Lingde Kong

Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis

To identify risk factors for periprosthetic joint infection following primary total joint arthroplasty, a systematic search was performed in Pubmed, Embase and Cochrane library databases. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Patient characteristics, surgical‐related factors and comorbidities, as potential risk factors, were investigated. The main factors associated with infection after total joint arthroplasty (TJA) were male gender (OR, 1·48; 95% CI, 1.19–1.85), age (SMD, −0·10; 95% CI, −0.17–−0.03), obesity (OR, 1·54; 95% CI, 1·25–1·90), alcohol abuse (OR, 1·88; 95% CI, 1·32–2·68), American Society of Anesthesiologists (ASA) scale > 2 (OR, 2·06; 95% CI, 1·77–2·39), operative time (SMD, 0·49; 95% CI, 0·19–0·78), drain usage (OR, 0·36; 95% CI, 0·18–0·74), diabetes mellitus (OR, 1·58; 95% CI, 1·37–1·81), urinary tract infection (OR, 1·53; 95% CI, 1.09–2.16) and rheumatoid arthritis (OR, 1·57; 95% CI, 1·30–1·88). Among these risk factors, ASA score > 2 was a high risk factor, and drain usage was a protective factor. There was positive evidence for some factors that could be used to prevent the onset of infection after TJA.

Incidence of subsequent vertebral body fractures after vertebroplasty

The causal relationship between vertebroplasty and new-onset vertebral fractures remains unproved. We undertook a systematic review and meta-analysis of randomized controlled trials to assess whether vertebroplasty increases the incidence of new vertebral fractures and adjacent vertebral fractures. A systematic literature search of PubMed, EMBASE and Cochrane Library databases up to April 2013 was conducted. Eligible studies were randomized controlled trials of osteoporotic vertebral fracture patients receiving vertebroplasty. Risk ratios (RR) and 95% confidence intervals (CI) were calculated and heterogeneity was assessed with both the chi-squared test and the I(2) test. Four studies with a total of 454 patients met the inclusion criteria. All four studies described the incidence of new vertebral fractures and three studies described adjacent vertebral fractures. The pooled results revealed that vertebroplasty was not associated with a significant increase in the incidence of new vertebral fractures (RR 1.12, 95% CI 0.75-1.67; p=0.59) or adjacent vertebral fractures (RR 2.31, 95% CI 0.36-15.06; p=0.38). Based on available evidence, it cannot be concluded that vertebroplasty can significantly increase the postoperative rate of new vertebral fractures and adjacent vertebral fractures. However, due to some limitations, the results of this meta-analysis should be cautiously accepted, but further studies are needed.

Impact of obesity on lumbar spinal surgery outcomes.

Controversy exists regarding the effect of obesity on surgical outcomes and complications following lumbar spinal surgery. A systematic electronic literature review of all relevant studies through to June 2015 was performed using the PubMed, Embase, and Cochrane library databases. Pooled risk ratios (RR) or standardised mean differences (SMD) with 95% confidence intervals (CI) were calculated using random or fixed effects models. The Newcastle-Ottawa Scale was used to evaluate the methodological quality, and Stata 11.0 was used to analyse data (StataCorp, College Station, TX, USA). Significant differences between obese and non-obese patients were found for operation time (SMD, -0.273; 95%CI, -0.424 to -0.121), blood loss (SMD, -0.265; 95%CI, -0.424 to -0.107), surgical site infections (RR, 0.610; 95%CI, 0.446 to 0.834), and nerve injury (RR, 0.188; 95%CI, 0.042 to 0.841). Deep vein thrombosis, dural tear, revision surgery, and mortality were not significantly differences between the two groups (P<0.05). Obesity appears to be associated with longer operative times, greater blood loss, and higher risk of surgical site infections and nerve injuries. However, the results of this meta-analysis should be interpreted with caution due to heterogeneity amongst the included studies.

Prevalence of adjacent segment disease following cervical spine surgery: A PRISMA-compliant systematic review and meta-analysis.

AbstractPrevalence estimates of adjacent segment degeneration (ASD) following cervical spine surgery varied greatly in current studies. We conducted a systematic review and meta-analysis to summarize the point prevalence of ASD after cervical spine surgery. MethodsComprehensive electronic searches of PubMed, Embase, Web of Knowledge, and Cochrane Library databases were conducted to identify any study published from initial state to January 2016. Those reporting the prevalence of ASD after cervical surgery were included. A random-effects model was used to estimate the prevalence of radiographic ASD, symptomatic ASD, and reoperation ASD. Univariate meta-regression analyses were conducted to explore the potential associations between prevalence and length of follow-up. All analyses were performed using R version 3.2.3 (R Foundation for Statistical Computing). ResultsA total of 83 studies were included in the meta-analysis. The prevalence of radiographic ASD, symptomatic ASD, and reoperation ASD after cervical surgery was 28.28% (95% confidence interval [CI], 20.96–36.96), 13.34% (95% CI, 11.06–16.00), and 5.78% (95% CI, 4.99–6.69), respectively, in a general analysis. It was found 2.79%, 1.43%, and 0.24% additions per year of follow-up in the incidence of radiographic ASD, symptomatic ASD, and reoperation ASD, respectively. ConclusionThis meta-analysis provides some details about the prevalence of radiographic ASD, symptomatic ASD, and reoperation ASD after cervical spine surgery. However, the results of this meta-analysis should be interpreted with caution because of the heterogeneity among the studies.

Radiographic Restoration of Sagittal Spinopelvic Alignment After Posterior Lumbar Interbody Fusion in Degenerative Spondylolisthesis.

Study Design:A retrospective study. Objectives:This study was aimed to analyze the changes in spinopelvic parameters after surgical correction of degenerative spondylolisthesis and to determine which deformity is most responsible for changes in sagittal spinopelvic alignment. Summary of Background Data:The basic deformities of degenerative spondylolisthesis are forward slippage of the vertebral body, segmental kyphotic angle, and loss of disk height. Correction of those deformities during surgery will subsequently affect the spinopelvic parameters. A few studies have reported the changes of sagittal spinopelvic alignment after surgical treatment of isthmic spondylolisthesis. However, there appears to be relatively little information regarding degenerative spondylolisthesis. Materials and Methods:Fifty-three patients with L4–L5 degenerative spondylolisthesis were included. All patients underwent posterior lumbar interbody fusion and posterior instrumentation. Back pain, as the clinical outcome, was evaluated by visual analogue scale (VAS). The preoperative and postoperative spinopelvic parameters, including sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), and L1 axis S1 distance were measured, and then the correlations between spinopelvic parameters and local deformity parameters such as slip degree, slip angle (SA), and height of the intervertebral disk were evaluated. Results:After surgical correction of local deformity, all spinopelvic parameters changed subsequently: PT and L1 axis S1 distance had a decrease, SS and LL had an increase. VAS score decreased from 6.1±2.3 before surgery to 2.4±1.7 at the final follow-up assessment. Patients with VAS score changes ≥3 showed significantly higher SS and LL, and lower PT compared with those with VAS score changes <3. Among deformity parameters, restoration of the SA revealed significant correlation with improvement of LL (r=0.32, P=0.02), increase of SS (r=0.29, P=0.03), and decrease of PT (r=−0.29, P=0.03). Conclusions:Surgical correction of degenerative spondylolisthesis with posterior lumbar interbody fusion and posterior instrumentation resulted in relief of back pain, which may be associated with improvement of sagittal spinopelvic alignment. Surgeons should consider deformity parameters, especially the SA, in the surgical treatment of degenerative spondylolisthesis.

Risk factors for new vertebral compression fractures after vertebroplasty: a meta-analysis

The risk factors for new vertebral compression fractures (VCFs) after vertebroplasty are unclear. The aim of this meta‐analysis was to identify potential risk factors.

Association between smoking and risk of knee osteoarthritis: a systematic review and meta-analysis

OBJECTIVE To investigate the association between smoking and the risk for knee osteoarthritis (OA). DESIGN Cohort, case-control, and cross-sectional studies were obtained from the Medline, Embase, and Web of Science databases. Estimates were calculated using a random-effects model. Subgroup analyses and meta-regression models were performed to investigate potential sources of heterogeneity. We further analyzed the dose-response relationship between cigarette consumption and risk of knee OA. RESULTS Thirty-eight independent observational studies that included 481,744 participants were analyzed. Those who had ever smoked had a significantly decreased risk of developing knee OA relative to those who had never smoked (RR = 0.80; 95% CI 0.73-0.88). This was unaffected by study design, and the pooled relative risks (RRs) were 0.79 (95% CI, 0.65-0.96), 0.71 (95% CI, 0.61-0.84) and 0.83 (95% CI, 0.73-0.94) for cohort, case-control, and cross-sectional studies, respectively. Analysis of subgroups stratified by gender reduced the heterogeneity from moderate to low in both males and females. The lower risk for developing knee OA was more apparent in male smokers (RR = 0.69; 95% CI 0.58-0.80) than female smokers (RR = 0.89; 95% CI 0.77-1.02) and dose-response analysis showed a linear decrease in knee OA with increased cigarette consumption. CONCLUSIONS We found an inverse association between cigarette smoking and risk of knee OA, irrespective of study design. This association was more apparent in males. However, we have not demonstrated a causal relationship between smoking and OA, and further investigations are needed.

Comparison of intra-articular versus intravenous application of tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials

Introduction There is much controversy about the optimal application of tranexamic acid (TXA) in total knee arthroplasty (TKA). The purpose of this meta-analysis was to compare the efficacy of the intra-articular and intravenous regimens of TXA in TKA. Material and methods A literature search of the PubMed, Embase and Cochrane Library databases was performed. Randomized controlled trials comparing the result of intra-articular and intravenous application of TXA during TKA were included. The focus was on the outcomes of blood loss, transfusion requirement and thromboembolic complications. Results Six studies were eligible for data extraction and meta-analysis. We found no statistically significant difference between intra-articular and intravenous administration of tranexamic acid in terms of total blood loss (WMD, 6.01; 95% CI: –96.78 to 108.79; p = 0.91), drain output (WMD = –20.26; 95% CI: –51.34 to 10.82; p = 0.20), hemoglobin drop (WMD = 0.33; 95% CI: –0.31 to 0.98; p = 0.31), or the incidences of transfusion (RR = 0.98; 95% CI: 0.56–1.70; p = 0.93) as well as deep vein thrombosis (RR = 0.49; 95% CI: 0.09–2.73; p = 0.42). Conclusions In comparison with intravenous application of TXA, intra-articular application had a comparable effect on reducing blood loss and the transfusion rate without increasing the complication rate.

Prevalence of and risk factors for Modic change in patients with symptomatic cervical spondylosis: an observational study

Background The aim of this study was to assess the prevalence of cervical Modic change (MC) in patients with cervical spondylosis and to develop a better understanding of the possible risk factors for the prevalence of MC. Methods Between January 2014 and April 2017, patients with cervical spondylosis were included in our study. All patients underwent magnetic resonance imaging (MRI) to evaluate the presence of MC. The MC was classified into three types according to the Modic classification. Potential risk factors were collected from demographic data, lifestyle variables, laboratory tests, and radiographic images. Both univariate and multivariate analysis were used to detect factors associated with MC. We further compared several variables related to fat metabolism between patients with Type 1 and Type 2 MC. Results The prevalence of MC in patients with cervical spondylosis was 9.24%. The MC was most frequent at C5–6, followed by C6–7, C4–5, and C3–4. The proportion of Type 1 MC in patients with neck pain was significantly higher than that in patients without neck pain (46.2% vs 13.6%, P=0.027). However, none of the variables associated with fat metabolism showed a significant difference between Type 1 and Type 2 MC. Multivariate logistic analysis showed that age ≥55 years (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.22–2.98) and body mass index (BMI) ≥25 kg/m2 (OR, 2.41; 95% CI, 1.62–3.59) were two significant independent factors that are associated with cervical MC in patients with cervical spondylosis (P<0.05). Conclusion It appears that advanced age and high BMI were two factors that may be responsible for cervical MC. Type 1 MC is associated with the prevalence of neck pain. However, we cannot confirm that Type 2 MC is correlated with fat metabolism.

Survivorship Analysis of Clinical Adjacent-Segment Pathology After Single-Level Cervical Fusion

Background Clinical adjacent-segment pathology (CASP) is an important problem after anterior cervical surgery. The purpose of this study was to predict prevalence of CASP and determine the possible risk factors for CASP after single-level anterior cervical discectomy and fusion surgery. Material/Methods We retrospectively reviewed a series of patients who underwent single-level cervical discectomy and fusion surgery (ACDF). Both basic and radiographic data of patients were collected. Life-table method and Kaplan-Meier analysis were used to calculate prevalence of CASP and disease-free survival rate. Cox analysis was performed to determine the predictive factors for it. Results A total of 256 patients were included in this study. The mean length of follow-up was 70.64 months. Among them, 31 patients were diagnosed as having CASP during follow-up. Nineteen of them were at the cephalad adjacent segment, and the other 12 were at the caudal segment. After ACDF procedures, 10.01% of patients developed new symptoms of CASP within 5 years, and the incidence increased to 23.89% after 10 years. The incidence rate of CASP was an average of 2.46% per year. Multivariate Cox regression analysis showed that congenital stenosis (hazard ratio [HR], 3.250; 95% confidence interval [CI], 1.538–6.867) and degeneration of adjacent segment (HR, 2.681; 95% CI, 1.259–5.709) were correlated with the incidence of CASP. Conclusions Patients with congenital stenosis and pre-existing degenerative changes of adjacent segments had a higher risk of developing CASP after single-level anterior cervical discectomy and fusion.