Parecoxib Provides Analgesic and Opioid-Sparing Effects Following Major Orthopedic Surgery: A Subset Analysis of a Randomized, Placebo-Controlled Clinical Trial.

INTRODUCTION: Orthopedic surgeries are among the most common and most painful surgeries performed. A multimodal analgesic approach is recommended to reduce opioid consumption, provide effective pain relief, and improve outcomes following surgery. This study examined the efficacy and opioid-sparing effects of parecoxib following major orthopedic surgery. METHODS: This subset analysis of a large, multicenter, randomized, double-blind, placebo-controlled study of parecoxib examined treatment effects on postoperative pain severity, pain interference with function, opioid consumption, occurrence of opioid-related symptoms, safety, and patient satisfaction following major orthopedic surgery. RESULTS: Pain scores were significantly lower in the parecoxib group (n = 142) compared with placebo (n = 139) on day 2 (-22%; p < 0.001) and day 3 (-17%; p = 0.004). Pain interference with function scores were also significantly lower in the parecoxib group on day 2 (-32%; p < 0.001) and day 3 (-27%; p = 0.003) relative to placebo. Additionally, significantly less supplemental morphine was required in the parecoxib group relative to placebo through 24 h (-28%; p = 0.008) and 48 h (-33%; p < 0.001). Patients in the parecoxib group had a reduced risk of experiencing opioid-related symptoms including fatigue, drowsiness, inability to concentrate, confusion, nausea, constipation, and confusion on day 2 and/or day 3. Finally, more patients receiving parecoxib (42%) rated treatment as "excellent" compared to those receiving placebo (21%). CONCLUSIONS: These findings support the use of parecoxib for the management of pain following major orthopedic surgery.

[Prophylaxis of venous thromboembolic disease in high-risk orthopedic surgery]. / Profilaxis de la enfermedad tromboembólica venosa en cirugía ortopédica de alto riesgo.

Venous thromboembolism (VTE) is a worldwide public health problem, with an annual incidence of 1-2 cases/1,000 individuals in the general population and a 1-5% associated mortality. Orthopedic surgery is a major surgical risk factor for VTE, but the problem is more important for patients with hip and knee joint replacement, multiple traumatisms, severe damage to the spine, or large fractures. Thromboprophylaxis is defined as the strategy and actions necessary to diminish the risk of VTE in high-risk orthopedic surgery. Antithrombotics may prevent VTE. At the end of this paper, we describe a proposal of thromboprophylaxis actions for patients requiring high-risk orthopedic surgery, based on the opinion of specialists in Orthopedics and Traumatology who work with high-risk orthopedic surgery patients. A search for evidence about this kind of surgery was performed and a 100-item inquiring instrument was done in order to know the opinions of the participants. Then, recommendations and considerations were built. In conclusion, this document reviews the problem of VTE in high-risk orthopedic surgery patients and describes the position of the Colegio Mexicano de Ortopedia y Traumatología related to VTE prevention in this setting.

Shoulder replacement in end-stage rotator cuff tear arthropathy: 5- to 11-year follow-up analysis of the bi-polar shoulder prosthesis.

Between 1991 and 1997, 49 patients with rotator cuff arthropathy underwent 52 Bi-Polar shoulder replacements and were followed for 5-11 years (average follow-up 6.7 years). Active forward flexion increased an average of 35.2 degrees (from 45 degrees preoperatively to 80.2 degrees postoperatively). UCLA scores improved from 8.4 (range 4-16) preoperatively to 24.3 (range 15-35) postoperatively. Average age- and sex-adjusted Constant scores were 83.4% and ASES index was 68.5 points at the time of final review. Two shoulders (3.8%) were revised--both secondary to periprosthetic fracture requiring long-stem implants. Probability of survival at 11 years using Kaplan-Meier survival estimates was 93.3% (95% Cl: 84%-100%). Bipolar shoulder arthroplasty is an effective way to treat end-stage rotator cuff arthropathy with clinical results as good or better than those reported in the literature for hemiarthroplasty and total shoulder replacement with reasonable follow-up.

Cement penetration using a tibial punch cement pressurizer in total knee arthroplasty.

This study describes a new tibial cement punch pressurizer to enhance cement penetration into the metaphyseal cancellous bone of the tibial plateau. Thirty knees of 15 patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were randomly selected to receive the tibial cement punch pressurizer on one side, with the opposite side serving as control. Using computerized and radiographic evaluation of both knees 2 weeks postoperatively, the punch pressurizer achieved 132 times better penetration of the cement. The tibial punch cement pressurizer offers a simple technique to provide reliable cement penetration and tibial component fixation in TKA.

Tight posterior cruciate ligament in posterior cruciate-retaining total knee arthroplasty: a cause of posteromedial subluxation of the femur.

Posteromedial subluxation has been reported as a mode of failure with flat-on-flat articular geometry. Medical records were reviewed to find patients who developed progressive subluxation of the femur. From a consecutive series of 2,773 primary anatomically graduated components (AGC) knees, 6 patients developed progressive posterior subluxation of the femur. The mean interval between the index total knee arthroplasty (TKA) and the diagnosis of subluxation was 4.8 years. Five cases were revised at an average of 6.2 years after index TKA. Tightness of the posterior cruciate ligament (PCL) was observed in all revised cases. Progressive posterior subluxation is a rare complication after AGC knees. It is believed that the primary factor causing progressive subluxation is tightness of the PCL. The PCL should be recessed if PCL tightness is seen at surgery.