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Рубрика: Эндопротезирование бедренных мыщелков и большеберцового плато в медиальном и латеральном компартментах

Новый сисобзор по травме! Migliorini 2019

Откуда инфа? См. запрос PubMed!
@article{Migliorini2019,
title = {Better outcomes with patellar resurfacing during primary total knee arthroplasty: a meta-analysis study},
issn = {1434-3916},
shorttitle = {Better outcomes with patellar resurfacing during primary total knee arthroplasty},
doi = {10.1007/s00402-019-03246-z},
abstract = {BACKGROUND: Total knee arthroplasty (TKA) is a feasible and cost-effective procedure. However, resurfacing of the patella sparks a heated debate. Anterior knee pain after TKA was supposed to be correlated to the patellofemoral joint, and the resurface of the patella was believed to be effective to avoid this complication.
AIM: A meta-analysis was performed to update current evidence concerning the outcomes of patellar resurfacing versus retaining for total knee arthroplasty. The first outcomes of interest were to compare the rate of anterior knee pain and revision surgeries.
MATERIAL AND METHODS: This study was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA). A comprehensive review of the literature was conducted accessing the main databases: Embase, Google Scholar, PubMed, Scopus. All the prospective clinical trials comparing the outcomes between patellar resurfacing versus retaining were included in this study. Only articles classified as level of evidence I to II were considered for inclusion. Only studies reporting a minimum 24 months follow-up were included. The following data were extracted: demographic baseline, anterior knee pain, reoperations, clinical scores (HSS, KSS and related subscales) and range of motion (ROM). Studies solely reporting quantitative data under the outcomes of interest were included.
RESULTS: In favor of the resurfacing group, we observed a statistically significant reduced rate of anterior knee pain (odd ratio 1.73) and reoperation (odd ratio 3.24). In the resurfacing group, a prevalence of anterior knee pain of 11.15\% was detected, whereas in the retaining group it amounted to 17.39\%. Furthermore, a greater KSS pain (+ 0.97\%), KSS clinical (+ 0.23\%), KSS functional (+ 2.44\%), KSS overall (+ 2.47\%) and HSS (+ 5.64\%) were reported. In the retaining group, we found a better range of motion (+ 3.09°).
CONCLUSION: Based on the main findings of this meta-analysis, patellar resurfaced TKA was demonstrated to have performed superior overall. Patellar resurfacing detected a lower rate of postoperative anterior knee pain and reoperation. Moreover, the resurfacing group showed greater value of the HSS, KSS and related subscales. In favor of the retaining group, a slightly better ROM was evidenced.
LEVEL OF EVIDENCE: Level II, meta-analysis of prospective clinical trials.},
language = {eng},
journal = {Archives of Orthopaedic and Trauma Surgery},
author = {Migliorini, Filippo and Eschweiler, Jörg and Niewiera, Marc and El Mansy, Yasser and Tingart, Markus and Rath, Björn},
month = jul,
year = {2019},
pmid = {31367842},
keywords = {Anterior knee pain, Patellar resurfacing, Patellar retaining, Prosthesis, Total knee arthroplasty}
}

Новый сисобзор! Price 2019

Откуда инфа? См. запрос PubMed!
@article{Price2019,
    title = {The {Arthroplasty} {Candidacy} {Help} {Engine} tool to select candidates for hip and knee replacement surgery: development and economic modelling},
    volume = {23},
    issn = {2046-4924},
    shorttitle = {The {Arthroplasty} {Candidacy} {Help} {Engine} tool to select candidates for hip and knee replacement surgery},
    doi = {10.3310/hta23320},
    abstract = {BACKGROUND: There is no good evidence to support the use of patient-reported outcome measures (PROMs) in setting preoperative thresholds for referral for hip and knee replacement surgery. Despite this, the practice is widespread in the NHS.
OBJECTIVES/RESEARCH QUESTIONS: Can clinical outcome tools be used to set thresholds for hip or knee replacement? What is the relationship between the choice of threshold and the cost-effectiveness of surgery?
METHODS: A systematic review identified PROMs used to assess patients undergoing hip/knee replacement. Their measurement properties were compared and supplemented by analysis of existing data sets. For each candidate score, we calculated the absolute threshold (a preoperative level above which there is no potential for improvement) and relative thresholds (preoperative levels above which individuals are less likely to improve than others). Owing to their measurement properties and the availability of data from their current widespread use in the NHS, the Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were selected as the most appropriate scores to use in developing the Arthroplasty Candidacy Help Engine (ACHE) tool. The change in score and the probability of an improvement were then calculated and modelled using preoperative and postoperative OKS/OHSs and PROM scores, thereby creating the ACHE tool. Markov models were used to assess the cost-effectiveness of total hip/knee arthroplasty in the NHS for different preoperative values of OKS/OHSs over a 10-year period. The threshold values were used to model how the ACHE tool may change the number of referrals in a single UK musculoskeletal hub. A user group was established that included patients, members of the public and health-care representatives, to provide stakeholder feedback throughout the research process.
RESULTS: From a shortlist of four scores, the OHS and OKS were selected for the ACHE tool based on their measurement properties, calculated preoperative thresholds and cost-effectiveness data. The absolute threshold was 40 for the OHS and 41 for the OKS using the preferred improvement criterion. A range of relative thresholds were calculated based on the relationship between a patient's preoperative score and their probability of improving after surgery. For example, a preoperative OHS of 35 or an OKS of 30 translates to a 75\% probability of achieving a good outcome from surgical intervention. The economic evaluation demonstrated that hip and knee arthroplasty cost of {\textless} £20,000 per quality-adjusted life-year for patients with any preoperative score below the absolute thresholds (40 for the OHS and 41 for the OKS). Arthroplasty was most cost-effective for patients with lower preoperative scores.
LIMITATIONS: The ACHE tool supports but does not replace the shared decision-making process required before an individual decides whether or not to undergo surgery.
CONCLUSION: The OHS and OKS can be used in the ACHE tool to assess an individual patient's suitability for hip/knee replacement surgery. The system enables evidence-based and informed threshold setting in accordance with local resources and policies. At a population level, both hip and knee arthroplasty are highly cost-effective right up to the absolute threshold for intervention. Our stakeholder user group felt that the ACHE tool was a useful evidence-based clinical tool to aid referrals and that it should be trialled in NHS clinical practice to establish its feasibility.
FUTURE WORK: Future work could include (1) a real-world study of the ACHE tool to determine its acceptability to patients and general practitioners and (2) a study of the role of the ACHE tool in supporting referral decisions.
FUNDING: The National Institute for Health Research Health Technology Assessment programme.},
    language = {eng},
    number = {32},
    journal = {Health Technology Assessment (Winchester, England)},
    author = {Price, Andrew and Smith, James and Dakin, Helen and Kang, Sujin and Eibich, Peter and Cook, Jonathan and Gray, Alastair and Harris, Kristina and Middleton, Robert and Gibbons, Elizabeth and Benedetto, Elena and Smith, Stephanie and Dawson, Jill and Fitzpatrick, Raymond and Sayers, Adrian and Miller, Laura and Marques, Elsa and Gooberman-Hill, Rachael and Blom, Ashley and Judge, Andrew and Arden, Nigel and Murray, David and Glyn-Jones, Sion and Barker, Karen and Carr, Andrew and Beard, David},
    month = jun,
    year = {2019},
    pmid = {31287051},
    keywords = {ARTHROPLASTY, COST–UTILITY ANALYSIS, HIP, KNEE, OSTEOARTHRITIS, OUTCOME, REFERRAL, SYSTEMATIC REVIEW, THRESHOLD},
    pages = {1--216}
}