scholarly journals Lisfranc injuries: fix or fuse?

2021 ◽  
Vol 2 (10) ◽  
pp. 842-849
Author(s):  
Noortje Anna Clasina van den Boom ◽  
Guido A. N. L. Stollenwerck ◽  
Laureanne Lodewijks ◽  
Jeroen Bransen ◽  
Silvia M. A. A. Evers ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Risk Of Bias ◽  
Level Of Evidence ◽  
Assessment Development ◽  
Significant Difference ◽  
Patient Reported ◽  
Mean Differences ◽  
Lisfranc Injuries

Aims This systematic review and meta-analysis was conducted to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA) in the treatment of Lisfranc injuries, regarding patient-reported outcome measures (PROMs), and risk of secondary surgery. The aim was to conclusively determine the best available treatment based on the most complete and recent evidence available. Methods A systematic search was conducted in PubMed, Cochrane Controlled Register of Trials (CENTRAL), EMBASE, CINAHL, PEDro, and SPORTDiscus. Additionally, ongoing trial registers and reference lists of included articles were screened. Risk of bias (RoB) and level of evidence were assessed using the Cochrane risk of bias tools and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. The random and fixed-effect models were used for the statistical analysis. Results A total of 20 studies were selected for this review, of which 12 were comparative studies fit for meta-analysis, including three randomized controlled trials (RCTs). This resulted in a total analyzed population of 392 patients treated with ORIF and 249 patients treated with PA. The mean differences between the two groups in American Orthopedic Foot and Ankle Society (AOFAS), VAS, and SF-36 scores were -7.41 (95% confidence interval (CI) -13.31 to -1.51), 0.77 (95% CI -0.85 to 2.39), and -1.20 (95% CI -3.86 to 1.46), respectively. Conclusion This is the first study to find a statistically significant difference in PROMs, as measured by the AOFAS score, in favour of PA for the treatment of Lisfranc injuries. However, this difference may not be clinically relevant, and therefore drawing a definitive conclusion requires confirmation by a large prospective high-quality RCT. Such a study should also assess cost-effectiveness, as cost considerations might be decisive in decision-making. Level of Evidence: I Cite this article: Bone Jt Open 2021;2(10):842–849.

scholarly journals Medial stabilised total knee arthroplasty achieves comparable clinical outcomes when compared to other TKA designs: a systematic review and meta-analysis of the current literature

2020 ◽  
Author(s):  
Sohail Nisar ◽  
Kashif Ahmad ◽  
Jeya Palan ◽  
Hemant Pandit ◽  
Bernard van Duren
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Implant Design ◽  
Cochrane Central Register ◽  
Rotating Platform ◽  
Level Of Evidence ◽  
Patient Reported

Abstract Purpose The purpose of this study was to perform a systematic review and meta-analysis to compare clinical and patient-reported outcome measures of medially stabilised (MS) TKA when compared to other TKA designs. Methods The Preferred Reporting Items for Systematic Review and Meta-Analyses algorithm was used. The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and EMCARE databases were searched to June 2020. Studies with a minimum of 12 months of follow-up comparing an MS TKA design to any other TKA design were included. The statistical analysis was completed using Review Manager (RevMan), Version 5.3. Results The 22 studies meeting the inclusion criteria included 3011 patients and 4102 TKAs. Overall Oxford Knee Scores were significantly better (p = 0.0007) for MS TKA, but there was no difference in the Forgotten Joint Scores (FJS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Society Score (KSS)-Knee, KSS-Function, and range of motion between MS and non-MS TKA designs. Significant differences were noted for sub-group analyses; MS TKA showed significantly worse KSS-Knee (p = 0.02) and WOMAC (p = 0.03) scores when compared to Rotating Platform (RP) TKA while significantly better FJS (p = 0.002) and KSS-knee scores (p = 0.0001) when compared to cruciate-retaining (CR) TKA. Conclusion This review and meta-analysis show that MS TKA designs result in both patient and clinical outcomes that are comparable to non-MS implants. These results suggest implant design alone may not provide further improvement in patient outcome following TKA, surgeons must consider other factors, such as alignment to achieve superior outcomes. Level of evidence III.

Kinematically Aligned Total Knee Arthroplasty Did Not Show Superior Patient-Reported Outcome Measures: An Updated Meta-analysis of Randomized Controlled Trials with at Least 2-Year Follow-up

2020 ◽  
Author(s):  
Shuhei Hiyama ◽  
Tsuneari Takahashi ◽  
Katsushi Takeshita
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Clinical Results ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Significant Difference ◽  
Patient Reported ◽  
Total Knee

AbstractKinematically aligned total knee arthroplasty (KATKA) was developed to improve the anatomical alignment of knee prostheses, assisting in restoring the native alignment of the knee and promoting physiological kinematics. Early clinical results were encouraging, showing better functional outcomes than with mechanically aligned total knee arthroplasty (MATKA). However, there have been concerns about implant survival, and follow-up at 10 years or more has not been reported. In addition, randomized controlled trials (RCTs) comparing KATKA with MATKA have reported inconsistent results. The current meta-analysis of RCTs with a minimum of 2 years of follow-up investigated the clinical and radiological differences between KATKA and MATKA. A systematic review of the English language literature resulted in the inclusion of four RCTs. The meta-analysis found no significant difference in any of the following parameters: postoperative range of motion for flexion (mean difference for KATKA − MATKA [MD], 1.7 degrees; 95% confidence interval [CI], −1.4 to 4.8 degrees; p = 0.29) and extension (MD, 0.10 degrees; 95% CI, −0.99 to 1.2 degrees; p = 0.86); Oxford Knee Score (MD, 0.10 points; 95% CI, −1.5 to 1.7 points; p = 0.90); Knee Society Score (MD, 1.6 points; 95% CI, −2.8 to 6.0 points; p = 0.49); and Knee Function Score (MD, 1.4 points; 95% CI, −4.9 to 7.8 points; p = 0.66). In addition, there was no significant difference between KATKA and MATKA in the rate of complications requiring reoperation or revision surgery (odds ratio, 1.01; 95% CI, 0.25–4.09; p = 0.99) or in the length of hospital stay (MD, 1.0 days; 95% CI, −0.2 to 2.2 days; p = 0.092). KATKA did not increase the number of patients with poor clinical results due to implant position, particularly for varus placement of the tibial component. In this meta-analysis based on four RCTs with a minimum of 2 years of follow-up, KATKA were only relevant to cruciate retaining TKA and could not be extrapolated to posterior stabilized TKA. Patient-reported outcome measures with KATKA were not superior to those with MATKA.

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.

Nonresponder bias in hand surgery: analysis of 1945 cases lost to follow-up over a 6-year period

2021 ◽  
pp. 175319342110456
Author(s):  
Paul H. C. Stirling ◽  
Paul J. Jenkins ◽  
Nathan Ng ◽  
Nicholas D. Clement ◽  
Andrew D. Duckworth ◽  
...  
Keyword(s):  
Postoperative Outcome ◽  
Hand Surgery ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Level Of Evidence ◽  
Loss To Follow Up ◽  
Significant Difference ◽  
Patient Reported ◽  
The Impact

The primary aim of this study was to identify factors associated with nonresponse to routinely collected patient-reported outcome measures (PROMs) after hand surgery. The secondary aim was to investigate the impact of nonresponder bias on postoperative PROMs. We identified 4357 patient episodes for which the patients received pre- and 1-year postoperative questionnaires. The response rate was 55%. Univariate and regression analyses were undertaken to determine factors predicting nonresponse. We developed a predictive model for the postoperative Quick version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores for nonresponders using imputation. Younger age, increasing deprivation, higher comorbidity, worse preoperative QuickDASH scores and unemployment predicted nonresponse. No significant difference in mean postoperative QuickDASH score was observed between the responders, and the scores for the responders combined with the predicted scores for the nonresponders. Preoperative function was the primary predictor of postoperative outcome. These results challenge the dogma that ‘loss to follow-up’ automatically invalidates the results of a study. Level of evidence: III

The Use of Postoperative Antibiotics Following Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Systematic Review and Meta-analysis

2021 ◽  
pp. 194589242198914
Author(s):  
Chloe E. Swords ◽  
Jeremy J. Wong ◽  
Kara N. Stevens ◽  
Alkis J. Psaltis ◽  
Peter J. Wormald ◽  
...  
Keyword(s):  
Adverse Events ◽  
Chronic Rhinosinusitis ◽  
Outcome Measures ◽  
Endoscopic Sinus Surgery ◽  
Meta Analysis ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Sinus Surgery ◽  
Significant Difference ◽  
Patient Reported

Background Endoscopic sinus surgery is performed for medically recalcitrant chronic rhinosinusitis. There is no universally accepted strategy regarding post-operative antibiotics despite the high rates of usage worldwide. The aim of this study was to analyse patient-reported and objective outcomes behind antibiotic use following endoscopic sinus surgery. Methods A search of electronic databases was performed. Eligible randomised controlled trials (RCTs) and observational trials were included. The primary outcome was patient reported outcome measures. Secondary outcomes were local infections, endoscopy scores and adverse events. Meta-analysis was performed. Results Of 1045 publications identified, 7 were included in the qualitative synthesis and 5 RCTs were included in meta-analysis. Antibiotic regimens varied between studies in terms of antibiotic selection, timing commenced and duration of use. Meta-analysis suggested no significant difference between placebo and antibiotics in patient reported outcome measures (standardised mean difference (SMD) –0.215, 95% confidence interval (CI) –0.637 to 0.207) or endoscopic scores (SMD –2.86, 95% CI –0.846 to 0.273). There was no consistent definition in reporting of infection; therefore, this outcome cannot be comprehensively considered. No severe adverse events were attributable to antibiotics. Conclusions From the studies analysed, there is no level 1 evidence to suggest that antibiotics improved patient outcomes following sinus surgery. However, there was significant heterogeneity in outcome measures and no clear data exists regarding the effects of antibiotics on postoperative infections. The available evidence at present is not enough to make a recommendation in either direction. Further designed larger RCTs are required to investigate these questions in more detail.

scholarly journals Enabling patient-reported outcome measures in clinical trials, exemplified by cardiovascular trials

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Theresa M. Coles ◽  
Adrian F. Hernandez ◽  
Bryce B. Reeve ◽  
Karon Cook ◽  
Michael C. Edwards ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Outcome Measures ◽  
Contextual Factors ◽  
The United States ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Think Tank ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Evidentiary Standards

Abstract Objectives There has been limited success in achieving integration of patient-reported outcomes (PROs) in clinical trials. We describe how stakeholders envision a solution to this challenge. Methods Stakeholders from academia, industry, non-profits, insurers, clinicians, and the Food and Drug Administration convened at a Think Tank meeting funded by the Duke Clinical Research Institute to discuss the challenges of incorporating PROs into clinical trials and how to address those challenges. Using examples from cardiovascular trials, this article describes a potential path forward with a focus on applications in the United States. Results Think Tank members identified one key challenge: a common understanding of the level of evidence that is necessary to support patient-reported outcome measures (PROMs) in trials. Think Tank participants discussed the possibility of creating general evidentiary standards depending upon contextual factors, but such guidelines could not be feasibly developed because many contextual factors are at play. The attendees posited that a more informative approach to PROM evidentiary standards would be to develop validity arguments akin to courtroom briefs, which would emphasize a compelling rationale (interpretation/use argument) to support a PROM within a specific context. Participants envisioned a future in which validity arguments would be publicly available via a repository, which would be indexed by contextual factors, clinical populations, and types of claims. Conclusions A publicly available repository would help stakeholders better understand what a community believes constitutes compelling support for a specific PROM in a trial. Our proposed strategy is expected to facilitate the incorporation of PROMs into cardiovascular clinical trials and trials in general.

scholarly journals Return to Sport After Large Single-Surface, Multisurface, or Bipolar Osteochondral Allograft Transplantation in the Knee Using Shell Grafts

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712096792
Author(s):  
James L. Cook ◽  
Kylee Rucinski ◽  
Cory R. Crecelius ◽  
Richard Ma ◽  
James P. Stannard
Keyword(s):  
Femoral Condyle ◽  
Case Series ◽  
Return To Sport ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Osteochondral Allograft ◽  
Level Of Evidence ◽  
Recreational Athletes ◽  
Patient Reported

Background: Return to sport (RTS) after osteochondral allograft (OCA) transplantation for large unipolar femoral condyle defects has been consistent, but many athletes are affected by more severe lesions. Purpose: To examine outcomes for athletes who have undergone large single-surface, multisurface, or bipolar shell OCA transplantation in the knee. Study Design: Case series; Level of evidence, 4. Methods: Data from a prospective OCA transplantation registry were assessed for athletes who underwent knee transplantation for the first time (primary transplant) between June 2015 and March 2018 for injury or overuse-related articular defects. Inclusion criteria were preinjury Tegner level ≥5 and documented type and level of sport (or elite unit active military duty); in addition, patients were required to have a minimum of 1-year follow-up outcomes, including RTS data. Patient characteristics, surgery type, Tegner level, RTS, patient-reported outcome measures (PROMs), compliance with rehabilitation, revisions, and failures were assessed and compared for statistically significant differences. Results: There were 37 included athletes (mean age, 34 years; range, 15-69 years; mean body mass index, 26.2 kg/m2; range, 18-35 kg/m2) who underwent large single-surface (n = 17), multisurface (n = 4), or bipolar (n = 16) OCA transplantation. The highest preinjury median Tegner level was 9 (mean, 7.9 ± 1.7; range, 5-10). At the final follow-up, 25 patients (68%) had returned to sport; 17 (68%) returned to the same or higher level of sport compared with the highest preinjury level. The median time to RTS was 16 months (range, 7-26 months). Elite unit military, competitive collegiate, and competitive high school athletes returned at a significantly higher proportion ( P < .046) than did recreational athletes. For all patients, the Tegner level at the final follow-up (median, 6; mean, 6.1 ± 2.7; range, 1-10) was significantly lower than that at the highest preinjury level ( P = .007). PROMs were significantly improved at the final follow-up compared with preoperative levels and reached or exceeded clinically meaningful differences. OCA revisions were performed in 2 patients (5%), and failures requiring total knee arthroplasty occurred in 2 patients (5%), all of whom were recreational athletes. Noncompliance was documented in 4 athletes (11%) and was 15.5 times more likely ( P = .049) to be associated with failure or a need for revision than for compliant patients. Conclusion: Large single-surface, multisurface, or bipolar shell OCA knee transplantations in athletes resulted in two-thirds of these patients returning to sport at 16 to 24 months after transplantation. Combined, the revision and failure rates were 10%; thus, 90% of patients were considered to have successful 2- to 4-year outcomes with significant improvements in pain and function, even when patients did not RTS.

The long-term outcome of simple trapeziectomy

2018 ◽  
Vol 44 (2) ◽  
pp. 146-150 ◽  
Author(s):  
Thomas F. M. Yeoman ◽  
Oliver Stone ◽  
Paul J. Jenkins ◽  
Jane E. McEachan
Keyword(s):  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Sustained Improvement ◽  
Patient Reported ◽  
The Mean ◽  
Joint Arthritis

The aim of this study was to investigate the long-term outcome of simple trapeziectomy by a single surgeon and to compare this with pre-operative function. Two hundred and five patients completed the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) and the EuroQoL five-dimensional questionnaire (EQ-5D) scores at a mean of 8.2 (range 3.5–17) years after simple trapeziectomy. There were no pre-operative scores available, so case controls were selected from our prospective database to compare pre- and post-operative patient-reported outcome measures. The mean QuickDASH score of the post-operative matched group was 37 (SD 17.0) and the mean EQ-5D was 0.56 (SD 0.31). The mean QuickDASH score of the pre-operative group was 54 (SD 17.0). The mean difference in QuickDASH between the pre- and post-operative groups was 17 (95% CI: 8 to 26, p = 0.0003). This study demonstrated a significant and sustained improvement in patient-reported function after simple trapeziectomy. It supports that simple trapeziectomy is a simple, safe and effective treatment for advanced trapeziometacarpal joint arthritis. Level of evidence: IV

scholarly journals Conservative management acutely improves functional movement and clinical outcomes in patients with pre-arthritic hip pain

2020 ◽  
Vol 7 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Ryan P McGovern ◽  
RobRoy L Martin ◽  
Amy L Phelps ◽  
Benjamin R Kivlan ◽  
Beth Nickel ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Conservative Management ◽  
Movement Control ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Hip Pain ◽  
Analysis Of Covariance ◽  
Functional Movement ◽  
Significant Difference ◽  
Patient Reported

Abstract Conservative management for individuals with pre-arthritic hip pain is commonly prescribed prior to consideration of surgical management. The purpose of this study is to determine if patients with pre-arthritic hip pain will improve their functional movement control and clinical outcome measures following the implementation of physical therapy and a home-exercise programme. Information was retrospectively collected on consecutive patients and included: demographics, diagnosis, initial and follow-up evaluation of the single leg squat test (SLST) and step-down test (SDT), and patient-reported outcome measures. An independent t-test and one-way analysis of covariance were performed for continuous patient-reported outcome measures and a Fisher’s exact test was performed for patient satisfaction. Forty-six patients (31 female and 15 male) diagnosed with pre-arthritic hip pain were included. A total of 30 patients improved their functional movement control during performance of the SLST, whereas 31 patients improved performance of the SDT. There was a statistically significant difference between patients that improved and did not improve (P ≤ 0.017). Patients with pre-arthritic hip pain who improved their functional movement control following a prescribed rehabilitation intervention are likely to report less pain and greater functional ability in their daily and sports-related activities. This study supports conservative management to acutely improve outcomes for patients with pre-arthritic hip pain.

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