Diffuse noxious inhibitory control (DNIC) is impaired in people with chronic pain such as knee osteoarthritis (KOA), which may predict the risk of acute-to-chronic pain transition. Electroacupuncture (EA) is effective in relieving pain in patients with KOA. However, whether EA may inhibit acute-to-chronic pain transition of KOA has not been systematically examined. This was a multicenter, three-arm parallel, single-blind randomized controlled trial involving a total of 450 patients with KOA. This study was approved by the Chinese Ethics Committee of Registering Clinical Trials (reference: ChiECRCT-20140035) and registered with Chinese Clinical Trial Registry (ChiCTR-ICR-14005411). Patients were divided into three groups based on EA current intensity: strong EA (>2mA), weak EA (<0.5mA) and sham EA (none acupoint). Treatments consisted of five sessions per week, for two weeks. Primary outcome measures were visual analog scale (VAS) and DNIC function.BACKGROUND
METHODS
Mobile-bearing knee prostheses have been designed in order to provide less constrained knee kinematics compared to fixed-bearing prosthesis. Currently, there is no evidence to confirm the superiority of either of the two implants with regard to walking performances. It has been shown that subjective outcome scores correlate poorly with real walking performance and it has been recommended to obtain an additional assessment of walking ability with objective gait analysis. We assessed recovery after total knee arthroplasty (TKA) with mobile- and fixed-bearing between patients during the first postoperative year, and at 5 years follow-up, using a new objective method to measure gait parameters in real life conditions.INTRODUCTION
OBJECTIVES
Fractures of the proximal femur are one of the
greatest challenges facing the medical community, constituting a
heavy socioeconomic burden worldwide. The National Hip Fracture
Audit currently provides a framework for service evaluation. This
evaluation is based upon the assessment of process rather than assessment
of patient-centred outcome and therefore it fails to provide meaningful
data regarding the clinical effectiveness of treatments. This study
aims to capture data from the cohort of patients who present with
a fracture of the proximal femur at a single United Kingdom Major
Trauma Centre. Patient-centred outcomes will be recorded and provide
a baseline cohort within which to test the clinical effectiveness
of experimental interventions.
Reverse shoulder replacement is a surgical option for cuff tear arthropathy. However scapular notching is a concern. Newer designs of glenospheres are available to reduce scapular notching. Eccentric glenosphere with a lowered centre of rotation have been shown to improve range of adduction in vitro. We hypothesize that the eccentric glenosphere improve clinical outcomes and reduce scapular notching. This is an ongoing randomized controlled double blind prospective clinical trial. Patients 70 years or older at North Shore hospital who have a diagnosis of cuff tear arthropathy and require surgery were consented for this study. Patients were allocated a concentric or eccentric 36 mm glenosphere intraoperatively, using a computer generated randomization contained in a sealed envelope. The surgical technique and post operative rehabilitation were standardized. Patients were followed up by a research nurse and postoperative radiographs were also taken at regular intervals. Clinical assessment include a visual analogue pain score, subjective shoulder rating, American Shoulder and Elbow Society Score, and Oxford shoulder score. Complications were checked for and radiographs were assessed for scapular notching.Introduction
Method
Femoral nerve block (FNB) following total knee arthroplasty (TKA) has had mixed results with some studies reporting improvement in pain and reduced narcotic exposure while others have not shown substantial differences. The effect of a FNB on rehabilitation indices (quadriceps strength, knee flexion) is also unclear. The study purpose was to compare the effect of FNB+ a multimodal analgesic protocol (MMA) to MMA only on the 1) development of a complete quadriceps motor block and 2) knee flexion during the first two postoperative days and 3) knee flexion out to 12 weeks after primary TKA. Secondarily, we compared hospital length of stay (LOS), postoperative pain, analgesic use and the incidence of nausea/vomiting. This was a controlled clinical trial undertaken at two tertiary hospitals that do high annual TJA volumes (>200 cases). Both hospitals followed the same regional clinical pathway for preoperative, perioperative and postoperative care. The pathway started mobilization on the day of surgery with a goal for discharge home on the third postoperative day. At one site, FNB was used for the first two postoperative days in addition to MMA as needed (FNB group [n=19]) while the other site used standardized MMA (MMA group [n=20]) only. The presence of a complete quadriceps block, knee flexion, pain, analgesic use, incidence of nausea and vomiting were recorded daily in hospital. Hospital LOS was also recorded and knee flexion and pain were assessed at two, six and 12 weeks post discharge.Purpose
Method
A delay in the diagnosis of paediatric acute
and subacute haematogenous osteomyelitis can lead to potentially devastating
morbidity. There are no definitive guidelines for diagnosis, and
recommendations in the literature are generally based on expert
opinions, case series and cohort studies. All articles in the English literature on paediatric osteomyelitis
were searched using MEDLINE, CINAHL, EMBASE, Google Scholar, the
Cochrane Library and reference lists. A total of 1854 papers were
identified, 132 of which were examined in detail. All aspects of
osteomyelitis were investigated in order to formulate recommendations. On admission 40% of children are afebrile. The tibia and femur
are the most commonly affected long bones. Clinical examination,
blood and radiological tests are only reliable for diagnosis in
combination. Most studies were retrospective and there is a need for large,
multicentre, randomised, controlled trials to define protocols for
diagnosis and treatment. Meanwhile, evidence-based algorithms are
suggested for accurate and early diagnosis and effective treatment.
To compare the clinical effectiveness, functional outcome and patient satisfaction following intra articular injection with Synvisc¯ and Hyalgan¯ in patients with osteoarthritis (OA) of the knee. 348 consecutive patients were randomised into two groups to receive either Hylan G-F 20 -Synvisc (n= 181) or Sodium Hyaluronate -Hyalgan (n=167). All patients were prospectively reviewed by independent assessors blinded for the treatment. Knee pain on a VAS were recorded. The functional outcome was assessed using Tegner, UCLA, Oxford knee score and EuroQol-5D scores. VAS was used to quantify patient satisfaction. Mean follow-up was 12 months.Aim
Methods
We performed a systematic review of the optimal management of septic arthritis in children as recommended in the current English literature using MEDLINE, EMBASE, CINAHL, the Cochrane Library and reference lists of retrieved articles without date restrictions up to 31 January 2009. From 2236 citations, 227 relevant full-text articles were screened in detail; 154 papers fulfilled the inclusion criteria, from which conclusions were drawn on the management of infected joints in children. Our review showed that no single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively joint infection. The roles of aspiration, arthrotomy and arthroscopy in treatment are not clear cut, and the ideal duration of antibiotic therapy is not yet fully defined. These issues are discussed. Further large-scale, multi-centre studies are needed to delineate the optimal management of paediatric septic arthritis.
This prospective controlled clinical trial compares the outcomes of metacarpophalangeal (MCP) arthroplasty in rheumatoid arthritis patients using the Swanson (S) and NeuFlex (N) MCP implants. Forty hands (thirty-seven patients) were randomised and evaluated preoperatively and at one year following MCP arthroplasty in digits two to five for range of motion (ROM; active and passive extension and flexion), ulnar drift and grip strength. Both implants restored extension and corrected flexion deformities. There was no significant difference in extension of all digits (summed) between the NeuFlex and Swanson implants (N: −20.8°; S: −13.8°; p=0.29). The NeuFlex implant, which is pre-flexed at 30°, preserved more flexion at the MCP joint than the Swanson implant in all digits (summed) (N:74.5°; S:55.8°; p=0.005), with the greatest difference observed in the fifth digit (N:69.6°; S:48.7°; p=0.009). The total arc of motion improved in all digits, with no significant differences between the Neu-Flex and Swanson groups in the second through fourth digits (N:53.8°; S:43.8°; p=0.154); a significantly greater improvement was observed in the NeuFlex group for the fifth digit (N:53.3°; S:42.5°; p=0.028). Both implants corrected ulnar drift deformity, while neither led to loss of grip strength. Hand function as measured by Sollerman score and Michigan Hand Questionnaire (MHQ) improved significantly in both groups (p=0.0119, p<
0.0001, respectively) with no significant difference between the Swanson and NeuFlex implants, except for MHQ function, aesthetics, and overall scores, which demonstrated superiority of the Swanson. Overall, there was a significant improvement in the range of motion, deformity and grip strength following MCP arthroplasty for the full patient group. While both implants restored similar amounts of extension, the NeuFlex implant maintained greater flexion and total range of motion, with the greatest difference in the fifth digit. The Swanson implant had better MHQ function and aesthetics subscores.
The results of a randomized controlled clinical trial of ninety patients comparing resurfacing to non-resurfacing of the patella in total knee arthroplasty (TKA) are reported with a minimum of ten-years of follow-up. Using a cruciate retaining hybrid TKA, the outcome measures included Knee Society Clinical Rating scores, functional testing (stair climb and flexion extension torques), patient satisfaction, anterior knee pain, and a patellofemoral specific questionnaire. The results indicated no difference between the groups in all categories. Results at two and ten years postoperatively are compared. This study represents the longest follow-up to date comparing resurfacing to nonresurfacing of the patella. Patellar resurfacing in TKA remains controversial. Purpose: To evaluate the results of resurfacing/non-resurfacing of the patella in a randomized controlled clinical trial at a minimum of ten-years of follow-up. One hundred knees (ninety patients) with osteoarthritis were enrolled in a prospective randomized controlled double-blinded trial using the same posterior cruciate retaining total knee replacement. Patients were randomized to resurfacing or nonresurfacing of the patella. Evaluations were performed preoperatively and yearly to a minimum ten years (range, 10.1–11.5 years) postoperatively. Disease specific (Knee Society Clinical Rating System), functional (stair climbing, knee flex-ion/extension torques, patellar examination) outcomes were measured. Patient satisfaction, anterior knee pain, and patellofemoral questionnaires were completed. Intraoperative grading of the articular cartilage was performed. No patients were lost to follow-up; forty-six knees remained alive. Nine revisions (9/90-ten percent) were performed – 7/48 (fifteen percent) in the nonresurfaced and 2/42 (five percent) in the resurfaced group. Three knees in the nonresurfaced group were revised to a resurfaced patella for anterior knee pain. One resurfaced patella was complicated by AVN and fracture, requiring revision. No significant difference was found between the groups regarding revision rates, KSCR score, functional, satisfaction, anterior knee pain, patellofemoral, and radiographic outcomes. Intraoperative cartilage quality was not a predictor of outcome. This study represents the longest follow up to date of a randomized controlled clinical trial to examine patellar resurfacing in TKA. The results showed no significant difference between the groups for all outcome measures at a minimum of ten-years.
The results of a randomized controlled clinical trial of ninety patients comparing resurfacing to non-resurfacing of the patella in total knee arthroplasty (TKA) are reported with a minimum of ten-years of follow-up. Using a cruciate retaining hybrid TKA, the outcome measures included Knee Society Clinical Rating scores, functional testing (stair climb and flexion extension torques), patient satisfaction, anterior knee pain, and a patellofemoral specific questionnaire. The results indicated no difference between the groups in all categories. Results at two and ten years postoperatively are compared. This study represents the longest follow-up to date comparing resurfacing to nonresurfacing of the patella. Patellar resurfacing in TKA remains controversial. Purpose: To evaluate the results of resurfacing/non-resurfacing of the patella in a randomized controlled clinical trial at a minimum of ten-years of follow-up. One hundred knees (ninety patients) with osteoarthritis were enrolled in a prospective randomized controlled double-blinded trial using the same posterior cruciate retaining total knee replacement. Patients were randomized to resurfacing or nonresurfacing of the patella. Evaluations were performed preoperatively and yearly to a minimum ten years (range, 10.1–11.5 years) postoperatively. Disease specific (Knee Society Clinical Rating System), functional (stair climbing, knee flexion/extension torques, patellar examination) outcomes were measured. Patient satisfaction, anterior knee pain, and patellofemoral questionnaires were completed. Intraoperative grading of the articular cartilage was performed. No patients were lost to follow-up; forty-six knees remained alive. Nine revisions (9/90-ten percent) were performed – 7/48 (fifteen percent) in the nonresurfaced and 2/42 (five percent) in the resurfaced group. Three knees in the nonresurfaced group were revised to a resurfaced patella for anterior knee pain. One resurfaced patella was complicated by AVN and fracture, requiring revision. No significant difference was found between the groups regarding revision rates, KSCR score, functional, satisfaction, anterior knee pain, patellofemoral, and radiographic outcomes. Intraoperative cartilage quality was not a predictor of outcome. This study represents the longest follow up to date of a randomized controlled clinical trial to examine patellar resurfacing in TKA. The results showed no significant difference between the groups for all outcome measures at a minimum of ten-years.
Total hip arthroplasty surgery may be associated with substantial loss of blood often necessitating blood transfusion. The risks associated with blood transfusions are widely known. Haemostatic drugs have been tried in the past to try and reduce this, and there has been renewed interest in these recently, in particular Aprotinin (Bayer). Aprotinin is a serine protease inhibitor, which has been shown to reduce blood loss in cardiac surgery by up to eighty percent. The aim of our study was to investigate whether or not high dose Aprotinin can reduce blood loss and transfusion rates in patients’ undergoing total hip arthroplasty. This was a randomised double blind controlled clinical trial, where 50 patients were randomised to receive either Aprotinin (2 x 106 KIU followed by an infusion of 5 x 105 KIU/hr), or an equivalent volume of normal saline. Blood loss and transfusion rates were measured as well as the incidence of deep vein thrombosis. There was a significant reduction in total blood loss seen in the Aprotinin group, median 817±350, when compared to the control group, median 1191±386. This translates to a 31% reduction in blood loss. DVT and transfusion rates were not significantly different between the two groups. There was no complications or deaths seen in the Aprotinin group. The use of high dose Aprotinin results in a reduction in blood loss in total hip arthroplasty. It has been proved to reduce blood loss in cardiac surgery, and although papers have shown it can reduce blood loss in orthopaedic surgery, its’ use should not as yet be routine. Further work is required to investigate the possibility of a future role for Aprotinin in orthopaedic surgery, as well as its’ mode of action. Until then more established methods of blood conservation should be used.
