RESUMO
BACKGROUND: Sarcopenia is a progressive loss of skeletal muscle mass and function. It is associated with adverse outcomes after several orthopaedic procedures. However, its role in total joint arthroplasty(TJA) is not fully explored. Therefore, we wanted to conduct a systematic review and meta-analysis to answer the following questions:(1) What is the prevalence of sarcopenia in patients undergoing TJA?;(2) What factors are associated with the prevalence of sarcopenia in patients undergoing TJA?;What is the impact of sarcopenia on medical outcomes following TJA?;and (4) What is the impact of sarcopenia on surgical outcomes following TJA? METHODS: Electronic databases PubMed, Scopus, Cochrane, and Google Scholar were searched. The data was pooled using the random-effects model and graphically represented by a forest plot. We included a total of thirteen studies, evaluating 399,097 patients. RESULTS: The pooled prevalence of sarcopenia was 20.1%(95% CI[confidence interval] 13.6 to 28.8%; P<0.00001;I2=94.7%) in total knee arthroplasty(TKA) and 5.2%(95% CI 0.1 to 69.7%;P=0.128;I2=99.6%) in total hip arthroplasty(THA). Meta-regression found no links between age, sex, body mass index(BMI), diabetes, obesity, arthroplasty type, and sarcopenia prevalence in TJA. Sarcopenia increased risk of blood transfusion (OR [odds ratio] 4.68[95% CI 3.51 to 6.25];P<0.00001), pneumonia (OR 1.94[95% CI 1.14 to 3.30];P=0.01),Urinary Tract Infection UTI (OR 1.64 [95% CI 1.31 to 2.05];P<0.001), prosthetic fracture (OR 2.12[95% CI 1.51 to 2.98];P<0.0001), prosthetic dislocation (OR 1.99[95% CI 1.62 to 2.44];P<0.00001), and mechanical loosening (OR 1.78[95% CI 1.43 to 2.22];P<0.00001) in TKA. Sarcopenic patients were at an increased the risk of UTI (OR 1.79 [95% CI 1.32 to 2.43];P=0.0002) and prosthetic loosening (OR 1.97[95% CI 1.10 to 3.53];P=0.02) post-THA. CONCLUSION: Baseline sarcopenia was prevalent in patients undergoing TJA. It was associated with an increased risk of UTI and prosthetic loosening following TKA and THA. Increased risk of blood transfusion, pneumonia, prosthetic fractures, and mechanical loosening following TKA.
RESUMO
BACKGROUND: There is a lack of evidence that directly shows the best antihypertensive treatment options for post partum management of the hypertensive disorders of pregnancy. Our objective was to analyze the safest and most effective antihypertensive drugs post partum for patients with hypertensive disorders of pregnancy. METHODS: PubMed, Cochrane, and MEDLINE were searched to find relevant articles published from inception to Feb 2024. We included randomized control trials, in English, featuring a population of postnatal women with hypertensive disorders of pregnancy or postpartum women with de novo hypertension with a follow-up of up to 6 months in which any antihypertensive medication was compared with Placebo or a comparison between different doses of antihypertensives was done. The statistical analyses were conducted using Review Manager with a random-effects model. RESULTS: Our analysis revealed that almost all antihypertensives are effective in treating postpartum hypertension. However, some medications had alternating roles in controlling specific outcomes. Using calcium channel blockers resulted in a faster time to sustain BP control than the control (SMD: -0.37; 95% CI: -0.73 to -0.01; P = 0.04). In contrast, using ACE inhibitors or ARBs demanded the use of other antihypertensives in contrast to all other drugs assessed (RR: 2.09; 95% CI: 1.07 to 4.07; P = 0.03). CONCLUSION: Timely management of the hypertensive disorders of pregnancy postpartum is life-saving. All the traditional antihypertensives we assessed effectively manage hypertension postpartum, thus allowing the physician to tailor the particular drug regimen according to the patient's needs and comorbidities without any hindrance.
