◽  
Richard Gonzalez ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Confidence Interval ◽  
Functional Outcome ◽  
Decompressive Craniectomy ◽  
Functional Outcomes ◽  
Structured Interview ◽  
Good Functional Outcome

Decompressive craniectomy (DC) is a surgical modality sometimes used in the management of elevated intracranial pressure. Questions remain as to its long-term benefits in traumatic brain injury patients. The extended Glasgow Outcome Scale (eGOS) is a scoring system based on a structured interview that allows for consistent and reproducible measurement of long-term functional outcomes. The purpose of this study was to determine the eGOS score of post-craniectomy patients after discharge and stratify survivors based on outcome. A multicenter review of patients who underwent DC was performed. Survivors underwent a phone survey at which time the eGOS was calculated. Patients with an eGOS ≥ 5 were considered to have a good functional outcome. Fifty-four patients underwent DC. Age (OR 1.038; confidence interval 1.003–1.074) and Glasgow Coma Scale (OR 0677; confidence interval 0.527–0.870) were predictors of mortality. Patients who were available for follow-up (n = 13) had poor functional outcomes at discharge (eGOS = 3); however, this improved at the time of follow-up survey (eGOS = 5; P = 0.005). DC is a controversial operation with high mortality and uncertain benefit. Among our cohort, the eGOS score was significantly higher at follow-up survey than it was at discharge. Although the mortality was high, if patients survived to discharge, most had a good functional outcome at follow-up survey.

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