The Journal of arthroplasty
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Meta Analysis
Postoperative cognitive dysfunction after total joint arthroplasty in the elderly: a meta-analysis.
This meta-analysis consolidated the research on postoperative cognitive dysfunction (POCD) following total joint arthroplasty (TJA). Data from 17 studies that assessed cognition pre- and post-surgery in TJA patients alone (15 studies) or matched TJA and control groups (2 studies) were analysed. ⋯ Very limited TJA and Control data indicated no group differences in the changes to performance over time; however, the TJA group was cognitively compromised pre- and post-surgery compared to Controls. Further appropriately controlled research is required to clarify whether POCD commonly occurs after TJA.
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Total hip arthroplasty (THA) may produce blood loss requiring allogenic blood transfusion. Recently several authors have reported success decreasing their transfusion rate with tranexamic acid (TXA). ⋯ Infusion of TXA acid produced a statistically significant difference in transfusion rate (p<0.001) while topical TXA failed to reach statistical significance (P=0.15). The transfusion rate without TXA was 19.86%, 4.39% with TXA infusion (odds ratio=5.36), and 12.86% (odds ratio=1.67) with topical TXA.
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We assessed the effectiveness of celecoxib in the prevention of heterotopic ossification (HO) following primary total hip replacement (THR). We studied 170 consecutive THRs. Sixty-three patients received celecoxib after surgery (200mg twice/daily) for 28 days and 84 did not. ⋯ None of the celecoxib patients developed HO Brooker class IV, while 2% in the non-celecoxib group did. No patient discontinued treatment or had revision for aseptic loosening. A short course of celecoxib for pain aids in the prevention of HO after primary THR, and could be a useful and safe option that does not interfere with anticoagulation.
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A private payer database was used to examine the incidence and rates of knee arthroscopy in patients less than 65 years of age and the subsequent risk of knee arthroplasty. Time to event analysis was performed using the Kaplan-Meier method; also, Cox regression analysis was used to evaluate the relative risk of subsequent knee arthroplasty for arthroscopic patients. Overall, 247,034 knee arthroscopies, done for injury or arthropathy, were identified between 2004 and 2009. ⋯ These increased to 5.2% and 2.4% at 5-years, respectively. The risk of arthroplasty following arthroscopy increased significantly with age. Further study is warranted to examine the benefit of arthroscopy in younger patients with OA.