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In the current literature, there is no consensus as to whether the medial pivot (MP) or posterior-stabilised (PS) knee provides the best result for the patient in the context of post-operative range of motion (ROM) and patient reported outcome measures (PROMs). The aim of this systematic review is to provide this equipoise with some clarity. We conducted this study following both the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement (PRISMA) and the Cochrane Handbook for systematic reviews and meta-analysis. Studies comparing the MP and PS knees from all regions and written in any language were included. Twenty- one studies were included in this meta-analysis. They were prepared and analysed using Review Manager V5.0 [Computer Program] (RevMan5). We calculated the risk ratio to measure the treatment effect, taking the heterogeneity of the studies into consideration. Random-effect models were also utilised. MP knees were found to have a significant advantage over PS knees in terms of WOMAC score at the midterm follow up, and insignificant advantages over PS knees in terms of ROM and FJS at one and two years follow- up. Additionally, the PS knees demonstrated an in significantly higher Knee Society Score (KSS) at short and midterm follow up. In terms of ROM, KSS, OKS and FJS this meta-analysis suggests a non-significant advantages for the MP knee compared with the PS prothesis in the short term. The MP implant also showed a significantly superior WOMAC score at short-term follow-up. An extended follow-up period is required to evaluate whether the MP knee is superior than the PS in the long-term.

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Background Genitourinary syndrome of menopause (GSM) is a common disturbing issue in the postmenopausal period. Unlike vasomotor symptoms, it has a progressive trend. Our study aims to evaluate the efficacy and safety of oxytocin gel versus placebo gel in postmenopausal women with GSM. Methods A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from Web of Science, SCOPUS, PubMed, and Cochrane Central Register of Controlled Trials databases on January 18, 2023. We used the risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes; both presented with the corresponding 95% confidence interval (CI). Results Seven studies with 631 patients were included. Regarding the maturation index, there was a statistically insignificant increase in the oxytocin arm (MD= 12.34, 95% CI (-12.52-37.19), P= 0.33). Vaginal atrophy showed a statistically significant reduction in the oxytocin group (RR= 0.32, 95% CI (0.23-0.10), P< 0.00001). For dyspareunia, vaginal pH as well as histological evaluation of vaginal atrophy, there was a statistically insignificant difference between the two groups (RR= 1.02, 95% CI (0.82 -1.27), P= 0.84), (MD= -0.74, 95% CI (-1.58-0.10), P= 0.08) and (MD= -0.38, 95% CI (-0.82-0.06), P= 0.09) respectively. There was no significant difference in the safety profile between the two groups as measured by endometrial thickness (MD= 0.00, 95% CI (-0.23-0.23), P= 0.99). Conclusions Although oxytocin has been proposed as a viable alternative to estrogen in the treatment of GSM, our findings show the opposite. Larger, high-quality RCTs are needed to confirm or refute our results. PROSPERO number CRD42022334357.

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