scholarly journals Patient relevant outcomes of unicompartmental versus total knee replacement: systematic review and meta-analysis

BMJ ◽  
2019 ◽  
pp. l352 ◽  
Author(s):  
Hannah A Wilson ◽  
Rob Middleton ◽  
Simon G F Abram ◽  
Stephanie Smith ◽  
Abtin Alvand ◽  
...  
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Total Knee Replacement ◽  
Cohort Studies ◽  
Knee Replacement ◽  
Risk Ratio ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Total Knee ◽  
Randomised Controlled

AbstractObjectiveTo present a clear and comprehensive summary of the published data on unicompartmental knee replacement (UKA) or total knee replacement (TKA), comparing domains of outcome that have been shown to be important to patients and clinicians to allow informed decision making.DesignSystematic review using data from randomised controlled trials, nationwide databases or joint registries, and large cohort studies.Data sourcesMedline, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Clinical Trials.gov, searched between 1 January 1997 and 31 December 2018.Eligibility criteria for selecting studiesStudies published in the past 20 years, comparing outcomes of primary UKA with TKA in adult patients. Studies were excluded if they involved fewer than 50 participants, or if translation into English was not available.Results60 eligible studies were separated into three methodological groups: seven publications from six randomised controlled trials, 17 national joint registries and national database studies, and 36 cohort studies. Results for each domain of outcome varied depending on the level of data, and findings were not always significant. Analysis of the three groups of studies showed significantly shorter hospital stays after UKA than after TKA (−1.20 days (95% confidence interval −1.67 to −0.73), −1.43 (−1.53 to −1.33), and −1.73 (−2.30 to −1.16), respectively). There was no significant difference in pain, based on patient reported outcome measures (PROMs), but significantly better functional PROM scores for UKA than for TKA in both non-trial groups (standard mean difference −0.58 (−0.88 to −0.27) and −0.29 (−0.46 to −0.11), respectively). Regarding major complications, trials and cohort studies had non-significant results, but mortality after TKA was significantly higher in registry and large database studies (risk ratio 0.27 (0.16 to 0.45)), as were venous thromboembolic events (0.39 (0.27 to 0.57)) and major cardiac events (0.22 (0.06 to 0.86)). Early reoperation for any reason was higher after TKA than after UKA, but revision rates at five years remained higher for UKA in all three study groups (risk ratio 5.95 (1.29 to 27.59), 2.50 (1.77 to 3.54), and 3.13 (1.89 to 5.17), respectively).ConclusionsTKA and UKA are both viable options for the treatment of isolated unicompartmental osteoarthritis. By directly comparing the two treatments, this study demonstrates better results for UKA in several outcome domains. However, the risk of revision surgery was lower for TKA. This information should be available to patients as part of the shared decision making process in choosing treatment options.Systematic review registrationPROSPERO number CRD42018089972.

scholarly journals Effectiveness of postdischarge interventions for reducing the severity of chronic pain after total knee replacement: systematic review of randomised controlled trials

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e020368 ◽  
Author(s):  
Vikki Wylde ◽  
Jane Dennis ◽  
Rachael Gooberman-Hill ◽  
Andrew David Beswick
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Total Knee Replacement ◽  
Randomised Controlled Trials ◽  
Risk Of Bias ◽  
Pain Severity ◽  
Controlled Trials ◽  
Registration Number ◽  
Total Knee ◽  
Randomised Controlled

ObjectiveApproximately 20% of patients experience chronic pain after total knee replacement (TKR). The aim of this systematic review was to evaluate the effectiveness of postdischarge interventions commenced in the first 3 months after surgery in reducing the severity of chronic pain after TKR.DesignThe protocol for this systematic review was registered on PROSPERO (registration number: CRD42017041382). MEDLINE, Embase, CINAHL, PsycINFO and The Cochrane Library were searched from inception to November 2016. Randomised controlled trials of postdischarge intervention which commenced in the first 3 months after TKR surgery were included. The primary outcome of the review was self-reported pain severity at 12 months or longer after TKR. Risk of bias was assessed using the Cochrane risk-of-bias tool.ResultsSeventeen trials with data from 2485 randomised participants were included. The majority of trials evaluated physiotherapy interventions (n=13); other interventions included nurse-led interventions (n=2), neuromuscular electrical stimulation (n=1) and a multidisciplinary intervention (n=1). Opportunities for meta-analysis were limited by heterogeneity. No study found a difference in long-term pain severity between trial arms, with the exception of one trial which found home-based functional exercises aimed at managing kinesiophobia resulted in lower pain severity scores at 12 months postoperatively compared with advice to stay active.ConclusionThis systematic review and narrative synthesis found no evidence that one type of physiotherapy intervention is more effective than another at reducing the severity of chronic pain after TKR. Further research is needed to evaluate non-physiotherapy interventions, including the provision of care as part of a stratified and multidisciplinary care package.PROSPERO registration numberCRD42017041382.

The Efficacy and Safety of Pharmacological Prophylaxis of VTE Following Elective Knee or Hip Replacement: Systematic Review and Network Meta-Analysis

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2314-2314
Author(s):  
Ander Cohen ◽  
Drost Pieter ◽  
Nick Marchant ◽  
Stephen Mitchell ◽  
Michelle Orme ◽  
...  
Keyword(s):  
Total Knee Replacement ◽  
Total Hip Replacement ◽  
Knee Replacement ◽  
Major Bleeding ◽  
Hip Replacement ◽  
Orthopaedic Surgery ◽  
Randomised Controlled Trials ◽  
Total Hip ◽  
Total Knee ◽  
Randomised Controlled

Abstract Abstract 2314 Venous thromboembolism (VTE) collectively describes the debilitating, painful and potentially fatal conditions of deep vein thrombosis (DVT) and pulmonary embolism (PE). High-risk surgical procedures can lead to VTE, and patients undergoing major orthopaedic surgery, such as total hip or knee replacement (THR and TKR, respectively), are in the highest risk category for VTE. In the absence of anticoagulant prophylaxis the estimated incidence of DVT following orthopaedic surgery ranges from 40–60%, and the overall risk of fatal PE has been estimated to be between 0.2 and 0.9%. Thromboprophylaxis, both mechanical and pharmacological, is current standard practice for the prevention of VTE in patients undergoing orthopaedic surgery.Currently available anticoagulant therapies such as low molecular weight heparins (LMWHs), which are most commonly used, fondaparinux, and warfarin have demonstrated efficacy but have a number of limitations. LMWHs and fondaparinux require parenteral administration and warfarin has a narrow therapeutic window which is difficult to attain. Apixaban, rivaroxaban and dabigatran are new anti-coagulants for thromboprophylaxis after orthopaedic surgery and have the advantages of oral administration and no requirement for routine laboratory monitoring. We compared the efficacy and safety of apixaban versus other anti-coagulants for the prevention of VTE following total hip replacement and total knee replacement surgery. We systematically searched MEDLINE, EMBASE, the Cochrane library and CINAHL up to July 2010 for randomised controlled trials (RCTs) evaluating apixaban, rivaroxaban, dabigatran, fondaparinux and low molecular weight heparins at European licensed doses. A series of direct and indirect comparisons and a network meta-analysis (NMA) were performed where there were sufficient data for analysis, using enoxaparin as the common control. Indirect comparisons found that dabigatran 220mg od was significantly less efficacious than apixaban 2.5mg bd for the prevention of all VTE and all-cause death in THR patients (OR 2.51; 95% CI 1.50–4.21), and in TKR patients (OR 1.72; 95% CI 1.22–2.42). Rivaroxaban 10mg odwas slightly more effective than apixaban 2.5mg bd in both THR and TKR patients (OR 0.69; 95% CI 0.38–1.25, and OR 0.83; 95% CI 0.57–1.19, respectively), but the differences were not statistically significant. For the incidence of major bleeding the adjusted indirect comparison found that dabigatran 220mg od and rivaroxaban 10mg od had higher, but not statistically significant, bleeding rates compared with apixaban 2.5mg bd. Dabigatran versus apixaban: for THR patients OR 1.13; 95% CI 0.50–2.54 and for TKR patients OR 1.75; 95% CI 0.51–5.99. Rivaroxaban versus apixaban: for THR patients OR 2.48; 95%CI 0.44–13.8 and for TKR patients OR 1.86; 95% CI0.47–7.30. Trials comparing fondaparinux with enoxaparin were only available in THR patients, and for the outcomes any DVT and major bleeding. The adjusted indirect comparison found that fondaparinux 2.5mg od had higher but non-significant rates of any DVT (OR 1.29; 95% CI 0.69–2.43) and major bleeding (OR 1.22; 95% CI 0.56–2.67) compared with apixaban 2.5mg bd. The NMA showedno significant differences between the treatments for the outcomes evaluated. Apixaban, rivaroxaban and dabigatran have demonstrated similar or improved efficacy and similar safety compared with current therapies for the prevention of VTE in patients undergoing orthopaedic surgery. Apixaban may be more effective than dabigatran and similar to rivaroxaban, whilst all three have a comparable safety profile. Considering practical and economic advantages, such as the ease of oral dosing and the substantial reduction in costs related to this, these new anti-coagulants represent an appealing alternative to conventional thromboprophylaxis regimens in patients undergoing THR and TKR surgery and may improve patient compliance and standard of care.Figure 1:Pooled estimates of the results of randomised controlled trials comparing the effects of apixaban, rivaroxaban and dabigatran versus enoxaparin on; the composite of all VTE and all-cause death for patients undergoing (A) total hip replacement and (B) total knee replacement and; major bleeding for patients undergoing (C) total hip replacement and (D) total knee replacementFigure 1:. Pooled estimates of the results of randomised controlled trials comparing the effects of apixaban, rivaroxaban and dabigatran versus enoxaparin on; the composite of all VTE and all-cause death for patients undergoing (A) total hip replacement and (B) total knee replacement and; major bleeding for patients undergoing (C) total hip replacement and (D) total knee replacement Disclosures: Cohen: Pfizer Ltd: Consultancy. Pieter:Pfizer/BMS: Employment. Marchant:Pfizer Ltd: Employment. Mitchell:Pfizer Ltd: Consultancy. Orme:Pfizer Ltd: Consultancy. Simon:BMS: Employment. Sutton:Pfizer Ltd: Consultancy. Rublee:Pfizer Ltd: Employment.

scholarly journals Efficacy of moisturizers in paediatric atopic dermatitis: A systematic review and meta-analysis of randomised controlled trials

2021 ◽  
Vol 0 ◽  
pp. 1-10
Author(s):  
Chawan Kritsanaviparkporn ◽  
Phoomphut Sangaphunchai ◽  
Arucha Treesirichod
Keyword(s):  
Systematic Review ◽  
Atopic Dermatitis ◽  
Confidence Interval ◽  
Risk Ratio ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Young Patients ◽  
Controlled Trials ◽  
Assessment Development ◽  
Randomised Controlled

Background: Topical moisturizer is recommended for atopic dermatitis. Aims: The aim of the study was to investigate the knowledge gap regarding the efficacy of moisturizer in young patients. Methods: A systematic review and meta-analysis were conducted on randomised controlled trials comparing participant’s ≤15 years with atopic dermatitis, receiving either topical moisturizer or no moisturizer treatment. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Results: Six trials were included (intervention n= 436; control n= 312). Moisturizer use extended time to flare by 13.52 days (95% confidence interval 0.05–26.99, I2 88%). Greater reduction in risk of relapse was observed during the first month of latency (pooled risk ratio 0.47, 95% confidence interval 0.31–0.72, I2 28%) compared to the second and third months (pooled risk ratio 0.65, 95% confidence interval 0.47–0.91, I2 35% and pooled risk ratio 0.63, 95% confidence interval 0.47–0.83, I2 33%, respectively).Treated patients were 2.68 times more likely to experience a three–six months remission (95% confidence interval1.18–6.09, I2 56%). Moisturizer minimally improved disease severity and quality of life. Limitations: There is a dire need to conduct randomised controlled trialswith more robust and standardised designs. Conclusion: Moisturizer benefits young patients with atopic dermatitis. However, more research is needed to better estimate its efficacy.

scholarly journals Effects of presurgical interventions on chronic pain after total knee replacement: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033248 ◽  
Author(s):  
Jane Dennis ◽  
Vikki Wylde ◽  
Rachael Gooberman-Hill ◽  
AW Blom ◽  
Andrew David Beswick
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Moderate Quality ◽  
Total Knee ◽  
Randomised Controlled ◽  
Quality Evidence

ObjectiveNearly 100 000 primary total knee replacements (TKR) are performed in the UK annually. The primary aim of TKR is pain relief, but 10%–34% of patients report chronic pain. The aim of this systematic review was to evaluate the effectiveness of presurgical interventions in preventing chronic pain after TKR.DesignMEDLINE, Embase, CINAHL,The Cochrane Libraryand PsycINFO were searched from inception to December 2018. Screening and data extraction were performed by two authors. Meta-analysis was conducted using a random effects model. Risk of bias was assessed using the Cochrane tool and quality of evidence was assessed by Grading of Recommendations Assessment, Development and Evaluation.Primary and secondary outcomesPain at 6 months or longer; adverse events.InterventionsPresurgical interventions aimed at improving TKR outcomes.ResultsEight randomised controlled trials (RCTs) with data from 960 participants were included. The studies involved nine eligible comparisons. We found moderate-quality evidence of no effect of exercise programmes on chronic pain after TKR, based on a meta-analysis of 6 interventions with 229 participants (standardised mean difference 0.20, 95% CI −0.06 to 0.47, I2=0%). Sensitivity analysis restricted to studies at overall low risk of bias confirmed findings. Another RCT of exercise with no data available for meta-analysis showed no benefit. Studies evaluating combined exercise and education intervention (n=1) and education alone (n=1) suggested similar findings. Adverse event data were reported by most studies, but events were too few to draw conclusions.ConclusionsWe found low to moderate-quality evidence to suggest that neither preoperative exercise, education nor a combination of both is effective in preventing chronic pain after TKR. This review also identified a lack of evaluations of other preoperative interventions, such as multimodal pain management, which may improve long-term pain outcomes after TKR.PROSPERO registration numberCRD42017041382.

scholarly journals Effect of reducing total fat intake on body weight: systematic review and meta-analysis of randomised controlled trials and cohort studies

BMJ ◽  
2012 ◽  
Vol 345 (dec06 1) ◽  
pp. e7666-e7666 ◽  
Author(s):  
L. Hooper ◽  
A. Abdelhamid ◽  
H. J. Moore ◽  
W. Douthwaite ◽  
C. M. Skeaff ◽  
...  
Keyword(s):  
Systematic Review ◽  
Body Weight ◽  
Cohort Studies ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Fat Intake ◽  
Total Fat ◽  
Randomised Controlled
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