Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialPain therapy following joint replacement.A randomized study of patient-controlled analgesia versus conventional pain therapy.
A prospective randomized trial in 42 patients undergoing elective total hip or knee arthroplasty under general anaesthesia was carried out to evaluate the efficacy of patient-controlled analgesia (PCA) versus demanded conventional pain therapy (CPT) for controlling postoperative pain. Four patients had to be excluded from the study (2 postoperative confusion, 1 elevated piritramid dosage caused by chronic pain therapy, 1 stressed by PCA pump handling). PCA group (n = 19) received piritramid via PCA pump, CPT group (n = 19) received tramadol (oral or intramuscularly) or piritramid intravenously. ⋯ The PCA group required on average twice as much piritramid-equivalent than the CPT group (P < 0.001). Patient satisfaction was good in both groups, but significantly better in the PCA group (P < 0.01), although the measured postoperative individual pain scores were above the preoperatively determined individual subjective pain threshold in the majority of both groups. From these results we draw the conclusion that even if the patients feel satisfied by the pain therapy administered, the majority are objectively treated below their individual subjective pain threshold.
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Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialPrevention of heterotopic bone formation after total hip arthroplasty: a prospective randomised study comparing postoperative radiation therapy with indomethacin medication.
Heterotopic ossification (HO) after total hip arthroplasty is known to be a major complication with an impact on the functional outcome. Efforts have been made to prevent the occurrence of HO by means of either radiation therapy or pharmacotherapy. To date, there are no data available regarding the relative benefit of radiation versus medication with non-steroidal anti-inflammatory drugs. ⋯ In conclusion, this study demonstrated that both radiation and indomethacin therapy are effective in the prevention of postoperative HO. The choice for either one of the treatments has to be based on availability, contraindications, side-effects, practicability, standardisation and cost. Based on these considerations together with the results of this study, we currently use postoperative radiation with 600 cGy for all patients undergoing primary total hip arthroplasty.
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Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Clinical TrialEffects of recombinant human erythropoietin on thrombosis and fibrinolysis in autologous transfusion for hip surgery.
Recombinant human erythropoietin (rHuEPO) is effective in allowing autologous blood donation in patients unable to donate because of anemia. As adverse effects of rHuEPO might include activation of coagulation and possibly fibrinolysis, we investigated these possibilities in the context of autologous blood donation preceding hip surgery. ⋯ Coagulation and fibrinolysis were increased significantly by intraoperative blood loss in both groups, but not by rHuEPO. Coagulation and fibrinolysis were not activated by rHuEPO for elective hip surgery.
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Arch Orthop Trauma Surg · Jan 1999
Metacarpophalangeal joint arthroplasty in rheumatoid arthritis: results of Swanson implants and digital joint operative arthroplasty.
We discuss 69 metacarpophalangeal (MP) implant arthroplasties performed in 30 patients with rheumatoid arthritis. The follow-up averaged 5 years. We studied 19 finger joint prostheses by Condamine, digital joint operative arthroplasty (stabilized version; DJOA) and 50 flexible silicone Swanson implants. ⋯ Secondly, adequate coaptation cannot be achieved with this prosthetic design, even in the presence of extensive soft-tissue reconstruction. Thirdly, the use of polyethylene in MP joint replacements is questionable. In contrast, the silicone Swanson implants in our series provided superior results when used as MP implants in the rheumatoid hand.
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Arch Orthop Trauma Surg · Jan 1999
Regeneration process of mechanoreceptors in the reconstructed anterior cruciate ligament.
We performed reconstructive surgery on the anterior cruciate ligament (ACL) of the rabbit using a free bone-patellar tendon-bone (BTB) graft and evaluated nerve regeneration in the graft. The right ACL of 15 Japanese white rabbits was resected and reconstructed using a BTB graft. The BTB and ACL from the contralateral knee served as controls. ⋯ The appearance of mechanoreceptors in the graft between 2 and 4 weeks postoperatively suggests that regeneration of mechanoreceptors occurred during this time period. At 4 and 8 weeks postoperatively, there was no significant difference in the number of mechanoreceptors between the intra-articular portion of grafted tendon and the contralateral ACL. The further increase between 4 and 8 weeks to control levels suggests that this regeneration may restore mechanoreceptors in BTB grafts to normal levels.