Background Periprosthetic joint infections (PJI) are a rare but severe complication of total joint arthroplasty (TJA). However, the diagnosis of PJI remains difficult. It is one of the research that focuses about diagnosis for PJI for majority researchers to discover a novel biomarker. This meta-analysis tried to evaluate diagnostic value of synovial calprotectin for PJI. Methods This meta-analysis search of the literature was conducted in PubMed, EMBASE, Web of Science, and the Cochrane Library. Literature quality was appraised using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) based on RevMan (version 5.3). The diagnostic value of calprotectin for PJI was evaluated by calculating sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), diagnostic score and area under SROC (AUC) based on the Stata version 14.0 software. We conduct subgroup analysis according to the study design, cutoff values, the country of study, and gold standard. Results Seven studies were included in this meta-analysis. The pooled sensitivity of synovial calprotectin for the diagnosis of PJI was 0.94 (95% CI, 0.87–0.98), and the specificity was 0.93 (95% CI, 0.87–0.96). The pooled AUC, PLR, and NLR for synovial calprotectin were 0.98 (95% CI, 0.96–0.99), 13.65 (95% CI, 6.89–27.07), and 0.06 (95% CI, 0.02–0.15), respectively. The pooled diagnostic score and DOR were 5.4 (95% CI, 3.96–6.85) and 222.32 (95% CI, 52.52–941.12), respectively. Conclusion In summary, this meta-analysis indicates that synovial calprotectin is a promising biomarker of assistant diagnosis for PJI, as well as recommended test for excluding diagnostic tool.
Background Non-vascularized bone grafting (NVBG) has demonstrated to treat osteonecrosis of the femoral head (ONFH). There are a number of articles updating the use of NVBG to treat the ONFH, but the percentage of patients subsequently undergoing a total hip arthroplasty (THA) is controversial. Methods Several electronic databases, including PubMed, Embase, Web of Science, and Cochrane databases, were searched to find studies using NVBG to treat ONFH. The pooled rate and 95% confidence interval (CI) were used to assess the conversion rate to THA after NVBG. In addition, we performed subgroup, sensitivity, and publication bias analysis. Results A total of 37 studies describing 2599 hips were included. The mean weighted follow-up time was 50.5 months and the mean age at surgery was 36.3 years. The conversion rate to THA after NVBG was 21% (95%CI: 17% to 25%), and subgroup analyzes indicated lightbulb, trapdoor and Phemister techniques incidences with THA of 15%, 19%, and 24%, respectively. Conclusions This study preliminarily obtained the general trend of the survival rate of NVBG patients, but these results should be interpreted cautiously. Pooled results from 2599 hips and of these nearly 80% with early stage of osteonecrosis, showed that approximately 21% of patients underwent a THA following NVBG. NVBG treatment for patient with ONFH appears to defer or at least delay the need for THA.
Purpose: Enhanced recovery after surgery (ERAS) is a surgical rehabilitation protocol of increasing interest to clinicians in recent years, with the aim of faster and better recovery of patients after surgery. Our main focus in this review is to analyze the effectiveness of ERAS rehabilitation protocols in orthopedic surgery. By comparing the post-operative recovery of patients receiving the ERAS rehabilitation program with that of patients receiving the conventional rehabilitation program, we observed whether the patients who have received the ERAS rehabilitation program could recover better and faster, thereby achieving the aim of a shorter hospital stay and reducing the incidence of complications. Methods: We conducted the literature searches in PubMed, MEDLINE, Web of Science, Cochrane Reviews, EMBASE and other databases on clinical studies related to orthopedic surgery regarding the effectiveness of rehabilitation using ERAS rehabilitation protocols compared with conventional rehabilitation protocols. A systematic review was performed in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement. If there was variability in the rehabilitation data of the patients between the two subgroups, it was considered that there was a difference in the rehabilitation effect of the ERAS rehabilitation protocol and the conventional rehabilitation protocol on the patients. Conclusion: The application of ERAS rehabilitation protocols can shorten patients’ hospital stay and reduce their expenses. In addition, patients with ERAS rehabilitation protocols will have fewer postoperative complications, while patients will have less postoperative pain than those with conventional rehabilitation, facilitating better postoperative recovery.
Purpose To explore the biomechanical effect and mechanism of cannulated compression screw in the treatment of non traumatic necrosis of femoral head with allogeneic fibula graft. Methods Based on the CT data of healthy adults, four groups of models were established by using finite element software: the normal group, the femoral head necrosis group, the hip preservation operation group with allogeneic fibula graft (later referred to as group A), and the hollow compression screw combined with allogeneic fibula graft (later referred to as group B). Apply 1440N, 2400N and 4200N loads to the four groups of models respectively, observe the changes of stress distribution on the surface and deep of the femoral head, internal mechanical transmission pathway in different groups under different loads, as well as the displacement of implants in the two groups of surgical models, and explore the biomechanical role and mechanism of hollow compression screws in the same kind of allogeneic fibula graft. Results (1) Under normal circumstances, the pressure of the femoral head surface and internal cancellous bone is mainly concentrated in the anterolateral weight-bearing area of the femoral head, and the internal stress can be well transmitted to the lower limbs through the femoral calcar, femoral neck and other parts, without obvious stress conduction barrier.(2) The closer the necrotic location is to the anterolateral column of the weight-bearing area, the stress peaks of the cartilage, cortical bone and cancellous bone on the surface of the femoral head increase significantly compared with the normal model. With the increase of load, the stress peaks of the above bones increase significantly. In type C1 and C2 necrosis, the stress transmission of femoral head and neck was abnormal, and the stress concentration occurred in the normal bone around the necrotic area.(3) Under different loads, the peak value of von Mises stress in type C1 necrotic area in group B decreased by 1.67mpa (-18.45%), 2.77mpa (-18.37%), 4.84mpa (-18.35%) respectively compared with group A. the peak value of von Mises stress in type C2 necrotic area in group B decreased by 0.05Mpa (-0.58%), 0.08mpa (-0.56%), 0.15Mpa (-0.6%) respectively compared with group A; At the same time, under different loads, the displacement distance of type C1 allogeneic fibula strips in group B decreased by 0.06mm (-8.7%), 0.1mm (-8.7%) and 0.17mm (-8.42%) respectively compared with group A. the displacement distance of type C2 allogeneic fibula strips in group B decreased by 0.01mm (-1.72%), 0.01mm (-1.03%) and 0.02mm (-1.19%) respectively compared with group A. Conclusion In the allogeneic fibula graft surgery, the addition of cannulated screws may have a better mechanical effect of dispersing the stress in the necrotic area and stabilizing the fibula strip, which is most significant in type C1 necrosis.
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