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You are viewing the most viewed ACE Reports by Orthopaedic Surgeons over the last 30 days in all specialties.
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3%
①
Synopsis:
1054 patients being treated for bone or joint infection at 26 UK centers were randomized in this non-inferiority trial to receive 6 weeks of oral antibiotic therapy (n=527) or 6 weeks of intravenous antibiotic therapy (n=527).The primary outcome of interest was the rate of definite treatment failure.Secondary outcomes of interest included the rate of treatment discontinuation, catheter complications, diarrhea caused by C.difficile, serious adverse events, length of hospitalization, and patient-reported outcomes (Oxford Hip and Knee Scores [OHS; OKS]; EuroQual-5Dimension scores [EQ-5D]).Outcomes were assessed at 6 weeks, 4 months, and 1 year follow-up.Oral antibiotics were found to be non-inferior to intravenous antibiotics with regards to the risk of definitive treatment failure.The incidence of early discontinuation of treatment and catheter complications, and length of hospitalization were significantly higher in the intravenous group, however, no differences in the incidence of diarrhea or serious adverse events were observed between the two groups. EQ-5D scores and...
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Level 1 RCT
3%
①
Synopsis:
One hundred twenty-four patients with postoperative stiffness after primary TKA due to osteoarthritis were randomized to receive either MUA with PT alone (n=58) or MUA with PT plus one dose of pre-MUA intravenous dexamethasone (8 mg) and 14 days of oral celecoxib (200 mg) (n=66).The primary outcome of interest was knee ROM at 6 weeks after MUA.Secondary outcomes included knee ROM at 1 year and clinical outcome measures at both time points.Outcomes were assessed immediately after MUA, at 6 weeks, and at 1 year.Overall, the results revealed that while MUA significantly improved ROM immediately by 46°, there was no statistically significant difference between the treatment and control groups at 6 weeks or at 1 year.Clinical outcomes were also similar between groups. These findings suggest...
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Level 1 RCT
3%
①
Synopsis:
Seventeen thousand eight hundred two patients with no history of cardiovascular disease or diabetes but with elevated hs-CRP were randomized to receive rosuvastatin 20 mg daily (n=8,901) or placebo (n=8,901).The primary outcome of interest was incident fracture.Secondary outcomes included subgroup effects by sex and hs-CRP tertiles, as well as site-specific fracture rates.Outcomes were assessed for a median follow-up of 1.9 years.Overall, the results of the study revealed no significant difference in fracture rates between the rosuvastatin and placebo groups (adjusted HR 1.06, 95% CI 0.88–1.28; p=0.53). The study concludes...
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Level 1 RCT
3%
①
Synopsis:
1,022 patients with primary knee osteoarthritis were randomized to receive either 2 grams of intrawound vancomycin powder (n=507) or no vancomycin (control, n=515) before arthrotomy closure.The primary outcome of interest was the incidence of periprosthetic joint infection (PJI) or surgical site infection (SSI).Secondary outcomes included rates of minor wound complications, reoperation rates, and nephrotoxicity incidence.Outcomes were assessed up to 12 months postoperatively.Overall, the study found no significant difference in PJI/SSI rates between the two groups. However, the vancomycin...
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Level 1 RCT
3%
①
Synopsis:
58 elderly patients undergoing hip arthroplasty under spinal anesthesia were randomized to receive either 5 mg oral midodrine (n=29) or a placebo (n=29).The primary outcome of interest was intraoperative ephedrine consumption.Secondary outcomes included the incidence of post-spinal hypotension, bradycardia, hypertension, mean arterial pressure (MAP), and heart rate (HR).Outcomes were assessed throughout the duration of the surgery.Overall, the results of the study revealed that the midodrine group had significantly lower intraoperative ephedrine consumption and a reduced incidence of hypotension compared to the control group. The findings suggest...
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Level 1 RCT
2%
①
Synopsis:
Two hundred sixty-five patients with osteoarthritis were randomized to receive either a stemless humeral implant (n=133) or a stemmed humeral implant (n=132) in anatomic total shoulder arthroplasty (aTSA).The primary outcomes were the American Shoulder and Elbow Surgeons (ASES) score at 2 years, the absence of device-related complications, and the absence of radiographic loosening.Secondary outcomes included range of motion, Single Assessment Numeric Evaluation (SANE) scores, and Constant scores, assessed at multiple time points over 2 years.Overall, the study found that the stemless implant was noninferior to the stemmed implant in all primary outcomes, with no significant differences in secondary outcomes between groups. These findings suggest...
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Level 1 RCT
2%
①
Synopsis:
84 patients over 18 years of age with isolated rib fractures were included in this single center, prospective, placebo controlled, double blind trial.Patients were randomly allocated to receive either 10% lidocaine spray (LS; n=29), etofenamate spray (ES; n=28) or placebo spray (PS; n=27).The primary outcome of interest was pain intensity measured using a numerical rating scale (NRS) at baseline, and 15, 30, 60 and 120 minutes.Other outcomes of interest included rescue medication requirements and adverse events.Study findings suggest that all three groups demonstrated similar NRS scores, with no significant difference in pain reduction found at any timepoint.The maximum reduction was seen in the LS group between baseline and 120 minutes, however this difference was not statistically significant.It was also seen that the need for rescue medication was lowest in the LS group; a difference that was found to be clinically significant but not statistically significant. Importantly, only one...
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Author verified Level 1 RCT
2%
Improved Pain & Function With 8 Weeks of Electroacupunture or Manual Acupuncture vs Sham for Knee OA
①
Synopsis:
Four hundred and eighty patients diagnosed with knee osteoarthritis (OA) were randomized to receive electroacupuncture (EA; n=160) or manual acupuncture (MA; n=160) or sham (n=160) for a total of 8 weeks, 3 times/week.The primary outcome of interest was the response rate which consisted of patients improving at least 2 points on the numeric rating scale (NRS) for pain and 6 points on the WOMAC function subscale.Secondary outcomes of interest included the following: NRS pain at weeks 4, 16, and 26; WOMAC function at weeks 4, 16, and 26; WOMAC pain; WOMAC stiffness; quality of life using the 12-item Short Form (SF-12) health survey (i.e., mental health and physical health); incidence of paracetamol; and patient’s global assessment (PGA).WOMAC stiffness, SF-12 , and PGA scores were measured at 4, 8, 16, and 26 weeks follow-up.Also, incidence of adverse events were reported.Results revealed that the response rate, at 8 weeks, was statistically significantly higher in the EA compared to sham (n=0.023) but this was not observed when comparing MA to sham (n=0.051).Furthermore, the response rate at 4, 16, and 26 weeks follow-up was statistically significantly favored in the EA vs sham group but this was observed for MA vs sham only at weeks 16 and 26 (p<0.05).The total incidence of adverse events included 18, 22, and 17 patients in the EA, MA, and sham groups, respectively.NRS scores were statistically significantly improved in the EA vs Sham and MA vs sham groups for all timepoints.WOMAC function and pain were statistically significantly improved in the EA vs sham for all timepoints; yet, for WOMAC function, MA vs sham was only statistically significantly improved at 16 weeks follow-up (p<0.05).For WOMAC pain, a statistical significant improvement in scores was observed for weeks 8,16, and 26 (p<0.05).Moreover, WOMAC stiffness did not statistically significantly differ in MA vs sham groups for all timepoints, but EA vs sham was statistically improved at weeks 8 and 26 (p<0.05).For SF-12 physical health, a statistical significant improvement for EA and MA when compared to sham were observed only at 16 weeks follow-up (p=0.009 for EA vs sham; p=0.026 for MA vs sham).Finally, SF-12 mental health scores statistically significantly favored the EA compared to sham group only at week 26 (p=0.01) whereas MA was favored at both weeks 16 and 26 compared to sham (p=0.024; p=0.001, respectively). Finally, 4, 2...
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Level 1 RCT
2%
①
Synopsis:
Two hundred forty patients with chronic midportion Achilles tendinopathy were randomized to receive either a single platelet-rich plasma (PRP) injection (n=121) or a sham subcutaneous dry needle injection (n=119).The primary outcome was the VISA-A score at 6 months, which assesses pain, function, and activity limitations related to Achilles tendinopathy.Secondary outcomes included the VISA-A score at 3 months, pain via visual analog scale (VAS), and health-related quality of life using EQ-5D-5L at multiple follow-up points (2 weeks, 3 months, and 6 months).Overall, the results of the study revealed no significant difference between the PRP and sham groups in any of the measured outcomes, including the primary VISA-A score at 6 months. These findings suggest...
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Level 1 RCT
2%
①
Synopsis:
Two hundred and eleven patients with either a displaced rib fracture with a flail chest or non-flail chest injury with severe chest wall deformity were randomized to receive either operative treatment (n=111) or non-operative treatment (n=100).The primary outcome of this trial was the number of ventilator-free days within the first 28 days of injury.Secondary outcomes of interest included total time on mechanical ventilation, length of stay in the ICU and hospital, surgical complications, and adverse events up to 12 months postoperatively.No significant differences were apparent between the two groups with regard to ventilator-free days, pneumonia, ventilator-associated pneumonia, sepsis, tracheostomy, and empyema.The incidence of death was significantly higher in the nonoperative group. In the ventilated...
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Level 1 RCT