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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
1%
Synopsis: 28 patients (30 fractures) with open tibial fractures or high-energy-induced complex tibial fractures were randomized after surgery to undergo low-intensity pulsed ultrasound (LIPUS) stimulation therapy or sham treatment.The purpose was to compare short-term clinical and radiological outcomes between groups.Patients treated with LIPUS had significantly earlier tenderness relief, full weight-bearing, external fixator removal, and appearance of bridging bone calluses.Additionally, LIPUS achieved a significantly higher percentage change in bone mineral content and plasma bone-specific phosphatase activity at various follow-up time points. Read More »
Level 2 RCT
1%
Synopsis: 84 patients scheduled for revision total hip arthroplasty were randomized to administration of either combined intravenous and topical tranexamic, or intravenous tranexamic acid administration alone during the procedure.The purpose of this study was to compare transfusion rate, blood loss parameters, and the incidence of venous thromboembolic complications between groups.Results demonstrated significantly lower transfusion rate, smaller maximum hemoglobin drop, and lower postoperative and total blood loss volume in the combined TXA group compared to the IV TXA group.The incidence of deep vein thrombosis was low, with only one case documented in the combined group. No patient in... Read More »
Level 2 RCT
1%
Synopsis: 220 patients scheduled for total hip arthroplasty were randomized to undergo the procedure on either an outpatient or inpatient basis.Outpatients were to be discharged within 12 hours of surgery, while inpatients were allocated to at least a one-night stay in hospital.Patients were assessed for pain on the day of surgery (POD0), postoperative day 1 (POD1), and at 4 weeks.Results demonstrated no significant differences between groups in pain on POD0 or at 4 weeks, but significantly higher pain among outpatients on POD1. There were no... Read More »
RCT
1%
Synopsis: 200 patients scheduled for direct anterior total hip arthroplasty were randomized to surgery with or without the use of computer assistance software (CAS group) for alignment of the acetabular cup.Target inclination angle was 40 degrees and target anteversion angle was 20 degrees.Radiographs obtained at 4 weeks postoperatively were used to measure alignment of the acetabular cup.For inclination, a significant difference in favour of the CAS group was observed in mean angle and mean error from 40 degrees, though the rate of outliers deviating >10deg from target alignment was 0% and 2% in the groups, respectively. For anteversion, no... Read More »
Level 2 RCT
<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: 90 patients scheduled for a total knee arthroplasty were randomized to receive Floseal, tranexamic acid or control for the reduction of peri-operative bleeding.Outcomes of interest included aspirated blood volume, pad weight, incidence of transfusion, drainage volume, hemoglobin decrease, total measured bleeding and range of motion.Follow up was performed for a minimum of 12 months.Results revealed significantly greater drainage output, hemoglobin decrease, total measured bleeding, aspirated blood volume and worse range of motion in the control group compared to the Floseal and tranexamic acid groups. Additionally, the Floseal... Read More »
Level 2 RCT
<1%
Synopsis: 62 patients with rotator cuff tendinosis were randomized to receive either xylocaine and betamethasone or xylocaine alone.Over 6 months, there was significant no difference observed between the two groups for pain, function, quality of life, active internal rotation, active external rotation, or the Neer impingement sign.Active forward elevation was greater in the betamethasone group compared to the xylocaine only group at 2 weeks, but the difference was not significant at any other time. Significant improvement was... Read More »
Level 1 RCT
<1%
Synopsis: 10 randomized controlled trials (RCTs) with a total of 525 patients were included in this meta-analysis to determine the effect of bisphosphonates in preventing femoral periprosthetic bone resorption in patients who underwent primary cementless total hip arthroplasty (THA). The femoral periprosthetic bone stock was divided and assessed in seven regions of interest (ROI.) Pooled results demonstrated a decrease in early femoral periprosthetic bone resorption with administration of bisphosphonates. Read More »
Level 1 Meta Analysis
<1%
Synopsis: 502 patients with an acute open or closed tibial fracture undergoing treatment with intramedullary (IM) nails were randomly assigned to receive either active or sham low-intensity pulse ultrasound (LIPUS) to determine whether the use of LIPUS demonstrated a significantly beneficial effect on functional recovery. The results of this study indicated that LIPUS treatment did not result in significantly improved functional outcome over the first 52 postoperative weeks, and demonstrated no significant effect on time to union when compared to sham LIPUS treatment. Read More »
Conference Report