Techniques and Technologies for the Intraoperative Assessment of Component Positioning, Leg Lengths, and Offset in Total Hip Arthroplasty: A Systematic Review.

Background: Many techniques and technologies exist for the intraoperative assessment of component positioning, leg lengths, and offset in total hip arthroplasty, but with limited comparative data. We conducted a systematic review of the available literature to evaluate the range of techniques and technologies for the intraoperative assessment of component position as well as leg lengths and offset in terms of accuracy, precision, surgical time, cost, and relationship to clinical outcomes. Methods: A comprehensive search of the Embase and Medline databases from 1974 to 2023 was performed. We included controlled or comparative prospective clinical studies. Cochrane's risk-of-bias tool for randomized trials and Risk of Bias in Non-Randomized Studies - of Interventions tools were used by 2 independent reviewers to evaluate each study for risk of bias. We conducted both qualitative and quantitative analyses of the studies included. However, a meta-analysis was deemed not to be feasible due to heterogeneity. Results: Our review included 25 studies with 52 intraoperative techniques and technologies. Mechanical guides and computerized navigation were most frequently evaluated in the included studies. Computerized navigation systems consistently showed the greatest accuracy and precision across all measures, at the cost of longer mean operative time. In contrast, freehand techniques demonstrated the poorest accuracy and precision. Insufficient data were found to reach any meaningful conclusions in terms of differences in overall surgical cost or clinical outcomes. Conclusions: Evidence shows that computerized navigation systems are most accurate and precise in positioning components during total hip arthroplasty. Further research is needed to determine their health and economic impact and whether the accuracy and precision of navigated techniques are justified in terms of clinical outcomes.

Change in treatment paradigm in people who previously injected drugs with chronic hepatitis C in the era of direct-acting antiviral therapy.

BACKGROUND: Chronic hepatitis C virus (HCV) infection is highly prevalent among people who inject drugs but is often undiagnosed. The treatment paradigm for HCV patients has been changing since the availability of direct-acting antiviral (DAA) treatment. We aimed to evaluate the change in treatment paradigm of people who previously injected drugs (ex-PWID) in Hong Kong before and after the availability of DAA. METHOD: Consecutive ex-PWID referred from various nongovernmental organizations attended education talks at rehabilitation centers and received point-of-care rapid test for HCV antibody (anti-HCV) at the same session. Subjects tested positive for anti-HCV were invited to undergo further assessment. Afterwards, the patients were referred to the regional hospitals for follow-up and/or treatment. RESULTS: Three hundred sixty-five ex-PWID received HCV rapid test; 268 (73.4%) were found to be anti-HCV positive. Among these 268 HCV-positive ex-PWID, 234 (87.3%) attended the assessment session (mean age 52 years, 90.2% male, 45.5% genotype 1b, 41.1% genotype 6a, and median liver stiffness 5.9 kPa); 187 (69.8%) attended follow-up visits at regional hospitals. Seventy-one patients received antiviral treatment for HCV; 69 first received peginterferon and ribavirin (PegIFN/RBV), whereas 10 patients (eight PegIFN/RBV-treated patients) received DAA treatment. Fifty-two patients achieved sustained virologic response at 12 or 24 weeks. Treatment uptake rates of PegIFN/RBV and DAA treatment in the pre-DAA versus post-DAA era were 22.3% versus 48.5% and 0% versus 15.6%, respectively. CONCLUSIONS: Targeted screening in ex-PWID is effective in identifying patients with HCV infection in the community. To improve treatment uptake, further improvements in the referral system and treatment regimens are needed.

Targeted hepatitis C screening among ex-injection drug users in the community.

BACKGROUND AND AIM: Chronic hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis and hepatocellular carcinoma worldwide. It is highly prevalent among injection drug users (IDUs) but is often undiagnosed because they represent an underprivileged group that faces multiple barriers to medical care. Here, we report the results of the New Life New Liver Project, which provides targeted HCV screening and education for ex-IDUs in the community. METHODS: Patients were recruited through the social worker networks and referrals by fellow ex-IDUs, and rapid diagnosis was based on point-of-care anti-HCV testing at rehabilitation centers. RESULTS: From 2009 to 2012, we served 234 subjects. One hundred thirty (56%) subjects were anti-HCV positive. The number needed to screen to detect one patient with positive anti-HCV was 1.8 (95% confidence interval, 1.6-2.0). However, only 69 (53%) HCV patients attended subsequent follow-up at regional hospitals, and 26 (20%) received antiviral therapy. Patients who attended follow-up were older, had higher education level and more active disease as evidenced by higher alanine aminotransferase, HCV RNA, and liver stiffness measurement by transient elastography. CONCLUSIONS: Targeted screening in ex-IDUs is effective in identifying patients with HCV infection in the community. Improvement in the referral system and introduction of interferon-free regimens are needed to increase treatment uptake.