Meniscus repair failure risk does not differ by sex: a systematic review

2020 ◽  
Vol 5 (2) ◽  
pp. 98-102
Author(s):  
Christopher Hamilton ◽  
David C Flanigan ◽  
Kishan H Patel ◽  
Nathaniel Lundy ◽  
Ryan Blackwell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Reported Outcomes ◽  
Meniscus Repair ◽  
Published Data ◽  
Level Of Evidence ◽  
Female Patients ◽  
Failure Risk ◽  
Significant Difference ◽  
Patient Reported ◽  
Meta Analyses

ImportanceMeniscus tears are common knee pathologies that are frequently treated with meniscus repair with a variety of techniques. Regardless of technique and implant choice, it is critical to understand and consider patient factors, including patient sex, which can influence outcome.ObjectiveWe sought to determine if there is an effect of sex on failure risk following meniscus repair.Evidence reviewA systematic review of the literature was undertaken to identify studies that reported failure risk independently for male and female patients. Meta-analyses were performed to identify the effect of patient sex on meniscus repair failure risk. Differences in patient-reported outcomes by sex were reported qualitatively.FindingsA total of 886 patients analysed were included in the 11 identified studies, including 556 males and 330 females. Meniscus repair failure was reported in 192 patients (21.7%). The failure risk was 21.1% in males and 21.5% in females. Meta-analyses demonstrated no significant difference in meniscus repair failure risk based on sex in neither the three studies that assessed repair success arthroscopically (p=0.66) nor the eight studies in which failure was defined with clinical assessment or as the need for repeat surgery (p=0.92).Conclusions and relevanceThere are no significant differences in meniscus repair failure risk in male versus female patients in the existing literature. More published data are needed to evaluate patient-reported outcomes of meniscus repair based on sex.Level of evidenceIV, systematic review.

scholarly journals Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes

Cartilage ◽  
2019 ◽  
pp. 194760351987085 ◽  
Author(s):  
Anthony Fiegen ◽  
Devin P. Leland ◽  
Christopher D. Bernard ◽  
Aaron J. Krych ◽  
Jonathan D. Barlow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Reported Outcomes ◽  
Glenohumeral Joint ◽  
Meta Analysis ◽  
Treatment Options ◽  
Surgical Techniques ◽  
Cartilage Defects ◽  
Imaging Findings ◽  
Level Of Evidence ◽  
Patient Reported

Objective To report radiographic and magnetic resonance imaging findings, patient-reported outcomes, and complications and/or reoperations following nonarthroplasty surgical intervention for focal glenohumeral cartilage defects. Design A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they possessed a chondral defect of the humeral head, glenoid, or both, which had been treated with a joint preserving nonarthroplasty procedure. Risk of bias assessment was performed using the Methodological Index for Non-Randomized Studies scoring system. Study demographics, surgical technique, imaging findings, patient-reported outcomes, complications, failures, and reoperations were collected. Results Fourteen studies with 98 patients (100 shoulders) met the inclusion criteria. Patient ages ranged from 7 to 74 years. The nonarthroplasty surgical techniques utilized included microfracture (67 shoulders), osteochondral transplantation (28 shoulders), chondrocyte transplantation (4 shoulders), and internal fixation (1 shoulder). The rates of radiographic union and progression of osteoarthritis ranged between 90% to 100% and 57% to 100%, respectively. Visual analog scores ranged from 0 to 1.9 at final follow-up. Mean postoperative ASES (American Shoulder and Elbow Surgeons) shoulder scores ranged from 75.8-100. Mean postoperative CSS (Constant Shoulder Score) scores ranged from 83.3-94. Mean postoperative SSV (Subjective Shoulder Value) ranged from 70% to 99%. Failure and reoperation rates ranged between 0% to 35% and 0% to 30%, respectively, with the most common reoperation being conversion to prosthetic arthroplasty. Conclusions In this systematic review, nonarthroplasty surgical techniques demonstrated acceptable rates of radiographic healing, improved patient reported outcomes, minimal complications, and low rates of failure or reoperation. Joint preserving techniques are likely viable options to prolong function of the native shoulder and provide short- to midterm pain relief in young and highly active patients. Level of Evidence Level IV.

scholarly journals Platelet-Rich Plasma Augmentation for Isolated Arthroscopic Meniscal Repairs Leads to Significantly Lower Failure Rates: A Systematic Review of Comparative Studies

2020 ◽  
Vol 8 (11) ◽  
pp. 232596712096453
Author(s):  
Kyle R. Sochacki ◽  
Marc R. Safran ◽  
Geoffrey D. Abrams ◽  
Joseph Donahue ◽  
Constance Chu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Odds Ratio ◽  
Patient Reported Outcomes ◽  
Platelet Rich Plasma ◽  
Meniscal Repair ◽  
Activity Level ◽  
Failure Rates ◽  
Significant Difference ◽  
Patient Reported ◽  
Variable Data

Background: Studies have reported relatively high failure rates of isolated meniscal repairs. Platelet-rich plasma (PRP) has been suggested as a way to increase growth factors that enhance healing. Purpose: To compare (1) meniscal repair failures and (2) patient-reported outcomes after isolated arthroscopic meniscal repair augmented with and without PRP. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Multiple databases were searched for studies that compared outcomes of isolated arthroscopic meniscal repair augmented with PRP versus without PRP in human patients. Failures and patient-reported outcome scores were reported for each study and compared between groups. Study heterogeneity was assessed using I 2 for each outcome measure before meta-analysis. Study methodological quality was analyzed. Continuous variable data were reported as mean and standard deviation from the mean. Categorical variable data were reported as frequency with percentage. All P values were reported with significance set at P < .05. Results: Five articles were analyzed (274 patients [110 with PRP and 164 without PRP]; 65.8% male; mean age, 29.1 ± 4.6 years; mean follow-up, 29.2 ± 22.1 months). The risk of meniscal repair failure ranged from 4.4% to 26.7% for PRP-augmented repairs and 13.3% to 50.0% for repairs without PRP. Meniscal repairs augmented with PRP had significantly lower failure rates than repairs without PRP (odds ratio, 0.32; 95% CI, 0.12-0.90; P = .03). One of the 5 studies reported significantly higher outcomes in the PRP-augmented group versus the no-PRP group for the International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee injury and Osteoarthritis Outcome Score (KOOS) ( P < .05 for all). The remaining 4 studies reported no significant difference between groups with regard to outcomes for the IKDC, Lysholm knee scale, visual analog scale for pain, or Tegner activity level. Conclusion: Although the studies were of mostly of low quality, isolated arthroscopic meniscal repairs augmented with PRP led to significantly lower failure rates (10.8% vs 27.0%; odds ratio, 0.32; P = .03) as compared with repairs without PRP. However, most studies reported no significant differences in patient-reported outcomes.

scholarly journals Preoperative optimisation in fast-track and enhanced recovery after surgery (ERAS) programs for total hip and knee joint replacement: a systematic review protocol

2021 ◽  
Author(s):  
Wei-Ju Chang ◽  
Justine Naylor ◽  
Victor Liu ◽  
Masiath Monuja ◽  
Sam Adie
Keyword(s):  
Systematic Review ◽  
Hospital Readmission ◽  
Patient Reported Outcomes ◽  
Fast Track ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Risk Of Bias ◽  
Total Hip ◽  
Patient Reported ◽  
Meta Analyses

ABSTRACTIntroductionEmerging evidence suggests that fast-track and enhanced recovery after surgery (ERAS) targeting modifiable risk factors reduce complications after total hip (THR) and knee replacement (TKR). However, what constitutes an effective preoperative optimisation protocol for THR and TKR remains unclear. The aims are to: (1) describe pre-operative optimisation protocols for THR and TKR; (2) evaluate the effects of pre-operative optimisation protocols for THR and TKR on morbidity, and patient-reported outcomes.Methods and analysisSystematic review and meta-analysis. Electronic databases will be searched using pre-determined search terms to identify relevant studies and evaluate the study eligibility and risks of bias. Two independent reviewers will select the eligible studies and any disagreement will be resolved through a third reviewer. We will include studies investigated pre-operative optimisation protocols administered prior to participants receiving primary THR or TKR to improve post-operative outcomes. Primary outcomes are hospital readmission, complications and patient-reported pain and function. Risk of bias will be assessed using the Cochrane RoB 1 tool and strength of evidence will be examined using the GRADE approach. Pre-operative optimisation protocols will be summarised qualitatively. Meta-analyses on the effects of included protocols will be conducted if appropriate.Ethics and disseminationThis systematic review does not require ethics approval. The findings will be disseminated in a peer-reviewed journal and presented at relevant conferences.RegistrationThis protocol has been submitted to the International Prospective Register of Systematic Reviews on 30 August 2021.ARTICLE SUMMARYStrength and LimitationsThis systematic review aims to describe pre-operative optimisation protocols for total hip and knee replacement and to synthesise evidence for the effects of pre-operative optimisation protocols on hospital readmission, complications and patient-reported outcomes.Two independent reviewers will conduct study selection, data extraction and risk of bias assessment.Meta-analyses, sub-group and sensitivity analyses will be performed where appropriate.

The popularity of outcome measures used in shoulder arthroplasty literature

2020 ◽  
pp. 175857322093586
Author(s):  
Fady Y Hijji ◽  
Thomas G Cheslik ◽  
Andrew D Schneider ◽  
Blake M Schach ◽  
Indresh Venkatarayappa
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Shoulder Arthroplasty ◽  
Patient Reported Outcomes ◽  
Reverse Shoulder Arthroplasty ◽  
Specific Measure ◽  
Level Of Evidence ◽  
Shoulder Hemiarthroplasty ◽  
Patient Reported ◽  
Disease Specific

Introduction Patient-reported outcomes (PROs) are frequently utilized within orthopaedics to determine the extent of patient disease and the efficacy of surgical treatments. Shoulder arthroplasty is a common treatment option for a range of pathologies; however, substantial variety exists regarding the instruments used within the published literature, limiting their quality and generalizability. The purpose of the present systematic review is to evaluate the overall number and frequency of outcome measures used in all clinical studies evaluating outcomes following shoulder arthroplasty. Methods This systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies that assessed patient reported outcomes following total shoulder arthroplasty, reverse shoulder arthroplasty, and shoulder hemiarthroplasty were obtained from PubMed, MEDLINE, and EMBASE databases. For each manuscript, the journal, authors, region of origin, level of evidence, and subject/pathology were recorded. The frequency of each reported outcome measure and category. Associations between study characteristics and measure categories were tested using Poisson regression with robust error variance. Results A total of 682 articles were included in the analysis, reporting 42 different PROs. The most popular tools were the Constant-Murley score (49.7%), the American Shoulder and Elbow Surgeons Evaluation Form (37.7%), and the Visual Analog Scale (34.3%). A generic outcome tool was used in 287 studies (42.1%), while 645 (94.6%) utilized a shoulder-specific measure and 49 (7.2%) used a disease-specific measure. The use of generic (p<0.001) and disease specific (p<0.001) measures were associated with higher level of evidence. Conclusion Studies assessing patient outcomes following shoulder arthroplasty employ a large range of PRO measuring tools, many of which are non-validated. Furthermore, only a small percentage of studies utilize a combination of tools from different categories despite current recommendations. Consensus on validated and clinically-meaningful tools from multiple categories is necessary to increase the generalizability and applicability of published studies in shoulder arthroplasty literature. Level of Evidence 1

Revision Anterior Cruciate Ligament Reconstruction Outcomes at a Minimum of 5-Year Follow-Up: A Systematic Review

2018 ◽  
Vol 32 (03) ◽  
pp. 218-221 ◽  
Author(s):  
Lea Johnson ◽  
Robert Brophy ◽  
Ljiljana Bogunovic ◽  
Matthew Matava ◽  
Matthew Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Patient Reported Outcomes ◽  
Cruciate Ligament ◽  
Level Of Evidence ◽  
Revision Acl Reconstruction ◽  
Patient Reported ◽  
Anterior Cruciate

AbstractRevision anterior cruciate ligament (ACL) reconstruction typically has worse outcomes than primary reconstructions. Minimal long-term data exist regarding 5-year results. We chose to perform a systematic review to evaluate midterm (5-year) revision ACL reconstruction outcomes (patient-reported outcomes, reoperation, stability, arthritis) in comparison to primary ACL reconstructions at similar time points. Embase, Cochrane, and PubMed databases were queried, and four studies met the inclusion criteria. Two authors reviewed and performed data extraction. All were level 4 studies. Review of the studies demonstrated that results at 5 years are consistently worse than those noted in primary reconstructions for objective and patient-reported outcomes. Revision ACL reconstruction outcomes remain worse than primary reconstructions at midterm 5-year follow-up. The level of evidence is 4.

A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis

2019 ◽  
Vol 30 (5) ◽  
pp. 513-522
Author(s):  
Satish Babu ◽  
Prashant Singh ◽  
Anatole Wiik ◽  
Oliver Shastri ◽  
Khalid Malik ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Total Hip Replacements ◽  
Significant Difference ◽  
Patient Reported ◽  
Hip Replacements ◽  
Meta Analyses

Introduction: Short stem hip replacements may allow preservation of proximal bone stock and minimise soft tissue disruption, easing future revision surgery. However patient satisfaction with these implants must be determined before widespread use. We aimed to compare patient reported outcome measures (PROMs) between short and conventional stem hip replacements. Methods: A systematic review was conducted according to PRISMA guidelines for studies comparing short and conventional stem hip replacements with validated PROMs. Meta-analyses were performed for studies reporting Harris Hip and WOMAC scores. Study bias was assessed with the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Results: 24 studies, incorporating 2593 total hip replacements were included for qualitative analysis. 17 studies were included in the meta-analyses. Of the 7 excluded, 1 study reported the Japanese Orthopaedic Association score and 2 others reported the Oxford Hip score. All three showed no difference between the stems. A meta-analysis of 17 studies reporting Harris hip scores showed no statistically significant difference between short and conventional stems (standard mean difference (SMD) −0.06, 95% CI −0.20—0.07, p = 0.35). 6 studies reported WOMAC scores with higher scores indicating worse outcome. No difference was seen between the two groups (SMD 0.21, 95%CI, −0.01—0.42, p = 0.06). 4 studies reported higher WOMAC scores as better. Once again, a meta-analysis showed no statistically significant difference between the stems (SMD 0.28, 95% CI −0.07—0.63, p = 0.12). Conclusions: Our systematic review showed no difference in PROMs between short and conventional stem total hip replacements. This is in keeping with previous evidence but is a more comprehensive analysis. Short stems may have an important role in younger individuals as they allow preservation of proximal femoral bone, minimal access surgery and are amenable to abnormal anatomy. The current literature is hindered by non-uniform methodologies and outcome assessments across studies. Further, standardised, high quality evidence is required before widespread changes in practice.

Are Oxinium Femoral Heads Superior to Alternative Bearing Surface Materials? A Systematic Review

2020 ◽  
Vol 4 (03) ◽  
pp. 142-148
Author(s):  
Anthony H. Zou ◽  
James E. Feng ◽  
David Novikov ◽  
Casey M. O'Connor ◽  
Afshin A. Anoushiravani ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stainless Steel ◽  
Patient Reported Outcomes ◽  
Linear Wear ◽  
Level Of Evidence ◽  
Wear Rates ◽  
Patient Reported ◽  
Femoral Heads ◽  
Bearing Materials ◽  
Alternative Bearing

AbstractOxidized zirconium (OxZr) femoral heads were developed to emulate the superior wear and scratch properties of ceramics while eliminating their unwanted tendency for brittle fracturing. Studies using OxZr have demonstrated reduced linear and volumetric wear of polyethylene (PE) liners when compared with cobalt chrome, ceramic, and steel femoral heads. The purpose of this systematic review was to determine the difference in revision rates, radiologically determined linear wear rates, and patient-reported outcomes among OxZr and alternative bearing materials. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis protocols, a systematic review of published literature through April 24, 2018 was conducted. Among the 862 cases included at a mean weighted follow-up of 4.78 years, the revision THA rate and patient-reported outcomes were similar among OxZr and alternative bearing materials. One of the five studies demonstrated significantly lower linear wear rates in the OxZr group when paired with ultrahigh molecular-weight PE (OxZr 0.03 mm/y vs. stainless-steel 0.11 mm/y; p < 0.001) and when paired with highly-crosslinked PE (OxZr 0.02 mm/y vs. stainless-steel 0.04 mm/y; p < 0.001). The remaining four studies found no difference in linear wear rates. OxZr demonstrated similar outcome to that of modern-day ceramic and metal femoral heads for short- and mid-term revision surgery rates and patient-reported outcomes. Longer term studies are needed to evaluate if any long-term wear advantages are seen with the use of OxZr femoral heads and if the use of OxZr is cost effective compared with ceramic or metal alternatives. The level of evidence of the study is level II, systematic review.

Enhanced Recovery Experience After Orthopaedic Surgery: A Systematic Review of Patient-Reported Outcomes

2019 ◽  
pp. 108-112
Author(s):  
Muath Alturkistani ◽  
Ali Alahmari ◽  
Hussam Alhumaidi ◽  
Mohammed Alharbi ◽  
Alhanouf Alqernas ◽  
...  
Keyword(s):  
Systematic Review ◽  
Orthopaedic Surgery ◽  
Patient Reported Outcomes ◽  
Enhanced Recovery ◽  
Patient Reported

The Patient-Reported Outcomes Measurement Information System in spine surgery: a systematic review

2019 ◽  
Vol 30 (3) ◽  
pp. 405-413 ◽  
Author(s):  
Brittany E. Haws ◽  
Benjamin Khechen ◽  
Mundeep S. Bawa ◽  
Dil V. Patel ◽  
Harmeet S. Bawa ◽  
...  
Keyword(s):  
Systematic Review ◽  
Information System ◽  
Patient Reported Outcomes ◽  
Neck Disability Index ◽  
Measurement Information ◽  
Strong Correlations ◽  
Comprehensive Overview ◽  
Outcomes Measurement ◽  
Patient Reported ◽  
Measurement Information System

OBJECTIVEThe Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to provide a standardized measure of clinical outcomes that is valid and reliable across a variety of patient populations. PROMIS has exhibited strong correlations with many legacy patient-reported outcome (PRO) measures. However, it is unclear to what extent PROMIS has been used within the spine literature. In this context, the purpose of this systematic review was to provide a comprehensive overview of the PROMIS literature for spine-specific populations that can be used to inform clinicians and guide future work. Specifically, the authors aimed to 1) evaluate publication trends of PROMIS in the spine literature, 2) assess how studies have used PROMIS, and 3) determine the correlations of PROMIS domains with legacy PROs as reported for spine populations.METHODSStudies reporting PROMIS scores among spine populations were identified from PubMed/MEDLINE and a review of reference lists from obtained studies. Articles were excluded if they did not report original results, or if the study population was not evaluated or treated for spine-related complaints. Characteristics of each study and journal in which it was published were recorded. Correlation of PROMIS to legacy PROs was reported with 0.1 ≤ |r| < 0.3, 0.3 ≤ |r| < 0.5, and |r| ≥ 0.5 indicating weak, moderate, and strong correlations, respectively.RESULTSTwenty-one articles were included in this analysis. Twelve studies assessed the validity of PROMIS whereas 9 used PROMIS as an outcome measure. The first study discussing PROMIS in patients with spine disorders was published in 2012, whereas the majority were published in 2017. The most common PROMIS domain used was Pain Interference. Assessments of PROMIS validity were most frequently performed with the Neck Disability Index. PROMIS domains demonstrated moderate to strong correlations with the legacy PROs that were evaluated. Studies assessing the validity of PROMIS exhibited substantial variability in PROMIS domains and legacy PROs used for comparisons.CONCLUSIONSThere has been a recent increase in the use of PROMIS within the spine literature. However, only a minority of studies have incorporated PROMIS for its intended use as an outcomes measure. Overall, PROMIS has exhibited moderate to strong correlations with a majority of legacy PROs used in the spine literature. These results suggest that PROMIS can be effective in the assessment and tracking of PROs among spine populations.

scholarly journals Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stefano Granieri ◽  
Francesco Sessa ◽  
Alessandro Bonomi ◽  
Sissi Paleino ◽  
Federica Bruno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Symptoms ◽  
Rare Complication ◽  
Meta Analysis ◽  
Treatment Options ◽  
Palliative Surgery ◽  
Review Of The Literature ◽  
Colovesical Fistula ◽  
Level Of Evidence ◽  
Meta Analyses

Abstract Background Entero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients. Methods A systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran’s Q test were computed to assess inter-studies’ heterogeneity. Results Twenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively. Conclusions Although burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).

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