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Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_5 | Pages 100 - 100
1 Apr 2019
Hasan M Zhang M Beal M Ghomrawi H
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Background

Effectiveness of computer-assisted joint replacement (CA-TJR) compared to conventional TJR has been evaluated by a large body of literature. Systematic reviews provide a powerful, widely accepted, evidence-based approach to synthesize the evidence and derive conclusions, yet the strength of these conclusions is dependent on the quality of the review. Multiple systematic reviews compared CA-TJR and conventional TJR with conflicting results. We aimed to assess the quality of these reviews.

Methods

We searched MEDLINE, EMBASE, the Cochrane, and Epistemonikos to identify SRs published through May 2017. Full-text articles that met inclusion criteria were retrieved and assessed independently by two reviewers. Evidence was qualitatively synthesized and summarized. Outcome measures were categorized into functional, radiological, and patient safety related. The corrected covered area (CCA) was calculated to assess the degree of overlap between SRs in analyzing the same primary studies. The AMSTAR 2, a valid and reliable tool, was applied to rate the confidence in the results of the SRs (Shea et al., 2017). AMSTAR-2 has 16 domains, of which 7 are critical (e.g., justification for excluding individual studies) and 9 are non-critical (e.g., not reporting conflict of interest for individual studies). Reviews are rated as high (no critical or non-critical flaws), moderate (only non-critical flaws), low (1 critical flaw) and critically low (more than one critical flaw). Disagreement between the 2 reviewers was resolved by discussion with the senior author to achieve consensus. We reported the quality ratings of these studies and the frequency of critical and non-critical flaws.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_II | Pages 122 - 122
1 Feb 2004
Dastgir N Hasan M O’Farrell D
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The management of three or four-part fractures of proximal Humerus remains difficult. Controversy still persists concerning the preferred treatment of these fractures. The aim of our study was to review the functional outcome and factors influencing the outcome after shoulder hemi arthroplasty in acute fractures of proximal humerus.

Material and Methods: Retrospective review of a consecutive series of 23 patients with three/four-part proximal humerus fractures, treated with shoulder hemi-arthroplasty between 1999 – 2002. Nineteen patients (one bilateral) were available for study. The mean follow-up period was 12 months. All fractures, 16 cases were Neer’s four-part fractures, while one case was fracture with posterior dislocation. Post operative pain, range of motion and function evaluated using Visual analogue score, Pain scale and UCLA functional score. The average age was 64 years (range 50–85).

Results: At follow-up pain relief was satisfactory in 15 of 20 cases. Patient’s satisfaction was 75%. Functional evaluation was good/fair in 14 cases. One patient developed chronic inferior subluxation post-operatively. We have found that age (75 years +) at the time of surgery, securing of tuberosities t the implant and compliance with the post-operative rehabilitation program are significant factors affecting the outcome.

Conclusion: We recommend careful patient selection, proper positioning of patient during surgery, use of x-ray screening of the implant prior to cementing and meticulous surgical technique to achieve optimal results.