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Synopsis: 9 randomized controlled trials were included in this meta-analysis, comparing arthroscopic surgery to conservative management for the treatment of degenerative meniscal tears in patients over the age of 40 years.Outcomes of interest included knee pain and knee function. The results from... Read More »
Level 1 Meta Analysis
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Synopsis: Eight randomized controlled trials were included in this meta-analysis comparing four different treatment options for 3- and 4-part humeral fractures in elderly patients: nonoperative management, open reduction and internal fixation (ORIF), hemiarthroplasty (HA), and reverse total shoulder arthroplasty (rTSA).The body of literature allowed comparison of rTSA to only HA, while nonoperative treatment, ORIF, and HA were all compared directly to each other. Pairwise comparisons identified... Read More »
Conference Report
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Synopsis: 4 out of 20 studies from this study were included in the network meta-analysis comparing radial head arthroplasty (RHA), open reduction and internal fixation with a biodegradable implant (ORIF-B), and ORIF with a metal implant (ORIF-M) for the treatment of displaced radial head fractures (RHF).The outcomes of interest included the odds of complications and of a 'good' or 'excellent' Broberg-Morrey score.The results from this study found favourable odds of both complications and of a 'good' or 'excellent' Broberg-Morrey score in the RHA group compared to both the ORIF-B and ORIF-M groups. The ORIF-B group... Read More »
Level 2 Meta Analysis
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Synopsis: Six studies were included in this meta-analysis comparing mid-term outcomes of cementless porous tantalum monoblock tibial components and cemented modular tibial components in total knee arthroplasty.Radiological results demonstrated a significantly lower incidence of radiolucency among cementless porous tantalum monoblock tibial components compared to cemented modular tibial components, but no significant differences were observed in the incidence of component loosening. Despite statistically significant... Read More »
Level 2 Meta Analysis
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Synopsis: Results from 14 RCTs and 5 systematic reviews were reviewed and pooled to determine the effect various THA interventions had on the pain, disability, and function experienced by patients with end stage arthritis of the hip.Results from the analysis indicated that patients experienced significant postoperative THA improvements in Harris Hip scores between 6 months and 10 years, but that improvements did not differ between various impact types.Additionally, a reduced risk of implant dislocation following intervention was noted for patients treated with a larger femoral head size or cemented cups (compared to smaller femoral heads and cementless cups, respectively).Those who received cross linked cup liners experienced reduced femoral head penetration and revision when compared to conventional polyethylene liners. Analysis of femoral... Read More »
Level 1 Meta Analysis
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Synopsis: 256 patients who underwent primary total hip/knee arthroplasty at least 12 months prior were randomized to participate in either a web-based follow-up or an in-person appointment, with the purpose of determining the feasibility and efficacy of web-based follow-up. Web-based follow-up appeared to be more feasible, cost-efficient and clinically effective alternative to in-person follow-up 12 months after total hip/knee arthroplasty. Read More »
Level 2 RCT
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Synopsis: 150 patients scheduled for primary unilateral total hip arthroplasty were randomized to one of three groups: a combined intravenous (IV) and topical tranexamic acid (TXA) protocol, IV TXA alone with topical placebo administration, or intravenous and topical placebo administration.The purpose of this study was to determine if the combined administration protocol demonstrated significantly greater efficacy in reducing blood loss and transfusion compared to IV TXA alone and placebo.The results of this study demonstrated that intraoperative blood loss, total blood loss, and transfusion rate were significantly lower with the combined IV and topical TXA protocol compared to both the IV TXA alone protocol and placebo group.There were no significant differences between the three groups in the incidence of deep vien thrombosis. Read More »
Author verified Level 2 RCT
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Synopsis: 90 patients scheduled for a total knee arthroplasty were randomized to receive Floseal, tranexamic acid or control for the reduction of peri-operative bleeding.Outcomes of interest included aspirated blood volume, pad weight, incidence of transfusion, drainage volume, hemoglobin decrease, total measured bleeding and range of motion.Follow up was performed for a minimum of 12 months.Results revealed significantly greater drainage output, hemoglobin decrease, total measured bleeding, aspirated blood volume and worse range of motion in the control group compared to the Floseal and tranexamic acid groups. Additionally, the Floseal... Read More »
Level 2 RCT
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Synopsis: 205 patients suffering from unstable (AO-A2) intertrochanteric hip fractures were randomized to compare the clinical and radiographic outcomes associated with intramedullary and extramedullary device fixation.Patients were assessed over 12 months, and were evaluated using the Lower Extremity Measure (LEM), a 2-minute walk test, the Timed Up and Go (TUG) test, the functional independent measure (FIM), and a Trendelenburg test.Radiographs were conducted for tip-to-apex distance (TAD), femoral neck shortening, and heterotopic ossification.Results from 168 patients who completed final follow-up indicate that intramedullary and extramedullary fixation present comparable clinical outcomes. Intramedullary devices are... Read More »
Conference Report
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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. Read More »
Level 1 RCT