Outcomes Of Reconstruction With Vascularized Vs Non Vascularized Bone Graft After Resection Of Bone Tumours- A Systematic Review And Meta-Analysis.

BACKGROUND: Vascularized (VBG) and non-vascularized (NVBG) bone grafting are two crucial biological reconstructive techniques in the management of bone tumours. The objective of this study is to compare the outcomes of reconstruction with vascularized and non-vascularized bone grafts after resection of bone tumours. METHODS: A systematic evaluation of the literature from 2012-2021 was undertaken using the online databases PubMed/Medline, Google Scholar, and Cochrane Library considering only comparative articles with specific outcomes for the restoration of the defect with vascularized and non-vascularized bone graft following the resection of bone tumours. The quality of the research methodology was evaluated using Oxford Quality Scoring System and Newcastle Ottawa Scale for randomized trials and non-randomized comparison research respectively. The SPSS version 23 was used to examine the data that was collected. Musculoskeletal tumour society score (MSTS), bone union time, and complications were the outcomes of this review. RESULTS: Four clinical publications were considered, totalling 178 participants (92 men and 86 women) with 90 patients with VBG and 88 with NVBG. MSTS score and bone union time were the key outcomes that were measured. The overall MSTS (p>0.05) and rate of complications (p>0.05) results were comparable between the two groups, however, VBG had a better rate of bone union (p<0.001). CONCLUSIONS: As a result of the quicker bone union, our systematic evaluation demonstrated that VBG causes earlier recovery. Complication rates and functional results were the same in both groups. The link between the bone union time and functional score following VBG and NVBG must also be demonstrated.

Outcomes Of Intraoperative Radiotherapy (Iort) For Spinal Tumours.

BACKGROUND: The spinal column is a major site of neoplastic proliferation where decisions regarding surgical or radiotherapeutic intervention are based upon spinal instability neoplastic score (SINS). A novel technique named 'Intraoperative radiotherapy (IORT) was proposed where surgery and radiotherapy were performed in the same session. During our literature search, we found no published systematic review or meta-analysis regarding the outcomes of IORT for spinal tumors. This review aims to provide the knowledge regarding the outcomes of IORT for spinal tumors to assist surgeons and radiologists. METHODS: PubMed, Google Scholar, Cochrane library for trials reporting the outcomes of IORTin spinal tumors. The search terms were "outcomes", "Intraoperative radiotherapy", "IORT", "spine neoplasia" and "spine metastasis" in different combinations. Standardized mean difference (SMD) in VAS for pain relief while proportionality for neurological improvement, local progression, and toxicities were plotted on forest plots, respectively. RESULTS: Eight studies comprising 610 patients were included with two conference proceedings. SMD for VAS was -1.715 while proportionality for neurological improvement, local progression, and toxicities were 0.9 (90%), 0.03 (3%), and 0.121 (12.1%), respectively. CONCLUSIONS: Pain relief was evident by a decrease in VAS scores in the majority of patients. The majority showed neurological improvement and regained motor and sensory functions while an overwhelming population showed local tumor control with lesser patients developing tumor progression and radiation-induced toxicities. Short follow-ups and the absence of randomized trials advocates the need for further clinical researches to confirm the outcomes of IORT in spinal tumors.

Clinical Outcomes Of Intra-Articular High Molecular Weight Hyaluronic Acid Injection For Hip Osteoarthritis- A Systematic Review And Meta-Analysis.

BACKGROUND: Osteoarthritis is the most common degenerative disease of the synovial joints in the elderly population with hip osteoarthritis as the second most commonly affected joint. A multitude of conservative treatments is used for pain relief and functional improvement including acetaminophen, NSAID, intra-articular corticosteroid, and viscosupplementation (VS). Different preparations of VS based on different molecular weights are commercially available. No systematic review or meta-analysis regarding the use of intra-articular high molecular weight hyaluronic acid (HMWHA) injection for the hip joint was published before. This review analyzes the efficacy of intra-articular HMWHA for hip osteoarthritis. METHODS: PubMed, Google Scholar, Cochrane Library for randomized trials describing the efficacy of HMWHA for hip osteoarthritis was searched. The search terms were osteoarthritis, hip joint, outcomes, viscosupplementation, and high molecular weight hyaluronic acid in different combinations. Standardized mean difference (SMD) in VAS for pain relief and Lequesne index for functional outcomes while risk ratio (RR) for complications was used for data pooling. RESULTS: Four studies comprising 185 and 189 patients in HMWHA and control groups were included, respectively. SMD for VAS and Lequesne index was -0.056 and -0.114, respectively while RR for complication was 0.879. CONCLUSIONS: Intra-articular HMWHA injection provided pain relief, functional improvement, and no severe complications on immediate short term basis. However, the results do not favor treatment with HMWHA over other treatment methods. Randomized trials are further necessary to provide data regarding comparisons between HMWHA for hip osteoarthritis concerning clinicians' convenience, compliance, duration of relief, and cost-effectiveness.