Radiographic severity of knee osteoarthritis and its relationship to outcome post total knee arthroplasty: a systematic review.

BACKGROUND: Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA). There are many contributing factors. The relationship between preoperative osteoarthritis (OA) severity and outcome post TKA remains unclear. This review explores the relationship between preoperative OA severity with patient reported pain, function and satisfaction post TKA. METHODS: A pre-registered systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Major databases were searched until September 2017. We included studies assessing adults undergoing TKA for OA. Minimum follow-up was 6 months. Methodological quality assessment was conducted using the Newcastle-Ottawa Scale. RESULTS: Twenty cohort studies with 7478 patients were included. There were 16 good, one fair and three poor quality studies. Knee OA was most commonly reported according to the Kellgren and Lawrence tool. Ten studies showed statistically significant pain outcomes for those with worse preoperative OA. This was supported by meta-analysis of the Knee Society Score pain change scores to final follow-up for those with Kellgren and Lawrence grade 4 OA. Six studies showed statistically significant results for various aspect of functional recovery, although meta-analysis of Knee Society Score function change scores identified no difference. Meta-analysis of final follow-up pain and function scores alone yielded no significant difference. Patients with more severe preoperative OA were more likely to be satisfied. There were no studies demonstrating that less severe OA resulted in better pain, function or satisfaction. CONCLUSION: Review of available research indicates that TKA for OA improves pain, function and satisfaction. Those with more severe preoperative radiological knee OA benefit most.

Volar locking plating versus percutaneous Kirschner wires for distal radius fractures in an adult population: a meta-analysis.

BACKGROUND: This paper compares volar locking plates (VLPs) and percutaneous Kirschner wire (K-wire) fixation for distal radius fractures in an adult population up to and beyond 12 months. The aim of this review is to compare functional and radiological outcomes along with complication rates. A meta-analysis was performed to investigate this. METHODS: A systematic review and meta-analysis was performed using the PRISMA guidelines. A search of major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL) was performed up to November 2017. Prospective and retrospective studies were included. Studies were assessed for quality using the Cochrane Risk of Bias tool. Meta-analysis was performed using the 'metafor' package with R. RESULTS: A total of 14 studies (five randomized controlled trials and nine comparative studies) (n = 1535) were identified. Disabilities of the Arm, Shoulder and Hand (DASH) scores were statistically significant for VLP at all follow-up intervals up to and beyond 12 months. Wrist movements were statistically significant for VLP at 6 weeks. Grip strength was significantly different favouring VLP at 12 months and final follow-up. VLP provided better restoration of ulnar variance at 6 weeks, but overall radiological outcomes were similar. These results were not clinically significant. K-wires were associated with an 18% higher risk of complication but the reoperation rate was higher for VLP (4.6% versus 3.2%). CONCLUSIONS: This study demonstrates similar clinical functional and radiological outcomes for VLP and K-wire fixation in the short and intermediate term. There is a higher rate of overall complication with K-wires, but the increased risk of reoperation must be considered when planning surgical fixation of these fractures.

Errors and Predictors of Confidence in Condom Use amongst Young Australians Attending a Music Festival.

Objectives. To determine the confidence and ability to use condoms correctly and consistently and the predictors of confidence in young Australians attending a festival. Methods. 288 young people aged 18 to 29 attending a mixed-genre music festival completed a survey measuring demographics, self-reported confidence using condoms, ability to use condoms, and issues experienced when using condoms in the past 12 months. Results. Self-reported confidence using condoms was high (77%). Multivariate analyses showed confidence was associated with being male (P < 0.001) and having had five or more lifetime sexual partners (P = 0.038). Reading packet instructions was associated with increased condom use confidence (P = 0.011). Amongst participants who had used a condom in the last year, 37% had experienced the condom breaking and 48% had experienced the condom slipping off during intercourse and 51% when withdrawing the penis after sex. Conclusion. This population of young people are experiencing high rates of condom failures and are using them inconsistently or incorrectly, demonstrating the need to improve attitudes, behaviour, and knowledge about correct and consistent condom usage. There is a need to empower young Australians, particularly females, with knowledge and confidence in order to improve condom use self-efficacy.