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2.
Pain Res Manag ; 2023: 7088004, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36686371

RESUMO

Objective: The purpose of the present study (a randomized clinical trial) was to evaluate the preemptive analgesic effects of pregabalin combined with celecoxib in total knee arthroplasty (TKA). Methods: From January 2019 to June 2021, we enrolled 149 patients who underwent TKA and divided them into four groups: the placebo group (n = 36), celecoxib group (n = 38), pregabalin group (n = 38), and combination group (n = 37). Each group was given the corresponding preemptive analgesia regimen at 12 and 2 hours before surgery. The pain score at rest and upon movement, cumulative dosage of sufentanil, knee range of motion (ROM), high-sensitivityC-reactive protein (hs-CRP) level, and adverse effects were evaluated after TKA to compare the effects of the preemptive analgesia regimens among the four groups. Results: The pain scores upon movement were significantly lower in the combination group than in the other three groups at 6, 12, 24, and 48 hours after surgery (P < 0.05). The cumulative dose of sufentanil within 48 hours after surgery was lowest in the combined group among the four groups (P < 0.05). Hs-CRP, ROM, and postoperative nausea and vomiting (PONV) were within 72 hours after surgery significantly improved in the combination group compared with those of the three other groups (P < 0.05). Conclusion: The preemptive analgesia regimen of pregabalin combined with celecoxib had positive effects on improving acute pain and reducing the cumulative dose of opioids after TKA. This trial is registered with ChiCTR2100041595.


Assuntos
Analgesia , Artroplastia do Joelho , Humanos , Celecoxib/uso terapêutico , Pregabalina/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Sufentanil , Estudos Prospectivos , Proteína C-Reativa , Analgésicos Opioides/uso terapêutico , Dor/etiologia , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Método Duplo-Cego
3.
BMC Musculoskelet Disord ; 24(1): 3, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36597083

RESUMO

BACKGROUND: Localized tibial strain is one of the hypotheses to explain residual pain after Oxford UKA. We evaluate whether the depth of the vertical cut during tibial resection correlates with medial knee pain. We aimed to investigate the association between the depth of tibial resection and medial knee pain after OUKA. METHODS: This prospective cohort study enrolled 85 patients (mean age: 64.5 ± 7.7 years) who underwent cemented OUKA at our institute during October 2018-June 2019. The depth of tibial resection was measured intraoperatively as the thickness of the anterior, middle, and posterior parts. The greatest of the three thicknesses was recorded. Medial knee pain was assessed at 6 weeks and followed to 6 months. Patients were divided into the pain (P) and no pain (NP) groups. Preoperative and postoperative radiographic findings and OKS were compared between groups. We used logistic regression to analyze the independent association. RESULTS: The mean preoperative Oxford Knee Score (OKS) was 27.2 ± 7.6. The incidence of medial knee pain was 23.5% at 6 weeks after OUKA. The P group had a significantly lower OKS at 6 weeks compared to the NP group (28.9 ± 9.7 vs 33.7 ± 6.5, p = 0.049). There was no significant difference in the depth of tibial resection between groups. Medial knee pain had resolved by 6 months in all patients, and the 6-month OKS was similar between groups. CONCLUSION: Medial knee pain was found to be common in the early postoperative period after OUKA, but this pain spontaneously resolved by 6 months. As a range of tibial resection level, post-operative pain is not associated with tibial resection thickness in this study. LEVEL OF EVIDENCE: Level II. TRIAL REGISTRATION: The study was approved by the Institutional review board of Siriraj Hospital, Mahidol university. [SIRB 691/2560(EC4)].


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Pessoa de Meia-Idade , Idoso , Artroplastia do Joelho/efeitos adversos , Estudos Prospectivos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Estudos Retrospectivos
4.
BMC Musculoskelet Disord ; 24(1): 5, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36600227

RESUMO

BACKGROUND: Tranexamic acid (TXA) has been widely applied in total knee arthroplasty (TKA) to significantly reduce perioperative blood loss and improve knee function recovery in patients after surgery. The choice of antithrombotic agents for venous thromboembolism (VTE) prevention after TKA is controversial. Therefore, this study aimed to compare the effects of different antithrombotic agents on patients after primary unilateral TKA in the context of applied TXA. METHODS: A total of 180 patients undergoing primary unilateral TKA from October 2020 to December 2021 were included in this study. All patients were given an intraoperative drip of 60 mg/kg TXA. Thereafter, patients were divided into three groups (n = 60 each). Baseline data were comparable among the three groups. The average follow-up time was 3.02 ± 0.09 months. Group 1 enrolled patients receiving oral rivaroxaban (RA) at 10 mg, Group 2 included patients who received subcutaneous Dalteparin sodium at 2500 IU, while Group 3 included patients taking oral aspirin (ASA) at 100 mg. Patients in all the three groups received treatment once a day for 30 days at 12 h postoperatively. The primary outcomes in this study were post-treatment drainage volume and thrombotic complication rate. The secondary outcomes included hematologic parameters, transfusion rate, intraoperative blood loss, total blood loss (TBL), and bleeding complication rate. RESULTS: The average drainage volume after treatment was significantly lower in Group 3 than in Group 1 and Group 2 (205.2 ± 69.0 vs 243.4 ± 72.5 vs 295.4 ± 72.5 ml, P < 0.001), and there was a significant difference between Group 1 and Group 2 (243.4 ± 72.5 mL vs 295.4 ± 72.5 mL, P < 0.001). The blood transfusion rate of Group 2 dramatically increased compared with Group 1 and Group 3 (20.0% vs 6.7% vs 5.0%, P = 0.01). The bleeding complication rate in Group 1 apparently increased relative to Group 2 and Group 3 (26.7% vs 10.0% vs 8.3%, P = 0.008). Besides, there was no significant difference in the thrombotic complication rate among the three groups. CONCLUSION: Under the background of TXA application, ASA, RA, and Dalteparin sodium were all effective on preventing VTE after TKA. In addition, ASA effectively reduced post-treatment Hemoglobin (Hb) loss, drainage volume, TBL, transfusion rate, and bleeding complications compared with RA and Dalteparin sodium. TRIAL REGISTRATION: The trial was registered at the Chinese Clinical Trial Registry (ChiCTR2200060169). Date of Registration: 21/05/2022.


Assuntos
Antifibrinolíticos , Artroplastia do Joelho , Ácido Tranexâmico , Tromboembolia Venosa , Humanos , Ácido Tranexâmico/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Fibrinolíticos/efeitos adversos , Antifibrinolíticos/efeitos adversos , Dalteparina , Estudos Prospectivos , Perda Sanguínea Cirúrgica/prevenção & controle , Rivaroxabana/efeitos adversos , Anticoagulantes , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/prevenção & controle
5.
Bone Joint J ; 105-B(1): 47-55, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36587261

RESUMO

AIMS: The aim of this study was to identify variables associated with time to revision, demographic details associated with revision indication, and type of prosthesis employed, and to describe the survival of hinge knee arthroplasty (HKA) when used for first-time knee revision surgery and factors that were associated with re-revision. METHODS: Patient demographic details, BMI, American Society of Anesthesiologists (ASA) grade, indication for revision, surgical approach, surgeon grade, implant type (fixed and rotating), time of revision from primary implantation, and re-revision if undertaken were obtained from the National Joint Registry data for England, Wales, Northern Ireland, and the Isle of Man over an 18-year period (2003 to 2021). RESULTS: There were 3,855 patient episodes analyzed with a median age of 73 years (interquartile range (IQR) 66 to 80), and the majority were female (n = 2,480, 64.3%). The median time to revision from primary knee arthroplasty was 1,219 days (IQR 579 to 2,422). Younger age (p < 0.001), decreasing ASA grade (p < 0.001), and indications for revision of sepsis (p < 0.001), unexplained pain (p < 0.001), non-polyethylene wear (p < 0.001), and malalignment (p < 0.001) were all associated with an earlier time to revision from primary implantation. The median follow-up was 4.56 years (range 0.00 to 17.52), during which there were 410 re-revisions. The overall unadjusted probability of re-revision for all revision HKAs at one, five, and ten years after surgery were 2.7% (95% confidence interval (CI) 2.2 to 3.3), 10.7% (95% CI 9.6 to 11.9), and 16.2% (95% CI 14.5 to 17.9), respectively. Male sex (p < 0.001), younger age (p < 0.001), revision for septic indications (p < 0.001) or implant fracture (p = 0.010), a fixed hinge (p < 0.001), or surgery performed by a non-consultant grade (p = 0.023) were independently associated with an increased risk of re-revision. CONCLUSION: There were several factors associated with time to first revision. The re-revision rate was 16.2% at ten years; however, the risk factors associated with an increased risk of re-revision could be used to counsel patients regarding their outcome.Cite this article: Bone Joint J 2023;105-B(1):47-55.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Humanos , Masculino , Feminino , Idoso , Artroplastia do Joelho/efeitos adversos , Desenho de Prótese , Prótese do Joelho/efeitos adversos , Fatores de Risco , Reoperação , Sistema de Registros , Falha de Prótese
6.
Rev Med Liege ; 78(1): 12-16, 2023 Jan.
Artigo em Francês | MEDLINE | ID: mdl-36634060

RESUMO

Total knee replacement (TKR) is currently the gold standard in the surgical management of degenerative knee diseases. It is a reliable operation with 95 % good results at 10 years after surgery. Aseptic loosening is the primary cause of TKR failure. It results from a periprosthetic osteolytic reaction secondary to the host's reaction to the wear particle of the prosthesis and responsible for an imbalance in osteoformation and osteolysis. Polyethylene (PE) is responsible for the majority of periprosthetic reactions but the release of metal particles may play an underestimated role with the risk of systemic manifestations. The first clinical signs appear on average 7 years after prosthesis placement. Radio-clinical assessment may be normal in the early stages. Infectious process must be systematically excluded before concluding to another type of complication.


L'arthroplastie par prothèse totale de genou (PTG) est actuellement l'intervention de référence dans la prise en charge chirurgicale des pathologies dégénératives du genou. C'est une opération fiable, avec 95 % de bons résultats à 10 ans de l'intervention. Le descellement aseptique représente la première cause d'échec d'une PTG. Il résulte d'une réaction ostéolytique périprothétique secondaire à la réaction de l'hôte aux particules d'usure de la prothèse, responsable d'un déséquilibre en ostéoformation et ostéolyse. Le polyéthylène (PE) est responsable de la majorité de ces réactions, mais la libération de particules métalliques pourrait jouer un rôle sous-estimé avec des risques de manifestations systémiques. Les premiers signes cliniques apparaissent en moyenne 7 ans après la mise en place de la prothèse. Le bilan radio-clinique peut être normal au stade débutant. Un processus infectieux doit systématiquement être exclu avant de conclure à un autre type de complication.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteólise , Humanos , Polietileno , Artroplastia do Joelho/efeitos adversos , Prótese do Joelho/efeitos adversos , Falha de Prótese , Articulação do Joelho , Osteólise/etiologia
11.
JBJS Case Connect ; 13(1)2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36608173

RESUMO

CASE: An active 64-year-old patient presented with new-onset lateral knee pain 42 days after an uncomplicated medial unicompartmental knee arthroplasty (UKA). Magnetic resonance imaging and diagnostic injection of local anesthetic identified an avulsion fracture of the popliteus tendon as the source of discomfort. Repair of the tendon to its native footprint was performed with suture anchor fixation. The patient was pain-free and returned to work without restrictions at 12 weeks. CONCLUSION: We identify a unique cause of knee pain after UKA-avulsion of the popliteus tendon. Successful management of this condition included anatomic repair of the tendon with suture anchor fixation.


Assuntos
Artroplastia do Joelho , Fratura Avulsão , Humanos , Pessoa de Meia-Idade , Fratura Avulsão/diagnóstico por imagem , Fratura Avulsão/etiologia , Fratura Avulsão/cirurgia , Articulação do Joelho/cirurgia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Músculo Esquelético/cirurgia , Tendões/cirurgia
12.
BMC Musculoskelet Disord ; 24(1): 9, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36609249

RESUMO

BACKGROUND: Distal femoral resection knee arthroplasty is a limb salvage procedure. The impact of distal femoral resection arthroplasty on patient function and health status is unknown. The aim of this study was to report knee function, quality of life, knee pain, and living conditions after distal femoral resection knee arthroplasty for non-tumor indications. METHODS: Of 52 patients (52 knees) undergoing distal femoral resection knee arthroplasty in a single institution between 2012 and 2021, 22 were excluded as 3 patients had ≤90 days follow-up, 6 had died, and 13 declined or were unable to participate for unrelated reasons. Thus, 30 patients were included and interviewed by telephone in March 2021 (mean follow-up 3.5 years after surgery). Patient completed the Oxford Knee Score (0-48, 48 best), EQ-5D-5L, and the Copenhagen Knee ROM, and information on pain and living conditions was obtained. RESULTS: The mean age was 67.9 years (SD 13.6), and 21 (70%) were female. Mean total Oxford Knee Score was 29.9 (SD 10.5), mean Copenhagen Knee ROM flexion was 116° (SD 21.6), and mean extension was - 2° (SD10.1). Mobility aids were used by 18 (60%) patients, i.e. a cane (30%), walker (26.7%) or wheelchair (3.3%). Mean EQ-5Dindex score was 0.70 (SD 0.22) and mean EQ-5D VAS score was 55.4 (SD 23.9). Nine (30%) patients used paracetamol or NSAID and 2 (6.7%) used opioids for knee pain. Mean VAS knee pain score was 1.30 (SD 2.2) at rest and 2.8 (SD 3.1) when walking. Most (90%) patients lived in their own home, with only 3 patients in nursing homes. Two-thirds (66.7%) required no home care, 5 (16.6%) received home care 1-2 times over 2 weeks, and 5 (16.6%) every day. CONCLUSION: Distal femoral resection knee arthroplasty appears to be a viable treatment option for non-tumor indications. Acceptable patient outcomes were achieved in terms of functional status and quality of life, especially considering treatment alternatives such as femoral amputation.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Feminino , Idoso , Masculino , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Qualidade de Vida , Condições Sociais , Resultado do Tratamento , Articulação do Joelho/cirurgia , Dor , Osteoartrite do Joelho/cirurgia
13.
J Orthop Surg Res ; 18(1): 18, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36609383

RESUMO

PURPOSE: The purpose of this study was to investigate the early outcomes of the new semi-constrained revision total knee arthroplasty (TKA) system by performing subgroup analysis according to the revision cause. MATERIALS AND METHODS: From August 2019 to July 2020, 83 revision TKAs using the fixed-bearing Attune® revision knee system with a minimum follow-up of 2 years were retrospectively reviewed. Clinically, the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, the Western Ontario and McMaster Universities Osteoarthritis Index, and range of motion (ROM) were evaluated. The incidence of systemic and specific postoperative complications was investigated. Each cohort was divided into septic (group A, 34 patients) and aseptic mode (group B, 41 patients), and compared to assess the outcomes. RESULTS: The mean age at the time of revision was 73.3 years (range 59.0 to 84.0 years), and the follow-up duration was 36.1 months (range 30.0 to 40.0 months). Clinical outcomes and ROM significantly improved at last follow-up (p < 0.001). Group A showed statistically inferior clinical outcomes in the last follow-up compared to group B. Four knees (5.3%) had a postoperative femoral joint line elevation of more than 5 mm. There were no serious systemic complications. One patient underwent re-revision TKA due to recurrence of infection. No stem tip impingement or cortical erosion was observed in all patients. CONCLUSIONS: Revision TKAs using a new semi-constrained revision system showed favorable short-term follow-up outcomes, with improvement in clinical scores and ROM. Moreover, by using stem offsets, no postoperative stem tip impingement or cortical erosion was found. LEVEL OF EVIDENCE: Level IV, Retrospective Case Series.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite , Humanos , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Estudos Retrospectivos , Seguimentos , Prótese do Joelho/efeitos adversos , Desenho de Prótese , Reoperação , Articulação do Joelho/cirurgia , Osteoartrite/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento
14.
BMC Musculoskelet Disord ; 24(1): 17, 2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36611148

RESUMO

BACKGROUND: Approximately 26% of patients undergoing major orthopedic elective procedures have preoperative anemia. This study aimed to investigate the effect of intravenous (IV) iron supplementation on the hemoglobin (Hb) level after staged bilateral total knee arthroplasty (TKA) in patients with or without preoperative anemia. METHODS: We retrospectively analyzed 418 patients who underwent staged bilateral TKA (1 week interval). The iron group (n = 220) received IV iron isomaltoside immediately after each TKA. The no-iron group (n = 198) was recommended to receive transfusion if postoperative anemia was diagnosed between the first and second TKA. Preoperative anemia was present in 42 (21.2%) and 50 (22.7%) patients in the no-iron and iron groups, respectively. Demographic data, preoperative and postoperative Hb levels, Hb level change (preoperative minus postoperative 6-week Hb level), and blood drainage amount were compared between groups. RESULTS: The transfusion rate was lower in the iron group than in the no-iron group (96.5% vs. 58.6%, P < 0.001). Overall, the demographic data, preoperative and postoperative 6-week Hb levels, Hb level change, and blood drainage amount were not significantly different between the two groups. Among patients with preoperative anemia, the iron group showed lower Hb level change (0.6 ± 0.9 vs. 0.1 ± 1.1, P = 0.016). CONCLUSION: Patients with preoperative anemia treated with IV iron showed lower Hb level change than did those without IV iron treatment. Despite the lower transfusion rate, the iron group showed similar postoperative 6-week Hb level and Hb level change to the no-iron group.


Assuntos
Anemia , Artroplastia do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Estudos Retrospectivos , Anemia/tratamento farmacológico , Anemia/etiologia , Administração Intravenosa , Suplementos Nutricionais , Hemoglobinas
15.
BMC Musculoskelet Disord ; 24(1): 15, 2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36611176

RESUMO

BACKGROUND: As healthcare economics shifts towards outcomes-based bundled payment models, providers must understand the evolving dynamics of medical optimization and fluid resuscitation prior to elective surgery. Dehydration is an overlooked modifiable risk factor that should be optimized prior to elective total knee arthroplasty (TKA) to reduce postoperative complications and inpatient costs. METHODS: All primary TKA from 2005 to 2019 were queried from the National Surgical Quality Improvement Program (NSQIP) database, and patients were compared based on dehydration status: Blood Urea Nitrogen Creatinine ratio (BUN/Cr) < 20 (non-dehydrated), 20 ≤ BUN/Cr ≤ 25 (moderately-dehydrated), 25 < BUN/Cr (severely-dehydrated). A sub-group analysis involving only elderly patients > 65 years and normalized gender-adjusted Cr values was also performed. RESULTS: The analysis included 344,744 patients who underwent TKA. Adjusted multivariate logistic regression analysis showed that the severely dehydrated cohort had a greater risk of non-home discharge, postoperative transfusion, postoperative deep vein thrombosis (DVT), and increased length of stay (LOS) (all p < 0.01). Among the elderly, dehydrated patients had a greater risk of non-home discharge, progressive renal insufficiency, urinary tract infection (UTI), postoperative transfusion, and extended LOS (all p < 0.01). CONCLUSION: BUN/Cr > 20 is an important preoperative diagnostic tool to identify at-risk dehydrated patients. Providers should optimize dehydration to prevent complications, decrease costs, and improve discharge planning. LEVEL OF EVIDENCE: Level III; Retrospective Case-Control Design; Prognosis Study.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Humanos , Idoso , Artroplastia do Joelho/efeitos adversos , Estudos Retrospectivos , Desidratação/etiologia , Desidratação/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Tempo de Internação , Fatores de Risco , Artroplastia de Quadril/efeitos adversos
16.
Comput Assist Surg (Abingdon) ; 28(1): 2162970, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36637291

RESUMO

Correct mechanical alignment (180° hip-knee-angle (HKA)) may be difficult to obtain on a consistent basis in obese patients. This is a randomized controlled study comparing the post-operative coronal alignment in obese patients between two surgical total knee arthroplasty (TKA) techniques - conventional and computer assisted navigation. The primary outcome was the post-operative HKA. A total of 60 patients were assigned to undergo conventional total knee arthroplasty (30 patients) or computerized assisted stereotaxic navigation system with Bluetooth communication surgery (30 patients). One patient from the study group was excluded due to malfunction of the navigation system. Good quality x-rays were available in 57 patients. There was no difference between the groups. Post-operative HKA was 2.8° and 2.9° in the study and control groups, respectively (p = 0.87). In obese patients undergoing TKA, computerized navigation had no impact on post-op HKA. Clincal Trial Registration Number: HMO 0092-13.


Assuntos
Artroplastia do Joelho , Cirurgia Assistida por Computador , Humanos , Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/cirurgia , Radiografia , Período Pós-Operatório
17.
BMC Musculoskelet Disord ; 24(1): 31, 2023 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-36639624

RESUMO

BACKGROUND: Total knee and hip arthroplasty are considered a clinically and cost-effective intervention, however, persistent pain post-surgery can occur, and some continue to take opioid medications long-term. One factor which has infrequently been included in prediction modelling is rehabilitation pathway, in particular, one which includes inpatient rehabilitation. As discharge to inpatient rehabilitation post-arthroplasty is common practice, we aimed to identify whether rehabilitation pathway (discharge to in-patient rehabilitation or not) predicts continued use of opioids at 3 months (90 days) post- total knee arthroplasty (TKA) and total hip arthroplasty (THA) whilst controlling for other covariates. METHODS: The study was nested within a prospective observational study capturing pre-operative, acute care and longer-term data from 1900 osteoarthritis (OA) patients who underwent primary TKA or THA. The larger study involved a part-random, part-convenience sample of 19 high-volume hospitals across Australia. Records with complete pre-and post-operative analgesic (35 days and 90 days) use were identified [1771 records (93% of sample)] and included in logistic regression analyses. RESULTS: Three hundred and thirteen people (17.8%) reported ongoing opioid use at 90 days post-operatively. In the adjusted model, admission to inpatient rehabilitation after surgery was identified as an independent and significant predictor of opioid use at 90-days. Inpatient rehabilitation was associated with almost twice the odds of persistent opioid use at 90-days compared to discharge directly home (OR = 1.9 (1.4, 2.5), p < .001). CONCLUSION: The inpatient rehabilitation pathway is a strong predictor of longer-term opioid use (90 days) post-arthroplasty, accounting for many known and possible confounders of use including sex, age, insurance status, major complications, smoking status and baseline body pain levels. TRIAL REGISTRATION: The study was nested within a prospective cohort observational study capturing pre-operative, acute-care and longer-term data from patients undergoing primary TKA or THA for osteoarthritis (ClinicalTrials.gov NCT01899443).


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Transtornos Relacionados ao Uso de Opioides , Osteoartrite , Humanos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/reabilitação , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/reabilitação , Analgésicos Opioides/uso terapêutico , Estudos Prospectivos , Alta do Paciente , Pacientes Internados , Osteoartrite/tratamento farmacológico , Dor/tratamento farmacológico , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia
18.
Medicine (Baltimore) ; 102(2): e32635, 2023 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-36637921

RESUMO

BACKGROUND: To systematically review the efficacy of 11 anticoagulants in the treatment of venous thromboembolism (VTE) after total hip or knee arthroplasty. METHODS: PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Data, VIP, and China Biology Medicine databases were electronically searched for studies assessing the efficacy of different anticoagulants for the prevention of VTE after total hip or knee arthroplasty from January 1, 2010, to January 27, 2022. Two reviewers independently screened the literature, extracted data, and graded the evidence using Confidence in Network Meta-Analysis. The network meta-analysis was then performed using Stata 16.0 software and R 4.1.0 software. RESULTS: A total of 61 articles were included. The results of network meta-analysis showed that apixaban, edoxaban, fondaparinux, rivaroxaban, and darexaban were the most effective anticoagulants for the prevention of deep vein thrombosis in patients undergoing total hip or knee arthroplasty (P < .05), while there was no difference in the efficacy among the anticoagulants for the prevention of pulmonary embolism (P > .05). CONCLUSION: Apixaban, edoxaban, fondaparinux, rivaroxaban, and darexaban have the best efficacy for the prevention of VTE after total hip or knee arthroplasty.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Tromboembolia Venosa , Humanos , Anticoagulantes/uso terapêutico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Rivaroxabana/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Fondaparinux/uso terapêutico , Metanálise em Rede , Artroplastia de Quadril/efeitos adversos
19.
Br J Anaesth ; 130(2): 234-241, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36526484

RESUMO

BACKGROUND: Tranexamic acid (TXA) reduces rates of blood transfusion for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Although the use of oral TXA rather than intravenous (i.v.) TXA might improve safety and reduce cost, it is not clear whether oral administration is as effective. METHODS: This noninferiority trial randomly assigned consecutive patients undergoing primary THA or TKA under neuraxial anaesthesia to either one preoperative dose of oral TXA or one preoperative dose of i.v. TXA. The primary outcome was calculated blood loss on postoperative day 1. Secondary outcomes were transfusions and complications within 30 days of surgery. RESULTS: Four hundred participants were randomised (200 THA and 200 TKA). The final analysis included 196 THA patients (98 oral, 98 i.v.) and 191 TKA patients (93 oral, 98 i.v.). Oral TXA was non-inferior to i.v. TXA in terms of calculated blood loss for both THA (effect size=-18.2 ml; 95% confidence interval [CI], -113 to 76.3; P<0.001) and TKA (effect size=-79.7 ml; 95% CI, -178.9 to 19.6; P<0.001). One patient in the i.v. TXA group received a postoperative transfusion. Complication rates were similar between the two groups (5/191 [2.6%] oral vs 5/196 [2.6%] i.v.; P=1.00). CONCLUSIONS: Oral TXA can be administered in the preoperative setting before THA or TKA and performs similarly to i.v. TXA with respect to blood loss and transfusion rates. Switching from i.v. to oral TXA in this setting has the potential to improve patient safety and decrease costs.


Assuntos
Antifibrinolíticos , Artroplastia de Quadril , Artroplastia do Joelho , Ácido Tranexâmico , Humanos , Ácido Tranexâmico/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Antifibrinolíticos/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Administração Intravenosa , Artroplastia de Quadril/métodos
20.
Curr Rheumatol Rep ; 25(2): 35-46, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36479669

RESUMO

PURPOSE OF REVIEW: Meniscus injury often leads to joint degeneration and post-traumatic osteoarthritis (PTOA) development. Therefore, the purpose of this review is to outline the current understanding of biomechanical and biological repercussions following meniscus injury and how these changes impact meniscus repair and PTOA development. Moreover, we identify key gaps in knowledge that must be further investigated to improve meniscus healing and prevent PTOA. RECENT FINDINGS: Following meniscus injury, both biomechanical and biological alterations frequently occur in multiple tissues in the joint. Biomechanically, meniscus tears compromise the ability of the meniscus to transfer load in the joint, making the cartilage more vulnerable to increased strain. Biologically, the post-injury environment is often characterized by an increase in pro-inflammatory cytokines, catabolic enzymes, and immune cells. These multi-faceted changes have a significant interplay and result in an environment that opposes tissue repair and contributes to PTOA development. Additionally, degenerative changes associated with OA may cause a feedback cycle, negatively impacting the healing capacity of the meniscus. Strides have been made towards understanding post-injury biological and biomechanical changes in the joint, their interplay, and how they affect healing and PTOA development. However, in order to improve clinical treatments to promote meniscus healing and prevent PTOA development, there is an urgent need to understand the physiologic changes in the joint following injury. In particular, work is needed on the in vivo characterization of the temporal biomechanical and biological changes that occur in patients following meniscus injury and how these changes contribute to PTOA development.


Assuntos
Artroplastia do Joelho , Cartilagem Articular , Menisco , Osteoartrite , Humanos , Osteoartrite/etiologia , Osteoartrite/metabolismo , Menisco/lesões , Citocinas/metabolismo , Artroplastia do Joelho/efeitos adversos , Cartilagem Articular/metabolismo
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