In this large clinical cohort, GDM was not associated with, but maternal pre-pregnancy obesity or overweight and EGWG were independently associated with an increased risk, and breastfeeding ≥6 months was associated with a decreased risk of childhood overweight at age 2 years.
Total knee arthroplasty (TKA) is a highly successful operation that improves patients' quality of life and functionality. Yet, up to 20% of TKA patients remain unsatisfied with their clinical result. Robotic TKA has gained increased attention and popularity as a means of improving patient satisfaction. The promise of robotic-assisted TKA is that it provides a surgeon with a tool that accurately executes bone cuts according to presurgical planning, as well as provides the surgeon with intraoperative feedback helpful for restoring knee kinematics and soft tissue balance. Several systems are now available, each with their own advantages and disadvantages. Evidence that the use of robotics will lead to improved implant survival, function, and patient-reported outcomes is slowly being accumulated, but this has not been clearly proven to date. Recent literature does show that the use of robotics during TKA is not associated with increased surgical time or complications. The goal of this review is to provide an objective assessment of the evidence surrounding robotic technology for TKA.
Introduction:
Posterolateral approach (PA) has been historically associated with an increased risk of dislocation after primary total hip arthroplasty (THA), especially when compared with the direct anterior approach (DAA). However, current evidence is inconsistent regarding the risk of dislocation with either approach. The purpose of this study is to determine whether surgical approach influences joint stability.
Methods:
A systematic search in PubMed, MEDLINE, and Embase databases was performed. Randomized controlled trials (RCTs) and non-RCTs comparing DAA with PA in primary THA were included. Pooled effect measure of risk differences, relative risk and mean differences for postoperative dislocation, acetabular implant positioning, and leg length discrepancy were calculated.
Results:
Twenty-five studies (5 RCTs and 20 non-RCTs) of 7,172 THAs were assessed. There were no significant differences in dislocation rates between approaches (risk difference = −0.00, 95% confidence interval: −0.01 to 0.00; P = 0.92; I2 = 0%). Results were similar in the subgroup analysis of RCTs (P = 0.98), posterior soft-tissue repair (P = 0.50), and learning curve (P = 0.77). The acetabular implant was better positioned within the safe zone in the DAA group (relative risk = 1.17; 95% confidence interval: 1.03 to 1.33; P = 0.01), but no significant differences were found in cup inclination (P = 0.8), anteversion (P = 0.10), and leg length discrepancy (P = 0.54).
Conclusion:
Dislocation rates after THA are not different between DAA and PA. Furthermore, no differences in the rate of dislocation were associated with cup positioning or surgical factors related with hip instability. Therefore, the surgical approach has little influence in prosthesis instability after primary THA.
Level of Evidence:
Level III
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