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Preserving the ligamenta flava as much as possible is beneficial in lumbar microdiscectomy97 patients with unilateral lumbar disc herniation were randomized to undergo lumbar microdiscectomy using either a traditional (control) or revised (test) technique, which focused on preserving as much of the ligamentum flavum as possible. The purpose of this study was to compare these two surgical approaches with respect to operative time, blood loss, pain and function. Results indicated that, although there were no significant differences between groups with respect to leg pain, operative time or blood loss, the test group yielded significantly better Oswestry scores at 12 weeks and 1 year post-operation. The revised procedure also resulted in significantly lower back pain scores at 3 days and 12 weeks postoperatively, however this significance was not maintained at 1 year. Both procedures were demonstrated to be safe, with no reports of reherniation, re-operation or infection.
Preserving the ligamenta flava as much as possible is beneficial in lumbar microdiscectomy
ACL remnant preservation favoured over remnant removal regarding tibial tunnel enlargement62 patients undergoing anterior cruciate ligament (ACL) reconstruction were randomly allocated to a preserving- or removing-remnant group to investigate the effect of remnant preservation on tibial tunnel enlargement in single-bundle ACL reconstruction using a tendinous autograft. Follow-up and assessment was conducted over 24 months postoperatively. Results demonstrated that preservation of the ACL remnants was favoured over the removal of these parts with respect to tibial tunnel enlargement, yet short-term clinical outcomes (Lysholm rating scale and KT-1000) did not appear to be significantly different between groups.
ACL remnant preservation favoured over remnant removal regarding tibial tunnel enlargement
Home-based strength and stretching exercises for chronic neck pain yield similar outcomes57 female patients with chronic neck pain were randomized to undergo either a home-based strength exercise program or stretching exercise program for one-year. The two interventions were compared with respect to changes in neck pain intensity and function. No significant difference was found in either neck pain intensity or function between the treatment groups at the 4-6 and 12-month follow-up assessments. A similar finding was observed when only completers who adhered to the exercise programs were considered. Although the exercise programs were safe, participant adherence rates for both interventions were low, especially after 6 months.
Home-based strength and stretching exercises for chronic neck pain yield similar outcomes
Intraosseous administration of low-dose vanomycin leads to higher tissue concentrations32 patients scheduled for total knee arthroplasty were randomized to received three different prophylactic antibiotic regimens: intraosseous administration of either 250mg or 500mg vanomycin, or 1g vanomycin administered intravenously. The purpose was to evaluate the effect of intraosseously administered vanomycin in terms of concentrations in subcutaneous fat, cancellous bone, and systemic blood samples. Intraoperative concentrations of vanomycin in tissue samples were significantly higher with either dose of intraosseous vanomycin compared to intravenous administration.
Intraosseous administration of low-dose vanomycin leads to higher tissue concentrations
de Quervain tenosynovitis: higher success rates with corticosteroid injection & thumb cast67 patients with de Quervain tenosynovitis were randomized to receive treatment with a corticosteroid injection (CSI) alone or in combination with thumb spica casting (TSC). The effectiveness of each treatment was examined and compared in terms of success rate, pain intensity, and functional outcomes. Within 3 weeks, both groups experienced significant improvements in success rates compared to their respective baseline outcomes, but with CSI + TSC achieving significantly better results when compared to CSI alone over the 6 month follow-up. The same trend was found in pain intensity and functional outcome at 6 months.
de Quervain tenosynovitis: higher success rates with corticosteroid injection & thumb cast
SCI: No significant improvement in urine output, swelling, or spasticity with FES cycling14 patients who had sustained a spinal cord injury within the previous 6 months underwent both an experimental and control phase using a randomized, cross-over design, and a 1-week washout period. The purpose of this study was to determine whether a 2-week functional electrical stimulation (FES) cycling program resulted in improved urine output, leg swelling and spasticity in this patient population. Results indicated that FES cycling increased urine output, as well as decreased lower limb swelling and spasticity, however these improvements were not statistically significant. Furthermore, there was a positive impression of change among all patients except two.
SCI: No significant improvement in urine output, swelling, or spasticity with FES cycling
Whole-body vibration exercise effective in improving mobility, balance, and general health44 frail elderly adults were randomized to treatment either through whole-body vibration (WBV) exercise or a control intervention consisting of usual care, physical therapy, and routine exercises. The effectiveness of each intervention was compared using mobility, balance, and general health outcomes. Over 8 weeks, individuals who underwent whole-body vibration exercise achieved greater and faster improvements in measures of mobility, knee strength, and physical and mental health. Additionally, WBV exercise was demonstrated to be well tolerated.
Whole-body vibration exercise effective in improving mobility, balance, and general health
No significant benefits with computer navigation for THA acetabular component positioning40 patients undergoing THA were randomized for operation with either a computer-assisted navigation method or the conventional method in the positioning of the acetabular component. One surgeon performed all surgeries. Postoperative CT scans were analyzed to compare the accuracy of both methods. Analysis of the operative anteversion and inclination angles, in addition to the percentage within Lewinnek\'s safe zone, revealed similar results between both groups. Operating time was longer for the computer-assisted group, although it was not associated with an increase in complication rates.
No significant benefits with computer navigation for THA acetabular component positioning
Mobile bearing yields similar functional outcome as fixed bearing in TKA at two years352 patients with knee osteoarthritis and scheduled to undergo total knee arthroplasty (TKA) were randomized to receive either a fixed or mobile bearing tibial component. Patients were further randomized to undergo patellar resurfacing or to have the patella retained. The purpose of this study was to compare these implants in terms of clinical outcomes. Results at 2 years indicated that patients who underwent TKA using mobile bearings displayed comparable knee function (i.e. Oxford Knee Scores, American Knee Society scores, and range of motion) and SF-12 health survey scores, versus those who received fixed bearings. Furthermore, these outcomes were also comparable whether or not the patient received patellar resurfacing.
Mobile bearing yields similar functional outcome as fixed bearing in TKA at two years
Adverse effects more frequent with bioabsorbable vs. metal screws in ACL reconstructionThis meta-analysis summarized results from eleven randomized control trials (RCTs) involving 878 randomly allocated patients to investigate the use of bioabsorbable interference screws compared to metal interference screws in single bundle primary anterior cruciate ligament (ACL) reconstruction. The study aimed to report adverse effects and clinical outcomes from different screw types after a minimum of one year postoperatively. Results revealed that the use of bioabsorbable screws applied to medial hamstring grafts demonstrated greater tunnel widening on the femoral side, and reported significantly higher rates of effusion and screw breakage with bioabsorbable screws compared to metal screws. Despite the presence of adverse effects, functional and clinical outcome measurements did not differ significantly between the two screw types.
Adverse effects more frequent with bioabsorbable vs. metal screws in ACL reconstruction
No effect of topical fibrinogen spray on blood loss and transfusion in TKA200 patients scheduled for total knee arthroplasty with tourniquet use (inflated prior to incision and deflated before wound closure) were randomized to surgery with or without the application of a fibrinogen topical spray following the cementing of components. Hemostatic parameters of hemoglobin and hematocrit levels, total blood loss, and transfusion requirements were monitored over the first 3 postoperative days. Clinical assessment was also conducted at 6 week follow-up. The results indicated that there were no significant differences in total blood loss and transfusion needs between the groups. Postoperative drain volume was significantly higher in the group treated with topical fibrinogen when drains were removed at 24 hours.
No effect of topical fibrinogen spray on blood loss and transfusion in TKA
The effectiveness of physical therapy for lumbar spinal stenosis remains unknown10 studies (5 RCTs, 2 controlled trials, 2 mixed-design studies, and 1 longitudinal cohort study) assessing the effectiveness of physical therapy interventions in patients with lumbar spinal stenosis were included in this review. The results from this study indicated that there is moderate-quality evidence suggesting pain and disability (but not walking distance) is significantly better in patients treated surgically at 2 years compared to those treated with physical therapy. The remaining conclusions were based on low-quality evidence and thus the effectiveness of physical therapy in the treatment of lumbar spinal stenosis remains uncertain.
POSTED: THIS WEEK
The effectiveness of physical therapy for lumbar spinal stenosis remains unknown
Oral tranexamic acid is safe and effective in reducing post-operative blood loss in TKA53 patients scheduled to undergo total knee arthroplasty (TKA) were randomized to either receive or not receive oral administration of tranexamic acid. The purpose was to determine whether this intervention was safe and effective in reducing the amount of postoperative blood loss. Results indicated that the tranexamic acid group displayed significantly better hematocrit levels post-operation and significantly lower bleeding rates 12 and 24 hours post-surgery. At 6 weeks postoperatively, there were no reported thrombotic complications in either group.
POSTED: THIS WEEK
Oral tranexamic acid is safe and effective in reducing post-operative blood loss in TKA
Local infusion analgesia using a double lumen catheter is safe and effective following TKA40 patients with knee osteoarthritis undergoing primary total knee arthroplasty (TKA) were randomized to receive post-operative administration of local infusion analgesia (LIA) or saline using a double lumen catheter. The purpose of this study was to evaluate the effectiveness and safety of this modified LIA for pain relief following TKA procedures. Results indicated that the modified LIA administration technique used in this study safely reduced pain following TKA, resulted in significantly lower serum C-reactive protein (CRP) levels, and significantly more patients treated with modified LIA could perform a straight leg raise on post-operative day 2. There were no significant between-group differences in mean fentanyl consumption or range of motion at any time point.
POSTED: THIS WEEK
Local infusion analgesia using a double lumen catheter is safe and effective following TKA
Intertrochanteric fractures: Similar rate of reoperation using fixed or sliding side plate163 patients with unstable intertrochanteric fractures were randomized to receive surgical treatment using either (1) a sliding hip screw and fixed side plate or (2) a sliding hip screw and a Medoff sliding side plate. The purpose of this study was to compare rates of re-operation and hip function scores following treatment with these two types of hardware. Results after 6 months indicated that the use of a sliding hip screw with a Medoff sliding side plate resulted in a similar re-operation rate, hip function recovery scores, length of hospital stay, haemoglobin drop, number of transfusions, transfusion units, leg-length discrepancy, loss in range of motion, and the incidence of complications. Surgical time was significantly greater in the Medoff sliding side plate group.
POSTED: THIS WEEK
Intertrochanteric fractures: Similar rate of reoperation using fixed or sliding side plate
Intra-articular bone marrow-derived stem cell injection effective in high tibial osteotomy56 patients with medial compartmental osteoarthritis and genu varum were randomized to undergo a high tibial osteotomy with or without an intra-articular injection of cultured autologous bone marrow-derived mesenchymal stem cells (MSC), administered 3 weeks post-treatment. The purpose of this study was to evaluate the clinical outcomes and MRI results of both the cell-recipient and control groups to determine whether bone marrow-derived MSC injections are safe and effective. Results after 2 years indicated that the cell-recipient group had significantly improved clinical outcomes (Tegner, Lysholm and International Knee Documentation Committee scores) and MRI results (cartilage coverage of their lesions and integration of regenerated cartilage) compared to the control group. There were no serious adverse events reported in either group.
POSTED: THIS WEEK
Intra-articular bone marrow-derived stem cell injection effective in high tibial osteotomy
TKA: Patient-specific guides offer no accuracy benefit over conventional instrumentation128 patients scheduled for total knee arthroplasty were randomized to intervention with either patient-specific guides (PSG) or conventional instrumentation. Participants allocated to PSG were managed with pre-operative planning using either Signature (Biomet Inc.), TruMatch (Depuy Inc.), Visionaire (Smith & Nephew Inc.), or Patient-Specific Instruments (Zimmer Inc.). Patients allocated to the conventional group were treated with standard intra- and extramedullary instrumentation. The results indicated that there was no significant improvement over conventional instrumentation offered by PSGs. Additionally, PSGs had to be abandoned intraoperatively in 14 cases, and outliers in tibial component alignment were significantly higher in the PSG cohort.
POSTED: THIS WEEK
TKA: Patient-specific guides offer no accuracy benefit over conventional instrumentation
Satisfaction and adverse events improved with multimodal analgesia in elbow surgery61 patients were randomized to determine the efficacy of multiodal analgesia compared to intravenous patient-controlled analgesia with opioids for pain management following elbow surgery. Pain, rescue analgesic requirements, ability to achieve scheduled rehabilitation, and patient satisfaction were assessed over the first 14 postoperative days. The results indicated that pain, either at rest or during exercise, was similarly reduced between the two analgesia methods. Opioid-related complications were lower with multimodal analgesia, and patients were more satisfied with the multimodal regimen.
POSTED: THIS WEEK
Satisfaction and adverse events improved with multimodal analgesia in elbow surgery
Quadriceps-sparing TKA reduced time to discharge vs standard minimally-invasive approach102 patients undergoing total knee arthroplasty (TKA) were randomized to receive either a minimally-invasive quadriceps-sparing (MIS) approach or the standard medial parapatellar approach. Clinical, functional and radiological outcomes were compared during the immediate postoperative period and again at 2 years. Results indicated that patients treated using the MIS technique experienced significantly shorter time to discharge readiness and fewer complications. Clinical and functional outcomes were comparable between groups, and there was no evidence of radiographic loosening in either group at the 2-year follow-up.
POSTED: THIS WEEK
Quadriceps-sparing TKA reduced time to discharge vs standard minimally-invasive approach
Knee OA: An 8-week non-weightbearing strengthening program yields greatest pain reductionEight randomized controlled trials were included in this meta-analysis which investigated the difference between muscle strengthening and aerobic exercise for treatment of knee osteoarthritis. The included trials featured 11 intervention groups composed of either non-weightbearing strengthening, weightbearing strengthening, or aerobic exercise protocols. The results indicated that all three rehabilitation techniques significantly reduced pain in the short term compared to control treatment, with the greatest effect size exhibited by non-weightbearing muscle strengthening.
POSTED: THIS WEEK
Knee OA: An 8-week non-weightbearing strengthening program yields greatest pain reduction
Autograft vs synthetic graft for ACL reconstruction50 patients with arthrocsopically confirmed unilateral ACL rupture were randomized to undergo reconstruction with middle third PT graft or the synthetic Leeds-Keio ligament graft. At the end of 5 year follow up, the overall functional outcome and patient satisfaction in patients undergoing Leeds-Keio (LK) ACL repair were found to be similar to the traditional autogenous patellar tendon ACL reconstruction.
Autograft vs synthetic graft for ACL reconstruction
Dynamic compression plates possibly advantageous in treatment of humeral shaft fracture10 studies (8 randomized and 2 quasi-randomized controlled trials) were included in this analysis comparing intramedullary nails and dynamic compression plates in the treatment of humeral shaft fractures. The results indicated that while fracture union, functional outcome, and rates of radial nerve injury and infection were similar between treatments, intramedullary nails were associated with higher incidences of intraoperative fracture communition, shoulder impingement, restricted range of motion, implant failure, and re-operation. The strength of these findings were limited by the low quality of evidence, as evaluated using the GRADE system.
Dynamic compression plates possibly advantageous in treatment of humeral shaft fracture
Potential improvement in vascularization following rotator cuff repair with L-PRF20 patients with a chronic full-thickness rotator cuff tear were randomized to undergo arthroscopic repair either with or without the application of leukocyte- and platelet-rich fibrin (L-PRF). The purpose of this study was to determine if L-PRF increased vascularization of the rotator cuff over the first 3 postoperative months. The results at 6 weeks indicated that vascularity was, indeed, improved in the group treated with L-PRF. However, the difference between groups at 12 weeks was not statistically significant. Both groups were observed to have similar repair integrity, repair quality, and clinical outcomes over the 3-month follow-up.
Potential improvement in vascularization following rotator cuff repair with L-PRF
All-inside versus conventional ACL reconstruction: impact on postoperative pain?46 patients scheduled for anterior cruciate ligament reconstruction were randomized to undergo surgery using either the all-inside technique or conventional technique. The purpose was to compare postoperative pain between the two techniques at 1 month following surgery, and measures of radiographic and functional outcome at 6 months. The results indicated lower pain with the all-inside technique, however the assessment was underpowered. Functional outcome was similar between the two techniques.
All-inside versus conventional ACL reconstruction: impact on postoperative pain?
Blood loss and transfusion needs reduced with TXA in major orthopaedic surgery46 randomized controlled trials were included in this meta-analysis to investigate the use of tranexamic acid (TXA) in major orthopaedic surgery. The purpose of this analysis was to determine if blood loss and transfusion requirements were reduced with the application of TXA. Results revealed that intraoperative, postoperative and total blood loss were significantly reduced with tranexamic acid. Transfusion requirements, including mean number of units and volume, were also significantly reduced. The incidence of deep vein thrombosis was similar between groups.
Blood loss and transfusion needs reduced with TXA in major orthopaedic surgery
Electro-acupuncture reduces arthralgia in cancer patients taking aromatase inhibitors67 women with non-metastatic breast cancer (Stage I-III) experiencing joint pain attributed to the use of aromatase inhibitor (AI) were included in this study. Subjects were randomized to an intervention group, or a wait list control (WLC) group. Those randomized to the intervention group were further randomly allocated to either electro-acupuncture (EA; electrical stimulation via acupuncture needles) or sham acupuncture (SA). The purpose of this study was to examine the effect of these interventions on reducing arthralgia, or joint pain, in these patients. Results at 8 weeks indicated that patients in the EA group experienced greater improvements in pain severity, pain-related interference, patient global impression of change, WOMAC scores, and DASH scores, compared to those in the WLC group. Significantly better improvements in pain severity and pain-related interference in the EA group were maintained at the 12-week follow-up. Notably, there were no significant differences in study outcomes between the EA and SA groups.
Electro-acupuncture reduces arthralgia in cancer patients taking aromatase inhibitors
PCL preservation not advantageous over resection in mobile-bearing TKA69 patients (90 knees) scheduled for total knee arthroplasty (TKA) with a highly conforming, mobile-bearing insert were randomized to have the posterior cruciate ligament (PCL) either retained for resected during surgery. The purpose was to determine if PCL preservation led to better kinematic and clinical outcome. Intraoperative kinematic measurements indicated that PCL-preserving TKA was associated with greater anterior translation and more varus femoral rotation than PCL-sacrificing TKA. Clinical outcome was similar between groups at a minimum of 2 years follow-up. Based on the results, PCL resection is suggested in highly conforming mobile-bearing TKA.
PCL preservation not advantageous over resection in mobile-bearing TKA
Alendronate & zoledronate both reduce hip and vertebral fracture risk compared to placebo19 randomized controlled trials were included in this systematic review which investigated the effect bisphosphonates on decreasing fracture risk and increasing bone mineral density in osteoporotic and osteopenic postmenopausal women. 17 studies were used for quantitative synthesis. The two drugs which were evaluated were alendronate and zoledronate. At a minimum of 1 year follow-up, hip and vertebral fracture risk was significantly reduced with both treatments. Alendronate was also associated with significant increases in bone mineral density at the total hip, femoral neck, and lumbar spine, although meta-analysis for BMD could not be performed for zoledronate.
Alendronate & zoledronate both reduce hip and vertebral fracture risk compared to placebo
Post-THA physical therapy exercises improve strength, gait speed and cadence5 randomized trials evaluating the effect of post-discharge rehabilitation exercises following a total hip arthroplasty (THA) were included in this review. The purposes of this meta-analysis/systematic review were to (1) examine the effectiveness of physical therapy exercises following THA and (2) determine whether supervised and home-based exercise regimens are comparable with respect to strength, gait, function, and quality of life. Results indicated that the prescription of exercise following THA resulted in significantly better hip abductor strength, gait speed, and cadence, but not hip flexor, hip extensor, or knee extensor strength. There were no significant differences between supervised or home-based exercise interventions with respect to gait speed, cadence, and functional outcomes, except for the Timed Up and Go Test, which favoured the supervised group.
Post-THA physical therapy exercises improve strength, gait speed and cadence
Platelet-rich plasma with needling effective in treatment of chronic tennis elbow230 patients presented with chronic tennis elbow were enrolled and randomized into either a platelet-rich plasma treatment group (PRP) or an active control group. This study was followed-up at 12 and 24 weeks to evaluate clinical efficacy based on pain and local elbow tenderness. At the 12-week follow-up, no significant differences were observed between the two groups. However, at the 24-week follow-up, clinically significant differences were found, favouring PRP-treated patients for outcome measures in pain and local tenderness.
Platelet-rich plasma with needling effective in treatment of chronic tennis elbow
Autologous conditioned plasma & ESWT may be beneficial in patients with plantar fasciitis54 patients diagnosed with plantar fasciitis were randomized to undergo one of three treatment options: an autologous conditioned plasma (ACP) injection, extra-corporeal shock wave therapy (ESWT), or conventional treatment (i.e. stretching exercises). The purpose of this study was to compare pain, function and thickness of the plantar fascia between these treatments. Results from this study indicated ESWT lead to significantly better pain improvements compared to conventional treatment at all time points, whereas ACP injections were only significantly better at 1 month. With respect to function, ACP and ESWT tended to be superior to conventional treatment; however, there were no significant differences between the two groups. Lastly, ACP was the superior treatment in regards to plantar fascia thickness improvements at 3 and 6 months.
Autologous conditioned plasma & ESWT may be beneficial in patients with plantar fasciitis
rhBMP-2 augmentation not recommended in intramedullary nailing of closed tibial fractures387 patients with closed tibial fractures were randomized in this study to investigate the efficacy and safety of the local application of recombinant human bone morphogenetic protein 2 (rhBMP-2) within a calcium phosphate matrix (CPM) in the treatment of closed tibial fractures. Participants were subject to intramedullary nail fixation in 1 of 4 treatment protocols: 1) nail fixation alone (standard of care), 2) augmented with 1.0mg/mL rhBMP-2/CPM, 3) augmented with 2.0mg/mL rhBMP-2/CPM, or 4) augmented with buffer/CPM. The study was terminated early due to futility, with a lack of efficacy in time to fracture union.
rhBMP-2 augmentation not recommended in intramedullary nailing of closed tibial fractures
SImilar efficacy between intra- and periarticular injections for acromioclavicular joint101 patients (106 shoulders) were randomized to investigate the efficacy of either an intra-articular injection or periarticular injection in the treatment of symptomatic acromioclavicular joints. Outcome measurements of pain and function were assessed up to 3 weeks post-injection. The results indicated that either injection provided similar, significant improvements in pain and function. There was no difference observed between groups, with the exception that less pain during the crossover arm test (COAT) was reported among participants treated with an intra-articular injection.
SImilar efficacy between intra- and periarticular injections for acromioclavicular joint
ORIF more effective and satisfactory treatment for comminuted clavicle fracturesTo compare the results of two treatment methods for comminuted, displaced midshaft fractures of the clavicle, 60 patients were randomized to either open reduction and internal fixation (ORIF) or non-operative treatment. After 1 year, ORIF had less complications and malunions than non-operative treatment. ORIF also provided increased patient satisfaction and significantly better functional scores.
ORIF more effective and satisfactory treatment for comminuted clavicle fractures
Electromagnetic stimulation use in fracture healing64 patients with closed femoral shaft fractures were operated on, treated with a locked intramedullary nail and randomized into two groups to determine the effectiveness of electromagnetic stimulation on bone growth. Patients were either treated with magnetic fields and low frequency signals or they received a placebo. The results suggest that electromagnetic stimulation may promote bone healing; however, the difference between the intervention and the control groups was not significant and further investigations are required before definitive conclusions can be drawn.
Electromagnetic stimulation use in fracture healing
Neuromuscular electrical stimulation not effective for pain relief or ROM post-stroke46 patients who had sustained a stroke resulting in paralysis or severe paresis in their upper limb, and a poor prognosis for functional recovery were randomized to undergo an 8-week treatment regimen of either neuromuscular electrical stimulation (NMES) and simultaneous passive range of motion stretches, or a sham treatment. This study was conducted in the sub-acute phase of stroke. Upon completion of the treatment period, results indicated that there was no significant difference in arm passive range of motion, shoulder pain, the ability to perform basic arm activities, the severity of hypertonia/spasticity, arm motor control and subluxation between the experimental and control groups.
Neuromuscular electrical stimulation not effective for pain relief or ROM post-stroke
Peri-operative blood losses similar with cemented and uncemented femoral components in TKA107 patients (age range 50 to 90 years), scheduled to undergo primary total knee arthroplasty, were randomized to have a cemented or uncemented femoral component. At the 5th post-operative day, the peri-operative blood losses were found to be similar with the use of a cemented or uncemented femoral component in the total knee arthroplasty procedure.
Peri-operative blood losses similar with cemented and uncemented femoral components in TKA
AAOS: Weightbearing-as-tolerated safe in rehabilitation following tibial shaft fractures62 patients undergoing intramedullary nailing for tibial shaft fractures were randomized to postoperative protocols of either immediate weightbearing-as-tolerated (WBAT) or non-weightbearing (NWB) for 6 weeks postoperatively. Functional and radiographic outcomes were monitored up to fracture union, or until treatment failure or revision surgery was required. The results indicated that there were no significant differences between groups regarding time to union, functional outcome, or complication rate. No patient of either group was observed to have malunion due to loss of reduction.
AAOS: Weightbearing-as-tolerated safe in rehabilitation following tibial shaft fractures
Similar functional outcomes with Wii Fit vs standard rehabilitation for ACL reconstruction30 patients who underwent ACL reconstruction with hamstring autograft were randomized to receive either a Nintendo Wii Fit or conventional rehabilitation technique to evaluate the differences in functional outcomes using both treatments. Results indicated that there was no difference in proprioception, balance, isokinetic knee strength, response time and coordination between the two groups at the 1st, 8th and 12th week post-surgery.
Similar functional outcomes with Wii Fit vs standard rehabilitation for ACL reconstruction
Knee OA: Improvements in pain and function with intermittent & continuous traction98 patients with diagnosed stage 3 knee osteoarthritis (OA) were randomized to receive either intermittent traction, continuous traction, or no traction (control group) to evaluate the differences in pain, disability and function between the 3 groups in the treatment of knee OA. In addition, all groups also received hot pack and short wave diathermy. Results indicated that decreases in VAS pain scores were more prominent in the intermittent and continuous traction groups compared to the control group. In addition, WOMAC pain, physical function and total scores were significantly better in both traction groups compared to the control group. Lastly, there was no difference in range of motion at the 7-week follow-up between the 3 groups.
Knee OA: Improvements in pain and function with intermittent & continuous traction
Cerebral Palsy: Similar muscle strength/spasticity with BoNT-A + strength training15 children with cerebral palsy were randomized to a 10-week strength training program either pre- or post- a series of Botulinum Toxin Type-A (BoNT-A) injections to evaluate the effects of strength training with BoNT-A treatment on muscle strength. Eight of these children also underwent a 6-month control period, receiving BoNT-A injections only. Results at 6 months indicated that strength training with BoNT-A injections provided no difference in knee flexor strength, knee extensor strength, spasticity, or motor control. Between the pre- and post- groups, there was no difference in these outcomes in the hamstrings, plantarflexor and dorsiflexor muscles.
Cerebral Palsy: Similar muscle strength/spasticity with BoNT-A + strength training
THA: Computer-navigated technique more favorable compared to conventional techniquesData from 7 randomized controlled trials were pooled to compare the effects of computer-navigated and conventional free-hand techniques in THA. Primary outcomes included abduction angle, anteversion angle, operation time, decrease in haemoglobin after 24 hours and the number of acetabular outliers. Results indicated a significant increase in accuracy and longer operation time in the computer-navigated technique compared to the free-hand technique. There was no difference in the reduction in haemoglobin after 24 hours between the two groups.
THA: Computer-navigated technique more favorable compared to conventional techniques
THA: No difference in body composition or BMD using full vs. partial weight-bearing rehab39 patients diagnosed with unilateral hip osteoarthritis undergoing total hip arthroplasty (THA) (33 of which completed the final follow-up) were randomized to perform either a full or partial weight-bearing rehabilitation protocol for 3 months, to examine the effects of these rehabilitation techniques on bone mineral density (BMD) and body composition (BC). Results indicated that there was no difference between the two treatment protocols in BMC and BC at 5 years post-operation. At 5 years, although there was no difference in fat mass and lean mass distribution, bone mineral density and total body composition each decreased compared to baseline.
THA: No difference in body composition or BMD using full vs. partial weight-bearing rehab
Similar infection rates with the use of erythromycin and colistin-loaded cement in TKA3000 patients undergoing total knee arthroplasty (TKA) (2948 of whom completed the study) were randomized to the use of either antibiotic-loaded or non-antibiotic-loaded cement in the fixation of their prosthesis. The primary goal of this study was to compare infection rates between the two groups and the secondary goal was to determine if risk factors existed for deep infection. Results indicated that there was no difference between the two groups in terms of deep or superficial infection rates. In addition, male sex and an operative time of longer than 125 minutes were determined to be risk factors for deep infection.
Similar infection rates with the use of erythromycin and colistin-loaded cement in TKA
Femoral neck fractures: Similar function, but higher revision rates using PCU-THR vs HA96 patients aged 70 or over who had suffered femoral neck fractures (32 at final follow-up) were randomized to receive either a total hip replacement with a polycarbonate-urethane acetabular component (PCU-THR), or a hemiarthroplasty (HA) treatment. The purpose of this study was to evaluate the functional outcomes associated with these two treatments. Results indicated that there was no difference in function at 3 months, 1 year, 2 years or 3 years post-operation and that pain was worse in the PCU-THR group at 1 and 2 years. Lastly, higher revision rates were observed in the PCU-THR group.
Femoral neck fractures: Similar function, but higher revision rates using PCU-THR vs HA
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