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  • Efficacy of ketamine, pregabalin, and combined analgesia in total hip arthroplasty

    142 patients scheduled for total hip arthroplasty were randomized to receive treatment with ketamine infusion during anaesthesia, preoperative oral pregabalin, combined ketamine and pregabalin, or placebo of both. The purpose was to determine if the combination of drugs was more efficacious than either alone. All patients received patient-controlled morphine analgesia postoperatively, and were evaluated for cumulative morphine consumption, pain at rest and on movement, side-effects experienced and secondary hyperalgesia for the first 48 postoperative hours. Compared to placebo, all other groups significantly reduced cumulative morphine dose, although there was no significant reduction in pain or opioid-related side-effects in any group.

    POSTED: TODAY

    Efficacy of ketamine, pregabalin, and combined analgesia in total hip arthroplasty

  • Intra-articular mesenchymal stem cells possibly beneficial for meniscus regeneration

    60 patients undergoing a partial meniscectomy were randomized to receive a single postoperative injection of allogeneic human mesenchymal stem cells (50x10^6 or 150x10^6 cell count) or a control vehicle injection of sodium hyaluronate, 7-10 days after surgery. The purpose of this study was to determine if a single intra-articular injection of mesenchymal stem cells caused meniscal regeneration over 2 years, as well as to investigate the safety of such treatment. More patients treated with the stem cell injection were observed to have an increase in meniscus volume of >15%, and patients with osteorthritis appeared to have an added benefit of reduced pain. No significant immunological responses were observed.

    POSTED: TODAY

    Intra-articular mesenchymal stem cells possibly beneficial for meniscus regeneration

  • IV tranexamic acid reduces postoperative autologous blood retransfusion in THA and TKA

    98 patients undergoing TKA or THA were randomized to receive a restrictive blood transfusion program either with an intraoperative intravenous 1.0 g dose of tranexamic acid (TXA) and a repeated dose 3 hours later or a placebo. Analysis revealed that a lower proportion of TXA patients required reinfusion of postoperatively collected autologous blood, in addition to a reduction in mean total external blood loss and blood drained in the first 24h after surgery. Blood pressures were not clinically impacted with TXA and were comparable with the placebo. No confirmed cases of pulmonary embolism, deep vein thrombosis, or seizures were reported in the TXA group.

    POSTED: TODAY

    IV tranexamic acid reduces postoperative autologous blood retransfusion in THA and TKA

  • THA: Decreased requirement for analgesics during surgery with use of auricular acupuncture

    120 patients diagnosed with degenerative osteoarthritis who were scheduled for a unilateral THA were randomized into two groups: one group received auricular acupuncture treatment and one group received a sham treatment. The amount of fentanyl required to perform the surgery was assessed for both groups. Results indicate that there was a 15% decrease in the amount of fentanyl required during the surgeries for the auricular acupuncture group compared to the non-acupuncture (or sham) group. There was no difference between groups in duration of anesthesia, body temperature, incidence of bradycardia, incidence of hypotension, incidence of nausea or vomiting or length of stay in the anesthesia recovery room.

    POSTED: TODAY

    THA: Decreased requirement for analgesics during surgery with use of auricular acupuncture

  • Complex Regional Pain Syndrome: short-term pain reduction using ketorolac with lidocaine

    12 patients suffering from complex regional pain syndrome (CRPS) in the lower extremity (10 of whom completed the study) underwent intravenous regional block treatment using 50mL lidocaine 0.5% in conjunction with 0mg, 30mg, 60mg or 120mg ketorolac. Dosage sequence order was randomly selected for each patient, and pain was measured using the numerical regional scale every day for one week following the injection. Other outcomes assessed in this pilot study included pain with motion, allodynia, joint pain score, edema, range of motion of the ankle, and skin temperature. Results indicate a significant decrease in pain one day post-injection for all treatments involving dosages of ketorolac, and no difference in all other outcomes, measured 1 week post-injection.

    POSTED: TODAY

    Complex Regional Pain Syndrome: short-term pain reduction using ketorolac with lidocaine

  • THA: Cylindrical stem distal design relieves distal loading

    21 patients requiring bilateral total hip arthroplasty received two different hip prostheses, one with a distally tapered stem and the other with a distally cylindrical stem to determine the effect of the distal design on bone remodelling. Patients were randomized as to which leg received the different prostheses. 7 years after surgery, all patients displayed good clinical and radiographic outcomes. Cancellous condensation was found in Gruen's zones 2 and 6 around the cylindrical stem and between Gruen's zones 2 and 3, and zones 5 and 6 around the tapered stem. Bone mineral density around Gruen's zones 2 and 6 was significantly lower around the tapered stem than the cylindrical stem, indicating the tapered stems may experience more distal loading than the cylindrical stems.

    POSTED: TODAY

    THA: Cylindrical stem distal design relieves distal loading

  • Subacromial impingement: Hyaluronic acid less effective than corticosteroid injection

    159 patients diagnosed with subacromial impingement were included in this randomized control trial to determine the effectiveness of different injectable substances for the treatment of subacromial impingement. Subjects were randomized to one of three groups receiving hyaluronic acid (HA) with lidocaine, corticosteroid with lidocaine, or lidocaine alone (control). All three treatments produced a reduction in pain for 60% of patients allocated to each group. The use of corticosteroids appeared to provide the greatest reduction in pain over the short term (3, 6, 12 weeks). The use of HA did not appear to provide any benefits when compared to the control group.

    POSTED: TODAY

    Subacromial impingement: Hyaluronic acid less effective than corticosteroid injection

  • TKR: No difference between oxidized zirconium and cobalt-chromium femoral components

    351 patients (701 knees) with osteoarthritis underwent simultaneous bilateral total knee replacement (TKR), in which each knee was randomized to receive an oxidised zirconium (OxZr) or a cobalt-chrome (CoCr) femoral component. After a mean of 7.5 years, there was no significant difference between the two groups for mean weight, size, and shape of the aspirated wear particles. The two groups also did not differ in pain, function ratings, range of movement, and satisfaction with treatment. Since the OxZr component costs more than the CoCr component, it can be concluded that the CoCr femoral component is most suitable for patients with osteoarthritis undergoing TKR following this mid-term assessment.

    POSTED: TODAY

    TKR: No difference between oxidized zirconium and cobalt-chromium femoral components

  • Displaced clavicle fracture: Non-operative treatment leads to increased rate of non-union

    60 patients with completely displaced midshaft clavicular fractures were randomized to operative plate fixation or non-operative sling treatment to assess functional and disability outcomes. Assessment using the Constant shoulder score and the Disabilities of the Arm, Shoulder and Hand score (DASH) indicated no difference between groups over a 12 month follow-up period. However, there was a significantly greater rate of non-union in the non-operative group.

    POSTED: TODAY

    Displaced clavicle fracture: Non-operative treatment leads to increased rate of non-union

  • Circumpatellar electrocautery does not reduce anterior knee pain following TKR

    200 patients undergoing total knee replacement (without patellar resurfacing) for degenerative joint disease were randomized to a procedure with or without circumpatellar electrocautery to determine its effect on anterior knee pain and function. Oxford knee and VAS pain scores were recorded over a 12 month period. The results indicated that there were no differences between the two groups at any time point. This study demonstrated that there was no beneficial effect of circumpatellar electrocautery on anterior knee pain or function for patients undergoing TKR without patellar resurfacing.

    POSTED: TODAY

    Circumpatellar electrocautery does not reduce anterior knee pain following TKR

  • Displaced femoral neck fractures: Similar mortality rates with cemented or uncemented HA

    12 randomized controlled trials comparing cemented and uncemented hemiarthroplasty (HA) in patients with displaced femoral neck fractures were included in this meta-analysis. This review aimed to compare the two methods with respect to mortality rates, the incidence of complications, blood loss, operative time, and hospital stay. Results indicated that cemented and uncemented HA resulted in similar mortality rates, incidences of complications, blood loss and residual pain. Cemented HA, however, was associated with a significantly longer operative time.

    POSTED: TODAY

    Displaced femoral neck fractures: Similar mortality rates with cemented or uncemented HA

  • Intraosseous administration of low-dose vanomycin leads to higher tissue concentrations

    32 patients scheduled for total knee arthroplasty were randomized to received three different prophylactic antibiotic regimens: intraosseous administration of either 250mg or 500mg vanomycin, or 1g vanomycin administered intravenously. The purpose was to evaluate the effect of intraosseously administered vanomycin in terms of concentrations in subcutaneous fat, cancellous bone, and systemic blood samples. Intraoperative concentrations of vanomycin in tissue samples were significantly higher with either dose of intraosseous vanomycin compared to intravenous administration.

    POSTED: TODAY

    Intraosseous administration of low-dose vanomycin leads to higher tissue concentrations

  • Cemented stem implantation: Finite element simulation vs. clinical bone densitometry

    64 patients scheduled to undergo total hip arthroplasty were randomized to receive either a VerSys or ABG-II cemented femoral stem. Bone mineral density was monitored over a 5 year follow-up period and a finite element (FE) simulation was run concurrently, modelling stem mechanical behavior and measuring the biomechanical variations. At 5 years postoperatively, correlations between clinical results and FE simulation models were found in several GRUEN zones, suggestive of biomechanical influences in the adaptive bone remodeling process. Additionally, bone growth was seen to progressively increase during the entire study period. Nonetheless, this area of research warrants further studies.

    POSTED: TODAY

    Cemented stem implantation: Finite element simulation vs. clinical bone densitometry

  • Effects of 2.5mg zoledronate are long-lasting and similar to 5mg dose in osteopenic women

    180 postmenopausal women with osteopenia were randomly allocated to receive either 1mg, 2.5 mg, or 5 mg intravenous infusion of zoledronate or a placebo. The purpose of this trial was to determine the optimal dosing regimen of zoledronate. Results indicated that a single administration of a 1 mg or 2.5 mg dose of intravenous zoledronate produces antiresorptive effects for at least two years, although the 1 mg antiresorptive effects appear to slow after 12 months. At 2 years post-intervention, the change in bone mineral density (BMD) and bone turnover markers in the 2.5 mg dose group were similar to effects induced by 5 mg.

    POSTED: TODAY

    Effects of 2.5mg zoledronate are long-lasting and similar to 5mg dose in osteopenic women

  • ACLR with lateral plasty may improve lateral compartment laxity in advanced chronic laxity

    120 patients with advanced chronic anterior laxity were randomized to receive ACL reconstruction (ACLR) with or without extra-articular ilio-tibial band tenodesis. The study aimed to examine ACLR outcomes and objective laxity when combined with lateral plasty. After 2 years, patients who underwent ACLR with lateral plasty experienced a greater improvement in anterior translation laxity of the lateral compartment versus ACLR alone. Anterior translation of the medial compartment, subjective scores, and overall IKDC scores were comparable between groups.

    POSTED: TODAY

    ACLR with lateral plasty may improve lateral compartment laxity in advanced chronic laxity

  • Adult stem cells do not appear to accelerate graft-to-bone healing in ACL reconstruction

    43 patients undergoing anterior cruciate ligament (ACL) surgery using a hamstring graft were randomly assigned to a stem cell or a control group to evaluate the effect of stem cells on graft-to-bone healing. In the study, adult non-cultivated bone marrow stem cells were harvested from select patients and intra-operatively delivered in and around the femoral end of the graft. Upon analysis, the non-cultivated bone marrow stem cells did not appear to advance graft-to-bone healing in ACL reconstruction at 3 months post-operative.

    POSTED: YESTERDAY

    Adult stem cells do not appear to accelerate graft-to-bone healing in ACL reconstruction

  • Internal fixation VS hemiarthroplasty for hip fractures produce similar outcomes at 6 yrs

    To determine the long term efficacy of surgical hip fracture techniques, 222 patients with displaced intracapsular femoral neck fractures were randomly allocated to undergo either hemiarthroplasty or internal fixation. Outcomes including patient pain, hip function, quality of life, survival, and frequency of re-operation were measured for a minimum of 4.9 years postoperatively. An analysis of results revealed re-operations were more frequent in the internal fixation group, but no other outcome measurements significantly differed between groups at long-term follow-up.

    POSTED: YESTERDAY

    Internal fixation VS hemiarthroplasty for hip fractures produce similar outcomes at 6 yrs

  • Lumbar spondylolisthesis: Low/moderate-quality evidence suggests PLIF is superior to PLF

    This systematic review/ meta-analysis was comprised of four RCTs and five comparative observational studies (520 patients), and was conducted to compare the efficacy of posterior lumbar interbody fusion (PLIF) versus posterolateral fusion (PLF) for the treatment of lumbar spondylolisthesis. Low-/moderate-quality evidence suggested favourable outcomes with PLIF compared to PLF in terms of clinical satisfaction and function, fusion rates, and reduction in postoperative pain. No significant differences were found between groups in terms of complication rate, blood loss, and operating time.

    POSTED: YESTERDAY

    Lumbar spondylolisthesis: Low/moderate-quality evidence suggests PLIF is superior to PLF

  • Preserving the ligamenta flava as much as possible is beneficial in lumbar microdiscectomy

    97 patients with unilateral lumbar disc herniation were randomized to undergo lumbar microdiscectomy using either a traditional (control) or revised (test) technique, which focused on preserving as much of the ligamentum flavum as possible. The purpose of this study was to compare these two surgical approaches with respect to operative time, blood loss, pain and function. Results indicated that, although there were no significant differences between groups with respect to leg pain, operative time or blood loss, the test group yielded significantly better Oswestry scores at 12 weeks and 1 year post-operation. The revised procedure also resulted in significantly lower back pain scores at 3 days and 12 weeks postoperatively, however this significance was not maintained at 1 year. Both procedures were demonstrated to be safe, with no reports of reherniation, re-operation or infection.

    POSTED: THIS WEEK

    Preserving the ligamenta flava as much as possible is beneficial in lumbar microdiscectomy

  • ACL remnant preservation favoured over remnant removal regarding tibial tunnel enlargement

    62 patients undergoing anterior cruciate ligament (ACL) reconstruction were randomly allocated to a preserving- or removing-remnant group to investigate the effect of remnant preservation on tibial tunnel enlargement in single-bundle ACL reconstruction using a tendinous autograft. Follow-up and assessment was conducted over 24 months postoperatively. Results demonstrated that preservation of the ACL remnants was favoured over the removal of these parts with respect to tibial tunnel enlargement, yet short-term clinical outcomes (Lysholm rating scale and KT-1000) did not appear to be significantly different between groups.

    POSTED: THIS WEEK

    ACL remnant preservation favoured over remnant removal regarding tibial tunnel enlargement

  • Home-based strength and stretching exercises for chronic neck pain yield similar outcomes

    57 female patients with chronic neck pain were randomized to undergo either a home-based strength exercise program or stretching exercise program for one-year. The two interventions were compared with respect to changes in neck pain intensity and function. No significant difference was found in either neck pain intensity or function between the treatment groups at the 4-6 and 12-month follow-up assessments. A similar finding was observed when only completers who adhered to the exercise programs were considered. Although the exercise programs were safe, participant adherence rates for both interventions were low, especially after 6 months.

    POSTED: THIS WEEK

    Home-based strength and stretching exercises for chronic neck pain yield similar outcomes

  • de Quervain tenosynovitis: higher success rates with corticosteroid injection & thumb cast

    67 patients with de Quervain tenosynovitis were randomized to receive treatment with a corticosteroid injection (CSI) alone or in combination with thumb spica casting (TSC). The effectiveness of each treatment was examined and compared in terms of success rate, pain intensity, and functional outcomes. Within 3 weeks, both groups experienced significant improvements in success rates compared to their respective baseline outcomes, but with CSI + TSC achieving significantly better results when compared to CSI alone over the 6 month follow-up. The same trend was found in pain intensity and functional outcome at 6 months.

    POSTED: THIS WEEK

    de Quervain tenosynovitis: higher success rates with corticosteroid injection & thumb cast

  • SCI: No significant improvement in urine output, swelling, or spasticity with FES cycling

    14 patients who had sustained a spinal cord injury within the previous 6 months underwent both an experimental and control phase using a randomized, cross-over design, and a 1-week washout period. The purpose of this study was to determine whether a 2-week functional electrical stimulation (FES) cycling program resulted in improved urine output, leg swelling and spasticity in this patient population. Results indicated that FES cycling increased urine output, as well as decreased lower limb swelling and spasticity, however these improvements were not statistically significant. Furthermore, there was a positive impression of change among all patients except two.

    POSTED: THIS WEEK

    SCI: No significant improvement in urine output, swelling, or spasticity with FES cycling

  • Whole-body vibration exercise effective in improving mobility, balance, and general health

    44 frail elderly adults were randomized to treatment either through whole-body vibration (WBV) exercise or a control intervention consisting of usual care, physical therapy, and routine exercises. The effectiveness of each intervention was compared using mobility, balance, and general health outcomes. Over 8 weeks, individuals who underwent whole-body vibration exercise achieved greater and faster improvements in measures of mobility, knee strength, and physical and mental health. Additionally, WBV exercise was demonstrated to be well tolerated.

    POSTED: THIS WEEK

    Whole-body vibration exercise effective in improving mobility, balance, and general health

  • No significant benefits with computer navigation for THA acetabular component positioning

    40 patients undergoing THA were randomized for operation with either a computer-assisted navigation method or the conventional method in the positioning of the acetabular component. One surgeon performed all surgeries. Postoperative CT scans were analyzed to compare the accuracy of both methods. Analysis of the operative anteversion and inclination angles, in addition to the percentage within Lewinnek\'s safe zone, revealed similar results between both groups. Operating time was longer for the computer-assisted group, although it was not associated with an increase in complication rates.

    POSTED: THIS WEEK

    No significant benefits with computer navigation for THA acetabular component positioning

  • Mobile bearing yields similar functional outcome as fixed bearing in TKA at two years

    352 patients with knee osteoarthritis and scheduled to undergo total knee arthroplasty (TKA) were randomized to receive either a fixed or mobile bearing tibial component. Patients were further randomized to undergo patellar resurfacing or to have the patella retained. The purpose of this study was to compare these implants in terms of clinical outcomes. Results at 2 years indicated that patients who underwent TKA using mobile bearings displayed comparable knee function (i.e. Oxford Knee Scores, American Knee Society scores, and range of motion) and SF-12 health survey scores, versus those who received fixed bearings. Furthermore, these outcomes were also comparable whether or not the patient received patellar resurfacing.

    POSTED: 04/15/2014

    Mobile bearing yields similar functional outcome as fixed bearing in TKA at two years

  • Adverse effects more frequent with bioabsorbable vs. metal screws in ACL reconstruction

    This meta-analysis summarized results from eleven randomized control trials (RCTs) involving 878 randomly allocated patients to investigate the use of bioabsorbable interference screws compared to metal interference screws in single bundle primary anterior cruciate ligament (ACL) reconstruction. The study aimed to report adverse effects and clinical outcomes from different screw types after a minimum of one year postoperatively. Results revealed that the use of bioabsorbable screws applied to medial hamstring grafts demonstrated greater tunnel widening on the femoral side, and reported significantly higher rates of effusion and screw breakage with bioabsorbable screws compared to metal screws. Despite the presence of adverse effects, functional and clinical outcome measurements did not differ significantly between the two screw types.

    POSTED: 04/15/2014

    Adverse effects more frequent with bioabsorbable vs. metal screws in ACL reconstruction

  • No effect of topical fibrinogen spray on blood loss and transfusion in TKA

    200 patients scheduled for total knee arthroplasty with tourniquet use (inflated prior to incision and deflated before wound closure) were randomized to surgery with or without the application of a fibrinogen topical spray following the cementing of components. Hemostatic parameters of hemoglobin and hematocrit levels, total blood loss, and transfusion requirements were monitored over the first 3 postoperative days. Clinical assessment was also conducted at 6 week follow-up. The results indicated that there were no significant differences in total blood loss and transfusion needs between the groups. Postoperative drain volume was significantly higher in the group treated with topical fibrinogen when drains were removed at 24 hours.

    POSTED: 04/15/2014

    No effect of topical fibrinogen spray on blood loss and transfusion in TKA

  • The effectiveness of physical therapy for lumbar spinal stenosis remains unknown

    10 studies (5 RCTs, 2 controlled trials, 2 mixed-design studies, and 1 longitudinal cohort study) assessing the effectiveness of physical therapy interventions in patients with lumbar spinal stenosis were included in this review. The results from this study indicated that there is moderate-quality evidence suggesting pain and disability (but not walking distance) is significantly better in patients treated surgically at 2 years compared to those treated with physical therapy. The remaining conclusions were based on low-quality evidence and thus the effectiveness of physical therapy in the treatment of lumbar spinal stenosis remains uncertain.

    POSTED: 04/14/2014

    The effectiveness of physical therapy for lumbar spinal stenosis remains unknown

  • Oral tranexamic acid is safe and effective in reducing post-operative blood loss in TKA

    53 patients scheduled to undergo total knee arthroplasty (TKA) were randomized to either receive or not receive oral administration of tranexamic acid. The purpose was to determine whether this intervention was safe and effective in reducing the amount of postoperative blood loss. Results indicated that the tranexamic acid group displayed significantly better hematocrit levels post-operation and significantly lower bleeding rates 12 and 24 hours post-surgery. At 6 weeks postoperatively, there were no reported thrombotic complications in either group.

    POSTED: 04/14/2014

    Oral tranexamic acid is safe and effective in reducing post-operative blood loss in TKA

  • Local infusion analgesia using a double lumen catheter is safe and effective following TKA

    40 patients with knee osteoarthritis undergoing primary total knee arthroplasty (TKA) were randomized to receive post-operative administration of local infusion analgesia (LIA) or saline using a double lumen catheter. The purpose of this study was to evaluate the effectiveness and safety of this modified LIA for pain relief following TKA procedures. Results indicated that the modified LIA administration technique used in this study safely reduced pain following TKA, resulted in significantly lower serum C-reactive protein (CRP) levels, and significantly more patients treated with modified LIA could perform a straight leg raise on post-operative day 2. There were no significant between-group differences in mean fentanyl consumption or range of motion at any time point.

    POSTED: 04/14/2014

    Local infusion analgesia using a double lumen catheter is safe and effective following TKA

  • Intertrochanteric fractures: Similar rate of reoperation using fixed or sliding side plate

    163 patients with unstable intertrochanteric fractures were randomized to receive surgical treatment using either (1) a sliding hip screw and fixed side plate or (2) a sliding hip screw and a Medoff sliding side plate. The purpose of this study was to compare rates of re-operation and hip function scores following treatment with these two types of hardware. Results after 6 months indicated that the use of a sliding hip screw with a Medoff sliding side plate resulted in a similar re-operation rate, hip function recovery scores, length of hospital stay, haemoglobin drop, number of transfusions, transfusion units, leg-length discrepancy, loss in range of motion, and the incidence of complications. Surgical time was significantly greater in the Medoff sliding side plate group.

    POSTED: 04/11/2014

    Intertrochanteric fractures: Similar rate of reoperation using fixed or sliding side plate

  • Intra-articular bone marrow-derived stem cell injection effective in high tibial osteotomy

    56 patients with medial compartmental osteoarthritis and genu varum were randomized to undergo a high tibial osteotomy with or without an intra-articular injection of cultured autologous bone marrow-derived mesenchymal stem cells (MSC), administered 3 weeks post-treatment. The purpose of this study was to evaluate the clinical outcomes and MRI results of both the cell-recipient and control groups to determine whether bone marrow-derived MSC injections are safe and effective. Results after 2 years indicated that the cell-recipient group had significantly improved clinical outcomes (Tegner, Lysholm and International Knee Documentation Committee scores) and MRI results (cartilage coverage of their lesions and integration of regenerated cartilage) compared to the control group. There were no serious adverse events reported in either group.

    POSTED: 04/11/2014

    Intra-articular bone marrow-derived stem cell injection effective in high tibial osteotomy

  • TKA: Patient-specific guides offer no accuracy benefit over conventional instrumentation

    128 patients scheduled for total knee arthroplasty were randomized to intervention with either patient-specific guides (PSG) or conventional instrumentation. Participants allocated to PSG were managed with pre-operative planning using either Signature (Biomet Inc.), TruMatch (Depuy Inc.), Visionaire (Smith & Nephew Inc.), or Patient-Specific Instruments (Zimmer Inc.). Patients allocated to the conventional group were treated with standard intra- and extramedullary instrumentation. The results indicated that there was no significant improvement over conventional instrumentation offered by PSGs. Additionally, PSGs had to be abandoned intraoperatively in 14 cases, and outliers in tibial component alignment were significantly higher in the PSG cohort.

    POSTED: 04/11/2014

    TKA: Patient-specific guides offer no accuracy benefit over conventional instrumentation

  • Satisfaction and adverse events improved with multimodal analgesia in elbow surgery

    61 patients were randomized to determine the efficacy of multiodal analgesia compared to intravenous patient-controlled analgesia with opioids for pain management following elbow surgery. Pain, rescue analgesic requirements, ability to achieve scheduled rehabilitation, and patient satisfaction were assessed over the first 14 postoperative days. The results indicated that pain, either at rest or during exercise, was similarly reduced between the two analgesia methods. Opioid-related complications were lower with multimodal analgesia, and patients were more satisfied with the multimodal regimen.

    POSTED: 04/10/2014

    Satisfaction and adverse events improved with multimodal analgesia in elbow surgery

  • Quadriceps-sparing TKA reduced time to discharge vs standard minimally-invasive approach

    102 patients undergoing total knee arthroplasty (TKA) were randomized to receive either a minimally-invasive quadriceps-sparing (MIS) approach or the standard medial parapatellar approach. Clinical, functional and radiological outcomes were compared during the immediate postoperative period and again at 2 years. Results indicated that patients treated using the MIS technique experienced significantly shorter time to discharge readiness and fewer complications. Clinical and functional outcomes were comparable between groups, and there was no evidence of radiographic loosening in either group at the 2-year follow-up.

    POSTED: 04/10/2014

    Quadriceps-sparing TKA reduced time to discharge vs standard minimally-invasive approach

  • Knee OA: An 8-week non-weightbearing strengthening program yields greatest pain reduction

    Eight randomized controlled trials were included in this meta-analysis which investigated the difference between muscle strengthening and aerobic exercise for treatment of knee osteoarthritis. The included trials featured 11 intervention groups composed of either non-weightbearing strengthening, weightbearing strengthening, or aerobic exercise protocols. The results indicated that all three rehabilitation techniques significantly reduced pain in the short term compared to control treatment, with the greatest effect size exhibited by non-weightbearing muscle strengthening.

    POSTED: 04/10/2014

    Knee OA: An 8-week non-weightbearing strengthening program yields greatest pain reduction

  • Autograft vs synthetic graft for ACL reconstruction

    50 patients with arthrocsopically confirmed unilateral ACL rupture were randomized to undergo reconstruction with middle third PT graft or the synthetic Leeds-Keio ligament graft. At the end of 5 year follow up, the overall functional outcome and patient satisfaction in patients undergoing Leeds-Keio (LK) ACL repair were found to be similar to the traditional autogenous patellar tendon ACL reconstruction.

    POSTED: 04/09/2014

    Autograft vs synthetic graft for ACL reconstruction

  • Dynamic compression plates possibly advantageous in treatment of humeral shaft fracture

    10 studies (8 randomized and 2 quasi-randomized controlled trials) were included in this analysis comparing intramedullary nails and dynamic compression plates in the treatment of humeral shaft fractures. The results indicated that while fracture union, functional outcome, and rates of radial nerve injury and infection were similar between treatments, intramedullary nails were associated with higher incidences of intraoperative fracture communition, shoulder impingement, restricted range of motion, implant failure, and re-operation. The strength of these findings were limited by the low quality of evidence, as evaluated using the GRADE system.

    POSTED: 04/08/2014

    Dynamic compression plates possibly advantageous in treatment of humeral shaft fracture

  • Potential improvement in vascularization following rotator cuff repair with L-PRF

    20 patients with a chronic full-thickness rotator cuff tear were randomized to undergo arthroscopic repair either with or without the application of leukocyte- and platelet-rich fibrin (L-PRF). The purpose of this study was to determine if L-PRF increased vascularization of the rotator cuff over the first 3 postoperative months. The results at 6 weeks indicated that vascularity was, indeed, improved in the group treated with L-PRF. However, the difference between groups at 12 weeks was not statistically significant. Both groups were observed to have similar repair integrity, repair quality, and clinical outcomes over the 3-month follow-up.

    POSTED: 04/08/2014

    Potential improvement in vascularization following rotator cuff repair with L-PRF

  • All-inside versus conventional ACL reconstruction: impact on postoperative pain?

    46 patients scheduled for anterior cruciate ligament reconstruction were randomized to undergo surgery using either the all-inside technique or conventional technique. The purpose was to compare postoperative pain between the two techniques at 1 month following surgery, and measures of radiographic and functional outcome at 6 months. The results indicated lower pain with the all-inside technique, however the assessment was underpowered. Functional outcome was similar between the two techniques.

    POSTED: 04/08/2014

    All-inside versus conventional ACL reconstruction: impact on postoperative pain?

  • Blood loss and transfusion needs reduced with TXA in major orthopaedic surgery

    46 randomized controlled trials were included in this meta-analysis to investigate the use of tranexamic acid (TXA) in major orthopaedic surgery. The purpose of this analysis was to determine if blood loss and transfusion requirements were reduced with the application of TXA. Results revealed that intraoperative, postoperative and total blood loss were significantly reduced with tranexamic acid. Transfusion requirements, including mean number of units and volume, were also significantly reduced. The incidence of deep vein thrombosis was similar between groups.

    POSTED: 04/08/2014

    Blood loss and transfusion needs reduced with TXA in major orthopaedic surgery

  • Electro-acupuncture reduces arthralgia in cancer patients taking aromatase inhibitors

    67 women with non-metastatic breast cancer (Stage I-III) experiencing joint pain attributed to the use of aromatase inhibitor (AI) were included in this study. Subjects were randomized to an intervention group, or a wait list control (WLC) group. Those randomized to the intervention group were further randomly allocated to either electro-acupuncture (EA; electrical stimulation via acupuncture needles) or sham acupuncture (SA). The purpose of this study was to examine the effect of these interventions on reducing arthralgia, or joint pain, in these patients. Results at 8 weeks indicated that patients in the EA group experienced greater improvements in pain severity, pain-related interference, patient global impression of change, WOMAC scores, and DASH scores, compared to those in the WLC group. Significantly better improvements in pain severity and pain-related interference in the EA group were maintained at the 12-week follow-up. Notably, there were no significant differences in study outcomes between the EA and SA groups.

    POSTED: 04/08/2014

    Electro-acupuncture reduces arthralgia in cancer patients taking aromatase inhibitors

  • PCL preservation not advantageous over resection in mobile-bearing TKA

    69 patients (90 knees) scheduled for total knee arthroplasty (TKA) with a highly conforming, mobile-bearing insert were randomized to have the posterior cruciate ligament (PCL) either retained for resected during surgery. The purpose was to determine if PCL preservation led to better kinematic and clinical outcome. Intraoperative kinematic measurements indicated that PCL-preserving TKA was associated with greater anterior translation and more varus femoral rotation than PCL-sacrificing TKA. Clinical outcome was similar between groups at a minimum of 2 years follow-up. Based on the results, PCL resection is suggested in highly conforming mobile-bearing TKA.

    POSTED: 04/08/2014

    PCL preservation not advantageous over resection in mobile-bearing TKA

  • Alendronate & zoledronate both reduce hip and vertebral fracture risk compared to placebo

    19 randomized controlled trials were included in this systematic review which investigated the effect bisphosphonates on decreasing fracture risk and increasing bone mineral density in osteoporotic and osteopenic postmenopausal women. 17 studies were used for quantitative synthesis. The two drugs which were evaluated were alendronate and zoledronate. At a minimum of 1 year follow-up, hip and vertebral fracture risk was significantly reduced with both treatments. Alendronate was also associated with significant increases in bone mineral density at the total hip, femoral neck, and lumbar spine, although meta-analysis for BMD could not be performed for zoledronate.

    POSTED: 04/08/2014

    Alendronate & zoledronate both reduce hip and vertebral fracture risk compared to placebo

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