Skin Closure Tape and Surgical Staples in Primary Total Knee Arthroplasty: A Systematic Review and Meta-Analysis

Background. Staples closure technology has been widely used in total knee arthroplasty (TKA) and achieved good results. In recent years, a new type of material called skin closure tape (SCT) has been applied to TKA which also showed good treatment results. However, since it is still not clear yet which one is better, this paper collects literatures for statistical analysis so as to provide evidence for the use of SCT in TKA. Methods. The comparative study on effects between SCT and staples is reviewed after the primary release of TKA in PubMed, the Cochrane library, and the EMBASE database up to March 2019. The two researchers independently screened the literature and evaluated the quality of the literature using bias risk tools. Results. A total of four studies (3330 knees) have been included in our meta-analysis. For the main point, the results show that the SCT can reduce readmission rates compared to staples (RR 0.68, 95% CI 0.49–0.95, P=0.03), with no significant difference in complications (RR 0.85, 95% CI 0.27–2.64, P=0.77). Secondly, the results suggest that although there is no significant difference in removal time between the two groups, the SCT can reduce pains, save time and costs, and have a better cosmetic effect. Conclusions. Our study indicates SCT as a closure method with fewer complications and faster speed compared with staples. Nevertheless, the cost and pain need to be further confirmed because of the small sample size included in this study.

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Does patellar denervation prevent anterior knee pain and improve patient-reported outcomes in patients undergoing non-resurfaced total knee arthroplasty? an updated meta-analysis of randomized controlled trials.

10.21203/rs.3.rs-26676/v1 ◽

2020 ◽

Author(s):

Hongzhi Liu ◽

Zhaohui Liu ◽

Qidong Zhang ◽

Wanshou Guo

Keyword(s):

Total Knee Arthroplasty ◽

Knee Pain ◽

Knee Arthroplasty ◽

Anterior Knee Pain ◽

Meta Analysis ◽

Cochrane Library ◽

Significant Difference ◽

Patient Reported ◽

Total Knee ◽

Anterior Knee

Abstract Background Anterior knee pain (AKP) is the most common complication of total knee arthroplasty (TKA). It is unclear which procedure of addressing AKP is preferable. Some data suggest patellar denervation (PD) provides effective AKP prevention. The purpose was to assess the effectiveness and safety of PD in primary TKA.Methods A meta-analysis was performed of randomized clinical trials (RCTs) from inception to March 26, 2020, using PubMed, Embase, Web of Science and Cochrane Library. Study-specific RR and MD were aggregated using random or fixed effects models. The outcomes were incidences of AKP, PS (patellar scores), VAS (visual analogue scale), ROM (range of motion), KSS knee (American Knee Society knee scores), KSS function (American Knee Society function scores), incidence of complications and revisions.Results Ten RCTs involving 1196 knees were included. The meta-analysis showed no significant in PD group on the incidence of AKP (RR = 0.64; 95% CI 0.37, 1.11; p = 0.11) with moderate heterogeneity (P < 0.01, I2 = 84%). Our results indicated PD had a significantly better VAS (MD = − 0.25; 95% CI -0.41, -0.09; p < 0.01), ROM (MD = 7.68; 95% CI 0.34, 15.20; p = 0.04) and PS (MD = 0.91; 95% CI 0.36, 1.46; p < 0.01). However, there was no significant difference no matter in KSS knee, KSS function, complications or revisions.Conclusions This meta-analysis showed that no difference in AKP between PD and NPD in patients undergoing non-resurfaced TKA. PD could improve clinical outcome in VAS, post-operative ROM and PS.

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A comparison of thrombosis in total knee arthroplasty with and without a tourniquet: a meta-analysis of randomized controlled trials

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02366-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jia Xie ◽

Hao Yu ◽

Fangyuan Wang ◽

Juehua Jing ◽

Jun Li

Keyword(s):

Clinical Trials ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Level Of Evidence ◽

Significant Difference ◽

Duration Of Surgery ◽

Total Knee

Abstract Background Tourniquets are widely used in total knee arthroplasty (TKA), but the issue of their safety remains controversial. Previous studies have focused on TKA blood loss, duration of surgery, and hemostatic drugs. The purpose of this meta-analysis was to analyze the effect of tourniquet use on postoperative deep venous thrombosis (DVT). Methods PubMed, SCOPUS, Web of Science, Embase, and the Cochrane Library were searched for randomized clinical trials published before April 17, 2020, that compared the effect of tourniquet use on postoperative DVT, knee circumference, D-dimers, and pain measured using the visual analog scale (VAS). Results Fourteen clinical trials that included 1321 unique participants were included in the meta-analysis. Among the total, 721 and 600 participants were randomized to the tourniquet and non-tourniquet groups, respectively. The incidence of postoperative thrombosis in the tourniquet group was significantly higher than in the non-tourniquet group (RR 2.30, 95% CI 1.51–3.49, P < 0.0001, I2 = 0%). On the 1st, 3rd, and 5th to 21st days, and 3 to 6 weeks after surgery, the knee circumference difference of the tourniquet group was significantly larger than that of the non-tourniquet group (P < 0.05). However, 4 to 6 months after the surgery, no significant difference in knee circumference was found between the two groups (MD 0.14, 95% CI −0.02–0.31, P = 0.09, I2 = 0%). The VAS score of the tourniquet group was higher than the non-tourniquet group on the 3rd and 5th days after surgery (P < 0.05). However, this difference was not significant (MD 0.31, 95% CI −0.05–0.66, P = 0.09, I2 = 89%). Conclusion Results of this meta-analysis indicate that tourniquet application could increase the incidence of postoperative DVT and aggravate postoperative pain and swelling in the short term. Level of evidence Level III

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A comparison of thrombosis in total knee arthroplasty with and without a tourniquet: A meta-analysis of randomized controlled trials

10.21203/rs.3.rs-268594/v1 ◽

2021 ◽

Author(s):

Jia Xie ◽

Hao Yu ◽

Fangyuan Wang ◽

Juehua Jing ◽

Jun Li

Keyword(s):

Clinical Trials ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Level Of Evidence ◽

Significant Difference ◽

Duration Of Surgery ◽

Total Knee

Abstract Background Tourniquets are widely used in total knee arthroplasty (TKA), but the issue of their safety remains controversial. Previous studies have focused on TKA blood loss, duration of surgery, and hemostatic drugs. The purpose of this meta-analysis was to analyze the effect of tourniquet use on postoperative deep venous thrombosis (DVT). Methods PubMed, SCOPUS, Web of Science, Embase, and the Cochrane Library were searched for randomized clinical trials published before April 17, 2020 that compared the effect of tourniquet use on postoperative DVT, knee circumference, D-dimers, and pain measured using the visual analogue scale (VAS). Results Fourteen clinical trials that included 1321 unique participants were included in the meta-analysis. Among the total, 721 and 600 participants were randomized to the tourniquet and non-tourniquet groups, respectively. The incidence of postoperative thrombosis in the tourniquet group was significantly higher than in the non-tourniquet group (RR 2.30, 95% CI: 1.51–3.49, P < 0.0001, I2 = 0%). On the 1st, 3rd, and 5th to 21st days, and 3 to 6 weeks after surgery, the knee circumference difference of the tourniquet group was significantly larger than that of the non-tourniquet group (P < 0.05). However, 4 to 6 months after the surgery, no significant difference in knee circumference was found between the two groups (MD 0.14, 95% CI: -0.02-0.31, P = 0.09, I2 = 0%). The VAS score of the tourniquet group was higher than the non-tourniquet group on the 3rd and 5th days after surgery (P < 0.05). However, this difference was not significant (MD 0.31, 95% CI: -0.05-0.66, P = 0.09, I2 = 89%). Conclusion Results of this meta-analysis indicate that tourniquet application could increase the incidence of postoperative DVT and aggravate postoperative pain and swelling in the short term. Level of evidence III.

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Impact of intraoperative medial collateral ligament injury on outcomes after total knee arthroplasty: a meta-analysis and systematic review

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02824-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Jiahao Li ◽

Zijian Yan ◽

Yan Lv ◽

Yijin Li ◽

Pengcheng Ye ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Medial Collateral Ligament ◽

Meta Analysis ◽

Cochrane Library ◽

Collateral Ligament ◽

Postoperative Function ◽

Significant Difference ◽

Total Knee ◽

The Impact

Abstract Background As an uncommon but severe complication, medial collateral ligament (MCL) injury in total knee arthroplasty (TKA) may be significantly under-recognized. We aimed to determine whether MCL injury influences postoperative outcomes of patients undergoing TKA. Methods Two independent reviewers searched PubMed, Cochrane Library, and EMBASE from their inception to July 1, 2021. The main outcomes were postoperative function, and secondary outcomes included the incidences of revision and complications. Results A total of 403 articles yielded 15 studies eligible for inclusion with 10 studies used for meta-analysis. This study found that there was a statistically significant difference in postoperative functional scores, range of motion (ROM), complications, and revision rates, with adverse outcomes occurring more commonly in patients with MCL injury. Conclusions This meta-analysis highlights the complexity of MCL injury during TKA and shows the impact on postoperative function, joint mobility, complications, and revision. Surgeons need to prevent and put more emphasis on MCL injury during TKA.

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Comparison between Zip-Type Skin Closure Device and Staple for Total Knee Arthroplasty: A Meta-Analysis

BioMed Research International ◽

10.1155/2021/6670064 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Peng Tian ◽

Yao-min Li ◽

Zhi-jun Li ◽

Gui-jun Xu ◽

Xin-long Ma

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Controlled Trial ◽

Meta Analysis ◽

Cochrane Library ◽

Closure Device ◽

Skin Closure ◽

Wound Pain ◽

Total Knee ◽

Closure Method

Purpose. To compare the efficacy and safety of zip-type skin closure device (SCD) and staple in total knee arthroplasty (TKA). Methods. Potential academic articles were identified from PubMed, Springer, ScienceDirect, and Cochrane Library from the inception of electronic databases to July 2020. The statistical analyses were performed with RevMan 5.1. Results. One randomized controlled trial (RCT) and 5 non-RCTs met the inclusion criteria. Present meta-analysis reveals that SCD is associated with lower wound pain score, scar score, and readmission compared with a staple. No significant differences are identified in terms of wound total complications, dehiscence, blisters, and infection. Conclusions. Comparing with a staple, zip-type SCD is a less painful skin closure method with fewer medical cost undergoing TKA.

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The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1422-4 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 14

Author(s):

D. F. Cai ◽

Q. H. Fan ◽

H. H. Zhong ◽

S. Peng ◽

H. Song

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Primary Total Knee Arthroplasty ◽

Operation Time ◽

Postoperative Blood Loss ◽

Cochrane Library ◽

Intraoperative Blood Loss ◽

Total Knee

Abstract Background The tourniquet is a common medical instrument used in total knee arthroplasty (TKA). However, there has always been a debate about the use of a tourniquet and there is no published meta-analysis to study the effects of a tourniquet on blood loss in primary TKA for patients with osteoarthritis. Methods We performed a literature review on high-quality clinical studies to determine the effects of using a tourniquet or not on blood loss in cemented TKA. PubMed, Web of Science, MEDLINE, Embase, and the Cochrane Library were searched up to November 2018 for relevant randomized controlled trials (RCTs). We conducted a meta-analysis following the guidelines of the Cochrane Reviewer’s Handbook. We used the Cochrane Collaboration’s tool for assessing the risk of bias of each trial. The statistical analysis was performed with Review Manager statistical software (version 5.3). Results Eleven RCTs involving 541 patients (541 knees) were included in this meta-analysis. There were 271 patients (271 knees) in the tourniquet group and 270 patients (270 knees) in the no tourniquet group. The results showed that using a tourniquet significantly decreased intraoperative blood loss (P < 0.002), calculated blood loss (P < 0.002), and the time of operation (P < 0.002), but tourniquet use did not significantly decrease postoperative blood loss (P > 0.05), total blood loss (P > 0.05), the rate of transfusion (P > 0.05), and of deep vein thrombosis (DVT) (P > 0.05) in TKA. Conclusions Using a tourniquet can significantly decrease intraoperative blood loss, calculated blood loss, and operation time but does not significantly decrease the rate of transfusion or the rate of DVT in TKA. More research is needed to determine if there are fewer complications in TKA without the use of tourniquets.

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Improvement of sleep quality 6 months after total knee arthroplasty: a systematic review and meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02493-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ali Alipourian ◽

Negin Farhadian ◽

Ehsan Zereshki ◽

Habibollah Khazaie

Keyword(s):

Total Knee Arthroplasty ◽

Sleep Quality ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Random Effect Model ◽

Cochrane Library ◽

Significant Difference ◽

Before And After ◽

Total Knee

Abstract Background Total knee arthroplasty (TKA) is an accepted, effective treatment to restore function, relieve pain, and improve the quality of life in patients with advanced osteoarthritis. One complication of this major surgery is impaired sleep quality. This study examines the quality of sleep in patients undergoing TKA before and after their operation. Methods All relevant records were obtained using a systematic search in three online databases: PubMed, Scopus, and Cochrane library. Out of the 177 records retrieved, only eight matched the inclusion criteria. Due to the lack of sufficient data, only four studies entered the meta-analysis. Values reported for sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) were extracted from patient records before and after surgery. A random-effect model was used to analyze the data. Results The results of the meta-analysis show a significant difference in the improvement of sleep quality after surgery at two time points of 4–6 weeks after surgery from the preoperative baseline (SMD − 0.16; 95% CI − 1.05 to 0.74; P = 0.0) and 3–6 months after surgery from the preoperative baseline (SMD − 0.92; 95% CI − 1.61 to − 0.24; P = 0.0). Conclusions The results show that TKA generally improves the patients’ sleep quality. Although some studies reported disrupted sleep quality in periods close to the surgery (especially in the early days after surgery), all studies have reported improved sleep quality in the late postoperative intervals.

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A commentary on “The optimal dosage, route and timing of glucocorticoids administration for improving knee function, pain and inflammation in primary total knee arthroplasty: A systematic review and network meta-analysis of 34 randomized trials” [Int. J. Surg. 82 (2020 Oct) 182–191]

International Journal of Surgery ◽

10.1016/j.ijsu.2021.01.014 ◽

2021 ◽

Vol 87 ◽

pp. 105888

Author(s):

Shijie Lin ◽

Baojin Wu ◽

Yufei Li

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Randomized Trials ◽

Meta Analysis ◽

Primary Total Knee Arthroplasty ◽

Knee Function ◽

Optimal Dosage ◽

Total Knee ◽

Primary Total Knee

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The role of perioperative intravenous low-dose dexamethasone in rapid recovery after total knee arthroplasty: a meta-analysis

Journal of International Medical Research ◽

10.1177/0300060521998220 ◽

2021 ◽

Vol 49 (3) ◽

pp. 030006052199822

Author(s):

Youguang Zhuo ◽

Rongguo Yu ◽

Chunling Wu ◽

Yuting Huang ◽

Jie Ye ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Low Dose ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Opioid Consumption ◽

Cochrane Library ◽

China National Knowledge Infrastructure ◽

Postoperative Rehabilitation ◽

Total Knee

Purpose The purpose of this meta-analysis was to evaluate the overall safety and effectiveness of perioperative intravenous dexamethasone to facilitate postoperative rehabilitation in patients after total knee arthroplasty (TKA). Methods A comprehensive literature search was performed using the Embase, PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for relevant randomized controlled trials (RCTs) from inception to 2020. Methodological quality of the trials was assessed using the Cochrane Risk of Bias Tool, and the relevant data were extracted using a predefined data extraction form. Results Ten RCTs with 1100 knees were included. Our study showed a significant reduction in pain using a postoperative pain visual analog scale (VAS) at 24 hours and 48 hours, total opioid consumption at 24 hours and 48 hours, postoperative nausea and vomiting (PONV), active range of motion (ROM) limitation, and passive ROM limitation at 72 hours in dexamethasone-treated groups compared with controls. Conclusion Intravenous low-dose dexamethasone is potentially useful in the perioperative setting for reducing postsurgical immediate ROM limitations, pain, opioid consumption, and PONV. There are no data that directly attribute an increase in postoperative complications to intravenous dexamethasone. More high-quality studies are necessary to draw these conclusions.

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