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Proximal interphalangeal joint arthrodesis in horses: A protocol for meta-analyses of the retrospectives studies

Anderson Fernando de Souza

Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo (USP), São Paulo, SP, Brazil

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Nicole Fidalgo Paretsis

Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo (USP), São Paulo, SP, Brazil

André Luis do Valle De Zoppa

Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo (USP), São Paulo, SP, Brazil

DOI: 10.15761/CRT.1000340

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Abstract

Introduction: The diseases of the equine proximal interphalangeal joint (PIJ) occur frequently and usually it is necessary to perform arthrodesis as a treatment option. A reasonable number of retrospective studies have been published referring to the outcomes of different ways to promote ankylosis of this joint, either from the point of view of indications or by the techniques employed. The aim of this study is to carry out a meta-analysis of retrospective studies of PIJ arthrodesis in horses to do a better evaluation and interpretation of the likely outcomes of different forms of intervention.

Methods and analysis: A systematic review of the literature will be carried in the CAB, Scopus, Web of Science, ScienceDirect, PubMed, following the recommendations of Cochrane and PRISMA, in search of retrospective studies of proximal interphalangeal arthrodesis in horses. Information on the length of hospital stay, time of rigid external immobilization (casting), time to return to activities, survival rate, presence of lameness after the end of treatment, will have their effects measured by standardized mean difference or odds ratio. The meta-analysis will be performed using fixed and random effect.

Key words

Equine, lameness, pastern, orthopaedic, veterinary surgery

Background

The disorders of the proximal interphalangeal joint (PIJ) are frequently present in the clinical routine of horses, represented by fractures of different types in the first and second phalanges, dislocations, traumas, sprains, and especially the degenerative processes. [1,2]. Being that in all the previous conditions, the process tends to evolve to osteoarthritis [3]. The horses involved in activities of the western modalities seem predisposed to injuries in this joint, probably due to the flexion and torsion forces generated during abrupt stops and changes of direction [3,4].

Conservative approaches for the osteoarthritis treatment in PIJ, in general, do not completely stop the process, in which some degree of lameness persists, relapses or aggravations of the pain processes occur, keeping the animal under medication, which can often configure doping. In addition to all expenses that will not lead to the definitive resolution [5-7]. The promotion of fusion (ankylosis) is often the effective option in the categorical resolution of proximal interphalangeal arthropathies, especially about osteoarthritis processes [3].

Similar to occurs at the distal tarsometatarsal and intertarsal joints, the PIJ movement is reduced, so ankylosis does not interfere during higher performance activities, and it has been observed that animals are likely to return to athletic activities after surgery [2,3,8]. In this regard, the description of different techniques to promoting PIJ ankylosis was carried out, with surgical interventions using plates and screws being the most efficient [3,8-10].

A reasonable number of retrospective studies have been published referring to the outcomes of different ways of promoting PIJ ankylosis in horses, either from the point of view of indications or by the techniques employed. Because of this, the aim of this work is to carry out a meta-analysis of retrospective studies of PIJ arthrodesis in horses to better characterize the likely outcomes of different forms of intervention.

Method

A systematic literature review will be carried out previously, following the recommendations of Cochrane review protocol [11], of the Vries, et al. [12] and PRISMA statement [13,14].

Specify the population/species studied

Equines (horses, mules, donkeys) of any breed, sex or age.

Specify the disease/health problem of interest

Proximal interphalangeal arthropathies (osteoarthritis, septic arthritis, dislocation (subluxation), joint instability, proximal and/or middle phalanx fractures and deformities.

Specify the intervention/exposure

Performing the PIJ fixation using orthopedic plates (DCP, LC-DCP, LCP, or other systems) made of stainless steel or titanium alloys, with or without transarticular cortex screws, or using only transarticular cortex screws. These procedures can be performed in standing or recumbency. Facilitation of ankylosis by the injection of alcohol (ethanol) or monoiodoacetate in any volume or concentration, associated or not with casting.

Specify the outcome measures

Stay of hospitalization, time of casting, time to return to activities, survival rate, and presence of lameness after treatment.

Search strategies

CAB Abstracts

((((equine) OR (horse)) AND ((pastern) OR (proximal interphalangeal joint)) AND ((arthrodesis) OR (ankylosis)) AND (retrospective study))

Medline/PubMed

(((equine) OR (horse)) AND ((pastern) OR (proximal interphalangeal joint)) AND ((arthrodesis) OR (ankylosis)) AND (retrospective study))

Scopus

TITLE-ABS-KEY ( ( ( ( equine ) OR ( horse ) ) AND ( ( pastern ) OR ( proximal AND interphalangeal AND joint ) ) AND ( ( arthrodesis ) OR ( ankylosis ) ) AND ( retrospective AND study ) ) )

SciencDirect

((equine OR horse) AND (pastern OR proximal interphalangeal joint) AND (arthrodesis OR ankylosis) AND retrospective study)

Web of Science

TS=(((equine OR horse) AND (pastern OR proximal interphalangeal joint) AND (arthrodesis OR ankylosis) AND retrospective study))

Identify other sources for study identification

The reference lists of included studies and reference lists of relevant reviews will be checked.

Study selection

Initially, pre-screening will be carried out based on the title and abstract by one of the authors (AFS), followed by the full-text screening of the eligible articles by two independent authors (AFS and NFP). If necessary a third opinion will be consulted (ALVZ).

Type of study

Inclusion criteria: Retrospective studies and case series (full-texts with three or more cases);

Exclusion criteria: Isolated case reports, book chapters, event summaries, review articles, editorials, letters to the editor, preprinted texts, experimental

Type of animals/population

Inclusion criteria: Equines of any breed, sex or age.

Exclusion criteria: Other species.

Type of intervention

Inclusion criteria: Any interventions to promote ankylosis of PIJ.

Exclusion criteria: not applicable

Language restrictions

Inclusion criteria: any language;

Exclusion criteria: not applicable.

Assessment risk of bias and/or study quality

By use of SYRCLE's Risk of Bias tool [15].

Data analysis/synthesis

Information on the length of hospital stay, time of rigid external immobilization (casting), time to return to activities, survival rate, presence of lameness after the end of treatment, will have their effects measured by standardized mean difference or odds ratio.

The statistical model of analysis

The meta-analysis will be performed using fixed and random effect.

The statistical methods to assess heterogeneity

Initial assessment of heterogeneity will be through visual inspection of forest plots, I2 (> 50%) and Cochran Q statistics.

The method for assessment of publication bias

Funnel-plots and Egger’s test.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Authors’ contributions

AFS: conceived the study idea, devised the study methodology, responsible for protocol writing and developed the search strategy. NFP: will screen identified literature, conduct data extraction and analyses the review findings. ALVZ: design and coordination of the study. All authors agreed on the final version of the manuscript.

Conflicts of interest

The authors declare they have no conflict of interest.

Animal welfare/ethical statement

Not applicable.

References

  1. Trotter GW, McIlwraith CW, Norrdin RW, Turner AS (1982) Degenerative joint disease with osteochondrosis of the proximal interphalangeal joint in young horses. J Am Vet Med Assoc 180: 1312-1318. [Crossref]
  2. McIlwraith CW, Goodman NL (1989) Conditions of the interphalangeal joints. Vet Clin North Am Equine Pract 5: 161-178. [Crossref]
  3. Lischer CJ, Auer JA (2019) Arthrodesis techniques. In: Equine Surgery (5th Edn) Auer JA, Stick JA, Kummerle and T. Prange, (Eds) Elsevier, Saint Louis. pp: 1374-1398.
  4. Scott M (2008) Musculoskeletal injuries in nonracing Quarter Horses. Vet Clin North Am Equine Pract 24: 133-152.
  5. Ghouri, A. and Conaghan, P.G. (2019) Update on novel pharmacological therapies for osteoarthritis. Ther Adv Musculoskelet Dis 11: 1759720X1986449. [Crossref]
  6. Goodrich LR, Nixon AJ (2006) Medical treatment of osteoarthritis in the horse – A review. Vet J 171: 51-69. [Crossref]
  7. Souza AF, Paretsis NF, Zoppa ALV (2020) What is the evidence of hyaluronic acid and polyacrylamide hydrogel in intra-articular therapy in equines? Systematic literature review. J Equine Vet Sci 86: 102909. [Crossref]
  8. Zubrod CJ, Schneider RK (2005) Arthrodesis techniques in horses. Vet Clin North Am Equine Pract 21: 691-711. [Crossref]
  9. Zoppa ALV, Santoni B, Puttlitz CM, Cochran K, Hendrickson DA (2011) Arthrodesis of the equine proximal interphalangeal joint: A biomechanical comparison of 3-hole 4.5 mm locking compression plate and 3-hole 4.5 mm narrow dynamic compression plate, with two transarticular 5.5 mm cortex screws. Vet Surg 40: 253-259. [Crossref]
  10. Latorre CAS, Souza AF, Ramos PAR, Nóbrega FS, van de Graaf GMM, et al. (2020) Comparison of a 3-hole 4.5-mm dynamic compression plate and a 7-hole 5.5-mm Y locking compression plate for arthrodesis of the proximal interphalangeal joint in horses - An ex vivo biomechanical study. J Equine Vet Sci 94: 103252. [Crossref]
  11. Higgins J, Thomas J (2020) Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Collabration.
  12. de Vries RBM, Hooijmans CR, Langendam MW, van Luijk J, Leenaars M, et al. (2015) A protocol format for the preparation, registration and publication of systematic reviews of animal intervention studies. Evidence-based Preclin Med 2: e00007.
  13. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339: b2535-b2535. [Crossref]
  14. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, et al. (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350: g7647. [Crossref]
  15. Hooijmans CR, Rovers MM, de Vries RB, Leenaars M, Ritskes-Hoitinga M, et al. (2014) SYRCLE’s risk of bias tool for animal studies. BMC Med Res Methodol 14: 43.

Editorial Information

Editor-in-Chief

Akira Sugawara
Tohoku University Graduate School of Medicine

Article Type

Research Article

Publication history

Received date: March 02, 2021
Accepted date: March 15, 2021
Published date: March 18, 2021

Copyright

©2021 Fernando de Souza A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Fernando de Souza A, Paretsis NF, Zoppa ALV (2021) Proximal interphalangeal joint arthrodesis in horses: A protocol for meta-analyses of the retrospectives studies. Clin Res Trials 7: doi: 10.15761/CRT.1000340

Corresponding author

Anderson Fernando de Souza

Department of Surgery, School of Veterinary Medicine and Animal Science, University of São Paulo (USP), Prof. Dr. Orlando Marques de Paiva Av., 87. Cidade Universitária Armando de Salles Oliveira, Butantã, São Paulo, SP 05508-270, Brazil.

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

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