Interposition Arthroplasty in the Treatment of End-Stage Hallux Rigidus: A Systematic Review

2021 ◽  
pp. 193864002110539
Author(s):  
Francesco Di Caprio ◽  
Massimiliano Mosca ◽  
Francesco Ceccarelli ◽  
Silvio Caravelli ◽  
Marco Di Ponte ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hallux Rigidus ◽  
Prosthetic Replacement ◽  
Interposition Arthroplasty ◽  
Level Of Evidence ◽  
Advantages And Disadvantages ◽  
Number Of Patients ◽  
Pubmed Search ◽  
End Stage

Purpose Patients affected by moderate to severe hallux rigidus may opt for interposition arthroplasty to avoid the movement restrictions of arthrodesis and the complications related to prosthetic replacement. The propose of this article was to review the current literature about interposition arthroplasty to examine the overall outcomes and to evaluate the advantages and disadvantages of different types of technique, compared with more consolidated procedures. Methods A literature PubMed search was performed. Studies reporting the results of interposition arthroplasty in moderate to severe hallux rigidus were included. The data were pooled and weighted for number of patients in every study. Results The overall results for interposition arthroplasties are comparable to other alternatives for end-stage hallux rigidus, providing better plantar load distribution than arthrodesis and avoiding the drawbacks of prosthetic replacement. Among the various interposition arthroplasty techniques, the Modified Oblique Keller Capsular Interposition Arthroplasty technique preserves toe length and flexor hallucis brevis function, showing the highest satisfaction rate, with lowest metatarsalgia and revision rate. Conclusion Although long-term randomized controlled trials are lacking for interposition arthroplasty, it represents a valid alternative for the treatment of end-stage hallux rigidus also in the young active patient who wants to avoid a definitive intervention immediately. Level of evidence III (systematic review of level III-IV-V studies)

scholarly journals Outcomes Following Interposition Arthroplasty of the First Metatarsophalangeal Joint for the Treatment of Hallux Rigidus: A Systematic Review

2019 ◽  
Vol 4 (2) ◽  
pp. 247301141881442 ◽  
Author(s):  
Brendan R. Emmons ◽  
Dominic S. Carreira
Keyword(s):  
Systematic Review ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Cochrane Central Register ◽  
Interposition Arthroplasty ◽  
Level Of Evidence ◽  
First Metatarsophalangeal Joint ◽  
Number Of Patients ◽  
Long Term Follow Up

Background: Interposition arthroplasty of the first MTP joint has recently experienced renewed interest as a treatment for hallux rigidus. The purpose of this study was to systematically review the rapidly expanding literature on PRO following interposition arthroplasty of the first MTP joint. Methods: PubMed Central, Embase, and the Cochrane Central Register for Controlled Trials (CENTRAL) were searched. Inclusion criteria included length of time to follow-up, number of patients, outcome measure, and use of allogeneic or autogenous soft tissue or a synthetic matrix as interposition. Results: 20 studies were included in the review, comprising 498 patients and 539 feet with mean time to follow-up of 4.5 years. The most common substance used for interposition in the included studies was autogenous first MTPJ capsular tissue, a technique reported on in 12 (60.0%) of the included articles. In studies reporting preoperative and postoperative outcomes by way of a standardized outcome scoring system, mean group improvements exceed minimal clinically important differences in the majority of studies. Eighty-five percent of the studies included in this review were of Level IV quality evidence, and of this subset of studies, 70.6% were of a retrospective nature. Progression to further surgery was observed in 3.8% of toes. The most common complication reported was transfer metatarsalgia of 1 or more lesser toes, observed in up to 57.9% of patients in one study. Conclusion: Interposition arthroplasty appears to be a viable option for the treatment of moderate to severe hallux rigidus in patients looking to salvage motion through the first metatarsophalangeal joint. A wide array of autogenous, allogeneic, and synthetic implant materials have surfaced in recent years, but long-term follow-up and prospective, comparative study designs with low risk of bias are limited. Level of Evidence: Level IV, systematic review of Level III-IV studies

scholarly journals Proposed treatment algorithm for hallux rigidus

2021 ◽  
Vol 15 (3) ◽  
pp. 205-207
Author(s):  
Mario Herrera-Perez ◽  
David González-Martín ◽  
Ramón Viladot-Pericé
Keyword(s):  
Systematic Review ◽  
Hyaluronic Acid ◽  
Gold Standard ◽  
Treatment Algorithm ◽  
Case Series ◽  
Stage Iv ◽  
Metatarsophalangeal Joint ◽  
Hallux Rigidus ◽  
Interposition Arthroplasty ◽  
Level Of Evidence

This study performs a literature review on the treatment of hallux rigidus and proposes a treatment algorithm.This literature systematic review expanded a similar study conducted in 2014 by the authors and analyzed the levels of recommendation according to scientific evidence.Most articles found in the search present scarce evidence (level IV or case series), we only found 8 articles with an at least moderate level of recommendation (B); of these, only one article had a level of evidence I.Conservative treatment is effective with the implementation of footwear modifications, use of insoles, and infiltrations with hyaluronic acid. Cheilectomy, either isolated or combined with Moberg osteotomy, shows good outcomes in stage III, or moderate, although its outcomes worsen after 5 years. Metatarsophalangeal joint (MTPJ) arthrodesis is still the gold standard in stage IV, or advanced. In recent years, the technique of interposition arthroplasty has re-emerged, especially with the use of a synthetic cartilage implant (Cartiva®), with outcomes at least similar to those of MTPJ arthrodesis in comparative studies. Level of Evidence III; Therapeutic Studies; Systematic Review of Level III Studies.

Additional appointments and discomfort associated with compliance-free fixed Class II corrector treatment: a systematic review

2018 ◽  
Vol 41 (4) ◽  
pp. 404-414 ◽  
Author(s):  
Ashley Phuong ◽  
Nathalia Carolina Fernandes Fagundes ◽  
Sahar Abtahi ◽  
Mary Roduta Roberts ◽  
Paul W Major ◽  
...  
Keyword(s):  
Systematic Review ◽  
Selection Process ◽  
Grey Literature ◽  
Class Ii ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Low Level ◽  
Weak Recommendation ◽  
Number Of Patients ◽  
Cross Sectional Studies

Summary Objective A critical analysis of the literature to determine the prevalence and type of emergency/additional appointments, and discomfort levels associated with fixed Class II correctors. Methods Studies examining patient’s sources of discomfort or emergency appointments associated with compliance-free Class II correctors were included. Comprehensive searches up to July 2018 were conducted using the following databases: MEDLINE (OvidSP), PubMed, Web of Science, and Embase. A partial grey literature search was taken using Google Scholar and OpenGrey. Two reviewers independently performed the selection process and risk of bias assessment. The Newcastle-Ottawa Scale for cross-sectional studies were used. A summary of the overall strength of evidence was presented using ‘Grading of Recommendations, Assessment, Development and Evaluation’ (GRADE) tool. Included studies were evaluated according to their design, study quality, consistency, and directness. Results The selected studies were published between 2001 and 2018, and the number of patients per studied group ranged from 8 to 182. One thousand five hundred forty-two patients were evaluated in total. The patients’ mean age at start of treatment ranged from 10 to 16.9 years and the fixed Class II corrector treatment duration ranged from 4 to 12 months. The included studies in this systematic review were too clinically heterogeneous (different appliances, different data recollection processes) to justify a meta-analysis. Limitations This review was not previously registered. A low level of evidence was observed among the two randomized trials, the 10 cohorts and three cross-sectional studies identified. Conclusions The main source of discomfort from Forsus-type appliances appears to be soreness in the cheeks (low level of evidence with a weak recommendation strength). Most evaluated patients treated with a Herbst appliance, regardless of design, will experience complications (fractures and/or dislodging) requiring emergency appointments (low level of evidence with a weak recommendation strength). Registration The review protocol was not registered.

Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? — A systematic review and meta-analysis

2019 ◽  
Vol 25 (5) ◽  
pp. 571-579 ◽  
Author(s):  
Harshadkumar A. Patel ◽  
Rishi Kalra ◽  
John L. Johnson ◽  
Samuel R. Huntley ◽  
Eva J. Lehtonen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Hallux Rigidus ◽  
Viable Option ◽  
Interposition Arthroplasty

scholarly journals A Systematic Review of Randomized Trials of Long-Term Opioid Management for Chronic Non-Cancer Pain

2011 ◽  
Vol 3;14 (2;3) ◽  
pp. 91-121
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Opioid Therapy ◽  
Functional Improvement ◽  
Controlled Trials ◽  
Chronic Opioid Therapy ◽  
Level Of Evidence

Background: Even though opioids have been used for pain for thousands of years, opioid therapy for chronic non-cancer pain is controversial due to concerns regarding the long-term effectiveness and safety, particularly the risk of tolerance, dependance, or abuse. While the debate continues, the use of chronic opioid therapy for chronic non-cancer pain has increased exponentially. Even though evidence is limited, multiple expert panels have concluded that chronic opioid therapy can be effective therapy for carefully selected and monitored patients with chronic non-cancer pain. Study Design: A systematic review of randomized trials of opioid management for chronic noncancer pain. Objective: The objective of this systematic review is to evaluate the clinical efficacy of opioids in the treatment of chronic non-cancer pain. Methods: A comprehensive evaluation of the literature relating to opioids in chronic non-cancer pain was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs) and Jadad criteria. A literature search was conducted by using PubMed, EMBASE, Cochrane library, ECRI Institute Library, U.S. Food and Drug Administration (FDA) website, U.S. National Guideline Clearinghouse (NGC), Database of Abstracts of Reviews of Effectiveness (DARE), clinical trials, systematic reviews and cross references from systematic reviews. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF) and used by other systematic reviews and guidelines. Outcome Measures: Pain relief was the primary outcome measure. Other outcome measures were functional improvement, withdrawals, and adverse effects. Results: Based on the USPSTF criteria, the indicated level of evidence was fair for Tramadol in managing osteoarthritis. For all the drugs assessed, including Tramadol, for all other conditions, the evidence was poor based on either weak positive evidence, indeterminate evidence, or negative evidence. Limitations: A paucity of literature, specifically with follow-up beyond 12 weeks for all types of opioids with controlled trials for various chronic non-cancer pain conditions. Conclusions: This systematic review illustrated fair evidence for Tramadol in managing osteoarthritis with poor evidence for all other drugs and conditions. Thus, recommendations must be based on non-randomized studies. Key words: Chronic non-cancer pain, opioids, opioid efficacy, opioid effectiveness, significant pain relief, functional improvement, adverse effects, morphine, hydrocodone, hydromorphone, fentanyl, tramadol, buprenorphine, methadone, tapentadol, oxycodone, oxymorphone, systematic reviews, randomized trials

Oral Status of Elderly Patients in Long-Term Care Facilities: A Systematic Review

2020 ◽  
Author(s):  
Juan Antonio Ruiz-Roca ◽  
Dora Martin-Fuentes ◽  
Yolanda Martinez-Beneyto ◽  
Ricardo Elias Oñate-Sanchez
Keyword(s):  
Systematic Review ◽  
Health Status ◽  
Oral Health ◽  
Elderly Patients ◽  
Soft Tissues ◽  
Oral Health Status ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Term Care

Abstract Background: elderly patients who spend long periods hospitalised or those who are in a situation of institutionalisation represent a risk group in this regard, since many of them suffer a degree of dependence and need help to perform the basic personal care tasks. It is therefore important to learn more about the oral health status of this group of patients in order to make a proper assessment of the situation as well as to develop protocols for its management. The purpose of this study was to conduct a systematic review to ascertain the oral health status of elderly patients institutionalised or hospitalised for a long period of time.Methods: a systematic review of the literature published in three different databases (PubMed, Embase and Cochrane Library) was conducted, with 12 different combinations of keywords based on the following selection criteria: studies published in the last 5 years, in English and/or Spanish and/or Portuguese, with samples of ≥30 patients, performed in patients older than 65 years, admitted to any type of institution and/or care centre for at least 7 days and in which the state of hard and/or soft tissues of the oral cavity were assessed in some way. The selected articles were subjected to a thorough analysis.Results: The search strategy covered 1,014 articles: 689 from Pubmed and 325 from Cochrane Library. After applying the eligibility criteria, five articles were selected for our review. The level of evidence of the articles was3, with a sample consisting of 773 patients in which most of them were women with an average age older than 70 years old.Conclusions: the oral health of patients aged more than 65 is worse than that of the rest of the population. Long-term in hospitals or being institutionalised in a retirement home makes this group susceptible to a worsening of their oral health status. It is necessary to develop protocols for the oral health care of these patients, accompanied by training programmes for the personnel.

scholarly journals Allograft Tendon Interposition Arthroplasty of the Hallux Metatarsophalangeal Joint: A Technique Guide and Literature Review

2018 ◽  
Vol 40 (1) ◽  
pp. 113-119 ◽  
Author(s):  
Troy S. Watson ◽  
Jordan Panicco ◽  
Amit Parekh
Keyword(s):  
Soft Tissue ◽  
Metatarsophalangeal Joint ◽  
Joint Space ◽  
Hallux Rigidus ◽  
Senior Author ◽  
Bone Tunnel ◽  
Interposition Arthroplasty ◽  
Level Of Evidence ◽  
Tissue Handling ◽  
Tendon Interposition

The “anchovy” interpositional arthroplasty technique can be used as a salvage option for failed hallux rigidus procedures. The operative technique utilized by the senior author is described. Careful soft-tissue handling, meticulous joint space and graft preparation, and interposition graft stabilization using a bone tunnel and suture anchors are unique aspects of this technique, which in the authors’ experience have contributed to improved outcomes. Current literature regarding indications and outcomes is limited and controversial. The proposed benefits of soft-tissue interposition arthroplasty of the hallux metatarsophalangeal joint for patients with prior failed implant arthroplasty are improved pain scores and preservation of range of motion. Level of Evidence: Level V, technique guide.

scholarly journals Obesity and 1-Year Mortality in Adults After Sepsis: A Systematic Review

2019 ◽  
Vol 22 (1) ◽  
pp. 103-113
Author(s):  
Jamie Robinson ◽  
Theresa Swift-Scanlan ◽  
Jeanne Salyer
Keyword(s):  
Systematic Review ◽  
Obesity Paradox ◽  
Obese Patients ◽  
Sepsis Mortality ◽  
Number Of Patients ◽  
Comprehensive Search ◽  
Nonobese Patients ◽  
Comprehensive Search Strategy ◽  
Long Term Mortality

Purpose: In recent years, researchers have noted an “obesity paradox,” where individuals with obesity survive sepsis at higher rates than their nonobese counterparts. This systematic review summarizes the literature on studies examining the association between obesity and 1-year mortality among patients admitted with sepsis, severe sepsis, or septic shock. Materials and Methods: Using a comprehensive search strategy, a systematic review was conducted to identify studies examining the association of obesity and sepsis mortality. PubMed, Cumulative Index of Nursing and Allied Health Literature, and Elton B. Stephens Company host databases were searched for the terms sepsis, obesity, mortality, and adult. Results: The initial search identified 189 studies, 9 of which met inclusion criteria. Of these, four provided evidence that obese or very obese patients with sepsis have lower mortality than nonobese patients. Methodologic differences in the remaining five studies, which reported conflicting results, limit generalizability. Conclusion: This systematic review on the association of obesity and sepsis mortality found three studies that demonstrated lower sepsis mortality among obese patients in the first 30 days and one showing that this protective effect extends up to 1 year. Given the increased number of patients surviving sepsis, it is important to consider long-term mortality and further describe the variables associated with increased survival.

scholarly journals Evaluation of the Meniscal repair in Bucket handle. Systematic review

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
Damián Bustos ◽  
Lucas Marangoni ◽  
Pablo Bertiche ◽  
Javier Núñez ◽  
Iván Bitar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Meniscal Repair ◽  
Level Of Evidence ◽  
Meniscal Lesions ◽  
Number Of Patients ◽  
Bibliographic Search ◽  
Rate Of Failure ◽  
Bucket Handle

Introduction: Faced with a bucket meniscal lesion we have two treatment options. A frequently practiced option is to remove the bucket handle, another is to repair it. Generally, they are associated with ligament injuries. In this context, it has been shown that meniscal repair has a good result, but the evolution of isolated meniscal repairs is not entirely clear. The purpose of this systematic review is to determine the results after the repair of bucket handle injuries. Materials and Methods: A bibliographic search of the computerized database was carried out pubmed. Eight articles were included according to the inclusion and exclusion criteria. The results of interest included, level of evidence, number of patients, follow-up, average age, surgical technique,% cure,% failure, complications, associated injuries and average time from injury to surgical repair. Results: The works studied, on average, 43 patients, with ages between 16 and 33 years making 341 patients. The follow-up period was focused on 58 months. The percentage of cure varies from 52% to 98%. Conclusion: The isolated repair of this type of meniscal lesions has a good overall evolution associated with a low rate of failure and complications Level of evidence: IV Type of study systematic review

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