Abstract Navigated total knee arthroplasty (TKA) is promoted as a means to improve limb and prosthesis alignment. This study involved a systematic review and meta-analysis for all randomized ...controlled trials in the literature from 1986 to 2009 comparing alignment outcomes between navigated and conventional TKA. Alignment outcomes were pooled using a random-effects model, and heterogeneity was explored. Twenty-three randomized controlled trials were identified comparing navigated vs conventional TKA involving 2541 patients. Patients who underwent navigated TKA had a significantly lower risk of implant malalignment at more than 3° as well as more than 2°. In addition, the risk of malalignment was reduced for the coronal plane tibial and femoral components as well as femoral and tibial slope. This meta-analysis demonstrates that navigated TKA provides significant improvement in prosthesis alignment.
Redesigning Curriculum in line with Industry 4.0 Ellahi, Rizwan Matloob; Ali Khan, Moin Uddin; Shah, Adeel
Procedia computer science,
2019, 2019-00-00, Letnik:
151
Journal Article, Conference Proceeding
Recenzirano
Odprti dostop
Development in information technology has resulted in revolutionizing all aspects of life and this revolution has been realized as Industrial Revolution 4.0 (IR4.0). The IR4.0 will reduce the gap ...between digital and physical world. Keeping ultramodern developments in view, an amalgamation of physical and digital systems will prove to be revolutionary. To elevate from the current state universities are required to prepare curriculum, academicians and students alike. Thus academia should weigh their capabilities putting effort to equip our generations with latest knowledge and skills to face future realism. Universities are required to enhance their approach and methods of education. Latest technologies such as Big Data Analytics, Artificial Intelligence, Augmented Reality, and Internet of Things, Cloud Computing and other advancements need to be focused in order for students to learn its application. This paper is based on qualitative research along with a deductive approach focused towards redesigning curriculum and teaching practices in line with IR4.0 practices. The research is focused upon various emerging challenges related to fundamental elements and objectives in academia. Based on the qualitative research a curriculum matrix has been proposed, the suggested matrix will enable universities to enhance their current curriculum in line with the technological competencies required in the upcoming era of Industry 4.0.
Purpose The purpose of this systematic review was to evaluate the anatomic structure and function of the anterolateral ligament (ALL) of the knee. Methods The Medline, Embase, and Cochrane databases ...were screened for all studies related to the ALL of the knee. Two reviewers independently reviewed all eligible articles and the references of these articles. Inclusion and exclusion criteria were applied to all searched studies. Quality assessment was completed for the included studies. Results Nineteen studies were identified for final analysis. Pooled analysis identified the ALL in 430 of 449 knees (96%) examined. The ligament was found to originate from the region of the lateral femoral epicondyle and insert on the proximal tibia midway between the Gerdy tubercle and the fibular head. The ALL was found to be 34.1 to 41.5 mm in length, 5.1 to 8.3 mm in width above the lateral meniscus, and 8.9 to 11.2 mm in width below the lateral meniscus. By use of magnetic resonance imaging, the ALL was identified in 93% of knees examined (clinical, 64 of 70; cadaveric, 16 of 16). In one case study the ligament was clearly visualized by ultrasound examination. Histologic analysis across 3 studies showed characteristics consistent with ligamentous tissue. Though not shown in biomechanical studies, it is hypothesized that the ALL provides anterolateral stability to the knee, preventing anterolateral subluxation of the proximal tibia on the femur. One study identified a network of peripheral nerves, suggesting a proprioceptive function of the ALL. Conclusions This systematic review shows the ALL to be a distinct structure with a consistent origin and insertion sites. The ALL is an extra-articular structure with a clear course from the lateral femoral epicondyle region, running anteroinferiorly, to the proximal tibia at a site midway between the Gerdy tubercle and the head of the fibula. The function of this ligament is theorized to provide anterolateral knee stability. Level of Evidence Level IV, systematic review of cadaveric and imaging studies.
Recent changes to payment models for elective total joint arthroplasty (TJA) have led to increased interest in postdischarge health care utilization. Although readmission has historically been of ...primary interest, emergency department (ED) presentation is increasingly a point of focus. The purpose of this review was to summarize the available literature pertaining to ED visits after total hip arthroplasty and total knee arthroplasty.
PubMed, MEDLINE, and Embase were searched. Clinical studies reporting rate, reasons, and/or risk factors associated with ED presentation after TJA were included. Pooled return to ED rates were calculated using weighted means.
Twenty-seven studies (n = 1,484,043) were included. After TJA, the mean 30-day and 90-day rates of ED presentation were 8.1% and 10.3%, respectively. Rates were slightly higher in total knee arthroplasty vs total hip arthroplasty patients at 30 days (11.5% vs 6.5%) and 90 days (10.8% vs 9.7%). The most common reasons for ED presentation after TJA were pain (4.6%-35%), medical concerns (5.6%-24.5%), and swelling (1.4%-17.5%). Studies analyzing the timing of ED visits found that most occurred within the first 2 weeks postdischarge. Black race and Medicaid/Medicare insurance coverage were identified as risk factors associated with ED visits.
ED visits present a high burden for the health care system, as upward of 1 in 10 patients will return to the ED within 90 days of TJA. Future efforts should be made to develop cost-effective and patient-centered interventions that reduce preventable ED visits after TJA. As well, these rates should be taken into consideration when allocating resources for the care of TJA patients.
To summarize the available evidence and examine the relationship between the critical shoulder angle (CSA) and (1) the incidence of chronic full-thickness rotator cuff tears (RCTs) and (2) outcomes ...after rotator cuff repair (RCR).
A comprehensive search of MEDLINE, Embase, and CINAHL was completed. Comparative studies were included and the influence of the CSA on either the incidence of chronic, full-thickness RCTs, or outcomes following RCR was evaluated. Demographic variables and outcomes were collected.
Seven comparative studies analyzed the influence of the CSA on the incidence of chronic, full-thickness RCTs (the control group constituted patients with a normal rotator cuff). High heterogeneity limited pooling of studies, but the majority concluded that a greater CSA significantly increased the likelihood of a chronic, full-thickness RCT. Conversely, 5 comparative studies analyzed the influence of CSA on outcomes following RCR, and although a greater CSA was associated with a greater re-tear rate, the majority reported that CSA did not significantly influence postoperative functional outcomes, including patient-reported outcome measures (PROMs), range of motion (ROM), and strength.
Based on the available evidence, there appears to be a relationship between a greater CSA and the presence of a chronic, full-thickness RCT. Furthermore, a greater CSA may be associated with a greater re-tear rate following RCR; however, CSA does not appear to influence functional outcomes following RCR. Despite these observations, the available evidence is of poor quality, and the clinical utility and role of the CSA in the diagnosis and surgical management of a chronic, full-thickness RCT remains in question.
Level IV: Systematic review of Level II-IV studies.
Postmenopausal osteoporosis is associated with microarchitectural deterioration and increased risk of fracture. Osteoporosis therapy effectively reduces the risk of vertebral, nonvertebral, and hip ...fracture and has been associated with increased survival. Currently approved treatments for osteoporosis include bisphosphonates, denosumab, selective estrogen receptor modulators, and teriparatide. This article reviews the adverse events of therapy associated with these medical interventions. Hormone replacement therapy is not included, because it is no longer indicated for the treatment of osteoporosis in all countries. Calcitonin and strontium ranelate are also not included, because their indication for osteoporosis has recently been limited or withdrawn.
The Makran accretionary wedge developed as a result of subduction of the Arabian Plate beneath the southern margin of Eurasia since the Eocene. Interpretation of 2D seismic profiles calibrated to ...offshore well data in a study area to the south of Gwadar Bay (SW Pakistan) indicates a major period of accretion from the mid‐Miocene, as evidenced by the occurrence of thick growth strata associated with large‐scale imbricate thrusts. The thrust faults originate from a deep detachment within the mud‐rich Oligocene interval, and well‐developed piggy‐back basin successions occur in thrust hanging walls. In the study area, the thrust structures are sealed by a thick, progradational Pliocene to Recent interval in which the presence of submarine canyons, up to 2.5 km across, indicate that sedimentary transport was from the north.
Fluid escape pipes and associated amplitude anomalies are observed in the seismic profiles studied and may be related to upward migration of thermogenic hydrocarbons from depth, as heavy hydrocarbon fractions <C3 have been reported from nearby wells. The hydrocarbons are believed to have been sourced from the Oligocene Hoshab Shale and to have then migrated up through a sedimentary succession in which permeability barriers are largely absent. Hanging wall anticlines mapped in the study area could provide structural traps, and turbidites in the Lower Miocene Panjgur Formation may represent a potential reservoir. Amplitude anomalies are also observed adjacent to shallow fluid escape pipes within the topsets of clinoforms in the Pleistocene Chatti and Omara Formations, and probably indicate the presence of biogenic hydrocarbons sourced from distal mudstones in bottomset strata.
Arthroscopy Up to Date: Hip Femoroacetabular Impingement Khan, Moin, M.D., M.Sc., F.R.C.S.C; Habib, Anthony, M.D; de SA, Darren, M.D ...
Arthroscopy,
2016, January 2016, 2016-Jan, 2016-01-00, 20160101, Letnik:
32, Številka:
1
Journal Article
Recenzirano
Purpose To provide a comprehensive review and summary of the research published in Arthroscopy: The Journal of Arthroscopic and Related Surgery and The American Journal of Sports Medicine ( AJSM ) ...related to hip arthroscopy for femoroacetabular impingement (FAI). Methods A comprehensive review was conducted in duplicate of Arthroscopy and AJSM from February 2012 to February 2015 for all articles related to FAI, and a quality assessment was completed for all included studies. Clinical outcomes were dichotomized into short-term (<6 months) and midterm (<24 months) outcomes, and values were pooled when possible. Results We identified 60 studies in Arthroscopy and 44 studies in AJSM , primarily from North America (78.8%), that predominantly assessed clinical outcomes after arthroscopic hip surgery (46.1%). Seventy-one percent of Arthroscopy studies and 20.5% of AJSM studies were Level IV evidence. The modified Harris Hip Score (mHHS) was used by 81.5% of included studies. Pooled weighted mean mHHS values after arthroscopic surgery for FAI showed improvements at the midterm from 60.5 points (range, 56.6 to 83.6 points) to 80.5 points (range, 72.1 to 98.0 points) out of a possible 100 points. Pooled weighted outcomes for labral repair showed mean mHHS improvements from 63.8 points (range, 62.5 to 69.0 points) preoperatively to 86.9 points (range, 85.5 to 89.9 points) up to 24 months postoperatively. Conclusions This comprehensive review of research published in Arthroscopy and AJSM over the past 3 years identified a number of key findings. Arthroscopic intervention results in improvements in functional outcomes at both the short-term and midterm for patients with symptomatic FAI in the absence of significant existing degenerative changes. Labral repair may result in improvements over labral debridement. The most commonly used outcome score was the mHHS for objective assessment of surgical success. There is a need for continued focus on improvement of methodologic quality and reporting of research pertaining to FAI. Level of Evidence Level IV, systematic review of Level IV studies.
Purpose
Post-operative spine surgical site infections are associated with substantial morbidity, mortality, and economic burden. Intrawound vancomycin may prevent infections after spine surgery, but ...recent studies have reported conflicting results. The objectives of this systematic review and meta-analysis were to determine: (1) In patients undergoing spine surgery, does the application of intrawound vancomycin lead to reduced rates of post-operative surgical site infections? (2) Are there differences in the estimates of effect between observational studies and randomized trials? (3) What adverse events are reported in the literature?
Methods
All published comparative studies of intrawound vancomycin in spine surgery were included. Two reviewers independently screened eligible articles and assessed study quality. Observational studies and randomized trials were pooled separately using a random-effects model.
Results
Eight observational studies and one randomized controlled trial met the inclusion criteria. Across observational studies, the odds of infection with intrawound vancomycin was 0.19 times the odds of infection without intrawound vancomycin (95 % CI 0.08–0.47,
p
= 0.0003,
I
2
= 52 %). The single randomized controlled trial produced a conflicting result (OR 0.96, 95 % CI 0.34–2.66,
p
= 0.93). There were no adverse events attributable to intrawound vancomycin. The quality of the evidence was low or very low.
Conclusions
There is a lack of high-quality evidence to inform the use of intrawound vancomycin in spine surgery. Surgeons should be cautious before widely adopting this intervention and should be vigilant in monitoring for adverse effects. Further investigation with additional randomized controlled trials is justified.
Purpose To determine the rate of return to play and to identify lesion or osteochondral graft characteristics that may influence the return to competitive athletics after osteochondral autograft ...transplantation (OAT) for symptomatic osteochondritis dissecans (OCD) lesions. Methods A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A duplicate search of PubMed, Embase, Scopus, Web of Science, and CENTRAL databases was performed, beginning from the database inception dates through July 2016, for all articles evaluating the return to play after OAT for OCD lesions of the capitellum. A methodological quality assessment was completed for all included studies. Patient demographics, osteochondral lesion and graft characteristics, the number of patients, and timing of return to competitive activity were collected and evaluated. Association between graft size/number, the time to osseous healing, and return to sport was evaluated. Results Seven articles met the inclusion criteria. All included studies were case series of moderate quality with a mean Methodological Index for Non-Randomized Studies score of 12/16. Overall, 94% (119/126) of patients undergoing OAT for OCD lesions of the capitellum successfully returned to competitive sports. The mean reported time for unrestricted return to athletic competition after OAT was 5.6 months (range, 3-14 months). Conclusions Current best evidence suggests that OAT is successful in treating advanced OCD lesions of the capitellum and returning athletes to high-level competition. Evidence supporting the association between the size and number of grafts used and the time to osseous healing and return to sport is currently limited. Our assessment of the time to return to athletic competition was limited because of variable surgical technique, postoperative rehabilitation protocols, and outcome assessment. Level of Evidence Level IV, systematic review of Level IV studies.
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