This study systematically reviewed the literature to compare outcomes of static versus articulating antibiotic spacers for infection following total knee arthroplasty. The review identified 7 comparative studies and 32 case series. Results showed similar reinfection rates between static (12%) and articulating (7%) spacers. However, articulating spacers resulted in greater knee range of motion after reimplantation (101° vs 91°). Despite this difference, functional scores were similar between groups. Complication rates were also similar. The review found articulating spacers provided improved motion but did not clearly demonstrate superiority in infection eradication.
This systematic review analyzed 49 studies including over 2,300 patients undergoing single-incision laparoscopic cholecystectomy (SILC) or standard laparoscopic cholecystectomy (SLC). The review found that complication rates for SILC ranged from 0-28.6% with an overall median of 7.37%, which may be underestimated due to lack of follow-up in many studies. Studies reported similar or worse pain outcomes for SILC compared to SLC in most cases. Three studies found significantly improved cosmetic outcomes with SILC while others found no significant difference. No definitive evidence suggests that SILC provides improved cosmesis or reduced pain over SLC, and complications may
The systematic review and meta-analysis found that:
1) Only 23% of patients passed return-to-sport testing on average based on 18 studies including over 800 patients.
2) Passing return-to-sport criteria did not significantly reduce the risk of subsequent knee injuries but did lower the risk of graft rupture by 60%. However, it also increased the risk of a contralateral ACL injury by 235%.
3) There was little evidence that passing return-to-sport criteria led to higher rates of return to play.
The effectiveness of manipulations to the thoracic spine on functional outcom...jmrobiso
This case report summarizes the treatment of a 58-year-old male patient with left rotator cuff syndrome and shoulder pain. Over the course of 9 physical therapy sessions in 5 weeks, the patient received interventions including exercise and manipulations to the thoracic spine. Outcome measures showed improvements in pain, range of motion, functional status as measured by the QuickDASH scale, and strength. The case report discusses the evidence supporting the use of thoracic manipulations for shoulder impairments and regional interdependence between adjacent joints.
Association between delayed initiation of adjuvant CMF or anthracycline-based...Enrique Moreno Gonzalez
Adjuvant chemotherapy (AC) improves survival among patients with operable breast cancer. However, the effect of delay in AC initiation on survival is unclear. We performed a systematic review and meta-analysis to determine the relationship between time to AC and
survival outcomes.
This systematic review examined the effects of stretching before and after exercise on muscle soreness and injury risk. Five studies on stretching and muscle soreness were included, all using static stretching. A meta-analysis found that stretching had a negligible effect on soreness up to 72 hours later, reducing it by less than 2mm on a 100-mm scale. Two studies on injury risk in army recruits found that a specific stretching protocol reduced lower extremity injuries by 5%, which was not a meaningful risk reduction. The evidence does not support stretching for reducing muscle soreness or injury risk.
This document summarizes a network meta-analysis of randomized controlled trials examining the effectiveness of exercise interventions for lower limb osteoarthritis. The analysis included 60 RCTs with 8,218 patients. It found that exercise programs combining strengthening, flexibility, and aerobic exercises were most effective at improving pain and physical function outcomes. The analysis provides evidence that a structured exercise program targeting multiple domains is the best exercise option clinicians can recommend to patients for treating lower limb osteoarthritis.
Surgical versus non-surgical treatment for humeral shaft fractures in adults ...mgosler
1) The document reviews the surgical versus non-surgical treatment of humeral shaft fractures in adults.
2) It found 4 studies that could not be included in a meta-analysis due to heterogeneity and lack of randomization. The studies showed varied complications and treatment approaches.
3) The conclusion is that a randomized controlled trial is needed to better compare surgical and non-surgical treatment, and to establish evidence-based guidelines for surgical indications.
This document summarizes 10 research studies on gait and balance as assessed through plantar pressure and center of pressure measurements. Several key findings are: 1) Certain center of pressure measures can predict chronic ankle instability but with low accuracy; 2) Center of pressure velocity can classify elderly fallers versus non-fallers with high accuracy; 3) Gait velocity affects orthotic prescription, as rearfoot pronation differs between walking and running; 4) Rocker-bottom shoes increase postural sway in response to perturbations compared to normal shoes; 5) Specific plantar pressure patterns are associated with lower leg injuries in runners; 6) Center of pressure data can indicate rearfoot motion but not precisely; 7) Plantar pressure can be reliably
This systematic review analyzed 49 studies including over 2,300 patients undergoing single-incision laparoscopic cholecystectomy (SILC) or standard laparoscopic cholecystectomy (SLC). The review found that complication rates for SILC ranged from 0-28.6% with an overall median of 7.37%, which may be underestimated due to lack of follow-up in many studies. Studies reported similar or worse pain outcomes for SILC compared to SLC in most cases. Three studies found significantly improved cosmetic outcomes with SILC while others found no significant difference. No definitive evidence suggests that SILC provides improved cosmesis or reduced pain over SLC, and complications may
The systematic review and meta-analysis found that:
1) Only 23% of patients passed return-to-sport testing on average based on 18 studies including over 800 patients.
2) Passing return-to-sport criteria did not significantly reduce the risk of subsequent knee injuries but did lower the risk of graft rupture by 60%. However, it also increased the risk of a contralateral ACL injury by 235%.
3) There was little evidence that passing return-to-sport criteria led to higher rates of return to play.
The effectiveness of manipulations to the thoracic spine on functional outcom...jmrobiso
This case report summarizes the treatment of a 58-year-old male patient with left rotator cuff syndrome and shoulder pain. Over the course of 9 physical therapy sessions in 5 weeks, the patient received interventions including exercise and manipulations to the thoracic spine. Outcome measures showed improvements in pain, range of motion, functional status as measured by the QuickDASH scale, and strength. The case report discusses the evidence supporting the use of thoracic manipulations for shoulder impairments and regional interdependence between adjacent joints.
Association between delayed initiation of adjuvant CMF or anthracycline-based...Enrique Moreno Gonzalez
Adjuvant chemotherapy (AC) improves survival among patients with operable breast cancer. However, the effect of delay in AC initiation on survival is unclear. We performed a systematic review and meta-analysis to determine the relationship between time to AC and
survival outcomes.
This systematic review examined the effects of stretching before and after exercise on muscle soreness and injury risk. Five studies on stretching and muscle soreness were included, all using static stretching. A meta-analysis found that stretching had a negligible effect on soreness up to 72 hours later, reducing it by less than 2mm on a 100-mm scale. Two studies on injury risk in army recruits found that a specific stretching protocol reduced lower extremity injuries by 5%, which was not a meaningful risk reduction. The evidence does not support stretching for reducing muscle soreness or injury risk.
This document summarizes a network meta-analysis of randomized controlled trials examining the effectiveness of exercise interventions for lower limb osteoarthritis. The analysis included 60 RCTs with 8,218 patients. It found that exercise programs combining strengthening, flexibility, and aerobic exercises were most effective at improving pain and physical function outcomes. The analysis provides evidence that a structured exercise program targeting multiple domains is the best exercise option clinicians can recommend to patients for treating lower limb osteoarthritis.
Surgical versus non-surgical treatment for humeral shaft fractures in adults ...mgosler
1) The document reviews the surgical versus non-surgical treatment of humeral shaft fractures in adults.
2) It found 4 studies that could not be included in a meta-analysis due to heterogeneity and lack of randomization. The studies showed varied complications and treatment approaches.
3) The conclusion is that a randomized controlled trial is needed to better compare surgical and non-surgical treatment, and to establish evidence-based guidelines for surgical indications.
This document summarizes 10 research studies on gait and balance as assessed through plantar pressure and center of pressure measurements. Several key findings are: 1) Certain center of pressure measures can predict chronic ankle instability but with low accuracy; 2) Center of pressure velocity can classify elderly fallers versus non-fallers with high accuracy; 3) Gait velocity affects orthotic prescription, as rearfoot pronation differs between walking and running; 4) Rocker-bottom shoes increase postural sway in response to perturbations compared to normal shoes; 5) Specific plantar pressure patterns are associated with lower leg injuries in runners; 6) Center of pressure data can indicate rearfoot motion but not precisely; 7) Plantar pressure can be reliably
The document presents a meta-analysis that compares the outcomes of external fixation (ExFix) versus open reduction and internal fixation (ORIF) for tibial pilon fractures based on 11 observational studies. The analysis found that ORIF had a lower risk of superficial infection, malunion and nonunion compared to ExFix, but a higher risk of unplanned hardware removal. No significant differences were found between the two methods in terms of deep infection, reduction quality, clinical evaluation scores, post-traumatic arthrosis development, or time to union. Overall, the analysis suggests ORIF may have better outcomes for certain complications, while ExFix resulted in fewer subsequent hardware removals.
Hammer Toe Correction Comparative StudyWenjay Sung
This study compared outcomes of 3 surgical treatments for hammertoe deformities: arthroplasty, arthrodesis, and interpositional implant arthroplasty. 114 patients underwent one of the procedures and were followed for at least 12 months. All treatments significantly improved pain and sagittal plane correction, but only implant arthroplasty provided significant transverse plane correction and had the lowest revision rate at 10.4%. The study demonstrates implant arthroplasty may have advantages over the other procedures for hammertoe correction.
Case-control Study on 2nd Hammertoe Deformity Correction TechniquesWenjay Sung
This is my case-control study on second hammertoe deformity correction techniques: arthroplasty, arthrodesis, and interpositional implant arthroplasty.
Critiquing Evaluation Criteria for Quantitative Research Article .docxmydrynan
Critiquing Evaluation Criteria for Quantitative Research Article: Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial)
Listed below are criteria that you will use to critique research articles pertinent to your research area of interest. Discuss how the investigator satisfied each criterion. Cite relevant passages in the articles, with reference to page number if appropriate.
I- Title of the Article and Authors
Is the title clear, including area of study and group studied?
Are the author’s credentials included?
II- Introduction
Is the purpose of the study presented?
Is the significance (importance) of the problem discussed?
Does the investigator provide a sense of what he or she is doing and why?
III- Problems Statement
Is the problem statement clear?
Does the investigator identify key research questions and variables to be examined?
Does the study have the potential to help solve a problem that is currently faced in clinical practice?
IV- Literature Review
Does the literature review follow a logical sequence leading to a critical review of supporting and conflicting prior work?
Is the relationship of the study to previous research clear?
Does the study have the potential gaps in the literature and support the necessity of the present study?
V- Theoretical Framework and Hypotheses
Is a rationale stated for the theoretical/conceptual framework?
Does the investigator clearly state the theoretical basis for hypotheses formulation?
Is the hypotheses stated precisely and in a form that permits it to be rested?
Are methods of data collection sufficiently described?
What are the identified and potential threats to internal and external validity that were present in the study?
If there was more than one data collector, was interrater reliability adequate?
VII- Sample
Are the subjects and sampling methods described?
Is the sample of sufficient size for the study, given the number of variables and design?
Is the adequate assurance that the rights of human subjects were protected?
VIII- Instruments
Are appropriate instruments for data collection used?
Are reliability and validity of the measurement instruments adequate?
IX- Data Analysis
Are the statistical tests used identified and the values reported?
Are appropriate statistics used, according to level of measurement, sample size, sampling method, and hypotheses/research questions?
X- Results
Are the results for each hypothesis clearly and objectively presented?
Do the figures and tables illuminate the presentation of results?
Are results described in light of the theoretical framework and supporting literature?
XI- Conclusion/Discussion
Are conclusions based on the results and related to the hypotheses?
Are study limitations identified?
Are implications of findings discussed (i.e., for practice, education, and research)?
Are recommendations for further research stated?
XII- Research Utilization Implicat.
This document summarizes several studies related to foot and ankle research. It highlights studies on muscle strength in patients with gout, muscle and joint factors associated with foot deformities in diabetics, the effectiveness of extracorporeal shock wave therapy for lower limb tendinopathies, and multidisciplinary management of diabetic foot disease. It also reviews evidence on treatments for plantar heel pain and vascular assessment techniques used by podiatrists. The introduction provides an overview of various foot and ankle conditions and clinical factors considered by clinicians in lower limb rehabilitation.
DIA2016_Comfort_Power Law Scaling AEPs-T43Shaun Comfort
This document summarizes a study that evaluated adverse event profiles (AEPs) across different therapeutic molecules to determine if they exhibited power law scaling behavior. The study found that AEPs from four marketed products spanning different therapeutic areas and mechanisms all demonstrated similar non-linear power law scaling. When plotted together, one equation could fit all the AEPs, suggesting this may be a common feature across adverse event data. However, the study was limited to one company's data, so further research is needed using larger safety databases to test if power law behavior is ubiquitous for AEPs.
Hip fractures are common and debilitating injuries among the elderly that can result in loss of independence and mortality. This study compared functional recovery outcomes between elderly patients treated surgically with either a dynamic hip screw (DHS) or proximal femoral nail (PFN) for intertrochanteric hip fractures. The study found that while functional recovery scores were similar between the DHS and PFN groups at 1-year post-surgery, patients treated with a DHS had significantly reduced function at 3 and 6 months compared to their pre-operative levels, whereas PFN patients did not experience this loss of function in the early months of recovery.
Evaluating the Quality of Trauma Care A Literature ReviewKaylie Butt
This literature review examines metrics used to evaluate the quality of trauma care. The author identifies the six dimensions of healthcare quality put forth by the Institute of Medicine: effectiveness, efficiency, timeliness, safety, patient-centeredness and equitability. Through a systematic search of databases, 79 relevant papers were identified and their metrics, patient cohorts and relationships between metrics were analyzed. The most common patient cohorts were general trauma and patients with an Injury Severity Score over 15. The top three metrics identified across studies were length of stay, morbidity and mortality, which represent the dimensions of effectiveness, efficiency, safety and timeliness.
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
Rischke_Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Re...Kari Zimmers
This study compared outcomes of patients receiving a viscoelastic total disc replacement (VTDR) to patients receiving anterior lumbar interbody fusion (ALIF) for lumbar disc degeneration using data from two independent spine registries. Linear regression models showed that VTDR was associated with significantly greater back and leg pain relief compared to ALIF, with differences of 2.76 and 2.12 points respectively. Additional factors influencing pain relief included female sex, monosegmental surgery, higher preoperative pain levels, and surgical level. The results suggest that viscoelastic total disc replacement may provide superior pain relief compared to anterior lumbar interbody fusion for patients with degenerative lumbar disc disease.
This document summarizes an article that systematically reviewed 18 studies examining the use of wavelet analysis on electromyography (EMG) signals from lower extremity muscles during walking and running. The main findings were: 1) Wavelet analysis can correctly classify individuals into groups with an accuracy of 68.4-100%. 2) Patients with ankle osteoarthritis or knee replacements showed delayed early stance muscle activation but prolonged mid-stance activation. 3) Atrophic muscles contained more energy in lower frequencies and lacked type II muscle fibers. Wavelet analysis provides valuable time-frequency information about muscle recruitment patterns during different speeds and phases of gait.
Union Rate of Tibiotalocalcaneal Nail with Internal or External Bone Stimulat...skisnfeet
This study compared the union rates of tibiotalocalcaneal (TTC) arthrodesis using an intramedullary nail with either internal or external bone stimulation. The study found that the union rates were similar between internal (53%) and external (57%) bone stimulation. Additionally, the rates of successful fusion capable of independent ambulation were similar between internal (81%) and external (83%) groups. While time to partial weight bearing was slightly faster with internal stimulation, there were no other significant differences in outcomes between the two bone stimulation methods.
Poster: Test-Retest Reliability and Equivalence of PRO MeasuresCRF Health
This literature review examined administration intervals used in test-retest reliability and equivalence studies for patient-reported outcome measures. The review found a large variance in intervals, ranging from immediate to 7 years for test-retest studies and from immediate to 1 month for equivalence studies. The most common intervals were 2 weeks for test-retest studies and 1 hour or less for equivalence studies. Intervals varied depending on the medical condition and type of study, with shorter intervals used for equivalence studies compared to test-retest studies for the same conditions.
Kabboord comobidity 2016 THE FINAL versionAnouk Kabboord
This systematic review and meta-analysis examined the association between comorbidity burden and functional rehabilitation outcomes after stroke or hip fracture. Twenty studies were included. The pooled correlation from seven studies showed a moderate negative association between comorbidity and functional status at discharge (r = -0.43). Assessments that included severity weighting of comorbidities revealed stronger associations. The Cumulative Illness Rating Scale severity index and Liu comorbidity index showed moderate negative correlations (r ranging from -0.25 to -0.50) with functional outcomes, explaining 12-16% and 4-7% of variance respectively. Assessments that only counted comorbid conditions showed weaker or no associations. The results indicate that comorbidity burden is modestly
A Qualitative Study to Understand the Barriers and Enablers in implementing a...Vojislav Valcic MBA
The document summarizes a qualitative study that explored barriers and enablers to implementing an Enhanced Recovery After Surgery (ERAS) program across several hospitals affiliated with the University of Toronto. Semistructured interviews were conducted with surgeons, anesthesiologists, and nurses. The interviews identified several common barriers, including lack of resources, poor communication, resistance to change, and patient factors. However, interviewees generally supported implementing a standardized ERAS program with guidelines based on evidence, education of staff and patients, and standardized order sets. Identifying these barriers and enablers is an important first step to successfully adopting an ERAS program.
1) The study investigated the effectiveness of platelet-rich plasma (PRP) combined with core decompression and allogeneic fibula rod support for treating osteonecrosis of the femoral head (ONFH).
2) Patients treated with PRP in addition to core decompression and rod support showed significantly improved Harris hip scores after surgery, with no differences compared to the control group that did not receive PRP.
3) Imaging at 3 months post-surgery found no deformities or collapses in either group, with the fibula rods properly positioned and beginning to integrate with surrounding bone.
Effective strategies to monitor clinical risks using biostatistics - Pubrica.pdfPubrica
In clinical science, biostatistics services are essential for data collection, analysis, presentation, and interpretation. Epidemiology, clinical trials, population genetics, systems biology, and other disciplines all benefit from it. It aids in the evaluation of a drug's effectiveness and safety in clinical trials.
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Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
This study examined the effectiveness of computer-designed insoles in reducing low back pain among 58 employees whose jobs involved extensive walking. The employees were randomly assigned to use either the computer-designed insoles or placebo insoles for 5 weeks, then switched to the other insole for another 5 weeks. Those using the computer-designed insoles experienced a greater reduction in reported low back pain according to a standardized questionnaire, with average pain decreasing by 1.49 points compared to a decrease of 0.31 points for those using placebo insoles. 81% of employees preferred the computer-designed insoles as more effective and comfortable than the placebo insoles. The results suggest computer-designed insoles more effectively reduce low back pain in workers whose
This study examines a two-stage revision technique using antibiotic-impregnated cement spacers to treat chronically infected total knee arthroplasties. 45 infected knee prostheses underwent revision, with a minimum 5-year follow-up. The technique involved removal of the infected prosthesis and placement of an antibiotic cement spacer. After infection clearance, the spacer was removed and a new prosthesis implanted. Infection was eradicated in 95.6% of cases, with significant pain reduction and functional improvement. While sometimes requiring extensive surgical approaches, this two-stage technique remains the standard treatment for chronic knee prosthesis infection.
This document reviews interventions for improving outcomes following total hip or knee arthroplasty. It finds that pre-operative patient education, nutrition management, and pain management can help reduce hospital stays and aid recovery. Specifically, education improves expectations and anxiety, while addressing malnutrition and anemia. Neuromuscular electrical stimulation pre-operatively may also enhance muscle strength and early mobility.
More Related Content
Similar to Use of static or articulating spacers for infection
The document presents a meta-analysis that compares the outcomes of external fixation (ExFix) versus open reduction and internal fixation (ORIF) for tibial pilon fractures based on 11 observational studies. The analysis found that ORIF had a lower risk of superficial infection, malunion and nonunion compared to ExFix, but a higher risk of unplanned hardware removal. No significant differences were found between the two methods in terms of deep infection, reduction quality, clinical evaluation scores, post-traumatic arthrosis development, or time to union. Overall, the analysis suggests ORIF may have better outcomes for certain complications, while ExFix resulted in fewer subsequent hardware removals.
Hammer Toe Correction Comparative StudyWenjay Sung
This study compared outcomes of 3 surgical treatments for hammertoe deformities: arthroplasty, arthrodesis, and interpositional implant arthroplasty. 114 patients underwent one of the procedures and were followed for at least 12 months. All treatments significantly improved pain and sagittal plane correction, but only implant arthroplasty provided significant transverse plane correction and had the lowest revision rate at 10.4%. The study demonstrates implant arthroplasty may have advantages over the other procedures for hammertoe correction.
Case-control Study on 2nd Hammertoe Deformity Correction TechniquesWenjay Sung
This is my case-control study on second hammertoe deformity correction techniques: arthroplasty, arthrodesis, and interpositional implant arthroplasty.
Critiquing Evaluation Criteria for Quantitative Research Article .docxmydrynan
Critiquing Evaluation Criteria for Quantitative Research Article: Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial)
Listed below are criteria that you will use to critique research articles pertinent to your research area of interest. Discuss how the investigator satisfied each criterion. Cite relevant passages in the articles, with reference to page number if appropriate.
I- Title of the Article and Authors
Is the title clear, including area of study and group studied?
Are the author’s credentials included?
II- Introduction
Is the purpose of the study presented?
Is the significance (importance) of the problem discussed?
Does the investigator provide a sense of what he or she is doing and why?
III- Problems Statement
Is the problem statement clear?
Does the investigator identify key research questions and variables to be examined?
Does the study have the potential to help solve a problem that is currently faced in clinical practice?
IV- Literature Review
Does the literature review follow a logical sequence leading to a critical review of supporting and conflicting prior work?
Is the relationship of the study to previous research clear?
Does the study have the potential gaps in the literature and support the necessity of the present study?
V- Theoretical Framework and Hypotheses
Is a rationale stated for the theoretical/conceptual framework?
Does the investigator clearly state the theoretical basis for hypotheses formulation?
Is the hypotheses stated precisely and in a form that permits it to be rested?
Are methods of data collection sufficiently described?
What are the identified and potential threats to internal and external validity that were present in the study?
If there was more than one data collector, was interrater reliability adequate?
VII- Sample
Are the subjects and sampling methods described?
Is the sample of sufficient size for the study, given the number of variables and design?
Is the adequate assurance that the rights of human subjects were protected?
VIII- Instruments
Are appropriate instruments for data collection used?
Are reliability and validity of the measurement instruments adequate?
IX- Data Analysis
Are the statistical tests used identified and the values reported?
Are appropriate statistics used, according to level of measurement, sample size, sampling method, and hypotheses/research questions?
X- Results
Are the results for each hypothesis clearly and objectively presented?
Do the figures and tables illuminate the presentation of results?
Are results described in light of the theoretical framework and supporting literature?
XI- Conclusion/Discussion
Are conclusions based on the results and related to the hypotheses?
Are study limitations identified?
Are implications of findings discussed (i.e., for practice, education, and research)?
Are recommendations for further research stated?
XII- Research Utilization Implicat.
This document summarizes several studies related to foot and ankle research. It highlights studies on muscle strength in patients with gout, muscle and joint factors associated with foot deformities in diabetics, the effectiveness of extracorporeal shock wave therapy for lower limb tendinopathies, and multidisciplinary management of diabetic foot disease. It also reviews evidence on treatments for plantar heel pain and vascular assessment techniques used by podiatrists. The introduction provides an overview of various foot and ankle conditions and clinical factors considered by clinicians in lower limb rehabilitation.
DIA2016_Comfort_Power Law Scaling AEPs-T43Shaun Comfort
This document summarizes a study that evaluated adverse event profiles (AEPs) across different therapeutic molecules to determine if they exhibited power law scaling behavior. The study found that AEPs from four marketed products spanning different therapeutic areas and mechanisms all demonstrated similar non-linear power law scaling. When plotted together, one equation could fit all the AEPs, suggesting this may be a common feature across adverse event data. However, the study was limited to one company's data, so further research is needed using larger safety databases to test if power law behavior is ubiquitous for AEPs.
Hip fractures are common and debilitating injuries among the elderly that can result in loss of independence and mortality. This study compared functional recovery outcomes between elderly patients treated surgically with either a dynamic hip screw (DHS) or proximal femoral nail (PFN) for intertrochanteric hip fractures. The study found that while functional recovery scores were similar between the DHS and PFN groups at 1-year post-surgery, patients treated with a DHS had significantly reduced function at 3 and 6 months compared to their pre-operative levels, whereas PFN patients did not experience this loss of function in the early months of recovery.
Evaluating the Quality of Trauma Care A Literature ReviewKaylie Butt
This literature review examines metrics used to evaluate the quality of trauma care. The author identifies the six dimensions of healthcare quality put forth by the Institute of Medicine: effectiveness, efficiency, timeliness, safety, patient-centeredness and equitability. Through a systematic search of databases, 79 relevant papers were identified and their metrics, patient cohorts and relationships between metrics were analyzed. The most common patient cohorts were general trauma and patients with an Injury Severity Score over 15. The top three metrics identified across studies were length of stay, morbidity and mortality, which represent the dimensions of effectiveness, efficiency, safety and timeliness.
To Determine Preference of Shoulder Pain Management by General Physicians in ...suppubs1pubs1
Rotator cuff muscles are functionally active and provide stability to the shoulder joint and also thereby allow the full Range of Motion (ROM) by moving the head of humerus in the glenoid cavity. Any tear or fragility of the rotator cuff muscles can cause the dislocation or instability and hence damaging other muscles specially the long head of biceps muscle. The diseases related to the supraspinatus tendon are frequently linked with the long head of the biceps tendon. Other cause of chronic shoulder pain is the adhesive capsulitis with large prevalence rates of more than 5.3% in the general target population [3].
Rischke_Viscoelastic Disc Arthroplasty Provides Superior Back and Leg Pain Re...Kari Zimmers
This study compared outcomes of patients receiving a viscoelastic total disc replacement (VTDR) to patients receiving anterior lumbar interbody fusion (ALIF) for lumbar disc degeneration using data from two independent spine registries. Linear regression models showed that VTDR was associated with significantly greater back and leg pain relief compared to ALIF, with differences of 2.76 and 2.12 points respectively. Additional factors influencing pain relief included female sex, monosegmental surgery, higher preoperative pain levels, and surgical level. The results suggest that viscoelastic total disc replacement may provide superior pain relief compared to anterior lumbar interbody fusion for patients with degenerative lumbar disc disease.
This document summarizes an article that systematically reviewed 18 studies examining the use of wavelet analysis on electromyography (EMG) signals from lower extremity muscles during walking and running. The main findings were: 1) Wavelet analysis can correctly classify individuals into groups with an accuracy of 68.4-100%. 2) Patients with ankle osteoarthritis or knee replacements showed delayed early stance muscle activation but prolonged mid-stance activation. 3) Atrophic muscles contained more energy in lower frequencies and lacked type II muscle fibers. Wavelet analysis provides valuable time-frequency information about muscle recruitment patterns during different speeds and phases of gait.
Union Rate of Tibiotalocalcaneal Nail with Internal or External Bone Stimulat...skisnfeet
This study compared the union rates of tibiotalocalcaneal (TTC) arthrodesis using an intramedullary nail with either internal or external bone stimulation. The study found that the union rates were similar between internal (53%) and external (57%) bone stimulation. Additionally, the rates of successful fusion capable of independent ambulation were similar between internal (81%) and external (83%) groups. While time to partial weight bearing was slightly faster with internal stimulation, there were no other significant differences in outcomes between the two bone stimulation methods.
Poster: Test-Retest Reliability and Equivalence of PRO MeasuresCRF Health
This literature review examined administration intervals used in test-retest reliability and equivalence studies for patient-reported outcome measures. The review found a large variance in intervals, ranging from immediate to 7 years for test-retest studies and from immediate to 1 month for equivalence studies. The most common intervals were 2 weeks for test-retest studies and 1 hour or less for equivalence studies. Intervals varied depending on the medical condition and type of study, with shorter intervals used for equivalence studies compared to test-retest studies for the same conditions.
Kabboord comobidity 2016 THE FINAL versionAnouk Kabboord
This systematic review and meta-analysis examined the association between comorbidity burden and functional rehabilitation outcomes after stroke or hip fracture. Twenty studies were included. The pooled correlation from seven studies showed a moderate negative association between comorbidity and functional status at discharge (r = -0.43). Assessments that included severity weighting of comorbidities revealed stronger associations. The Cumulative Illness Rating Scale severity index and Liu comorbidity index showed moderate negative correlations (r ranging from -0.25 to -0.50) with functional outcomes, explaining 12-16% and 4-7% of variance respectively. Assessments that only counted comorbid conditions showed weaker or no associations. The results indicate that comorbidity burden is modestly
A Qualitative Study to Understand the Barriers and Enablers in implementing a...Vojislav Valcic MBA
The document summarizes a qualitative study that explored barriers and enablers to implementing an Enhanced Recovery After Surgery (ERAS) program across several hospitals affiliated with the University of Toronto. Semistructured interviews were conducted with surgeons, anesthesiologists, and nurses. The interviews identified several common barriers, including lack of resources, poor communication, resistance to change, and patient factors. However, interviewees generally supported implementing a standardized ERAS program with guidelines based on evidence, education of staff and patients, and standardized order sets. Identifying these barriers and enablers is an important first step to successfully adopting an ERAS program.
1) The study investigated the effectiveness of platelet-rich plasma (PRP) combined with core decompression and allogeneic fibula rod support for treating osteonecrosis of the femoral head (ONFH).
2) Patients treated with PRP in addition to core decompression and rod support showed significantly improved Harris hip scores after surgery, with no differences compared to the control group that did not receive PRP.
3) Imaging at 3 months post-surgery found no deformities or collapses in either group, with the fibula rods properly positioned and beginning to integrate with surrounding bone.
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Open debridement and radiocapitellar replacement in primary and post-traumati...Alberto Mantovani
Background: Postmortem and clinical studies have shown an early and prevalent involvement of the radiohumeral
joint in primary and secondary arthritis of the elbow. The lateral resurfacing elbow (LRE) prosthesis
has recently been developed for the treatment of lateral elbow arthritis. However, few data have been
published on LRE results.
Materials and methods: A prospective multicenter study was designed to assess LRE preliminary results.
There were 20 patients (average age, 55 years). Preoperative diagnosis were primary osteoarthritis in 11
and post-traumatic osteoarthritis in 9. All patients underwent open debridement and LRE prosthesis.
Patients were evaluated preoperatively and postoperatively with the Mayo Elbow Performance Score
(MEPS), modified American Shoulder Elbow Surgeons (m-ASES) elbow assessment, and the Quick
Disabilities of the Arm, Shoulder and Hand (Quick-DASH). Mean follow-up was 22.6 months.
Results: At the last follow-up, the mean improvement of MEPS and m-ASES was 35 (P ¼ .001) and 34
(P ¼ .001) respectively; the average Quick DASH decreased by 29 (P ¼ .001). Average range of motion
was improved by 35 (P ¼.001). MEPI results were excellent in 12 patients, good in 2, and fair and poor in
3 each. Mild overstuffing was observed in 5 patients, and an implant malpositioning in 3. The implant
survival rate was 100%.
Conclusion: LRE showed promising results in this prospective investigation. Most patients had an
uneventful postoperative course and have shown a painless elbow joint, with satisfactory functional
recovery at short-term follow-up. Further studies with longer follow-up are warranted.
This study examined the effectiveness of computer-designed insoles in reducing low back pain among 58 employees whose jobs involved extensive walking. The employees were randomly assigned to use either the computer-designed insoles or placebo insoles for 5 weeks, then switched to the other insole for another 5 weeks. Those using the computer-designed insoles experienced a greater reduction in reported low back pain according to a standardized questionnaire, with average pain decreasing by 1.49 points compared to a decrease of 0.31 points for those using placebo insoles. 81% of employees preferred the computer-designed insoles as more effective and comfortable than the placebo insoles. The results suggest computer-designed insoles more effectively reduce low back pain in workers whose
This study examines a two-stage revision technique using antibiotic-impregnated cement spacers to treat chronically infected total knee arthroplasties. 45 infected knee prostheses underwent revision, with a minimum 5-year follow-up. The technique involved removal of the infected prosthesis and placement of an antibiotic cement spacer. After infection clearance, the spacer was removed and a new prosthesis implanted. Infection was eradicated in 95.6% of cases, with significant pain reduction and functional improvement. While sometimes requiring extensive surgical approaches, this two-stage technique remains the standard treatment for chronic knee prosthesis infection.
This document reviews interventions for improving outcomes following total hip or knee arthroplasty. It finds that pre-operative patient education, nutrition management, and pain management can help reduce hospital stays and aid recovery. Specifically, education improves expectations and anxiety, while addressing malnutrition and anemia. Neuromuscular electrical stimulation pre-operatively may also enhance muscle strength and early mobility.
This document summarizes a chapter about managing prosthetic joint infections according to the infecting organism. It discusses that prosthetic joint infections are increasing in incidence due to the rise in joint replacement surgeries. Staphylococcus aureus and coagulase-negative staphylococci are the most common causes, though infections can also be caused by other bacteria or fungi. Diagnosis involves identifying the infecting organism from intraoperative cultures. Treatment options aim to eradicate the infection while maintaining joint function, and include surgical strategies like debridement with implant retention or one- or two-stage implant exchange. Management is tailored based on factors like infection duration and organism type or resistance.
This study evaluated the treatment of 89 stable total hip and knee replacements with deep postoperative or hematogenous infections using debridement, prosthesis retention, and local antibiotics. The treatment involved multiple debridement surgeries with implantation of gentamicin-loaded PMMA beads or collagen fleeces for 2-week periods. Staphylococcus aureus was the most common causative organism. The results showed that treatment success decreased as the postoperative infection interval increased, with a failure rate below 50% considered acceptable up to 8 weeks postoperatively. Treatment of hematogenous infections with short durations of symptoms was also largely successful.
Bone loss following knee arthroplasty potential tmrcs89
The document discusses potential treatment options for bone loss following knee arthroplasty. It analyzes the causes of bone loss including mechanical loosening, infection, wear debris, and implant removal. Modular augmentation with metals or tantalum is presented as having advantages over allografts by providing more stable revisions, shortening surgical times, and decreasing complications like infection. While allografts can restore bone stock, their use has been limited by risks of failure, fracture, resorption, and higher infection rates compared to modular augmentation.
Artrodesis sin fusión ósea con clavo modularmrcs89
Este documento describe un estudio retrospectivo de 29 pacientes que recibieron una artrodesis de rodilla sin fusión ósea utilizando un clavo modular intramedular tras una revisión de una prótesis de rodilla infectada. Los resultados mostraron bajas tasas de complicaciones y buenos resultados funcionales, con la mayoría de los pacientes sin dolor y capacidad para realizar actividades diarias. El método demostró ser efectivo para fijar la rodilla y restaurar la alineación y longitud del miembro.
Este estudio evaluó 28 pacientes que fueron sometidos a resección quirúrgica de tumores malignos o benignos localmente agresivos en el tercio proximal del peroné. Los resultados mostraron una supervivencia general del 89% a los 7 años de seguimiento, una tasa de recidiva local del 11% y una tasa de amputaciones secundarias del 6%. La reinserción del complejo ligamentario posterolateral en la tibia proporcionó estabilidad funcional de la rodilla sin consecuencias funcionales a largo plazo.
Morbimortalidad en fracturas de húmero proximmrcs89
Este estudio analizó la mortalidad y la capacidad para realizar actividades de la vida diaria (AVD) en 94 pacientes con fracturas de húmero proximal tratadas quirúrgicamente con un seguimiento promedio de 8 años. Se encontró una tasa de mortalidad del 18,6% y que el 85,4% de los pacientes tenían comorbilidades. La mayoría de los pacientes (79,5%) podían realizar las AVD de forma independiente. El tipo de fractura y tratamiento no se asociaron con la mortalidad, pero los pacientes tratados con hemiartro
Este documento describe un estudio en el que se rellenaron defectos óseos en 9 pacientes utilizando esferas microcompartimentadas de cerámica (-TCP y HA) para evaluar si esto podía regenerar un hueso esponjoso capaz de soportar cargas. Los resultados mostraron que cuando el relleno era completo se formaba hueso, mientras que si era incompleto no se formaba hueso trabecular. Las esferas fueron reabsorbidas o integradas en el hueso, demostrando que las cerámicas osteoconduct
Artroplastia total de cadera no cementada tras fracturamrcs89
Este estudio prospectivo comparó los resultados de la artroplastia total de cadera no cementada como tratamiento de fracturas cervicales femorales agudas en pacientes activos previamente, con los resultados de la misma cirugía para tratar la coxartrosis. Se emparejaron 76 pacientes con fractura y 76 con coxartrosis. Los resultados funcionales fueron similares entre los grupos, aunque los pacientes con fractura usaron más ayudas para caminar. No hubo diferencias significativas en las tasas de complicaciones, revisiones o supervivencia de la prótesis
Manual de pruebas diagnosticas en traumatologia y ortopedia jurado buenomrcs89
El documento habla sobre la importancia de la privacidad y la seguridad en línea en la era digital. Explica que los usuarios deben tomar medidas para proteger su información personal, como usar contraseñas seguras y software antivirus actualizado. También enfatiza que las empresas deben implementar políticas claras sobre cómo protegen los datos de los clientes.
Manual de ortopedia y traumatología carlos firpomrcs89
El documento presenta el currículum del Dr. Carlos A. N. Firpo, profesor titular de ortopedia y traumatología. Firpo ha sido jefe de división en varios hospitales y ha fundado y presidido numerosas sociedades médicas. También ha publicado varios libros y artículos sobre ortopedia y traumatología. El documento detalla sus logros profesionales y académicos en una larga carrera dedicada a la especialidad.
Hoppenfeld, stanley & de boer, piet abordajes en cirugía ortopédicamrcs89
Este documento presenta un índice detallado con numerosas secciones y subsecciones. El índice cubre una amplia gama de temas relacionados con el documento principal.
Este documento presenta una clasificación de fracturas óseas en 3 oraciones o menos. Proporciona una clasificación detallada de fracturas en diferentes huesos como el húmero, radio, cúbito, fémur y tibia, dividiendo cada hueso en segmentos proximales, diafisiarios y distales. Además, clasifica cada fractura según su gravedad y características anatómicas usando códigos numéricos y letras para una comunicación clínica efectiva.
Este documento proporciona instrucciones detalladas sobre las posiciones correctas del paciente y del equipo de rayos X para realizar radiografías de diferentes partes del cuerpo, incluyendo los dedos de la mano, la mano, la muñeca, el antebrazo, el codo, el húmero, el hombro, la clavícula y la columna cervical. Describe la estructura anatómica que debe observarse y las posiciones específicas del paciente y del rayo central para cada tipo de proyección radiográfica.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Use of static or articulating spacers for infection
1. Use of Static or Articulating Spacers for Infection
Following Total Knee Arthroplasty
A Systematic Literature Review
Pramod B. Voleti, MD, Keith D. Baldwin, MD, MSPT, MPH, and Gwo-Chin Lee, MD
Investigation performed at the Department of Orthopaedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Background: The so-called gold standard for treatment of periprosthetic joint infection following total knee arthroplasty
is two-stage reimplantation. However, it is unclear whether use of static or articulating antibiotic-impregnated spacers
during the interim period between these two stages is superior. The purpose of this study was to compare the outcomes of
static and articulating spacers in the treatment of infection following total knee arthroplasty.
Methods: A systematic review of the peer-reviewed literature indexed by MEDLINE and Embase was performed to identify
studies reporting the outcomes of antibiotic spacers in the treatment of infection following total knee arthroplasty. Seven
Level-III comparative studies and thirty-two Level-IV case series remained following the screening process. The data in
these studies were extracted and aggregated to compare the reinfection rate, range of knee motion, functional scores,
and complication rates between static and articulating spacers.
Results: The two types of spacers demonstrated similar reinfection rates (7% for articulating and 12% for static, p = 0.2).
However, the articulating spacers resulted in significantly greater range of knee motion after reimplantation (101° for
articulating and 91° for static, p = 0.0002). Despite this difference in ultimate knee motion, functional scores in the treatment
groups were similar. Rates of wound-related and spacer-related complications were similarly low with both types of spacers.
Conclusions: Our review failed to identify a significant difference in the ability of static or articulating spacers to eradicate
periprosthetic infection following total knee arthroplasty. Compared with static spacers, articulating spacers provided
improved knee motion following reimplantation, although functional scores were similar in the two treatment groups. We
encourage arthroplasty surgeons to consider both static and articulating spacers in the treatment of infection following
total knee arthroplasty and to tailor treatment on the basis of patient-related factors.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
R
eported rates of periprosthetic joint infection following
primary total knee arthroplasty range from 0.4% to 2.5%1-5
.
This catastrophiccomplication results in substantial morbid-
ity, is associated with a mortality rate approaching 2.5%, and costs
approximately $50,000 per episode (exclusive of lost wages)6
.
The so-called gold standard for treatment of subacute and
chronic periprosthetic infection following total knee arthro-
plasty is two-stage reimplantation6-11
. In the first stage, a resec-
tion arthroplasty is performed with placement of an antibiotic
spacer. The antibiotic spacer provides local delivery of antibi-
otics, and systemic intravenous antibiotics are administered
simultaneously. The goals of spacer use are to maintain align-
ment, prevent contracture, increase patient comfort, enhance
soft-tissue healing, and deliver antibiotics12
. Controversy exists
regarding whether static or articulating antibiotic spacers are superior
in the treatment of infection following total knee arthroplasty.
Proponents of the use of static spacers during the interim
period between resection arthroplasty and reimplantation
maintain that static spacers are more effective than articulating
spacers at delivering antibiotics and thus controlling the peri-
prosthetic joint infection13
. However, critics argue that articu-
lating spacers provide better function during the interim period,
Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any
aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work,
with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has
had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this
work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.
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J Bone Joint Surg Am. 2013;95:1594-9 d http://dx.doi.org/10.2106/JBJS.L.01461
2. superior knee motion and functional outcomes following re-
implantation, and decreased bone loss resulting from spacer
migration14-17
. Despite the multitude of studies comparing static
and articulating spacers, the question still remains: are static or
articulating spacers superior in the treatment of periprosthetic
joint infection following total knee arthroplasty?
The purpose of this study was to analyze the peer-
reviewed literature in order to compare the outcomes (reinfection
rate, range of knee motion and functional scores following re-
implantation, and complication rate) of static spacers with
those of articulating spacers in the treatment of infection fol-
lowing total knee arthroplasty.
Materials and Methods
We performed a systematic query of both the MEDLINE and Embase
computerized literature databases to identify articles containing the key-
word terms ‘‘total knee arthroplasty’’ and ‘‘spacer.’’ The search was performed
on May 1, 2012, and all studies published prior to that date were considered. In
addition to this primary search, we performed a secondary search by scruti-
nizing all references cited in the articles retrieved from the primary search and
identifying additional studies of interest. Each of the three authors indepen-
dently reviewed all articles retrieved from the primary and secondary searches
with use of the systematic strategy outlined below. Each author was blinded
with regard to the determinations of the other two authors.
Studies were included if they (1) described patients treated with static
and/or articulating spacers for periprosthetic infection following primary total
knee arthroplasty; (2) reported reinfection rates, knee motion after reimplan-
tation, functional scores after reimplantation, and/or complication rates; and
(3) followed patients for at least two years. Review articles, technique descrip-
tions, and editorials were excluded.
The initial combined MEDLINE and Embase search with use of the
aforementioned keyword terms yielded 259 unique articles. The titles of these
articles were reviewed independently by all three authors. Articles whose titles
indicated that they were clearly irrelevant to the topic in question (118) were
eliminated. The abstracts of the remaining 141 articles were then scrutinized
independently by all three authors. Articles that clearly did not meet the inclusion
criteria on the basis of the information contained in the abstract (ninety-three)
were eliminated. The abstracts of the remaining forty-eight articles were de-
termined to meet the inclusion criteria by at least one author, and the corre-
sponding full text was therefore reviewed independently by all three authors.
After review of the full text, sixteen of these articles were eliminated unani-
mously by all three authors because they failed to meet the inclusion criteria.
The remaining thirty-two articles from the primary search were retained. At
each phase of review, if one or more authors selected an article, it moved on to
the next phase. In the final (full text) phase of review, there was no disagreement
regarding which articles should ultimately be included.
All references cited in the articles retrieved in the initial query were then
compiled for the secondary search. These references were screened in the same
manner as the articles from the primary search (title review, then abstract
review, then full text review). Seven of the additional articles identified in the
secondary search met the inclusion criteria and were retained. Therefore, a total
of thirty-nine articles underwent the data retrieval process (Fig. 1); seven of
Fig. 1
Flow diagram outlining the systematic search utilized in this study.
TABLE I Characteristics of the Seven Included Level-III Comparative Studies
No. of Patients Follow-up (mo)
Study Overall Static Spacers Articulating Spacers Overall Static Spacers Articulating Spacers
Fehring, 2000
18
40 25 15 33 36 27
Emerson, 2002
14
48 26 22 70 90 46
J¨amsen, 2006
19
30 8 22 31 49 25
Freeman, 2007
13
114 38 76 70 87 62
Hsu, 2007
15
28 7 21 69 101 58
Park, 2010
16
36 20 16 33 36 29
Chiang, 2011
17
45 22 23 41 40 41
Total 341 146 195
Mean 54 63 48
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3. these represented Level-III comparative studies that described both static and
articulating spacer treatment groups
13-19
, and thirty-two represented Level-IV
case series that described either patients treated with static spacers (eleven studies,
references 23 through 33 in the Appendix) or patients treated with articulating
spacers (twenty-one studies, references 34 through 54 in the Appendix).
The data published in these articles were meticulously extracted and
compiled. The data obtained from the seven Level-III comparative studies were
used to generate a random-effects meta-analysis model to compare reinfection
rates and frequency-weighted mean knee motion after reimplantation. The
meta-analysis was performed with MIX meta-analysis software (version 1.7 for
Windows; BiostatXL). The data obtained from the thirty-nine Level-III and
Level-IV studies were used to calculate frequency-weighted means and groupwise
variance for the reinfection rate, range of motion after reimplantation, and
functional scores after reimplantation as well as to compare complication rates
between the treatment groups.
Source of Funding
No external funding sources were utilized for this investigation.
Results
The seven Level-III comparative studies included a total of
341 patients, 146 treated with static spacers and 195 treated
with articulating spacers (Table I). The population sizes for the
individual studies ranged from twenty-eight to 114 patients. Of
note, the frequency-weighted mean duration of follow-up was
greater for static spacers (sixty-three months) than for articu-
lating spacers (forty-eight months). This was because the au-
thors of four of these studies13-15,18
initially used static spacers
exclusively and then transitioned gradually to using articulating
spacers more frequently.
Six of the seven Level-III studies13,15-19
demonstrated a
greater reinfection rate in the static spacer group than in the
articulating spacer group (Table II). However, because of the
overall paucity of reinfections, none of these individual studies
demonstrated a significant difference between the reinfection
rates in the two treatment groups. Aggregation of the reinfec-
tion rate data with use of the random-effects meta-analysis
model revealed a frequency-weighted mean reinfection rate of
12% for static spacers and 7% for articulating spacers (Fig. 2).
This difference was again not significant (p = 0.2). The anti-
biotic concentration within the spacer cement was identical in
the two spacer groups in five of the studies13-16,18
, greater in the
static spacer group than in the articulating spacer group in one
study17
, and not reported in one study19
(see Appendix).
All six Level-III comparative studies that included data
on the range of knee motion after reimplantation14-19
indicated
that articulating spacers resulted in greater range of motion
after reimplantation than did static spacers (Table III). This
difference reached significance in four of the six studies14-17
. The
remaining two studies18,19
were likely underpowered with re-
gard to this variable, although no power analysis was reported.
The results of the combined analysis of the thirty-nine
Level-III and Level-IV studies are shown in Table IV. These
studies included a total of 1526 patients, 654 treated with sta-
tic spacers and 872 treated with articulating spacers. The
frequency-weighted mean duration of follow-up was similar in
the two treatment groups (fifty-seven months for static spacers
and fifty-two months for articulating spacers, p = 0.4). The
mean reinfection rate was again greater, but not significantly so,
in the static spacer group (12%) than in the articulating spacer
group (8%, p = 0.1). Importantly, there was a significant dif-
ference between the groups with regard to knee motion after
reimplantation (91° for static spacers and 101° for articulating
spacers, p = 0.0002). Despite this difference in range of motion,
the treatment groups demonstrated similar functional out-
comes (p = 0.5 for the HSS [Hospital for Special Surgery] score
and p = 0.7 for the Knee Society score). Wound-related
TABLE II Reinfection Rates Reported in the Included Level-III
Comparative Studies
Reinfection Rate (%)
Study Overall Static Spacers
Articulating
Spacers
Fehring
18
10 12 7
Emerson
14
8 8 9
J¨amsen
19
13 25 9
Freeman
13
6 8 5
Hsu
15
11 14 10
Park
16
11 15 6
Chiang
17
11 14 9
Mean 9 12 7
Fig. 2
Forest plot showing the meta-analysis of reinfection rates. The diamond
indicates the pooled estimate of the ratio between the infection rates in the
two treatment groups, the horizontal bars and the width of the diamond
indicate the 95% confidence intervals, and the box sizes indicate the
relative weighting of each study. AS = articulating spacers, and SS = static
spacers.
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USE OF STATIC OR ARTICULATING SPACERS FOR INFECTION
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4. complications occurred in 8% of patients treated with static
spacers compared with 2% of patients treated with articulating
spacers, and spacer-related complications occurred in 1% of
patients treated with static spacers compared with 3% of patients
treated with articulating spacers. Given the infrequency of these
complications, the present study was underpowered to demon-
strate a significant difference between these complication rates.
Discussion
Periprosthetic joint infection following total knee arthro-
plasty is a catastrophic complication that results in substan-
tial pain, disability, and health-care costs. Even after successful
eradication of the infection, the patient may experience long-
term residual pain and continued disability20
. These poor func-
tional results may be attributed to multiple causes, including
(but not limited to) patient comorbidities, wound-healing
complications, bone loss, and residual infection. Therefore,
optimizing the outcomes of these patients by determining the
ideal type of antibiotic spacer is of critical importance.
Concerns that have been raised regarding static spacers
include bone erosion, spacer subluxations and dislocations,
spacer fractures, knee stiffness, and increased difficulty of expo-
sure during reimplantation. Additionally, patient function during
the interim period between resection arthroplasty and reim-
plantation is limited if static spacers are used, as the patient is
required to keep the affected lower extremity extended. Articu-
lating spacers have gained in popularity because they are thought
to allow limited motion, decrease stiffness, increase the range of
knee motion after reimplantation, reduce surgical exposure time
during reimplantation, and result in improved functional outcomes.
However, some concerns have been raised regarding whether
articulating spacers deliver antibiotics as well as static spacers do.
We failed to identify a significant difference in the ability
of static or articulating spacers to eradicate periprosthetic in-
fection following total knee arthroplasty. Our meta-analysis of
Level-III comparative studies demonstrated a reinfection rate
of 12% for static spacers and 7% for articulating spacers (p =
0.2). The combined analysis of Level-III and Level-IV studies
also demonstrated similar reinfection rates in the two treat-
ment groups (12% for static spacers and 8% for articulating
spacers, p = 0.1). Therefore, the currently available evidence
suggests that the two types of spacers are similarly effective at
TABLE III Range of Motion After Reimplantation Reported in the Included Level-III Comparative Studies*
Range of Motion (deg)
Study Overall Static Spacers Articulating Spacers Reported P Value
Fehring
18
101 98 105 0.14
Emerson
14
100 94 108 0.01†
J¨amsen
19
101 92 104 0.143
Freeman
13
NR NR NR NR
Hsu
15
91 78 95 0.019†
Park
16
99 92 108 0.04†
Chiang
17
99 85 113 <0.05†
Mean 99 92 105
*NR = not reported. †Significant (p < 0.05).
TABLE IV Clinical Data Reported in the Thirty-nine Included Level-III and Level-IV Studies*
Variable Overall Static Spacers Articulating Spacers P Value
No. of patients 1526 654 872 NC
Follow-up (mo) 54 57 52 0.4
Reinfection rate 10% 12% 8% 0.1
Postop. range of motion 97° 91° 101° 0.0002†
HSS score 82 81 83 0.5
Knee Society score 78 77 80 0.7
Wound complication rate 4% 8% 2% NC
Spacer complication rate 2% 1% 3% NC
*NC = not calculated. †Significant (p < 0.05).
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5. controlling infection in patients undergoing two-stage reim-
plantation for periprosthetic infection following total knee
arthroplasty.
Knee stiffness is a frequent complication of periprosthetic
infection following total knee arthroplasty, even after eradica-
tion of the infection20
. Factors that contribute to knee stiffness
include relative immobility during the interval between the two
stages of the revision procedure, multiple surgical procedures,
and scar tissue formation. According to our analysis, articulating
spacers resulted in significantly greater post-reimplantation
range of knee motion compared with static spacers. All six
Level-III comparative studies in which the final range of mo-
tion was reported demonstrated greater knee motion for pa-
tients treated with articulating spacers compared with static
spacers. The frequency-weighted mean range of motion after
reimplantation was 105° for articulating spacers and 92° for
static spacers. Additionally, the combined analysis of the Level-
III and Level-IV studies demonstrated a similar difference in
ultimate range of motion (101° for articulating spacers and 91°
for static spacers, p = 0.0002). The difference in mean flexion
appears small, but the greater ultimate range of motion in
patients treated with articulating spacers may actually result in
a difference in the ability to perform activities of daily living,
such as stair climbing and rising from a chair21
.
Despite the difference in ultimate range of motion, pa-
tients in the two treatment groups had similar clinical and
functional outcomes. We found no significant difference be-
tween the groups with regard to the HSS score (p = 0.5) or the
Knee Society score (p = 0.7). The reason for this lack of dif-
ference in function is unknown. One possible explanation in-
volves the fact that the range of knee motion accounts for only a
small proportion of these two functional scores (18 out of 100
total points in the HSS score and 25 out of 100 total points
in the Knee Society score). Other components of the HSS and
Knee Society scores include pain, ability to perform activities
of daily living (walking, stairs, and transfers), muscle strength,
alignment, and stability. Therefore, although patients treated
with articulating spacers experienced improved range of mo-
tion after reimplantation compared with patients treated with
static spacers, the contribution of residual pain and diminished
activity level to these scores may have led to statistically insig-
nificant improvements in overall knee function.
Finally, the rates of complications—both wound-related
and spacer-related—appeared similar between the treatment
groups. The most common wound-related complications were
wound dehiscence and superficial infection, and the most
common spacer-related complications were spacer migration
and bone loss. Of note, these complications were so uncom-
mon that statistical comparisons could not be performed even
after aggregating all available data. Consequently, it appears
that either articulating or static spacers, when placed in well-
selected patients with use of an appropriate surgical technique,
can yield similarly low complication rates.
The present study has some important limitations. As
with all systematic reviews and meta-analyses, this investiga-
tion is limited by the inherent weaknesses of the component
studies (which were all Level-III comparative studies and Level-
IV case series characterized by retrospective study designs,
limited population sizes, and medium-term follow-up dura-
tions). There was also notable heterogeneity among the com-
ponent studies with regard to surgical technique, spacer
preparation method, spacer antibiotic selection and concen-
tration, duration of intravenous antibiotic treatment, and du-
ration of spacer use. Furthermore, our analysis did not control
for confounding variables (such as medical comorbidities,
body mass index, the extent of bone loss, skin quality, or sur-
gical history) and it did not directly evaluate certain important
outcomes (such as spacer-related bone erosion and operative
time). Our ability to take such confounding variables and ad-
ditional outcomes into account was unfortunately hindered by
inconsistent reporting of this information in the component
retrospective studies. In addition, the included studies were
nonrandomized, and our analysis was therefore likely affected
by selection bias as the authors of the component studies may
have tailored the treatment on the basis of patient-related
variables (such as medical comorbidities, body mass index, the
extent of bone loss, skin quality, and the surgical history). For
example, static spacers may have been employed preferentially
in patients with more severe bone loss. Pooling data from
nonrandomized comparative and observational studies is con-
troversial and does have important statistical limitations that
may impact the results of the review. However, some research
questions, such as the ones addressed in this investigation, are
not amenable to randomized trials; in such cases, the Cochrane
Collaboration notes that authors of reviews are justified in
including nonrandomized studies22
.
Despite its limitations, the present systematic literature
review does make important comparisons between static and
articulating spacers with regard to reinfection rates, knee mo-
tion and functional outcomes following reimplantation, and
complication rates. Given the similar reinfection and compli-
cation rates in the two treatment groups, we encourage arthro-
plasty surgeons to consider both static and articulating spacers
in the treatment of periprosthetic infection following total knee
arthroplasty and to tailor treatment on the basis of patient-
related factors (such as comorbidities, bone deficiency, the soft-
tissue envelope, skin quality, and the infecting microorganism).
Evidence-based medicine dictates that medical decisions
should be guided by sound evidence in the literature. One of
the most important findings of the present study is that the
currently available literature comparing static with articulating
antibiotic spacers in the treatment of infection following total
knee arthroplasty is extremely limited. We encourage the initi-
ation of large, multicenter, prospective, randomized controlled
trials to further elucidate the best treatment protocols for
periprosthetic joint infection following total knee arthroplasty.
Appendix
A table listing the antibiotic concentrations in the seven
included Level-III comparative studies as well as refer-
ences for the thirty-two Level-IV case series are available with
the online version of this article as a data supplement at jbjs.org. n
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6. Pramod B. Voleti, MD
Keith D. Baldwin, MD, MSPT, MPH
Gwo-Chin Lee, MD
Department of Orthopaedic Surgery,
Hospital of the University of Pennsylvania,
3400 Spruce Street,
2 Silverstein, Philadelphia, PA 19104.
E-mail address for G.-C. Lee: Gwo-Chin.Lee@uphs.upenn.edu
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