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

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.

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

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Xiangli Luo ◽  
Wenhui Zhang ◽  
Peijing Yan ◽  
Zongru He ◽  
Yuping Yang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Primary Total Knee Arthroplasty ◽  
Small Sample ◽  
Cochrane Library ◽  
Skin Closure ◽  
Significant Difference ◽  
Total Knee

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.

A Novel Skin Closure Device for Total Knee Arthroplasty: Randomized Controlled Trial versus Staples

2019 ◽  
Vol 33 (11) ◽  
pp. 1116-1120 ◽  
Author(s):  
Rodney W. Benner ◽  
Jonathan P. Behrens
Keyword(s):  
Total Knee Arthroplasty ◽  
Randomized Controlled Trial ◽  
Knee Arthroplasty ◽  
Physical Therapist ◽  
Controlled Trial ◽  
Closure Device ◽  
Skin Closure ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Total Knee

AbstractTwenty-five patients undergoing simultaneous, bilateral total knee arthroplasty (TKA) were randomized to receive skin closure with Zip device on one knee and staples on the other. Patients' pain and scar appearance were rated from 0 (best) to 10 (worst). Knee arc of motion was measured by a physical therapist. At 2 weeks postoperatively, pain scores were significantly better with the Zip device during device wear (p = 0.03) and during device removal (p = 0.003); arc of motion was significantly better with the Zip device (p = 0.002). At 8 weeks of follow-up, scar appearance was significantly better in the Zip device knee as rated by the patients (1.3 vs. 2.6, p = 0.04), the surgeon (1.9 vs. 3.3, p = 0.0006), and three independent plastic surgeons (3.7 vs. 4.8, p < 0.001). Results of this randomized controlled trial show that skin closure with the Zip device resulted in less pain and better scar appearance and knee arc of motion than with staples.

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

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.

scholarly journals Serious adverse events and 30-day hospital readmission rate following elective total knee arthroplasty: a systematic review and meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Costas Papakostidis ◽  
Peter V. Giannoudis ◽  
J. Tracy Watson ◽  
Robert Zura ◽  
R. Grant Steen
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Readmission Rate ◽  
Meta Analysis ◽  
Deep Infection ◽  
Cochrane Library ◽  
Eligibility Criteria ◽  
Serious Adverse Events ◽  
Surgical Methods ◽  
Total Knee

Abstract Background Elective total knee arthroplasty (TKA) is a common surgery which has evolved rapidly. However, there are no recent large systematic reviews of serious adverse event (SAE) rate and 30-day readmission rate (30-dRR) or an indication of whether surgical methods have improved. Methods To obtain a pooled estimate of SAE rate and 30-dRR following TKA, we searched Medline, Web of Science, Cochrane Library, and Google Scholar databases. Data were extracted by two authors following PRISMA guidelines. Eligibility criteria were defined prior to a comprehensive search. Studies were eligible if they were published in 2007 or later, described sequelae of TKA with patient N > 1000, and the SAE or 30-dRR rate could be calculated. SAEs included return to operating room, death or coma, venous thromboembolism (VTE), deep infection or sepsis, myocardial infarction, heart failure or cardiac arrest, stroke or cerebrovascular accident, or pneumonia. Results Of 248 references reviewed, 28 are included, involving 10,153,503 patients; this includes 9,483,387 patients with primary TKA (pTKA), and 670,116 patients with revision TKA (rTKA). For pTKA, the SAE rate was 5.7% (95% CI 4.4−7.2%, I2 = 100%), and the 30-dRR was 4.8% (95% CI 4.3−5.4%, I2 = 100%). For rTKA, the SAE rate was 8.5% (95% CI 8.3−8.7%, I2 = 77%), while the 30-dRR was 7.2% (95% CI 6.4−8.0%, I2 = 81%). Odds of 30-dRR following pTKA were about half that of rTKA (OR 0.57, 95% CI 0.53−0.62%, p < 0.001, I2 = 45%). Of patients who received pTKA, the commonest SAEs were VTE (1.22%; 95% CI 0.83−1.70%) and genitourinary complications including renal insufficiency or renal failure (1.22%; 95% CI 0.83−1.67%). There has been significant improvement in SAE rate and 30-dRR since 2010 (χ2 test < 0.001). Conclusions TKA procedures have a relatively low complication rate, and there has been a significant improvement in SAE rate and 30-dRR over the past decade.

scholarly journals 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.

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.

scholarly journals Comparison of minimally invasive approaches and standard median parapatellar approach for total knee arthroplasty: A systematic review and network meta-analysis of randomized controlled trials

2020 ◽  
pp. 1-18
Author(s):  
Li Zhang ◽  
Xian Li ◽  
Julian M. Rüwald ◽  
Kristian Welle ◽  
Frank A. Schildberg ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Minimally Invasive ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Orthopedic Surgeons ◽  
American Knee Society Score ◽  
Total Knee ◽  
Meta Analyses

BACKGROUND: Minimally invasive total knee arthroplasty (TKA) has been actively advertised by the orthopedic industry. The purpose of this network meta-analysis was to comprehensively compare the effectiveness of four minimally invasive surgery (MIS) approaches and the medial parapatellar (MPP) approach to improve the American Knee Society Score (KSS) in primary TKA. MATERIALS AND METHODS: Studies were comprehensively searched on PubMed, Embase, Cochrane Library (CENTRAL), Web of Science and Science Direct up to June 2018 with a major focus on the outcome of KSS. Risk of bias was assessed using the Cochrane risk of bias tool. Quality assessment was performed using the GRADE system. Both pair-wise and network meta-analyses are calculated to comprehensively compare the effectiveness of four MIS and TKA approaches. RESULTS: Eleven trials with 1025 knees undergoing TKA were included. Our analysis showed that both MPP and MIS approaches provided improvement in terms of short-term (four-eight weeks) total, objective and functional KSS score. The network-meta analysis revealed that MIS approaches showed a trend towards superior KSS improvement over standard MPP approaches. However, statistical advantages were only observed in the mini-MPP group for functional KSS scores when compared with conventional MPP and quadriceps-sparing (QS) group. CONCLUSIONS: Evidence shows that MIS TKA approaches are effective alternatives to MPP approaches. However, orthopedic surgeons should be cautiously optimistic about minimally invasive TKA in terms of KSS improvement.

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

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

scholarly journals Effect of tourniquet application on cement penetration in primary total knee arthroplasty: a meta-analysis

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Shuxin Yao ◽  
Weijie Zhang ◽  
Jianbing Ma ◽  
Jianpeng Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Randomized Controlled Trials ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Cement Penetration ◽  
Total Knee

Abstract Background Tourniquet application is expected to improve surgery exposure and cementation process in total knee arthroplasty (TKA) but its effectiveness remains controversial and needs to be further explored. The aim of this meta-analysis was to assess the effect of tourniquet in primary TKA. The hypothesis is that the tourniquet application affects the cement penetration in TKA. Methods A search was conducted in PubMed, Embase, and the Cochrane Library for the potentially eligible articles. Two independent researchers reviewed the articles retrieved against the pre-designed inclusion and exclusion criteria. In primary TKA, cement penetration was assessed, and the data between the tourniquet-assisted and non-tourniquet-assisted TKAs were compared. Statistical significance was set at P < 0.05. Results A total of 4 randomized controlled trials and 3 non-randomized controlled trials (involving 675 patients) were included. There was no significant difference between the tourniquet-assisted and non-tourniquet-assisted TKAs in terms of cement penetration (P > 0.05). There were no significant differences in the total surgical time, blood loss, blood transfusion, the Knee Society Score, and the visual analogue scale (VAS) between the two kinds of procedures (P > 0.05). Conclusions Tourniquet application may not affect cement penetration in primary TKA and may not help reduce blood loss, ease knee pain or improve the knee function. A surgeon may choose to use a tourniquet or not according to his or her own preference. Level of Evidence Level Ib, meta-analysis.

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