Background: D-dimer, a coagulation-related indicator, has recently been used as a tool for the diagnosis of periprosthetic joint infection (PJI), but its reliability is uncertain. The purpose of this systematic review and metaanalysis was to explore the accuracy of D-dimer in the diagnosis of PJI after joint arthroplasty. Methods: We systematically searched the MEDLINE, EMBASE, and Cochrane databases for relevant literature about D-dimer in the diagnosis of PJI. QUADAS-2 was used to assess the risk of bias and clinical applicability of each included study. We used the bivariate meta-analysis framework to pool the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the SROC curve (AUC). Univariate meta-regression and subgroup analyses were performed to explore the sources of heterogeneity. Results: We included 8 eligible studies. The pooled diagnostic sensitivity and specificity were 0.82 (95% CI, 0.70-0.89) and 0.70 (95% CI, 0.55-0.82), respectively. The pooled PLR, NLR, and DOR were 2.7 (95% CI, 1.7-4.4), 0.26 (95% CI, 0.15-0.46), and 10 (95% CI, 4-25), respectively. The AUC was 0.83 (95% CI, 0.8-0.86). Serum Ddimer might have higher diagnostic accuracy than plasma D-dimer for PJI (pooled sensitivity: 0.88 vs 0.67; pooled specificity: 0.76 vs 0.61). Conclusions: D-dimer has limited performance for the diagnosis of PJI.
Background Arthroscopic decompression is commonly used to treat shoulder impingement, while the role of conservative treatment in these patients remains unclear. The objective of this paper is to synthesise available evidence regarding the effectiveness of subacromial decompression for shoulder impingement compared with conservative treatment to verify whether arthroscopic surgery is superior to conservative treatment. Methods We systematicly retrieved the Cochrane databases, Embase as well as Pubmed (from inception to July. 02, 2019) for randomized controlled trials. Cochrane risk-of-bias tool was used to assess all referred studies’ quality and we pooled outcomes with a random-effects model. We divided the outcomes into short-term subgroup(<2 years) and long-term subgroup (≥2 years). Results 7 randomised controlled trials (RCTs) were included, involving a total of 607 patients, 297 patients operated arthroscopic decompression, compared to 310 patients treated with conservative management. We found no significant differences either in shoulder pain scores or shoulder function scores between arthroscopic decompression and conservative management wether in long-term or short-term follow-up subgroups. Conclusion No significant difference was demonstrated on the treatment outcomes of shoulder impingement between arthroscopic decompression and conservative management in our meta-analysis. Thus, we suggested that conservative management should be chosen firstly for patients with shoulder impingement, when patients’ symptom cannot be relieved from the conservative treatment, arthroscopic decompression should be taken into consideration.Levels of Evidence Level-I study
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