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Impact of enhanced recovery pathways on safety and efficacy of hip and knee arthroplasty:A systematic review and meta-analysis

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World Journal of Orthopedics 2022年第3期13卷 307-328页

作者： Marion JLF Heymans Nanne P Kort Barbara AM Snoeker martijn gm schotanus Zuyderland Academy Zuyderland Medical CenterSittard 6155 NHNetherlands Department of Orthopedic Surgery CortoclinicsSchijndel 5482 WNNetherlands Department of Clinical Epidemiology Biostatistics and BioinformaticsAmsterdam Medical CenterUniversity of AmsterdamAmsterdam 1105 AZNetherlands Department of Orthopaedic Surgery and Traumatology Zuyderland Medical CenterSittard-Geleen 6162 BGLimburgNetherlands Care and Public Health Research Institute Maastricht University Medical CentreFaculty of HealthMedicine&Life SciencesMaastricht 6229 ERLimburgNetherlands

BACKGROUND Over the past decades,clinical pathways(CPs)for hip and knee arthroplasty have been strongly and continuously evolved based on scientific evidence and *** The present systematic review,including meta-analysis,aimed to compare the safety and efficacy of enhanced recovery pathways(ERP)with regular pathways for patients with hip and/or knee *** A literature search in healthcare databases(Embase,PubMed,Cochrane Library,CINAHL,and Web of Science)was conducted from inception up to June *** randomized controlled trials as well as observational studies comparing ERP,based on novel evidence,with regular or standard pathways,prescribing care as usual for hip and/or knee arthroplasty,were *** effect of both CPs was assessed for(serious)adverse events[(S)AEs],readmission rate,length of hospital stay(LoS),clinician-derived clinical outcomes,patient reported outcome measures(PROMs),and financial *** possible,a meta-analysis was *** case of considerable heterogeneity among studies,a qualitative analysis was *** Forty studies were eligible for data extraction,34 in meta-analysis and 40 in qualitative *** total sample size consisted of more than 2 million patients undergoing hip or knee arthroplasty,with a mean age of 66 years and with 60%of *** methodological quality of the included studies ranged from average to *** ERP had lower(S)AEs[relative risk(RR):0.9,95%confidence interval(CI):0.8-1]and readmission rates(RR:0.8,95%CI:0.7-1),and reduced LoS[median days 6.5(0.3-9.5)],and showed similar or improved outcomes for functional recovery and PROMs compared to regular *** analyses for readmission presented a statistically significant difference in the enhanced recovery pathway in favor of knee arthroplasties(P=0.01).ERP were reported to be cost effective,and the cost reduction varied largely between studies(€109 and$20573).The overall outcomes of all studies reported

关键词： Hip arthroplasty Knee arthroplasty Joint arthroplasty Clinical pathway Enhanced recovery pathway Systematic review Meta-analysis

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Patient specific guides for total knee arthroplasty are ready for primetime

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World Journal of Orthopedics 2016年第1期7卷 61-68页

作者： martijn gm schotanus Bert Boonen Nanne P Kort Depart-ment of Orthopaedic Surgery Zuyderland Medical Centre

AIM: To present the radiological results of total knee arthroplasty(TKA) with use of patient specific matched guides(PSG) from different manufacturer in patients suffering from severe osteoarthritis of the knee ***: This study describes the results of 57 knees operated with 4 different PSG systems and a group operated with conventional instrumentation(n = 60) by a single surgeon. The PSG systems were compared with each other and subdivided into cut- and pin PSG. The biomechanical axis [hip-knee-ankle angle(HKA)], varus/valgus of the femur [frontal femoral component(FFC)] and tibia(frontal tibial component) component, flexion/extension of the femur [flexion/extension of the femur component(LFC)] and posterior slope of the tibia [lateral tibial component(LTC)] component were evaluated on long-leg standing and lateral X-rays. A percentage of > 3° deviation was seen as an outlier. RESULTS: The inter class correlation coefficient(ICC) revealed that radiographic measurements between both assessors were reliable(ICC > 0.8). Fisher exact test was used to test differences of proportions. The percentage of outliers of the HKA-axis was comparable between both the PSG and conventional groups(12.28% vs 18.33%, P < 0.424) and the cut- and pin PSG groups(14.3% vs 10.3%, P < 1.00). The percentage of outliers of the FFC(0% vs 18.33%, P < 0.000), LFC(15.78% vs 58.33%, P < 0.000) and LTC(15.78% vs 41.67%, P < 0.033) were significant different in favour of the PSGgroup. There were no significant differences regarding the outliers between the individual PSG systems and the PSG group subdivided into cut- and pin ***: PSG for TKA show significant less outliers compared to the conventional technique. These single surgeon results suggest that PSG are ready for primetime.

关键词： Total knee arthroplasty Patient specific matched guides Patient matched instruments Single surgeon Alignment Conventional instruments Cutting guides Pin guides

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Cost-effectiveness of patient specific vs conventional instrumentation for total knee arthroplasty:A systematic review and meta-analysis

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World Journal of Orthopedics 2023年第6期14卷 458-470页

作者： Isobel M Dorling Lars Geenen Marion J L F Heymans Jasper Most Bert Boonen martijn G M schotanus Department of Orthopaedic Surgery and Traumatology Zuyderland Medical CenterSittard-Geleen 6162 BGLimburgNetherlands Zuyderland Academy Zuyderland Medical CenterSittard-Geleen 6155 NHLimburgNetherlands School of Care and Public Health Research Institute(CAPHRI) Faculty of HealthMedicine and Life SciencesMaastricht 6229 ERLimburgNetherlands Department of Orthopaedic Surgery and Traumatology Maastricht University Medical CenterMaastricht 6229 HXLimburgNetherlands

BACKGROUND Over the past years,patient specific instrumentation(PSI)for total knee arthroplasty(TKA)has been implemented and routinely *** clear answer has been given on its associated cost and cost-effectiveness when compared to conventional instrumentation(CI)for *** To compare the cost and cost-effectiveness of PSI TKA compared to CI *** A literature search was performed in healthcare,economical healthcare,and medical databases(MEDLINE,EMBASE,CINAHL,Web of Science,Cochrane Library,EconLit).It was conducted in April 2021 and again in January *** literature included randomised controlled trials,retrospective studies,prospective studies,observational studies,and case control *** studies were assessed on methodological *** outcomes included incremental cost-effectiveness ratio,quality-adjusted life years,total costs,imaging costs,production costs,sterilization associated costs,surgery duration costs and readmission rate *** eligible studies were assessed for risk of ***-analysis was performed for outcomes with sufficient *** Thirty-two studies were included into the systematic *** were included in the metaanalysis.3994 PSI TKAs and 13267 CI TKAs were included in the sample *** methodological quality of the included studies,based on Consensus on Health Economic Criteria-scores and risk of bias,ranged from average to *** TKA costs less than CI TKA when considering mean operating room time and its associated costs and tray sterilization per patient *** TKA costs more compared to CI TKA when considering imaging and production *** total costs per patient case,PSI TKA is more expensive in comparison to CI ***-analysis comparing total costs for PSI TKA,and CI TKA showed a significant higher cost for PSI *** Cost for PSI and CI TKA can differ when considering distinct aspects of their *** costs per patient case are increased for PSI TKA whe

关键词： Total knee arthroplasty Patient specific instrumentation Instrumentation for total knee arthroplasty Cost-effectiveness Systematic review

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