Archives of orthopaedic and trauma surgery
-
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.
-
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.
-
Arch Orthop Trauma Surg · Jan 1999
Randomized Controlled Trial Clinical TrialDeep vein thrombosis in elderly Hong Kong Chinese with hip fractures detected with compression ultrasound and Doppler imaging: incidence and effect of low molecular weight heparin.
Seventy-eight patients of average age 78 years suffering from an unilateral non-pathological hip fracture underwent compression ultrasound and pulsed and colour Doppler examination of both legs. Twenty-three patients were randomly placed on low molecular weight heparin (LMWH). Twenty-nine (37%) suffered deep venous thrombosis (DVT). ⋯ There was no statistically significant difference in overall incidence of DVT between patients on prophylactic heparin and the control group. Patients on prophylactic heparin had no thigh DVTs in comparison to the control group. LMWH may thus be effective in preventing thigh DVTs and pulmonary emboli.
-
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.
-
Arch Orthop Trauma Surg · Jan 1999
Comparative StudySurgical management of low-grade lytic spondylolisthesis with C-D instrumentation in adult patients.
In this retrospective study, 45 patients with low-grade (I-II) isthmic spondylolisthesis are reported. Spinal decompression, stabilization and fusion were performed in 19 patients (group I). Stabilization and fusion without decompressive laminectomy were performed in 26 patients (group II). The results, which are mostly encouraging, show no significant difference between the two groups.