ABSTRACT
BACKGROUND: Total hip arthroplasty is the gold standard for the end stage of elderly hip disease, but Birmingham hip resurfacing has become an effective alternative to total hip arthroplasty for young people with high levels of exercise. Whether Birmingham hip resurfacing has an advantage over total hip arthroplasty is still inconclusive. OBJECTIVE: To systematically review the efficacy and metal ion level of Birmingham hip resurfacing and total hip arthroplasty. METHODS: The electronic databases of PubMed, EMBASE, Cochrane library, and Web of Science, which last updated on November 30, 2018, were searched for clinical control study of Birmingham hip resurfacing and total hip arthroplasty. Literature data were extracted and literature quality was evaluated. Meta-analyses were performed with RevMan 5.3 software. RESULTS AND CONCLUSION: (1) Twelve studies were identified with a total of 2 317 patients (n=1 279 in Birmingham hip resurfacing group and n=1 038 in total hip arthroplasty group). (2) Meta-analysis results demonstrated that in the primary outcome measures, the Birmingham hip resurfacing group did not differ from the total hip arthroplasty group during short-term follow-up (RR=0.13, 95% CI [0.02, 1.01], P=0.05), but Birmingham hip resurfacing had a lower revision rate during long-term follow-up (RR=0.27, 95% CI [0.15, 0.50], P 0.05). (4) Finally, in the metal ion level, whether it was short-term follow-up or long-term follow-up, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty (P < 0.05). While at the Cr ion level, there was no significant difference between Birmingham hip resurfacing and total hip arthroplasty in short-term follow-up (P=0.55), but long-term follow-up showed that Birmingham hip resurfacing released more Cr ions than total hip arthroplasty after surgery, and the difference between the groups was statistically significant (P=0.03). (5) In conclusion, compared with total hip arthroplasty, Birmingham hip resurfacing has a smaller revision rate and overall complication, a better hip function score, but its Cr ion level is higher. This conclusion still needs further a great amount of large-sample, multi-center, high-quality randomized controlled trials to verify its correctness.
ABSTRACT
BACKGROUND: Intraarticular injection of corticosteroids after arthroscopic shoulder surgery is one of the effective methods to relieve shoulder pain and stiffness after surgery. However, whether the use of corticosteroids will increase the complications associated with arthroscopic shoulder surgery is still controversial. OBJECTIVE: To evaluate the safety and clinical efficacy of corticosteroid injections after arthroscopic shoulder surgery. METHODS: The electronic databases including PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for clinical controlled trials of corticosteroid injection into the articular cavity after arthroscopic shoulder surgery from the inception of the databases to September 2019. Data extraction and quality appraisement were performed independently by two investigators according to inclusion and exclusion criteria. Merging and analysis of effect quantities was conducted on RevMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of six comparative studies were included. A total of 7 418 patients were enrolled, of which 3 920 were in the corticosteroid injections group and 3 498 in the control group. (2) Meta-analysis showed that there was no significant difference in tear rate, Constant score, ASES score and UCLA score between the two groups [OR=0.71, 95%CI[0.45, 1.13], P=0.15; MD=-0.99, 95% CI(-12.44, 10.46), P=0.87; MD=-0.12, 95%CI(−1.80, 1.56), P=0.89; MD=−1.46, 95%CI(−3.22, 0.30), P=0.10]. The infection rate of corticosteroid injections group was higher than that of control group (P 0.05). (3) The results showed that the injection of corticosteroids did not increase the rate of postoperative tear, but the injection of corticosteroids within one month after the operation would increase the rate of postoperative infection. Therefore, when using corticosteroids after the operation, clinicians should weigh the advantages and disadvantages according to the actual situation of patients, and pay attention to avoid injecting intraarticular hormone treatment within 1 month after operation.