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19%
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
3%
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
2%
Synopsis: 151 patients with knee osteoarthritis (OA) pain were randomized to receive cooled radiofrequency ablation (CRFA) or intra-articular corticosteroid (IAS) injections.Patients in the IAS group were given the opportunity to cross over to CRFA treatment after 6 months, however these patients were not included in the CRFA group analysis.The primary outcome of interest was the cost per quality-adjusted life year (QALY) gained.Additional outcomes of interest included QALYs, treatment cost, incremental QALY gain, incremental cost, and total cost.Follow up was performed at 6 and 12 months post-treatment. The findings revealed... Read More »
Level 2 RCT
2%
Synopsis: 3 studies (1691 patients) were included in this meta-analysis comparing EACA and TXA for the reduction of blood loss and transfusion requirement in total knee arthroplasty.The primary outcome of interest was blood loss and the amount of transfusion required.Secondary outcomes of interest included operative time, tourniquet time and complications. No significant differences... Read More »
Level 2 Meta Analysis
2%
Synopsis: 120 patients with symptomatic knee osteoarthritis were randomized to receive intra-articular (IA) injections of platelet rich plasma (PRP), hyaluronic acid (HA) or corticosteroid for the treatment of pain and improvement of function.Outcomes of interest included the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, Visual Analog Scale (VAS) for pain and adverse events.Follow up was performed at 3, 6.9 and 12 months.The results of the study found significant improvements from pre-treatment scores in both WOMAC and VAS pain outcomes in all three groups.Moreover at 6, 9 and 12 months, the PRP group showed significantly favourable WOMAC scores compared to both the hyaluronic acid and corticosteroid injection groups. There were no... Read More »
Level 2 RCT
2%
Synopsis: 81 patients scheduled for primary total knee arthroplasty for the treatment of knee osteoarthritis were randomized to receive wound closure with the knee either in flexion (90deg) or extension.Outcomes of interest included the knee and function sub-scores of the American Knee Society Score (AKSS), knee range of motion in flexion, and isokinetic muscle strength (peak torque, total work, peak torque difference, total work difference).Follow up was performed up to 6 months post-operation. Results revealed no... Read More »
Level 1 RCT
1%
Synopsis: Seven RCTs (515 patients) were included in this meta-analysis comparing local injection of platelet rich plasma (PRP) and local injection of corticosteroid for the treatment of lateral epicondylitis.Outcomes of interest included pain on a Visual Analog Scale (VAS), the Modified Mayo Performance Index, the Disability of the Arm, Shoulder and Hand (DASH) score, and the risk of adverse events.Outcomes were analyzed up to 6 months post-treatment.Results revealed significantly favourable VAS pain, Mayo, and DASH in the PRP group compared to the corticosteroid group at all time points. The risk of... Read More »
Level 1 Meta Analysis
1%
Synopsis: 192 patients with knee osteoarthritis were randomized to three weekly intraarticular injections with either platelet-rich plasma or hyaluronic acid.The focuse of the current study was outcome after 2 and 5 years following treatment.Results for clinical outcome on the International Knee Documentation Committee (IKDC) subjective score, the EuroQoL 5-dimensions (EQ-5D) and the Tegner activity scale demonstrated no significant differences between the PRP group and HA group at 2 or 5 years.Within the first 2 years of treatment, rate of reintervention, including either repeat injection therapy or surgery, was significantly lower in the PRP group compared to the HA group. However, at 5... Read More »
Level 1 RCT
1%
Synopsis: 102 patients scheduled for a volar locking plate fixation of a distal radius fracture were randomized to receive venous pressure assist system (VPAS) therapy or hand elevation for the reduction of hand edema following surgery.The primary outcome of interest was the reduction in hand edema, measured by hand and finger girth.Secondary outcomes of interest included pain on a Visual Analog Scale (VAS), finger flexion measured with pulp-palm distance (PPD), wrist range of motion in flexion-extension, forearm range of motion in pronation-supination, grip strength (percentage of contralateral hand), the Quick Disability of the Arm, Shoulder and Hand (DASH) score, the patient reported wrist evaluation (PRWE), the the incidence of complications.Follow up was performed up to 12 weeks post-operation.Results revealed no significant differences between the VPAS and elevation groups in all outcomes, at all time points. No cases of... Read More »
Level 2 RCT
1%
Synopsis: This is a follow-up to a previously published multi-centre randomized controlled trial.The authors randomized 461 patients undergoing surgery for distal radius fractures to Kirschner wire fixation versus plate fixation.They report outcomes (function and quality of life) at five years post-operatively.There was no significant difference between the two groups at any of the yearly follow-ups between one and five years as measured on the Patient-Related Wrist Evaluation (PRWE) and EuroQol Five-Dimension Three-Level (EQ-5D-3L). Read More »
Level 2 RCT