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You are viewing the most viewed ACE Reports by Primary Care Physicians over the last 30 days in all specialties.
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①
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
4%
①
Synopsis:
Seven RCTs (515 patients) were included in this meta-analysis comparing local injection of platelet rich plasma (PRP) and local injection of corticosteroid for the treatment of lateral epicondylitis.Outcomes of interest included pain on a Visual Analog Scale (VAS), the Modified Mayo Performance Index, the Disability of the Arm, Shoulder and Hand (DASH) score, and the risk of adverse events.Outcomes were analyzed up to 6 months post-treatment.Results revealed significantly favourable VAS pain, Mayo, and DASH in the PRP group compared to the corticosteroid group at all time points. The risk of...
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Level 1 Meta Analysis
2%
Synopsis:
8 ACE Reports (all randomized controlled trials) from the OrthoEvidence database were included in this review/meta-analysis examining the effect of arthroscopic surgery and physical therapy in the treatment of degenerative tears of the meniscus and knee osteoarthritis.The purpose of this review was to determine if any differences in outcome were demonstrated between arthroscopy followed by physical therapy versus physical therapy alone, regarding pain, function, satisfaction, adverse events, or osteoarthritis progression.Pain results were pooled at 3 different time point: 2-3 months, 6 months, and 12-24 months postintervention.At short-term (2-3 months) and long-term (12-24 months) follow-up, pain was similar between groups, with no significant difference observed.There tended to be less pain experienced at 6 months following arthroscopy, however this only reached significance in the KOOS pain outcome and the clinical importance of this observation is unknown.Assessments of functional outcome, either pooled or qualitative, suggested no significant difference between groups as well. The rate of...
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ACE Review
2%
②
Synopsis:
120 patients with symptomatic knee osteoarthritis were randomized to receive intra-articular (IA) injections of platelet rich plasma (PRP), hyaluronic acid (HA) or corticosteroid for the treatment of pain and improvement of function.Outcomes of interest included the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, Visual Analog Scale (VAS) for pain and adverse events.Follow up was performed at 3, 6.9 and 12 months.The results of the study found significant improvements from pre-treatment scores in both WOMAC and VAS pain outcomes in all three groups.Moreover at 6, 9 and 12 months, the PRP group showed significantly favourable WOMAC scores compared to both the hyaluronic acid and corticosteroid injection groups. There were no...
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Level 2 RCT
2%
①
Synopsis:
192 patients with knee osteoarthritis were randomized to three weekly intraarticular injections with either platelet-rich plasma or hyaluronic acid.The focuse of the current study was outcome after 2 and 5 years following treatment.Results for clinical outcome on the International Knee Documentation Committee (IKDC) subjective score, the EuroQoL 5-dimensions (EQ-5D) and the Tegner activity scale demonstrated no significant differences between the PRP group and HA group at 2 or 5 years.Within the first 2 years of treatment, rate of reintervention, including either repeat injection therapy or surgery, was significantly lower in the PRP group compared to the HA group. However, at 5...
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Level 1 RCT
2%
②
Synopsis:
151 patients with knee osteoarthritis (OA) pain were randomized to receive cooled radiofrequency ablation (CRFA) or intra-articular corticosteroid (IAS) injections.Patients in the IAS group were given the opportunity to cross over to CRFA treatment after 6 months, however these patients were not included in the CRFA group analysis.The primary outcome of interest was the cost per quality-adjusted life year (QALY) gained.Additional outcomes of interest included QALYs, treatment cost, incremental QALY gain, incremental cost, and total cost.Follow up was performed at 6 and 12 months post-treatment. The findings revealed...
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Level 2 RCT
2%
Synopsis:
8 ACE Reports (7 randomized controlled trials and 1 systematic review and meta-analysis, n=694) from the OrthoEvidence database assessing the effectiveness of corticosteroid injections in comparison to control injections (either saline or local anesthesia) for the treatment of lateral epicondylitis were included in this review.The purpose of this review was to determine the impact of corticosteroid injections on pain and physical function in comparison to these control treatments.As such, information and data on platelet-rich plasma (PRP) injection efficacy as a treatment was not included from reports.Statistical pooling of VAS pain scores and Quick DASH scores exhibited that corticosteroid injections provided significant pain relief, compared to control injections only in the short-term (6-12 weeks), while having no functional benefits over control injections at any time point within a 6 month period. Similar results were...
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ACE Review
2%
②
Synopsis:
60 patients with Kellgren-Lawrence grade I-II knee osteoarthritis were randomized to treatment with either intraarticular hyaluronic acid or oral hyaluronic acid.Patients allocated to IAHA were administered three weekly injection, and patients allocated to oral HA were given daily tablets to take for 40 days.Outcome measures included pain on a visual analog scale and the American Knee Society Score. Within-group improvement from...
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Level 2 RCT
2%
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...
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Level 2 Meta Analysis
2%
②
Synopsis:
141 patients aged 50 or above with knee osteoarthritis were randomized to receive kinesiotaping of the knee, sham kinesiotaping of the knee, or no treatment.The primary outcomes of interest were the sub-scores (pain, stiffness, function) of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index.Secondary outcomes of interest included the balance error scoring system (BESS), the maximum voluntary isometric contraction (MVIC), the 10 meter walk test, and range of motion in flexion and extension.Follow up was performed 3 days after the application of treatment.Results revealed significantly different WOMAC pain, stiffness, and function sub-scores amongst the three groups, in favour of the kinesiotaping group. No significant differences...
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Level 2 RCT