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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
2%
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: 8 randomized controlled trials (1100 patients/fractures) comparing bipolar and unipolar hemiarthroplasty in elderly patients with femoral neck fractures were included in this study.The purpose of this meta-analysis was to compare the two surgical treatments in terms of clinical and functional outcomes. The results displayed... Read More »
Level 1 Meta Analysis
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Synopsis: 50 elderly male patients with displaced intracapsular fractures were randomly assigned to treatment with either internal fixation or arthroplasty.The purpose was to determine the comparative efficacy between these two surgical options for treatment in this patient population.Operative data demonstrated a significantly reduced operative time for internal fixation.Results after one year revealed a higher rate of re-operation and fracture healing complications with internal fixation compared to arthroplasty. No significant differences... Read More »
Conference Report
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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: 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
<1%
Synopsis: Six ACE Reports (5 randomized controlled trials and 1 systematic review/meta-analysis) were identified from the OrthoEvidence database which evaluated the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis.All included studies were randomized controlled trials, and reported clinical and functional assessment at various time points between 1 and 6 months following treatment.Pooled analysis of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Total scores suggested a possible beneficial effect with PRP injection in comparison to saline and a lower effect versus hyaluronic acid.Beneficial effects were also noted for individual subscales of the WOMAC assessment (pain, stiffness, and physical function).However, pooling of OMERACT-OARSI responders and a review of the literature indicated that there was no significant difference between PRP and comparison groups in other functional outcome measures, such as the International Knee Documentation Committee (IKDC) assessment and Knee Injury and Osteoarthritis Outcome Score (KOOS).Furthermore, contrasting results were obtained between two studies reporting function on the Lequesne Index. The discrepancy in... Read More »
ACE Review
<1%
Synopsis: 219 hips in 192 patients diagnosed with degenerative hip joint disease, were randomly assigned to treatment with either metal-on-metal hip resurfacing or total hip replacement.The purpose was to compare to two in terms of clinical benefits, metal ion levels, and radiographic outcomes over 8 years after treatment.The results of the study indicated that for young patients suffering from hip joint degeneration, both total hip replacement and hip resurfacing result in similar, improving clinical outcomes and revision rates approximately 8 years postoperatively. Osteolysis was observed... Read More »
Author verified Level 2 RCT
<1%
Synopsis: 313 patients with subacromial impingement were randomized to either arthroscopic subacromial decompression, arthroscopic irrigation alone, or no treatment.Patients were primarily assessed for function, on the Oxford Shoulder Score, after 6 and 12 months.Comparing the two arthroscopic interventions to each other, no significant difference in functional scores were observed between the arthroscopic subacromial decompression group and the arthroscopic irrigation alone group at 6 or 12 months.Comparing the two arthroscopic interventions to no treatment, while statistically significant greater function scores were observed for both arthroscopy groups compared to no treatment, the differences were deemed not likely to be clinically relevant as they did not meet the minimum clinically important difference of 4.5pts for the Oxford Shoulder Score. Read More »
Level 2 RCT
<1%
Synopsis: 30 blinded randomized controlled trials evaluating the use of hyaluronic acid injections in comparison to a placebo injection in patients with knee osteoarthritis were included in this systematic review and meta-analysis.The objective of this systematic review and meta-analysis was to compare the efficacy and safety of hyaluronic acid injections across different dosing regimens.At 3 months, data were available for 2-4 injection and 5+ injection groups.The 2-4 injection groups demonstrated significantly lower pain scores compared placebo (SMD -0.76 p<0.00001), while the 5+ injection groups did not demonstrate significantly lower pain compared to placebo (SMD -0.20; p=0.09).At 6 months, both the 2-4 injection group (SMD -0.36; p=0.008) and 5+ injection group demonstrated significantly lower pain compared to placebo (SMD -0.18; p=0.04).The single injection groups did not significantly reduce pain compared to placebo at 6 months (SMD -0.04; p=0.67).When looking at the incidence of adverse events, only the 5+ injection group demonstrated a significantly greater incidence compared to placebo (RR 1.67; p=0.02). Read More »
Meta Analysis