Background Myofascial pain syndrome (MPS) is a common musculoskeletal pain and dysfunction, which is characterised by myofascial trigger points. Therapeutic physical modalities, as potentially effective treatment options, are commonly used in the clinical setting for the patients with MPS. Objective This systematic review aimed to evaluate the safety and effectiveness of therapeutic physical modalities in the treatment of MPS, investigate its therapeutic mechanisms and provide a scientific evidence-based decision. Methods According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Cochrane Central Library, Embase, and CINAHL databases were searched for randomized controlled clinical studies published from database inception to October 30, 2022. A total of 25 articles met the study inclusion criteria. Data were extracted from these studies and a qualitative analysis was performed. Results Transcutaneous electrical nerve stimulation therapy, extracorporeal shock wave therapy, laser therapy, and other therapeutic physical modalities have been demonstrated to improve the pain symptoms, joint mobility, psychological state, and quality of life in the patients with MPS and no side effects have been reported. The curative effect of therapeutic physical modalities was found to be possibly associated with increased blood perfusion and oxygen supply in ischaemic tissues, reduced hyperalgesia in the peripheral and central nerves, and decreased involuntary muscle contractions. Conclusion The systematic review has shown that therapeutic physical modalities could provide a safe and effective therapeutic option for MPS. However, the consensus is currently lacking regarding the optimal treatment paradigm, therapeutic parameters, and mutual combination of therapeutic physical modalities. The clinical trials with robust quality are required to further promote the evidence-based application of therapeutic physical modalities for MPS.
designer series describes ten year survival rates of up to 98%, with no failures due to polyethylene wear or aseptic loosening of the tibial component. However, some smaller non-designer series have failed to replicate these results. Recent commentaries on registry data have added to the debate and there is still some confusion as to the true outcome of this procedure. It has been suggested that both the centre and the individual surgeons experience are critical is achieving good results. As yet no previous authors have presented the results of trainees with this prosthesis. Trainees may be expected to achieve worse results with a technique that is highly surgeon dependent. The aim of this study is to present the survival of a large consecutive cohort of medial OUKA performed in a specialist centre, by multiple non-designer surgeons, with the majority performed by trainees. Methods: 1085 consecutive primary medial OUKA in 944 patients performed between 1998 and 2008 were identified at a tertiary centre of excellence from operative records. In each case the operation was performed by a lower limb arthroplasty surgeon outside the designer team. Operations performed by both trainee and consultant surgeons were included. Failure was defined as need for revision of any of the prosthetic components for any cause and identified from hospital records, repeat postal questionnaire to all patients and telephone follow-up of nonresponders. Family Doctor records were consulted in patients who remained uncontactable. In patients who had died the Family Doctor was contacted to determine the status of the knee at time of death. Survivorship analysis was by construction of life table and cumulative survival calculation. Results were stratified by grade of surgeon and level of supervision. Results: 1085 patients with an average age of 67yrs (SD 6.9) at time of operation were identified. 681 (62.8%) knees were inserted by over 50 different trainees, 404 (37.2%) by 9 different consultants. At 10 years, 9 (0.83%) patients were lost to follow up and 76 (7%) had died. 46 knees underwent revision surgery; 34 were revised to total knee arthroplasty (TKA), 3 had revision of tibial or femoral component, 5 had additional lateral unicompartmental knee arthroplasty for lateral compartment progression of arthritis, and 4 underwent bearing change for dislocation or impingement. The best case survival for the Oxford Medial Unicompartmental Knee Arthroplasty was 91% at 10 years. There was no difference in the survival rates between consultants or registrars (p¼0.47). If the Consultant was not in theatre at the time of the operation, registrars achieved a 95% 10 year survival. The presence of the Consultant in theatre with the trainee reduces survival to 82% at 10 years. Conclusions: This is the largest single centre non designer series of Oxford Unicompartmental Knee Arthroplasty ever reported and it demonstrates excellent survival at 10 years. Over 60 surgeons were involved and there was no difference in terms of survival between trainee and con...
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