Acta orthopaedica
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Randomized Controlled Trial
Effects of celecoxib on blood loss, pain, and recovery of function after total knee replacement: a randomized placebo-controlled trial.
Pain management after surgery has been used as a sales argument for the use of COX-2 inhibitors, but their potential positive and negative effects have not been fully investigated. We thus conducted a controlled evaluation of the effect of celecoxib on perioperative blood loss, pain relief and consumption of analgesics, range of motion, and subjective outcome in conjunction with total knee replacement (TKR). ⋯ Celecoxib does not increase perioperative blood loss but reduces pain during the postoperative period after TKR. It is not necessary to discontinue celecoxib before surgery. The postoperative use of celecoxib did not increase range of motion or subjective outcome 1 year after TKR.
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Anterior knee pain and young age of the patient have been considered justification for removal of a tibial intramedullary nail. There have been few reports on the outcome after nail removal, however. ⋯ The results of nail removal to alleviate pain are poor. Removal of a nail should not be undertaken unless there is a convincing indication.
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The mechanical properties of current external fixator systems for unstable (type C) pelvic ring fractures are inferior to internal fixation, and are not optimal for definitive treatment. We explored methods to increase stability of external fixator constructs. ⋯ The new concept of parasymphyseal pin fixation connected to an external fixator of the pelvic ring produces a considerable increase in stability for the treatment of type C pelvic ring injuries, as does an increase in pin diameter and alternative pin positioning.
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Bone-saving hip arthroplasty techniques, which facilitate revision, are gaining importance as the number of hip replacements in younger patients increases. ⋯ The medium-term survival with this type of femoral component is unsatisfactory, with a high rate of aseptic loosening. The surviving prostheses had a good clinical outcome.