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You are viewing the most viewed ACE Reports by Orthopaedic Resident/Interns over the last 30 days in all specialties.
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Synopsis:
Femoral neck fractures, a type of hip fracture, are a common and disabling injury, particularly given an ageing population in many countries.Throughout the past half-century, multiple different treatments have evolved for the treatment of these fractures, and these include sliding hip screws, cannulated screws, hemiarthroplasty (HA), and total hip arthroplasty (THA).Given that femoral neck fractures have the potential to compromise blood flow to the femoral head, arthroplasty options have gained prominence in recent years.However, it remains unclear which of the two options (THA or HA) is optimal in this population.Thus, in this definitive, landmark randomized controlled trial, which is by far the largest of its kind to date, the investigators randomized 1495 patients 50 years of age older with a displaced femoral neck fracture to undergo HA or THA.The trial was conducted across 80 centres in 10 different countries.Primary outcome was a secondary hip procedure within 24 months.Secondary endpoints included death, serious adverse events, hip-related complications, health-related quality of life, function, and overall health.There was no significant difference between the two groups in terms of revision rate, mortality, serious adverse events, revision procedures, EQ-5D, timed up and go test, or Short-Form 12 scores.There was a trend toward higher dislocation rates in THA, though this was not statistically significant.There was a significant difference in favour of THA on the WOMAC total and sub-scores, though this difference fell below the minimal clinically important threshold.Overall, in the absence of a convincing indication for THA, HA is a comparable treatment for femoral neck fracture which does not result in a significant difference in revision rate.There may be a slightly higher rate of serious adverse events with THA, and slightly better function with THA, though these differences may not reach clinical significance.
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Level 1 RCT
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Synopsis:
548 patients with osteoarthritis (OA) of the knee or hip were randomized to receive one of two treatments.The first group took etoricoxib (30 mg) once a day and the second group took ibuprofen (800 mg) three times a day (for a total of 2400 mg).The co-primary outcomes were pain, function and patient global assessment.Results indicated that there was comparable efficacy between the etoricoxib (30mg) and ibuprofen (2400mg) treatments. The two interventions...
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Level 1 RCT
3%
①
Synopsis:
Use of cemented versus un-cemented implant fixation in total hip arthroplasty (THA) has long been an area of debate. Although cemented components have long had unsurpassed prosthesis survival rate, more and more THAs are being performed with un-cemented components. The current systematic review and meta analysis compared the pros and cons to cemented versus un-cemented fixation to determine which has a better overall performance. The study found that although the performance of un-cemented components is improving, cemented fixation continues to be unparalleled.
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Author verified Level 1 Meta Analysis
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Synopsis:
1099 postmenopausal women randomized to receive alendronate in FIT and underwent 5 years of prior alendronate treatment were further randomized to receive 5 mg or 10 mg of alendronate, or a placebo for 5 years. The results of the study revealed that women who had discontinued alendronate treatment after 5 years experienced a moderate decline in bone mineral density and a moderate rise in biochemical markers, but did not experience a rise in fracture risk other than for clinical vertebral fractures.
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Level 2 RCT
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Synopsis:
120 community-dwelling patients over the age of 65 were randomized to receive a single dose of intramuscular vitamin D, intramuscular placebo, oral vitamin D, or oral placebo. The results of the study indicate that both intramuscular and oral vitamin D improve quality of life and functional mobility, and decreases pain among community dwelling seniors.
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Level 1 RCT
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①
Synopsis:
108 patients who underwent total hip arthroplasty (THA) were analyzed to examine the influence of socioeconomic data and preoperative patient data on THA outcomes.Participants were randomized to receive two different implant stems (Co-Cr stem or proximally coated titanium stem) and were assessed using several different measures of THA outcomes.Clinical outcomes did not differ between stem types. The study demonstrated...
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Level 1 RCT
3%
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Synopsis:
A total of 90 patients with carpal tunnel syndrome (CTS) were randomized to undergo surgical treatment using either open carpal tunnel release (OCTR) with a classic incision, OCTR with a short incision approach, or endoscopic carpal tunnel release (ECTR).The purpose of this study was to compare the efficacy of each treatment in terms of post-operative pain, and the disappearance of paraesthesia, as well as grip strength, range of motion, sick leave, and rate of associated complications.At 24 weeks, results demonstrated no significant intergroup differences in pain, paresthesia, range of motion, risk of complication, and grip strength. However, a significantly...
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Author verified Level 2 RCT
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Synopsis:
Data from randomized controlled trials was pooled to comparatively evaluate the efficacy of cemented versus uncemented fixation in total hip arthroplasty, in order to determine a superior intervention. The evidence presented in this study indicated that cemented fixation resulted in comparable outcomes of implant survival, mortality and complication rates, along with superior short-term clinical outcomes.
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Conference Report
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Synopsis:
Eighty patients scheduled for primary total knee arthroplasty were randomized to instrumentation with custom cutting blocks or to conventional intramedullary and extramedullary instrumentation.Intraoperative data concerning operative time and blood loss were collected, and radiographic outcome was analyzed at 6 weeks postoperatively.The results indicated that mechanical alignment was adequate with the use of custom cutting blocks, and similar to that achieved by conventional instrumentation.The groups did differ significantly in rotation of the femoral component, with patients of the custom cutting blocks group displaying significantly less external rotation (1° external rotation) and more consistency in placement (Range 0°-2.5° external rotation) compared to conventional instrumentation (Mean 1.6° external rotation; Range 2.3° internal - 4.9° external rotation). Operative times were...
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Author verified Level 2 RCT
3%
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Synopsis:
120 patients with axial or discogenic neck pain (i.e.without disc herniation, radiculitis, spinal stenosis, spondylosis or facet joint pain) lasting at least 6 months, and for whom conservative treatment was unsuccessful, were randomized to receive an interlaminar epidural injection of local anaesthetic either with or without steroids in the cervical spine.The purpose of this study was to compare pain, function, opioid consumption and work status between treatment groups.Results at 2 years indicated that, although both groups demonstrated significant improvements in pain and function, and were equally safe, there was no significant difference in these outcomes whether steroids were included in the injection, or not. Furthermore, there was...
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Author verified Level 1 RCT