Efficacy of multimodal analgesia injection combined with corticosteroids after arthroscopic rotator cuff repair.

INTRODUCTION: Although arthroscopic rotator cuff repair is minimally invasive, there is still considerable postoperative pain, especially during the first 48 hours. The present study assessed the short-term efficacy and safety of multimodal analgesic (MMA) injection associated to corticosteroids in arthroscopic rotator cuff tear surgery. MATERIAL AND METHOD: A single-center prospective randomized study included 50 patients undergoing arthroscopic rotator cuff tear surgery. The study group received subacromial injection of a mixture of morphine, ropivacaine and methylprednisolone associated to intra-articular injection of morphine plus methylprednisolone; the control group received only isotonic saline. All patients had had 24 hours self-administered morphine associated to standard analgesia. Postoperative data were recorded at 30 minutes and 1, 2, 4, 6, 12, 18 and 24 hours: pain intensity, morphine intake and side effects, and also time to first morphine bolus and additional analgesic intake. Constant, ASES and SST functional scores were recorded at 3 months. RESULTS: Postoperative pain was significantly less intense in the MMA group than in controls at 30 min, H1, H4, H6, H12, H18 and H24 (P<0.05). A rebound at D10 occurred in both groups. During the first 24 hours, MMA significantly reduced cumulative resort to morphine (P<0.05 at H1/2, P<0.001 at H1-24). Mean time to first bolus was significantly longer in the MMA group (71.6 vs. 33 min; P<0.05). The rate of opioid-related side effects was similar between groups. At last follow-up, functional scores were similar between groups. There were no cases of infection or delayed skin healing. CONCLUSION: MMA associated to corticosteroids after arthroscopic rotator cuff tear surgery provided immediate benefit in terms of analgesia and morphine sparing, without apparent risk of infection. The practice is presently little known in France and deserves longer-term assessment, especially as regards functional rehabilitation and tendon healing. LEVEL OF EVIDENCE: 2.

[Are the concerns regarding metal-on-metal total hip arthroplasties founded in 2012?]. / Les inquiétudes liées au couple métal-métal dans les prothèses totales de hanche sont-elles fondées en 2012?

Metal-on-metal total hip arthroplasty (MOM THA) fuels debate in the orthopedic community after statistics showed higher-than-expected short-term failures in comparison with metal-on-polyethylene THA. The problem of early failure in the young, active patient with a metal-on-polyethylene implant has prompted the research of another couple. Multiple studies showed the advantages of MOM THA. The results of MOM resurfacing and MOM THA in our hospital did not show concerning results. Nonetheless, the data in the literature shows divergent opinions. The most recent statistics indicate that the results are disappointing, particularly with specific types of implants. Several institutions, in the USA and in Europe, are developing protocols for the follow-up of patients with MOM hip implants. Today, we are headed towards imposing a moratorium on using MOM THA.

[Clinical case of the month. Computerized tomographic diagnosis of hematoma of the rectus abdominis muscle]. / Le cas clinique du mois. Diagnostic scanographique d'un hématome du muscle droit de l'abdomen.

The development of an acute abdominal pain and of a palpable mass following a muscular strain, such as after coughing or sneezing, are features higly suggestive of an abdominal wall hematoma in the patient with predisposing factors. The diagnosis is often difficult since the condition mimics the clinical features of other abdominal pathologies. The diagnostic accuracy has significantly improved however after the advent of ultrasonogarphy and of computed tomography. Once the diagnosis is confirmed, the patient should be treated conservatively since surgery entails the risk of various complications.