New Oral Anticoagulants for Venous Thromboembolism Prophylaxis in Total Hip and Knee Arthroplasty: A Systematic Review and Network Meta-Analysis

Background: There is controversy over whether use of new oral anticoagulants (NOACs) associates with increased hemorrhage risk compared with non-NOAC. Meanwhile, determining which NOAC to use remains unclear. We aimed to summarize the evidence about NOACs in venous thromboembolism (VTE) prevention for patients with total hip and knee arthroplasty (THA and TKA).Methods: We searched RCTs assessing NOACs for VTE prophylaxis in adults undergoing THA and TKA in Medline, Embase, and Cochrane up to May 2021. Primary outcomes were VTE [included deep vein thrombosis (DVT) and pulmonary embolism (PE)], major VTE, and major bleeding. The rank probabilities of each treatment were summarized by the surface under the cumulative ranking curve area (SUCRA).Results: 25 RCTs with 42,994 patients were included. Compared with non-NOAC, NOACs were associated with a decreased risk of VTE (RR 0.68; 95% CI 0.55–0.84) and major VTE (RR = 0.52; 95% CI 0.35–0.76). Additionally, rivaroxaban, apixaban, and edoxaban but not dabigatran and betrixaban, did confer a higher efficacy compared with non-NOAC. None of the individual NOACs increased the risk of bleeding, while apixaban and betrixaban were even associated with a decreased risk of bleeding. In the comparison of different NOACs, rivaroxaban was associated with the greatest benefits in VTE (SUCRA = 79.6), DVT (SUCRA = 88.8), and major VTE (SUCRA = 89.9) prevention. Furthermore, subgroup analysis confirmed that NOACs associated with a higher efficacy tendency in patients with follow-up duration <60 days than follow-up duration ≥60 days.Conclusion: Evidence suggests that NOACs exert more benefits on VTE prophylaxis, and none of the individual NOACs increased hemorrhage compared with non-NOAC. Among various NOACs, rivaroxaban is recommended in patients with lower bleeding risk, and apixaban is recommended in patients with higher bleeding risk.Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021266890].

Gender Influences on Shoulder Arthroplasty

Purpose of Review As the incidence of shoulder arthroplasty continues to increase, there is growing interest in patient-based factors that may predict outcomes. Based on existing literature demonstrating gender-based disparities following total hip and knee arthroplasty, gender may also influence shoulder arthroplasty. The purpose of this review is to discuss the recent literature on the influence of gender on shoulder arthroplasty, focusing on differences in preoperative parameters, perioperative complications, and postoperative outcomes. Recent Findings While both female and male patients generally benefit from shoulder arthroplasty, several differences may exist in preoperative factors, acute perioperative complications, and postoperative outcomes. Preoperatively, female patients undergo shoulder arthroplasty at an older age compared to their male counterparts. They may also have greater levels of preoperative disability and different preoperative expectations. Perioperatively, female patients may be at increased risk of extended length of stay, postoperative thromboembolic events, and blood transfusion. Postoperatively, female patients may achieve lower postoperative functional scores and decreased range of motion compared to male patients. Differences in postoperative functional scores may be influenced by gender-based differences in activities of daily living. Finally, female patients may be at greater risk for periprosthetic fracture and aseptic loosening while male patients appear to be at greater risk for periprosthetic infection and revision surgery. Summary Current literature on the influence of gender on shoulder arthroplasty is limited and conflicting. Further research is necessary to delineate how gender affects patients at the pre- and postoperative levels to better inform decision-making and outcomes.

CLINICAL AND DIAGNOSTIC SIGNIFICANCE OF THE ANATOMICAL SHORT LEG

В статье изучены клинические и диагностические значимости анатомической короткой ноги у 150 пациентов с деформацией стоп, патологией крупных суставов нижних конечностей, а у 24 пациентов было произведено эндопротезирование тазобедренных и коленных суставов. Они страдали хроническими болевыми синдромами, принимали консервативное лечение без эффекта. У всех наблюдавшихся при обследовании выявили наличие разницы в длине ног в 10 и более мм, соответственно перекоса таза с искривлением позвоночника. Одной из основных причин асимметрий осанки, повышенной утомляемости и хронических болей опорно-двигательной системы является нераспознанная структуральная разница в длине ног. При такой ситуации всякое мануальное и фармакологическое лечение носит лишь симптоматический характер. Решение механической проблемы требует механического подхода путем биомеханической коррекции с помощью индивидуальных ортезов стопы по системе Формтотикс. The article describes the clinical and diagnostic significance of the anatomical short leg in 150 patients. Hip and knee arthroplasty was performed in 24 patients. The patients had chronic pain syndrome. All those observed during the examination revealed the presence of a difference in the length of the legs of more than 10 mm. In this situation, pharmacological treatment is symptomatic. One of the solutions to the problem is to correct the difference in leg length with the help of individual Formtotics orthoses.

Cost Disclosure of Surgeon “Scorecards”: Effects on Operating Room Costs for Total Hip and Knee Arthroplasty

Background: Rising health care costs, coupled with an emphasis on cost containment, continue to gain importance. Surgeon cost scorecards developed to track case-based expenditures can help surgeons compare themselves with their peers and identify areas of potential quality improvement. Purpose: We sought to investigate what effect surgeon scorecards had on operating room (OR) costs in orthopedic surgery. Methods: Our hospital distributed OR cost scorecards to 4 adult reconstruction fellowship-trained orthopedic surgeons beginning in 2012. The average direct per-case supply cost of procedures was calculated quarterly and collected over a 5-year period, and each surgeon’s data were compared with that of their peers. All 4 surgeons were made aware of the costs of other surgeons at the 2-year mark. The initial 2 years of data was compared with that of the final 2 years. Results: The average direct per-case supply cost ranged from $4955 to $5271 for total knee arthroplasty (TKA) and $5469 to $5898 for total hip arthroplasty (THA) during the initial 2-year period. After implementing disclosures, the costs for TKA and THA, respectively, ranged from $4266 to $4515 (14% annual cost savings) and from $5073 to $5727 (5% annual cost savings); 3 of the 4 surgeons said that cost transparency altered their practice. Conclusion: Our comparison suggests that orthopedic surgeons’ participation in a program of operative cost disclosure may be useful to them; we found a possible association with reduced per-case costs for TKA and THA at our institution over a 5-year period. More rigorous study that incorporates the effects of the scorecards on patient outcomes is warranted.

Evaluation of language analysis to summarize the literature: a comparison to traditional meta-analysis in primary hip and knee surgery

IntroductionSentiment analysis, by evaluating written wording and its context, is a growing tool used in computer science that can determine the level of support expressed in a body of text using artificial intelligence methodologies. The application of sentiment analysis to biomedical literature is a growing field and offers the potential to rapidly and economically explore large amounts of published research and characterize treatment efficacy.MethodsWe compared the results of sentiment analysis of 115 article abstracts analyzed in a recently published meta-analysis of peripheral nerve block usage in primary hip and knee arthroplasty to the conclusions drawn by the authors of the original meta-analysis.ResultsA moderately positive outlook supporting the utilization of regional anesthesia for hip and knee arthroplasty was found in the 115 articles that were included for analysis, with 46% expressing positive sentiment, 35% expressing neutral sentiment, and 19% of abstracts expressing negative sentiment. This was well aligned with the conclusions reached by a previous meta-analysis of the same articles.DiscussionSentiment analysis applied to the medical literature can rapidly evaluate large collections of published data and generate an impression of overall findings that are aligned with the findings of a traditional meta-analysis.