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Synopsis: Four thousand two hundred thirty-nine patients undergoing joint replacement surgery were randomized to receive either vancomycin plus cefazolin (n=2044) or cefazolin plus placebo (n=2069).The primary outcome was the incidence of surgical site infections within 90 days.Secondary outcomes included hypersensitivity reactions, acute kidney injury, and other adverse events.Outcomes were assessed up to 90 days post-surgery.Overall, the results of the study revealed that surgical-site infections occurred in 4.5% of the vancomycin group and 3.5% of the placebo group, with a relative risk of 1.28 (P=0.11).Adverse events, including hypersensitivity and acute kidney injury, were similar between groups, with the exception of a higher rate of hypersensitivity reactions in the vancomycin group. The study concluded... Read More »
Conference Report
4%
Synopsis: 134 patients with high-energy Pauwels type III femoral neck fractures were randomized to receive either compressive buttress screw (CBS) fixation (n=67) or off-axial partial threaded cannulated screw (OPTCS) fixation (n=67).The primary outcome of interest was complication rates, including fixation failure, fracture nonunion, and avascular necrosis of the femoral head (ANFH) at 24 months.Secondary outcomes of interest included fixation loosening, femoral neck shortening and varus collapse, patient function using the Harris hip score (HHS), and quality of life using the EuroQol-5D-5L (EQ-5D) questionnaire.Outcomes were assessed at 24 months.Overall, the results of the study revealed that CBS fixation significantly reduced the rates of fixation failure and fracture nonunion compared to OPTCS fixation.The CBS group also demonstrated better functional outcomes and quality of life scores. These findings suggest... Read More »
Level 1 RCT
4%
Synopsis: One hundred ninety-three patients with pertrochanteric femoral fractures were randomized to receive either the Gamma3 nail (n=96) or a sliding hip screw (SHS) (n=97).The primary outcome of interest was the quality of life, measured with the EQ-5D Index and Visual Analogue Scale (VAS) scores, 12 months after surgery.Secondary outcomes included surgical duration, Parker Mobility Score, Harris Hip Score, living situation, use of walking aids, revision rates, complication rates, and mortality rates.Outcomes were assessed up to 12 months post-surgery.Overall, the results of the study revealed that the Gamma3 group had significantly shorter surgical durations and lower revision rates compared to the SHS group.However, no significant differences were observed in quality-of-life scores or other clinical measures. The findings suggest... Read More »
Conference Report
3%
Synopsis: 159 patients scheduled for total knee or total hip arthroplasty were randomized to patient education via an automated text messaging service (StreaMD; SMS bot group) or standard preoperative clinic appointment and perioperative instructions (control group).The purpose of this study was to determine if the SMS bot group demonstrated greater daily postoperative exercise compared to the control group over the first 6 weeks after surgery.Results demonstrated a statistically significant longer duration of daily exercise in the SMS bot group compared to the control group. In addition, significant... Read More »
Level 2 RCT
3%
Synopsis: Eighteen patients were randomized into the accelerated or the standard rehabilitation programs. The primary outcome was tendon lengthening.Secondary outcomes included the Achilles Tendon Total Rupture Score (ATRS) and Patient-Reported Outcomes Measurement Information System Pain Interference Short Form (PROMIS PI-SF) score. Results revealed no... Read More »
Level 1 RCT
3%
Synopsis: A series of 60 patients with recurrent anterior should instability were randomized to receive either arthroscopic (n=28) or open (n=32) stabilization and were available at 15 year follow-up.The primary outcome of interest was clinical failure defined as recurrent dislocation or subjective instability.Secondary outcomes of interest were the Single Assessment Numeric Evaluation (SANE), the Simple Shoulder Test (SST), the UCLA score and evaluation of the glenoid track.At 15 year follow-up, there was no difference in clinical failure between the groups.Similarly, there was no difference in the SANE, SST or UCLA scores at final follow-up.The presence of an off-track glenoid lesion was associated with higher rates of failure but was similar between groups. Read More »
Author verified Level 1 RCT
3%
Synopsis: Fourteen randomized controlled trials including 979 patients with displaced midshaft clavicle fractures were included in this systematic review and meta-analysis comparing intramedullary fixation versus plate fixation.Pooled outcomes of interest included Disabilities of Arm, Shoulder and Hand Score (DASH Score), Constant Murley Score (CM Score), hospitalization time, operation time, incision size, infection, non-union, reintervention or revision, refracture, irritation and pain, and cosmetic dissatisfaction.The results indicated no significant difference in DASH and CM scores between the two groups.However, intramedullary fixation showed significantly lower hospitalization time, operation time, incision size, infection rates, reintervention or revision rates, irritation and pain, and cosmetic dissatisfaction compared to plate fixation. These findings suggest... Read More »
Conference Report
2%
Synopsis: 80 individuals, predominantly active duty service members, with femoroacetabular impingement were randomized to either arthroscopic intervention or a 6-week physiotherapy programme consisting of 12 supervised PT sessions.Participants were assessed for hip-related functional outcome, including the Hip Outcome Score ADL and Sports subscales and the International Hip Outcome Tool (iHOT-33).Primary analysis demonstrated no significant differences between groups for any of the outcome measures.Due to a high degree of crossover from the PT group to arthroscopy (28/40 patients), sensitivity analysis was performed comparing those who had and had not undergo surgery by final follow-up. Similarly, no significant... Read More »
Level 2 RCT
2%
Synopsis: Five randomized controlled trials were included in this meta-analysis which sought to investigate the efficacy of mesenchymal stem cell injections in patients with knee osteoarthritis.Included studies featured various control groups, including placebo injection, hyaluronic acid injection, and no injection, as well as various concomitant treatments, including high tibial osteotomy, microfracture, platelet rich plasma injection and hyaluronic acid injection.Accordingly, clinical heterogeneity was assumed.Data was pooled from 12-24 month time points. Analyses on visual... Read More »
Level 2 Meta Analysis
2%
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... Read More »
Level 1 RCT