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In an attempt to reduce postoperative pain and discomfort, intraoperative joint viscosupplementation with hyaluronic acid (HA) has been used. However, there has been uncertainty surrounding the clinical benefits of adding hyaluronic acid post-arthroscopy for symptomatic degenerative arthropathy, given conflicting results from previous studies. This study aimed to assess the evidence surrounding the use of HA immediately after knee arthroscopy.
Five randomized controlled studies including 363 patients undergoing arthroscopic surgery for degenerative arthropathy of the knee were included in this systematic review acomparing the addition of intra-articular hyaluronic acid (HA) immediately after surgery (Treatment A, n=181) vs. placebo or no additional treatment (Treatment B, n=182). Pooled outcomes of interest included postoperative pain and functional recovery.
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Patients in both groups showed statistically significant improvements in pain and function at 2 weeks and 2 months post-operation compared to pre-intervention, which were clinically relevant (both exceeded the minimum clinically important difference).
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However, the meta-analysis found no significant differences in pain relief or functional recovery between the group being treated with hyaluronic acid immediately after knee arthroscopy and the control group.
Bottom line. This study demonstrates that supplementing the joint with hyaluronic acid immediately after knee arthroscopy may not provide additional benefits in terms of pain or functional recovery for patients with symptomatic degenerative arthropathy.
Read the full ACE Report on this study here. |
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Low-molecular-weight heparin has long been the go-to prevention strategy against thromboembolic events in total knee arthroplasty. However, it’s expensive. Aspirin has been explored as an alternative option, costing a fraction of the price of low-molecular-weight heparins. Reviewing the current high-quality evidence on the topic is crucial if we are to make recommendations for aspirin over low-molecular-weight heparin that is both safe and effective.
Six randomized controlled trials including a total of 6,772 total knee arthroplasty patients were included in this systematic review and meta-analysis comparing aspirin to low-molecular-weight heparin. Outcomes of interest included the pooled risk of venous thromboembolic (VTE) events and bleeding complications. Subgroup analyses by VTE type, and for gastrointestinal bleeding – an important consideration with aspirin use.
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The pooled risk of venous thromboembolic events was significantly lower in patients who received low-molecular-weight heparin compared to those who received aspirin (RR 1.46 [95% CI 1.16, 1.84])
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The pooled risk of bleeding was similar between the aspirin and low-molecular-weight heparin groups (RR 0.90 [95% CI 0.71, 1.14])
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Subgroup analyses by VTE type found no differences between groups in the risk of deep vein thrombosis or pulmonary embolism.
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Subgroup analyses for gastrointestinal bleeding found no difference between the two groups
Bottom line. For patients undergoing total knee arthroplasty, aspirin is associated with a higher risk of venous thromboembolic events compared to low-molecular-weight heparin. However, safety outcomes were similar between the two treatments.
Read the full ACE Report on this systematic review & meta-analysis here. |
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Accurate placement of an acetabular prosthesis in total hip arthroplasty (THA) is crucial to avoid complications. Portable navigation systems are regularly used to improve accuracy without the drawbacks of conventional computer navigation systems. Recently, an inexpensive augmented reality (AR)-based system has entered the fray…but is it superior to existing portable navigation tools?
126 undergoing unilateral THA were randomly assigned to receive either an AR-based portable navigation system (n=62) or an accelerometer-based portable navigation system (n=64) during surgery. The primary outcome was the absolute difference between the cup placement angle. Secondary outcomes included intraoperative or postoperative complications.
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The study revealed no significant difference in radiographic inclination angles between AR and accelerometer groups.
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The AR group showed a smaller absolute difference in radiographic anteversion angles.
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Complications were few in both groups, and no differences in operative time was observed.
Bottom line. The study revealed no significant difference in radiographic inclination angles, complications or operative time between AR and accelerometer groups. However, the AR group showed a smaller absolute difference in radiographic anteversion angles, which suggests a potential slight improvement in accuracy.
Read the full ACE Report on this trial here. |
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EDITOR’S PICKS |
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Hyaluronic Acid, Corticosteroid, and Knee Pain – In this OrthoPod, we sat down with Dr. Eric Babins, family physician, sports medicine expert, and owner of the Southland Sport Medicine Clinic in Calgary, Alberta. We discussed the existing knee injectable options for patients, his clinical experience treating athletes of all levels, and the essential importance of a good patient history. (Watch) |
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The Use of BMI and Cutoffs in Orthopaedic Surgery – In this OE Insight, we discuss everything BMI. We start by looking at the history of BMI, its rise to becoming the standard measure of obesity in clinical research settings, the advantages and disadvantages of BMI – whether its clinical convenience justifies its widespread use – and finally, alternatives that could help surgeons and clinicians make better decisions for their patients. (Read) |
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