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Synopsis: Sixty patients undergoing unilateral primary TKA were randomized to receive surgery with a handheld semi-active robot (n=32) or a control group without robotic assistance (n=28).The primary outcomes of interest were postoperative mechanical alignment, joint line deviation and prosthesis rotation.The robotic group demonstrated improved overall mechanical alignment and reduced joint line deviation compared to the control group. No differences in... Read More »
Level 1 RCT
13%
Synopsis: Sixteen randomized controlled studies containing a total of 3084 patients were included in this meta-analysis including patients with displaced femoral neck fractures undergoing total hip arthroplasty (THA; n=1521) or hemiarthroplasty (HA; n=1563).Pooled outcomes of interest included the following: incidence of revision, functional outcomes (evaluated using the Harris hip score), incidence of mortality, health-related quality of life (QoL; evaluated using the EuroQol-5 Dimensions [EQ-5D] Index), incidence of periprosthetic fracture, incidence of dislocation, and operative time.Subgroup analyses was conducted by level of risk of bias.Revision surgery, incidence of mortality and dislocation were all analyzed at 12-60 months follow-up, where as the rest of the outcomes were assessed at 12-36 months.Pooled results revealed that health-related quality of life, evaluated using EQ-5D Index, was statistically significantly in favour of the THA group vs.HA (p=0.001).However, pooled operative time was statistically significantly shorter in the HA group vs THA (p=0.001). All other pooled... Read More »
Author verified Level 1 Meta Analysis
13%
Synopsis: The PREPARE Trial was a cluster-randomized, crossover trial part of the PREP-IT program, which compared alcohol-based anti-septic solutions of iodine povacrylex vs.chlorhexidine gluconate in operative fracture patients.THE PREPARE Trial included a total of 8485 patients who underwent fracture fixation: 1700 patients with open limb fractures and 6785 with closed lower-limb or pelvic fractures.Randomization occurred at the hospital level.The primary outcome of interest was the incidence of surgical-site infection, which included superficial incisional infections within 30 days and deep incisional or organ-space infections within 60 days post-surgery.Secondary outcomes included unplanned fracture-related reoperations and serious adverse events.The iodone povacrylex group (77/3205; 2.4%) had a lower incidence of surgical site infections compared to chlorhexidine (108/3272; 3.3%) in closed-fracture patients [OR, 0.74; 95% CI, 0.55 to 1.00; p=0.049].The rates were similar in open-fracture patients between the iodine (54/3272; 6.5%) and chlorhexidine (60/3272; 7.3%) [OR, 0.86; 95% CI, 0.58 to 1.27; p=0.45].In the closed-fracture group, 5.5% in the iodine group and 5.9% in the chlorhexidine group underwent unplanned reoperations [OR, 0.96; 95% CI, 0.77 to 1.20].In the open-fracture group, the figures were 16.1% for iodine and 14.5% for chlorhexidine [OR, 1.16; 95% CI, 0.87 to 1.54]. The results of... Read More »
Level 1 RCT
6%
Synopsis: 109 patients with degenerative knee cartilage were randomized to determine the efficacy of platelet-rich plasma (PRP) compared to viscosupplementation via hyaluronic acid (HA) as a treatment method.Patients were allocated to three injections of either solution, and were followed up for 12 months.Results revealed that there were no differences between groups in clinical outcome for the duration of the study. Interestingly, a sub-group... Read More »
Level 2 RCT
6%
Synopsis: 94 postmenopausal women with osteoporosis were randomized to receive either teriparatide, denosumab, or a combination of the two treatments.The purpose of this study was to determine the effectiveness of combined therapy with regards to bone microarchitecture and estimated strength. Findings indicated that... Read More »
Level 2 RCT
6%
Synopsis: One hundred and seventy-seven patients with chronic knee pain from knee osteoarthritis (OA) were randomized to receive cooled radiofrequency ablation (CRFA; n=89) of the genicular nerves or a single intra-articular hyaluronic acid (HA; n=88).The primary outcome of interest was the number of patients who reported a =>50% reduction in pain scores from baseline after 6 months.Additional outcomes of interest included pain scores on a Numeric Rating Scale (NRS), the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, WOMAC pain scores, WOMAC physical function scores, WOMAC stiffness scores, patient perception of treatment effect as reflected by the Global Perceived Effect (GPE) score, the Euro-Qol-5 Dimensions-5 Level (EQ-5D-5L) quality of life questionnaire, and the incidence of treatment-related and non-treatment related adverse events.Outcomes were assessed at 1, 3, and 6 months post-treatment.Results revealed a statistically significantly higher proportion of patients in the CRFA group who reported =>50% improvement in pain scores from baseline compared to the HA group (71% vs.38%, p<0.0001).NRS pain scores, WOMAC total scores, WOMAC pain scores WOMAC physical function scores, GPE scores, and EQ-5D-5L scores were statistically significantly in favour of the CRFA group at all time points compared to the HA group (p<0.05 for all).WOMAC stiffness scores were statistically significantly in favour of the CRFA group at 3 months (p=0.0022) and 6 months (p<0.0001) post-treatment. The incidence of... Read More »
Author verified Level 1 RCT
6%
Synopsis: One hundred and sixty-four patients with severe knee osteoarthritis scheduled for a total knee arthroplasty were randomized to receive pre-operative cryoneurolysis plus standard of care pain management (n=62) or standard of care pain management only (n=62).The primary endpoint was cumulative opioid consumption.Secondary endpoints included improvement in Numeric Rating Scale (NRS) pain scores and functional outcomes (Knee Injury and Osteoarthritis Outcomes Score [KOOS]; timed up and go test; range of motion).Results revealed significantly less opioid consumption in the cryoneurolysis group compared to the control group in the per-protocol analysis, however, no differences in opioid consumption were observed in the intent-to-treat analysis. Improvements from baseline... Read More »
Level 1 RCT
6%
Synopsis: Eighty-eight patients with atraumatic rotator cuff tears were randomized to receive adduction manipulation (n=44) or physiotherapy (n=44).Outcomes of interest included range of motion, pain on a Visual Analog Scale (VAS), the American Shoulder and Elbow Surgeons (ASES) score, Constant Shoulder Score, and glenohumeral adduction angle.The adduction manipulation group demonstrated significantly better glenohumeral adduction angle, greater range of motion and superior short-term function vs. physiotherapy, indicating that... Read More »
Level 1 RCT
6%
Synopsis: 34 patients with knee osteoarthritis were randomized to receive rehabilitation exercises with either low-level laser therapy (LL + EX; n=17) or high-intensity laser therapy (HL + EX; n=17).Outcomes of interest included Knee Injury and Osteoarthritis Outcome Score (KOOS) for knee function, pain on a Numeric Rating Pain Scale (NPRS), active knee flexion, and Timed Up-and-Go (TUG) test after 12 weeks.Overall, the HL + EX group showed significantly better NPRS, active knee flexion, and TUG scores 12 weeks after treatment, with KOOS scores favoring the LL + EX group. When comparing pre-... Read More »
Level 1 RCT
6%
Synopsis: 12 randomized controlled trials (788 patients) comparing the use of a minimally invasive medial midvastus approach (MMV-TKA) versus the standard medial parapatellar total knee arthroplasty (MP-TKA) were included in this systematic review and meta-analysis.Outcomes of interest included the Knee Society Score (KSS), knee pain on a Visual Analog Scale (VAS), knee function on a Normalized Function Scale, knee range of motion (ROM), time to straight leg activity, incidence of loose outboard support belt use, operative time, length of stay, blood loss, and incidence of postoperative complications.KSS scores, VAS pain scores, and knee joint flexural activity at 3 months, and days of straight leg raises were significantly better in the MMV-TKA group.Operative time was significantly shorter in the MP-TKA group. All other outcomes... Read More »
Level 1 Meta Analysis