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Synopsis: 220 patients with isolated pertrochanteric femoral fractures were randomized to receive surgical intervention with a short or long cephalomedullary nail.Primary outcomes of interest included the Short Form 36 (SF-36) questionnaire and the Harris Hip Score.Secondary outcomes of interest included implant failure, peri-implant failure, mortality, operative time, estimated blood loss and the incidence of re-operation.Outcomes were assessed up to 12 months post-operation.Results revealed significantly favourable 3 month Harris Hip scores, lower operative time and lower estimated blood loss in the short nail group compared to the long nail group. No significant differences... Read More »
Level 2 RCT
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Synopsis: Forty-nine thousand, five hundred and ninety-seven patients aged 60 years or older from Ontario who underwent either total hip arthroplasty or hemi-arthroplasty for the treatment of displaced femoral neck fractures were included in this retrospective study examining clinical outcomes and associated factors with each procedure.A matched cohort of 9,238 patients was used to compare clinical outcomes.Outcomes of interest included the risk of hip dislocation, revision surgery, and death.Results of the study found a higher risk of 1-year revision surgery and dislocation in the total hip arthroplasty group compared to the hemi-arthroplasty group. The risk of... Read More »
Conference Report
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Synopsis: 128 patients were randomized to examine whether stripping of the posterior knee capsule could improve flexion and range of motion (ROM) following total knee arthroplasty (TKA).Patients received posterior capsular stripping (PCS) or no stripping, and were assessed at 3 months and 1 year postoperatively. Results revealed that... Read More »
Level 1 RCT
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Synopsis: Five randomized controlled trials were included in this meta-analysis which sought to investigate the efficacy of mesenchymal stem cell injections in patients with knee osteoarthritis.Included studies featured various control groups, including placebo injection, hyaluronic acid injection, and no injection, as well as various concomitant treatments, including high tibial osteotomy, microfracture, platelet rich plasma injection and hyaluronic acid injection.Accordingly, clinical heterogeneity was assumed.Data was pooled from 12-24 month time points. Analyses on visual... Read More »
Level 2 Meta Analysis
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Synopsis: Historically, there have always been perceived advantages to hip resurfacing rather than total hip arthroplasty.However, as newer generation hip arthroplasties with improved design have emerged, these previously established failure rate comparisons may no longer be valid.The current study used a meta-analysis to analyze current evidence on this subject. Findings revealed that pooled mechanical failure rates of the femoral component were lower in total hip arthroplasty when compared to the resurfacing, although these rates were low for both procedures. Acetabular and overall... Read More »
Level 1 Meta Analysis
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Synopsis: The decision to resurface or leave the patella unresurfaced during total knee arthroplasty (TKA) has been a controversial issue.Ten trials (1,003 knees) were identified in this meta-analysis to examine the advantages and disadvantages of patellar resurfacing during TKA for patients with osteoarthritis (OA).The available evidence demonstrated that patellar resurfacing reduced the risk of reoperation following TKA; however, the absolute risk difference for reoperation was low.Moreover, no difference in anterior knee pain was observed with patellar resurfacing. This meta-analysis was... Read More »
Level 1 Meta Analysis
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Synopsis: Six ACE Reports were identified from the OrthoEvidence database which compared intra-articular injection(s) of hyaluronic acid to corticosteroid in the treatment of osteoarthritis of the knee.All of the included studies were randomized controlled trials which reported pain and/or functional outcomes within 6 months of intervention.Pooled analysis of pain on a visual analog scale indicated that pain relief was significantly better with hyaluronic acid injections at both 3 and 6 months follow-up; however, this finding was strongly influenced by two studies of lower methodological quality. No significant differences between hyaluronic acid and corticosteroid injections were observed in any functional outcome measurement.Due to incomplete or lack of reporting adverse events, an assessment of safety could not be performed along with this review. Furthermore, these findings... Read More »
ACE Review
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Synopsis: 29 studies were included in this meta-analysis comparing operative and non-operative treatment for acute Achilles tendon ruptures.The primary outcome of interest was the rate of re-rupture.Secondary outcomes included the rate of complications, functional outcomes, time to return to sports and time to return to work.The results revealed a significantly lower rate of re-rupture, but a higher rate of complications, in the operative group compared to the non-operative group.Similar findings to the primary analyses were observed in the sensitivity analyses based on early and late weight bearing status, high quality studies and studies conducted after the year 2000.There were no significant differences in re-rupture rate in studies utilizing accelerated functional rehabilitation. There was no... Read More »
Level 1 Meta Analysis
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. Read More »
Level 1 RCT
1%
Synopsis: Sixty patients with shoulder impingement syndrome were randomized to receive a dual-target (long head of bicep tendon and subacromial bursa) subacromial corticosteroid injection or a standard subacromial corticosteroid injection for the relief of pain and improvement of functional outcomes.The primary outcomes of interest were the Shoulder Pain and Disability Index (SPADI) pain, function and total scores.Secondary outcomes of interest included pain at rest, during the night, and during overhead activities.Follow up was performed at 1 and 3 months post-injection.Results found no significant differences in the improvement of all outcomes from baseline at 1 month post-injection between the two groups. However, the improvement... Read More »
Level 1 RCT