New and Updated Cochrane Systematic Reviews

Purpose: To evaluate the incidence of adjacent segment disease (ASD) requiring surgical intervention between anterior cervical decompression and fusion (ACDF) and total disc replacement (TDR).Background: The concern for ASD has led to the development of motion-preserving technologies such as TDR. However, whether replacement arthroplasty in the spine achieves its primary patient-centered objective of lowering the frequency of adjacent segment degeneration is not verified yet.Methods: A comprehensive literature search was performed using PubMed, Cochrane Central Register of Controlled Trials and Embase. These databases were thoroughly searched for prospective randomized studies comparing ACDF and TDR. Eight studies met the inclusion criteria for a meta-analysis and were used to report an overall rate of ASD for both ACDF and TDR.Results: Pooling data from 8 prospective studies, the overall sample size at baseline was 1,726 patients (889 in the TDR group and 837 in the ACDF group). The ACDF group had significantly more ASDs compared with the TDR group at 24 months postoperatively [odds ratios (OR), 1.31; 95 % confidence interval (CI), 1.04-1.64; p = 0.02]. The TDR group had significantly fewer adjacent segment reoperations compared with the ACDF group at 24 months postoperatively (OR, 0.49; 95 % CI, 0.25-0.96; p = 0.04).Conclusions: For patients with one-level cervical degenerative disc disease (CDDD), total disc replacement was found to have significantly fewer ASDs and reoperations compared with the ACDF. Cervical replacement arthroplasty may be superior to ACDF in ASD. Therefore, cervical arthroplasty is a safe and effective surgical procedure for treating CDDD. We suggest adopting TDR on a large scale. Publication type: Journal: Article Source: EMBASE 18.Title: Incidence of Revision After Primary Implantation of the Salto Mobile Version and Salto TalarisTM Total Ankle Prostheses: A Systematic Review Citation: Journal of Foot and Ankle Surgery, May 2015, vol./is. 54/3(311-319), 1067-2516;1542-2224 (01 May 2015) Author(s): Roukis T.S., Elliott A.D. Language: English Abstract: The incidence of revision of total ankle replacement prostheses remains unclear. We undertook a systematic review to identify the material relating to the incidence of revision after implantation of the Salto mobile version and Salto TalarisTM total ankle prostheses. Studies were eligible for inclusion only if they had involved primary total ankle replacement with these prostheses and had included the incidence of revision. Eight studies involving 1,209 Salto mobile version prostheses, with a weighted mean follow-up period of 55.2 months, and 5 studies involving 212 Salto TalarisTM total ankle prostheses, with a weighted mean follow-up period of 34.9 months, were included. Forty-eight patients with Salto mobile version prostheses (4%) underwent revision, of whom 24 (70.5%) underwent ankle arthrodesis, 9 (26.5%) metallic component replacement, and 1 (3%) below-the-knee amputation. Five (2.4%) Salto TalarisTM total ankle prostheses underwent revision (3 metallic component replacement and 2 ankle arthrodeses). Restricting the data to the inventor, design team, or disclosed consultants, the incidence of revision was 5.2% for the Salto mobile version and 2.6% for the Salto TalarisTM total ankle prostheses. In contrast, data that excluded these individuals had an incidence of revision of 2.8% for the Salto mobile version and 2.0% for the Salto TalarisTM total ankle prostheses. We could not identify any obvious difference in the etiology responsible for the incidence of revision between these mobileand fixed-bearing prostheses. The incidence of revision for the Salto mobile version and Salto TalarisTM total ankle prostheses was lower than those reported through systematic review for the AgilityTM and Scandinavian Total Ankle ReplacementTM systems without obvious selection (inventor) or publication (conflict of interest) bias. Publication type: Journal: Article