Tag: statistics

Acta Orthop Belg. 2024 Sep;90(3):549-558. doi: 10.52628/90.3.12669.

ABSTRACT

This meta-analysis focuses on the controversial efficacy and safety of microfragmented adipose tissue (MFAT) as compared with platelet-rich plasma (PRP) in the clinical treatment of knee osteoarthritis (KOA). We have attempted to provide an evidence-based medicine protocol for the conservative treatment of KOA. Researchers collected and compared randomized controlled trials (RCTs) that used microfragmented adipose tissue and platelet-rich plasma to treat knee osteoarthritis. We searched CNKI, Wanfang Database, CMJD, PubMed, Sinomed, Cochrane Library, and Embase for studies published up to May 31, 2023. Two investigators independently screened literature, extracted data, and assessed bias risk using the Cochrane bias risk tool. The researchers then performed a meta-analysis using Revman 5.4 statistics software provided by the Cochrane Library. A total of 4 randomized controlled trials involving 266 patients (326 knees) were included. There were 161 knees in the MFAT group and 165 knees in the PRP group. Meta-analysis showed a statistically significant difference in VAS scores between the MFAT group and the PRP group at 12 months after treatment [MD=0.99, 95% CI (0.31, 1.67), P=0.004]. This result showed that VAS scores were lower in the PRP group than in the MFAT group, and that PRP injection reduced pain more effectively than MFAT injection. At 6 months after treatment, Tegner activity scale scores in the MFAT group were higher than that in the PRP group [MD=0.65, 95% CI (0.11, 1.19), P=0.02], and the difference was statistically significant. There were no significant differences in the remaining indicators between the two groups. Based on this meta-analysis, PRP appears to be more effective than MFAT in treating KOA in terms of long-term pain relief. However, MFAT was superior to PRP in improving short-term activity function. Overall, there was no significant difference between MFAT and PRP in the treatment of KOA. In addition, MFAT does not increase the risk of adverse events compared to PRP. However, at present, there are few clinical studies on MFAT and PRP, which need to be verified by more rigorously designed clinical trials.

PMID:39851028 | DOI:10.52628/90.3.12669

Acta Orthop Belg. 2024 Sep;90(3):535-542. doi: 10.52628/90.3.12274.

ABSTRACT

Avascular necrosis (AVN) is a known complication during the management of developmental dysplasia of the hip (DDH). It has the potential to alter the growth of the head or acetabulum and prevent the best outcomes. While past literature has evaluated the risks of AVN and strategies to avoid it, studies on the impact of AVN on the outcomes are scarce. In this systematic review, we aim to study the extent of the effects of AVN on the outcomes, in the management of DDH. In this systematic review series for 1990 to 2021 were pooled. The clinical and radiological outcomes of the AVN and non-AVN groups were compared. The effects of other modifying factors were also evaluated. A total of 170 AVN and 585 non-AVN hips from 21 papers were compared. The analysis did not show any statistically significant difference between the AVN and non-AVN groups in terms of clinical or radiological parameters. Interestingly patients who had the index surgery at a younger age had a higher risk of further surgery, with acetabular osteotomy being the most common secondary procedure. The negative impact of AVN may not be as severe as previously thought. Thus, the fear of AVN should not take precedence over the primary goal of DDH management i.e. obtaining a stable concentric mobile hip.

PMID:39851026 | DOI:10.52628/90.3.12274

Acta Orthop Belg. 2024 Sep;90(3):523-533. doi: 10.52628/90.3.10758.

ABSTRACT

Several studies suggested that total hip arthroplasty (THA) was more technical demanding following previous pelvic osteotomy (PO), resulting in poor outcomes compared with primary THA. However, the other studies regarding this topic had reported contradictory results. Therefore, we conducted this meta-analysis to compare the clinical results and other parameters between total hip arthroplasty following pelvic osteotomy and primary total hip arthroplasty. We systematically searched PubMed, the Cochrane Library, EMBASE, Web of Science, Scopus, EBSCO and Web of science from inception to September 2020. This study compared the outcomes between THA following previous PO and primary THA with respect to operative time, blood loss, Harris hip score (HHS), revision rates, complication rates, cup position, cup size, cup coverage and hip joint center. 14 studies with 3913 participants were included. The THA after PO group had longer operative time (MD, 13.8 mins; 95% CI, 4.73 to 22.87 mins; P=0.003), greater blood loss (MD, 82.21 ml; 95% CI, 27.94 to 136.48 ml; P=0.003), worse HHS (MD, -2.79 points; 95% CI, -4.08 to -1.50 points; P<0.00001), smaller acetabular anteversion angle (MD, -3.98°; 95% CI, -6.72 to -1.24°; P=0.004), larger cup size (MD, 1.52 mm; 95% CI, 0.75 to 2.28 mm; P=0.0001), more lateral (MD, 2.83 mm; 95% CI, 1.22 to 4.43 mm; P=0.0005) and superior (MD, 2.26 mm; 95% CI, 1.11 to 3.40 mm; P=0.0001) hip joint center. No statistically significant differences were demonstrated between the THA after PO group and primary THA group in revision rates, complication rates, acetabular abduction angle, cup coverage. THA after pelvic osteotomy was associated with inferior intraoperative outcomes, lower functional scores and worse inferior positioning of acetabular component compared with primary THA. Due to the alerted anatomical structure after PO, the findings of current study implicated that preoperative assessment such as computed tomography scan should be conducted in order to achieve satisfactory results.

PMID:39851025 | DOI:10.52628/90.3.10758

Acta Orthop Belg. 2024 Sep;90(3):475-483. doi: 10.52628/90.3.12839.

ABSTRACT

There is a lack in understanding the reasons for different lengths of sick leave in patients who sustain ankle fractures. The aim of this study is to examine variations in the length of sick leave in ankle fracture patients and how treatment, type of ankle fracture and the patient-reported outcome are associated with the length of sick leave. In this study were data from the Swedish Social Insurance Agency (SSIA) and the Swedish Fracture Register (SFR), combined. Patients who sustained an ankle fracture were identified and the length of the sick leave calculated. Variables associated to the length of the sick leave were analysed. Fifty-three percent of the patients were on sick leave for an average of 88 days. Factors that were associated with the length of sick leave were an open fracture, operative treatment, multiple treatments, AO/OTA classification, and previous sick leave. Patients on sick leave for 22 weeks or more scored 15 points (CI 95% 12-18) worse on the dysfunction index of the Short Musculoskeletal Function Assessment in the 1-year follow-up compared to the pre- injury survey. This can be compared to 3 points (CI 95% 2-5) lower in patients with the shortest sick leave. There is an association between the severity of the injury and the length of sick leave following an ankle fracture, as well as between the patient-reported outcome after one year and the length of the sick leave.

PMID:39851020 | DOI:10.52628/90.3.12839

Acta Orthop Belg. 2024 Sep;90(3):463-473. doi: 10.52628/90.3.12420.

ABSTRACT

The object is to objectively identify the 100 most influential scientific publications in total knee arthroplasty (TKA) and provide an analysis of their main characteristics. The Clarivate Analytics Web of Knowledge database was used to obtain data and metrics of TKA research. The search list was sorted by the number of citations, and articles were included or excluded based on relevance to TKA. The information extracted for each article included author name, publication year, country of origin, journal name, article type, and the level of evidence. These 100 studies generated a total of 35,399 cita- tions, with an average of 355.9 citations per article. The most-cited article was cited 1273 times. The 100 studies included in this analysis were published between 2000 and 2017. 23 different journals published these 100 publications. Majority of the publications were from United States (n = 52), followed by UK (n = 10) and Canada (n = 8). The most prevalent study designs were case series (n = 32) and cohort studies (n = 30). The 100 most influential articles in TKA were cited a total of 35,399 times. The study designs most prevalent were case series and cohort studies. This article serves as a reference to direct orthopedic surgeons to the 100 most influential studies in total knee arthroplasty. More than half of the studies are from North America, and three journals hold two-thirds of the 100 most cited publications on the topic.

PMID:39851019 | DOI:10.52628/90.3.12420

Acta Orthop Belg. 2024 Sep;90(3):455-461. doi: 10.52628/90.3.11997.

ABSTRACT

Cephalomedullary nail is the gold standard treatment for intertrochanteric fracture in geriatric population. The aim of the study was to investigate the differences of the reamed versus the unreamed short proximal femoral nailing (PFN), in terms of the duration of surgery and the outcome. The impact of patients and fracture characteristics to the outcome was also evaluated. A retrospective analysis of 158 elderly patients, who sustained intertrochanteric fracture of the femur, with a minimum follow up of one year, was performed. 78 patients underwent a reamed proximal femoral nailing (PFN) whereas 80 patients underwent an unreamed PFN. The duration of surgery, the outcome and the complications between the reamed and the unreamed nailing were compared. A logistic regression was also conducted to estimate the risk factors affecting mortality. The mean duration of surgery for reamed and unreamed G nail was 48,87 min (C.I.: 47,30-50,44) and 42,45 min (C.I.: 41,30-43,60) respectively. No statistically significant difference regarding the need for transfusion and complications, such as wound healing problems and screw cut out was identified between the two types of nailing. The most important factors affecting mortality were the ASA (beta coefficient: 3,127, p-value: 0,002) and the need for transfusion (beta coefficient: 1,367, p-value: 0,05). The only difference found between the reamed and the unreamed PFN was the operation time, which was less for the later one. Both types of fixation were similar in terms of outcome and complications.

PMID:39851018 | DOI:10.52628/90.3.11997

Acta Orthop Belg. 2024 Sep;90(3):443-447. doi: 10.52628/90.3.13030.

ABSTRACT

The aim of this comparative study was to examine the possible benefits of a dedicated Orthopaedic Trauma Room (DOTR) and in the care of patients with proximal femur fractures. A retrospective study of all orthopaedic cases with a hip fracture from 2020 to 2022 at CHC Montlegia has been undertaken, the group is compared to patients with the same impairment from 2018-2020 admitted to Saint Joseph/Esperance CHC hospitals (before the merge and the existence of a DOTR). The delay between the arrival at the emergency department and transfer to the operating room, as well as the mortality are evaluated. The length of hospital stay, the operating time, the ASA score, and the Charlson Index were also examined. A total of 734 cases were analysed, with 384 patients pre-DOTR and 350 patients post-DOTR. The 2 groups were compara- ble in gender, age, fracture type, Asa-score and Charlson Index. The time to the operating room (OR) has been reduced by 14h36 (37h35 vs 23h09, p< 0,001). There was no statistical difference detected in mortality after implementation of an DOTR, not after 3 months, neither a year. Novel oral anticoagulants (NOAC) intake showed no significant effect on the mortality postoperatively. The Length of hospital stay in your study was decreased by 1, 54 days (p< 0,001). A dedicated orthopaedic trauma room reduced the time to OR and the length of hospital stay. There was no statistical difference detected in mortality after implementation of an DOTR, not after 3 months, neither a year. With a DOTR, the care of trauma patients can be optimized and should become a standard of care.

PMID:39851016 | DOI:10.52628/90.3.13030

Acta Orthop Belg. 2024 Sep;90(3):435-441. doi: 10.52628/90.3.12842.

ABSTRACT

Clavicle fractures represent one of the most frequent type of fractures. However, there is no consensus on the treatment of these fractures and their relative indications for surgery. The purpose of this study is to determine whether surgical treatment of mid-diaphyseal clavicular fractures indeed results in fewer complications and better radiological outcomes, as current trends suggest, in comparison to conservative treatment. A retrospective multicenter study was conducted between January 2005 and April 2017, involving adult patients aged 16 to 75 years with mid-diaphyseal clavicular fractures. Out of a total of 715 clavicle fractures assessed, 220 met the inclusion criteria for this study. The research encompassed a matched-pair cohort, comparing clavicle fractures treated surgically and those managed conservatively. The consolidation rate was respectively 94.5% In the operative group, and 89.1% in the conservative group. There was no statistically significant difference in terms of consolidation (p-value: 0.219). The surgical group had an infection rate of 1.8%. Additionally, 31.8% of patients experienced hardware-related discomfort, and 43.6% required a secondary surgery to remove the plate. The results of this study reveal a similar rate of consolidation between the two treatment approaches. However, there is a noticeable but not significant difference in pseudarthrosis incidence in the conservative group, which is typically asymptomatic and does not usually require surgical intervention. On the other hand, patients who have undergone osteosynthesis often experience hardware-related discomfort and may require a subsequent procedure for hardware removal. Low profile dual plating might reduce this inconvenient.

PMID:39851015 | DOI:10.52628/90.3.12842

Acta Orthop Belg. 2024 Sep;90(3):409-414. doi: 10.52628/90.3.11905.

ABSTRACT

The purpose of the present study was to evaluate and compare the clinical outcomes of two groups of patients subject to bi-cruciate retaining (BCR) or posterior-stabilized (PS) implants. It was hypothesized that patients treated with BCR prostheses would present higher flexion and better clinical and functional results than those treated with PS implants. This prospective study included thirty-two patients treated for primary knee osteoarthritis and assigned to two matched groups for their demographic characteristics and comorbidities. Those with functioning cruciate ligaments received bi- cruciate retaining prostheses. In the case of ligaments’ insufficiency, the posterior-stabilised design was selected. The primary outcome was knee flexion, and secondary outcomes included the patient’s reported outcomes as recorded by the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, visual analogue scale (VAS) for pain, treatment- related complications, and surgical time. Complete data were recorded for all patients with a minimum of 2 years of follow-up. This study found a statistically significant improvement in all the analysed clinical and functional assessment tools from baseline to the latest follow-up (p<0.05) for both groups. However, no statistically significant difference was found between the two groups. Furthermore, bi-cruciate retaining design is surgical time. There was no evidence of clinical superiority of bi-cruciate retaining compared to posterior stabilized knee implants. Therefore, further randomized studies with more participants and a longer follow-up on comparing bi-cruciate retaining and posterior stabilized implants in primary knee osteoarthritis could be rewarding.

PMID:39851011 | DOI:10.52628/90.3.11905

Jpn J Ophthalmol. 2025 Jan 24. doi: 10.1007/s10384-025-01167-6. Online ahead of print.

ABSTRACT

PURPOSE: To compare the efficac and safety of a dual-blade 20,000 cuts per minute (cpm) vitrectomy probe with a single-blade 10,000 cpm probe for primary rhegmatogenous retinal detachment (RRD).

STUDY DESIGN: Prospective, randomized controlled clinical trial.

METHODS: Evaluations were conducted preoperatively, intraoperatively, and at three months postoperatively. The main outcome measure focused on the duration of core vitrectomy, with secondary outcomes including peripheral vitreous shaving duration, balanced salt solution (BSS) consumption, anatomical and functional outcomes, as well as the incidence of surgical procedure-related complications.

RESULTS: Overall, 35 cases in the 20,000 cpm group and 37 cases in the 10,000 cpm group completed the trial without significant differences in baseline demographic characteristics. The 20,000 cpm group demonstrated significantly shorter core vitrectomy duration (161.6 ± 10.4 vs. 206.8 ± 10.1 s) (P = 0.003) and peripheral vitreous shaving time (446.3 ± 20.3 vs. 544.2 ± 22.2 s) (P = 0.002) compared to the 10,000 cpm group. BSS consumption was higher in the 20,000 cpm group but without statistical significance (P = 0.231). There were no significant differences in the need for scleral sutures and the incidence of iatrogenic retinal breaks (P = 0.331 and 0.523). At the 3-month follow-up, there were no statistically significant differences in primary success, final anatomical success, or mean visual acuity (P > 0.9, P = 0.326). Rates of complications, including ocular hypertension, epiretinal membrane formation, and endophthalmitis also showed no statistically significant differences (P > 0.6).

CONCLUSION: The utilization of the new-generation 27-gauge system with a 20,000 cpm probe may herald a new paradigm of high-flow, smaller-diameter instrumentation, thereby enhancing the efficiency of the small gauge technique.

PMID:39849295 | DOI:10.1007/s10384-025-01167-6