Although controversy surrounding the use of metal-on-metal (MoM) arthroplasty implants continues to exist, satisfactory clinical and radiological outcomes have been reported following Birmingham Hip Resurfacing (BHR) at long-term follow-up, leading to an Orthopaedic Data Evaluation Panel (ODEP) rating of 13A. The purpose of this study was to systematically review the literature to evaluate the functional outcomes, radiological outcomes and revision rates following BHR at a minimum of 10 years follow-up. Using the PRISMA guidelines, two independent reviewers performed a literature search using Pubmed, Embase and Scopus databases. Only studies reporting on outcomes of BHR with a minimum of 10 years’ follow-up were considered for inclusion. A total of 12 studies including 7132 hips (64.8% males), with mean follow-up of 11.5 years (10-15.3), met our inclusion criteria. Of included patients, 94.3% of patient underwent BHR for osteoarthritis at a mean age was 52.0 years (48-52). At final follow-up, 96% of patients reported being satisfied with their BHR, with mean Harris Hip Scores of 93.6 and Oxford Hip Scores of 16.5. Rates of radiological femoral neck narrowing of greater than 10% and non-progressive radiological loosening were reported as 2.0% and 3.8% respectively. At final follow-up, the overall revision rate was 4.9% (334/7132), deep infection rate was 0.4%, metal allergy/insensitivity rate was 1.6%, metal reaction rate was 0.3%, rate of peri-prosthetic fracture was 0.9% and aseptic loosening rates were 1.6%. This systematic review demonstrates that BHR results in satisfactory clinical outcomes, acceptable implant survivorship, low complication rates and modest surgical revision rates in the long-term at minimum 10-year follow-up.
Although rare in incidence, pregnancy-induced osteoporosis (PIO)-associated OVCFs represent a significant cause of morbidity for the young, peri-partum female population.
The aim of this study was to analyze and compare clinical, radiological and mortality outcomes of patients who underwent cemented hip hemiarthroplasty for displaced neck of femur fractures using a SPAIRE technique when compared to a pair-matched control cohort who underwent the same procedure using the direct lateral approach. A retrospective review of patients who underwent cemented hip hemiarthroplasty for displaced neck of femur fractures by a single surgeon using a SPAIRE technique over a two-year period between July 2019 and July 2021 was performed. These were subsequently pair matched in a 5:1 ratio for age, gender, ASA grade and residential status with a control group who underwent cemented hip hemiarthroplasty by 4 other surgeons using a direct lateral approach The study included a total of 240 patients (40 and 200 pairmatched to SPAIRE and control groups respectively), with a mean age of 81.0 ± 8.2 years (63–99) and a mean follow-up of 12 ± 3 months (3–30). Overall, there was no significant difference in any of the radiological or mortality outcome scores assessed between the SPAIRE and control groups (p > 0.05 for all). There was a significantly lower number of patients in the SPAIRE group who dropped a level of mobility from their pre-injury baseline at 30-days post-operatively (8.1% versus 31.6%; p = 0.003). However, this appeared to have resolved at 120-day follow-up with no significant differences between the groups in terms of those acquiring a new baseline mobility at 120-days post-operatively (2.7% versus 13.2%, p = 0.09). In cases of cemented hip hemiarthroplasty for displaced intracapsular neck of femur fractures, the SPAIRE technique appears to offer patients an earlier return to levels of baseline pre-injury mobility when compared to a direct lateral approach.
In the treatment of acute Achille's tendon rupture, there is no uniform consensus on which of the many treatment modalities for this common injury is superior with respect to all possible complications. This review is to assess the statistical quality of the available evidence.The P value is the common method to determine the significance of a finding, but it does not convey statistical robustness. The reversal of a small number of outcome events can be enough to change a finding of significance; this is known as statistical fragility, which can be measured with the fragility index (FI) and fragility quotient (FQ). The purpose of this study was to examine the statistical fragility of randomised control trials (RCTs) reporting outcomes of acute Achille's tendon rupture (AATR) management.A systematic search strategy was used to find RCTs published since 1990 investigating AATR management. The FI was calculated using Fisher's exact test by sequentially altering the number of events until there was a reversal of significance. The FQ was calculated by dividing the FI by the sample size. Each trial was assigned an overall FI and FQ calculated as the median result of its reported findings.Overall, 55 RCTs met the inclusion criteria, including 4,205 patients, 82.7% of which were male, there was a mean age of 41 and follow-up of 21 months; 60% of RCTs either did not report a statistical power analysis or were statistically underpowered. The overall FI was 4, indicating the reversal of just four outcomes would change the significance finding. The overall FQ was 0.082, suggesting that reversing eight patients out of every 100 would alter significance. In 22/55 (40%) RCTs, the number of patients lost to follow-up was greater than or equal to the FI of the trial.This review indicates the RCT literature for AATR management may be vulnerable to statistical fragility, with a handful of events required to reverse a finding of significance. We recommend that future trials in this area report the FI, FQ, and P value, to aid readers in assessing the evidence, therefore impacting clinical decision making.I; Systematic Review of Randomised Control Trials.
The COVID-19 pandemic has had catastrophic impact on a global scale, affecting people from all walks of life including elite athletes.The purpose of this study was to evaluate the reported rates of return to play (RTP) in conjunction with the expert-derived guidelines previously recommended to enable safe RTP post COVID-19 infection.Two independent reviewers searched the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing the MEDLINE, Embase, and Scopus databases. Only studies that reported rates of RTP and/or recommended guidelines for safe RTP were included.Overall, 17 studies (3 level III and 14 level V) were included. A total of 3 studies reported rates of RTP in a total of 1255 athletes and 623 officials; 72 (30 symptomatic) were infected with COVID-19, 100% of whom were able to RTP post COVID-19 infection. Of the 14 studies recommending guidelines for safe RTP, 3 and 9 studies recommended 7 and 14 days of rest in isolation respectively for asymptomatic patients with COVID-19 infection, prior to safe RTP. In contrast, 7 studies recommended 3 to 6 months of rest (following 14 d isolation) in cases of COVID-19-induced myocarditis as a safe timeframe for safe RTP. Of the 11 studies reporting on whether blanket testing prior to RTP was recommended, only 7 studies recommended a negative test result as mandatory prior to RTP for athletes previously infected with COVID-19.Although excellent rates of RTP have been reported for elite athletes post COVID-19 infection, discrepancies in recommended rest periods, requirement for mandatory negative test results, and the magnitude of screening investigations required continue to exist in the literature, with a need for further standardized international guidelines required in future.Level V; systematic review of all forms of evidence.
Background: Acromioclavicular (AC) joint dislocation is a common clinical problem among young and athletic populations. Surgical management is widely used for high-grade dislocations (Rockwood III-VI) and in high-demand athletes at high risk of recurrence. Purpose: To systematically review the evidence in the literature to ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after surgical treatment for AC joint dislocation. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted in the PubMed database. Clinical studies were eligible for inclusion if they reported on RTP after surgical treatment for AC joint dislocation. Statistical analysis was performed with SPSS. Results: We found 120 studies including 4327 cases meeting our inclusion criteria. The majority of patients were male (80.2%), with a mean age of 37.2 years (range, 15-85) and a mean follow-up of 34.5 months. Most were recreational athletes (79%), and the most common sport was cycling. The overall rate of RTP was 91.5%, with 85.6% returning to the same level of play. Among collision athletes, the rate of RTP was 97.3%, with 97.2% returning to the same level of play. In overhead athletes, the rate of RTP was 97.1%, with 79.2% returning to the same level of play. The mean time to RTP was 5.7 months (range, 1.5-15). Specific RTP criteria were reported in the majority of the studies (83.3%); time to return to play was the most commonly reported item (83.3%). Type III Rockwood injuries had the highest RTP rate at 98.7% and the earliest RTP at 4.9 months. Among the different surgical techniques, Kirschner wire fixation had the highest rate of RTP at 98.5%, while isolated graft reconstruction had the earliest RTP at 3.6 months. Conclusion: The overall rate of RTP was reportedly high after surgical treatment for AC joint dislocation, with the majority of patients returning to their preinjury levels of sport. There is a lack of consensus in the literature for what constitutes a safe RTP, with further focus on this topic required in future studies.
Reverse shoulder arthroplasty (RSA) is used in the treatment of traumatic and arthritic pathologies, with expanding clinical indications and as a result there has been an increase in clinical research on the topic. The purpose of this study was to examine the statistical fragility of randomized control trials (RCTs) reporting outcomes from RSA. A systematic search was undertaken to find RCTs investigating RSA. The Fragility Index (FI) was calculated using Fisher's exact test, by sequentially altering the number of events until there was a reversal of significance. The Fragility Quotient (FQ) was calculated by dividing the FI by the trial population. Each trial was assigned an overall FI and FQ calculated as the median result of its reported findings. Overall, 19 RCTs warranted inclusion in the review, representing 1146 patients, of which 41.2% were male, with a mean age of 74.2 ± 4.3 years and mean follow-up of 22.1 ± 9.9 months. The median RCT population was 59, with a median of 9 patients lost to follow-up. The median FI was 4.5, and median FQ was 0.083, indicating more patients did not complete the trial than the number of outcomes which would have to change to reverse the finding of significance. This review found that the RCT evidence for RSA management may be vulnerable to statistical fragility, with a handful of events required to reverse a finding of significance.
To compare the outcomes of athletes who have been treated for either primary or recurrent anterior shoulder instability with arthroscopic Bankart repair (ABR).A retrospective review of patients who underwent ABR for anterior shoulder instability, with a minimum of 24 months' follow-up, was performed. Those who underwent ABR for primary instability were matched in a 1:1 ratio for age, sex, sport, and level of preoperative play to those who underwent ABR for recurrent instability. The rate, level, and timing of return to play (RTP), as well as the Shoulder Instability-Return to Sport After Injury score, were evaluated. Additionally, the recurrence rate, visual analog scale score, Subjective Shoulder Value, Rowe score, satisfaction, and whether patients would undergo the same operation again were compared.After analysis of 467 patients, 100 athletes who underwent ABR for primary instability were identified and subsequently pair matched to 100 patients who underwent ABR for recurrent instability, with a mean age of 27.2 years, 87% male patients, 68% collision athletes, and a mean follow-up period of 61.9 months. There was no significant difference between the groups in the rate of RTP (80% vs 79%, P = .86) or RTP at the preinjury level (65% vs 65%, P >. 999); however, there was a significant difference in time to RTP (6.9 ± 2.9 months vs 5.9 ± 2.5 months, P = .02). There were no significant differences in visual analog scale score, Shoulder Instability-Return to Sport After Injury score, Subjective Shoulder Value, Rowe score, patient satisfaction, and whether patients would undergo the operation again (P > .05 for all). There was no difference in the rate of recurrent instability after ABR (10% vs 16%, P = .29).ABR results in excellent clinical outcomes, high rates of RTP, and low recurrence rates for both athletes with primary instability and those with recurrent instability.Level III, retrospective comparative cohort study.
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