The Journal of arthroplasty
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Review Meta Analysis
The use of preoperative erythropoiesis-stimulating agents (ESAs) in patients who underwent knee or hip arthroplasty: a meta-analysis of randomized clinical trials.
Erythropoiesis-stimulating agents (ESAs) have been used in orthopedic patients to reduce allogeneic blood transfusion (ABT). The purpose of this systematic review of randomized clinical trials is to evaluate the efficacy of preoperative administration of ESAs on hemoglobin level at discharge and frequency of ABT in patients undergoing hip or knee surgery. ⋯ There was no difference in the risk of developing thromboembolism between ESA and control groups [RD: 0, 95 % CI: -1%-2%, P=0.95]. ESAs offer an alternative blood conservation method to avoid ABT in patients undergoing hip or knee surgery.
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Randomized Controlled Trial Comparative Study
Prospective randomized study of direct anterior vs postero-lateral approach for total hip arthroplasty.
Benefits of a direct anterior approach (DAA) versus a posterior-lateral (PA) approach to THA were assessed in a single-surgeon, IRB-approved, prospective, randomized clinical study. Subjects (43 DAA and 44 PA) were evaluated at 6 weeks, and 3, 6 and 12 months. The primary end point was ability to climb stairs normally and walk unlimited at each time point. ⋯ DAA subjects performed better during the immediate post-operative period; they had lower VAS pain scores on the first post-operative day, more subjects climbing stairs normally and walking unlimited at 6 weeks, and higher HOOS Symptoms scores at 3 months. There were no significant differences between groups at later time points. Findings confirm previous reports of benefits of DAA versus PA in early post-operative phases.
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Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. ⋯ A significant difference was seen in CPNP patients who were on average younger (62.1 years) and had higher BMI (34.5 kg/m(2)) than those who did not have nerve palsy (67.5 years and 31.8 kg/m(2), respectively). Only 37 patients with palsies could be followed, 32 (62.2%) had incomplete nerve palsy, twenty four (75%) of them fully recovered, while only 1 of patients with complete nerve palsy fully recovered. More severe initial injury was a negative prognostic factor for recovery of palsy (P<0.03).
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Outcome is best assessed with both generic and disease-specific instruments, but using many, lengthy questionnaires increases the burden, quality, and cost of data collection. We evaluated a short, hip-oriented Core Outcome Measures Index (COMI-hip), comprising six items (pain, function, symptom-specific well-being, quality of life, and disability) extracted from established full-length questionnaires; 214 consecutive total hip arthroplasty (THA) patients participated. ⋯ The COMI-hip proved a simple but valid outcome instrument in THA patients. Its brevity renders it a potentially valuable instrument for routine use.
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Multicenter Study
Knee pain during the first three months after unilateral total knee arthroplasty: a multi-centre prospective cohort study.
Many patients have an unfavourable pain outcome post total knee arthroplasty (TKA). This multi-centre prospective cohort study recorded weekly pain scores one week before TKA and 12 weeks post TKA. 96 patients were enrolled into the study. Patients kept a record of their weekly scores pre-operation and post-operation by using the visual acuity score. ⋯ Patients with a pre-operative pain scores ≤ 4 were identified as an at risk group for poor pain outcome. Female gender, age and anaesthetics type were not identified as risk factors for poor pain outcome. Pain trajectory analysis also identified general patterns of pain response post TKA.