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Surgical site infection remains one of the greatest concerns in joint arthroplasty. Anesthesia has been explored as a risk factor -- spinal and general anesthesia are the two most commonly used, however, evidence is conflicting on whether infection rates differ between the two. A meta-analysis of the available RCT data was of interest.
This systematic review included 15 RCTs with a grand total of 156,405 patients, comparing general and spinal anesthesia. Pooled meta-analyses for the incidence of surgical site infection were performed. Additionally, a subgroup analyses by anatomical region (hip; knee; hip and knee) was performed to assess the effect in different types of arthroplasties.
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Patients who received spinal anesthesia had a 23% lower likelihood of developing surgical site infections post-operation compared to general anesthesia (p<0.001).
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The sub-group analyses found spinal anesthesia to result in a significantly lower odds of surgical site infection in hip arthroplasty, knee arthroplasty, and hip/knee arthroplasty.
Bottom line. For patients undergoing total joint arthroplasty, the use of spinal anesthesia could significantly reduce the risk of surgical site infection compared to general anesthesia.
Read the full ACE Report on this systematic review here. |
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Despite the prevalence of femoral neck fracture surgery the optimal treatment remains controversial, particularly for non-displaced fractures in elderly patients.
Recent literature has shown that percutaneous compression plates could provide some advantages over screw fixation. But high quality evidence comparing compression plating to parallel screws in elderly, non-displaced femoral neck fracture patients was lacking. Researchers conducted an RCT to compare the two interventions
218 patients over the age of 60 with closed, non-displaced femoral neck fractures were randomized to receive fracture fixation with a percutaneous compression plate (n=109) or a parallel screw (n=109). Clinical, patient-reported, and radiographic outcomes were assessed up to 12 months post-operation.
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No differences between the two groups were observed in operative time, blood loss, length of stay, reduction quality, hip function, or complications (p>0.05 for all).
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The time to full weight-bearing was significantly shorter in the percutaneous compression plate group compared to the parallel screw group (p<0.001).
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Fracture healing time was significantly quicker in the percutaneous compression plate group (p=0.014).
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The rate of implant failure was significantly higher in the parallel screw group (p=0.029).
Bottom line. Percutaneous compression plating may be the superior option compared to parallel screw fixation for patients with non-displaced femoral neck fractures, providing earlier weightbearing, quicker fracture healing, and a lower rate of implant failure.
Read the full ACE Report on this RCT here. |
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Low back pain. It’s one of the most prevalent musculoskeletal conditions, affecting 80% of adults at some point in their life. Treatment is typically conservative – NSAIDs and exercise are among the front-line interventions but can have limited effectiveness. Alternatives are needed: enter, vibration therapy.
Vibration therapy – including whole-body and local vibration treatment – has been explored in several RCTs as a modality to manage chronic low back pain. But is it effective? A systematic review of the literature aimed to find out.
14 studies including a total 860 patients were included in this systematic review and meta-analysis comparing vibration therapy to various control interventions (e.g., oral medication, exercise, daily activity, physiotherapy, herbal treatment). Pooled outcomes of interest included pain, function, and disability.
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Pooled pain scores (measured with a Visual Analog Scale or Numeric Rating Scale) were significantly in favour of the vibration therapy group (p<0.001). This result was consistent in the subgroup analyses by vibration therapy type (whole-body or local).
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Pooled Oswestry Disability Index scores were significantly in favour of the vibration therapy group (p=0.03). Again, the result was consistent in in the subgroup analyses by vibration therapy type.
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Pooled Roland Morris Disability Questionnaire scores were significantly in favour of the vibration therapy group (p=0.0003).
Bottom line. The current literature on vibration therapy suggests a potential advantage in clinical outcomes over other conservative treatments for the management of chronic low back pain. Future studies with larger sample sizes are needed further establish the efficacy of vibration therapy, as well as identify optimal frequencies and amplitudes.
Check out our full ACE Report on this paper. |
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EDITOR’S PICKS |
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The Direct Anterior Approach – Featuring arthroplasty surgeons Dr. Tom Wood & Dr. Rodriguez-Elizalde, OE hosted a webinar on optimal approaches in total hip arthroplasty. In particular, Dr's Wood and Rodriguez-Elizalde discuss the benefits of the direct anterior approach, and how you can to learn it. (Read) |
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Investing with An Evidence-Based Mindset – In this OrthoPod, we sat down with Gareth Tingling, financial advisor & portfolio manager, for a discussion on the importance of data-based decision making, and how the same approaches we apply in evidence-based medicine can help us in the world of investing. (Watch) |
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