The role of Platelet-Rich Plasma (PRP) intraarticular injections in restoring articular cartilage of osteoarthritic knees. A systematic review and meta-analysis

To assess the effect of PRP on knee articular cartilage content (thickness/volume) and examine the correlation between cartilage changes and clinical outcomes in patients with knee OA. A systematic literature search was performed using the Cochrane methodology in four online databases. Studies were included if they reported on cartilage content with cross-sectional imaging pre- and post-injection. A random-effects model meta-analysis was performed. Correlation with clinical outcomes was evaluated. 14 studies (n ​= ​1099 patients) from 1452 records met the inclusion criteria: seven RCTs (n ​= ​688), one prospective (n ​= ​50), one retrospective (n ​= ​68), and four case-series (n ​= ​224). The PRP preparation process and treatment protocol varied widely (follow-up 6-12 months). In meta-analysis, PRP treatment was not associated with a significant increase in cartilage thickness (4 studies, n ​= ​187, standardized mean difference: Hedges g: 0.079; 95%CI: 0.358 - 0.516; p ​= ​0.723). Meta-analysis of 3 RCTs (n ​= ​112) showed no significant difference in the change of overall knee cartilage content with PRP injections compared with no PRP (Hedges' g: 0.217; 95%CI: 0.177 - 0.611; P ​= ​0.281). The current literature does not support the PRP as chondrogenic in treatment of knee OA. However, there is substantial heterogeneity in the evaluated studies which limits the robustness of any conclusion. An adequately powered RCT, with a standardized PRP regime and standardized high-resolution MRI is needed to definitely define any effect of PRP on knee cartilage content and its relation to clinical outcomes. Until such high-quality evidence becomes available, we recommend that PRP is not administered with the intention of promoting chondrogenesis. [Abstract copyright: © 2022 The Authors.

Perioperative hypothermia is associated with increased 30-day mortality in hip fracture patients in the UK. Α systematic review and meta-analysis

Introduction/Objectives: Peri-operative hypothermia is common in trauma and surgical patients. The aim of this study was to undertake a systematic review and meta-analysis to determine the relationship between perioperative hypothermia and mortality following surgery for hip fracture. A systematic literature search of Medline, EMBASE, CINAHL, and Cochrane CENTRAL databases was performed using the Cochrane methodology for systematic reviews. The identified studies were assessed and compared against predetermined inclusion and exclusion criteria. Data extraction and quality appraisal was performed on selected articles. A meta-analysis was conducted using a random-effects model. The literature search identified 1016 records. After removing duplicates and those not meeting inclusion criteria, 3 studies measuring 30-day mortality were included. All included studies were carried out in the UK. The mortality rate was higher in the hypothermic groups as compared to the normothermic group in all the studies, with the difference being significant in two of the studies (p<0.0001). The meta-analysis showed that low body temperature was associated with an increased mortality risk (estimated OR: 2.660; 95%CI:1.948-3.632, P<0.001) in patients undergoing surgery for hip fracture. This study shows that low body temperature in hip fracture patients is associated with an increased 30-day mortality risk in the UK. Randomised control trials are required to determine whether the association between perioperative hypothermia in hip fracture patients and mortality is causal. Nevertheless, based on this analysis we urge the maintenance of normal body temperature in the peri-operative period to be included in national hip fracture guidelines. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. [Abstract copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

High rate of radiolucent lines following the cemented original design of the ATTUNE total knee arthroplasty

Aims Loosening of components after total knee arthroplasty (TKA) can be associated with the development of radiolucent lines (RLLs). The aim of this study was to assess the rate of formation of RLLs in the cemented original design of the ATTUNE TKA and their relationship to loosening. Methods A systematic search was undertaken using the Cochrane methodology in three online databases: MEDLINE, Embase, and CINAHL. Studies were screened against predetermined criteria, and data were extracted. Available National Joint Registries in the Network of Orthopaedic Registries of Europe were also screened. A random effects model meta-analysis was undertaken . Results Of 263 studies, 12 were included with a total of 3,861 TKAs. Meta-analysis of ten studies showed high rates of overall tibial or femoral RLLs for the cemented original design of the ATTUNE TKA. The overall rate was 21.4% (95% confidence interval (CI) 12.7% to 33.7%) for all types of design but was higher for certain subgroups: 27.4% (95% CI 13.4% to 47.9%) for the cruciate-retaining type, and 29.9% (95% CI 15.6% to 49.6%) for the fixed-bearing type. Meta-analysis of five studies comparing the ATTUNE TKA with other implants showed a significantly higher risk of overall tibial or femoral RLLs (odds ratio (OR) 2.841 (95% CI 1.219 to 6.623); p = 0.016) for the ATTUNE. The rates of loosening or revision for loosening were lower, at 1.2% and 0.9% respectively, but the rates varied from 0% to 16.3%. The registry data did not report specifically on the original ATTUNE TKA or on revision due to loosening, but ‘all-cause’ five-year revision rates for the cemented ATTUNE varied from 2.6% to 5.9%. Conclusion The original cemented ATTUNE TKA has high rates of RLLs, but their clinical significance is uncertain given the overall low associated rates of loosening and revision. However, in view of the high rates of RLLs and the variation in the rates of loosening and revision between studies and registries, close surveillance of patients who have undergone TKA with the original ATTUNE system is recommended