Visual Analog Scale Pain Scores Research Articles

Meniscal healing status after medial meniscus posterior root repair negatively correlates with a midterm increase in medial meniscus extrusion.

The second-look arthroscopic score of pullout repair for medial meniscus posterior root tears (MMPRTs) is associated with contemporaneous clinical scores and progression of cartilage damage. However, the relationship among these scores, midterm clinical scores and magnetic resonance imaging (MRI) evaluations is unknown. The relationship between the second-look arthroscopic score at 1 year and the clinical scores or MRI at 3 years was evaluated. Sixty-three patients were included. Medial meniscus extrusion (MME) was evaluated preoperatively and at 3 years postoperatively. Clinical scores were evaluated preoperatively, and 1 and 3 years postoperatively. Meniscal healing status was assessed using the semiquantitative second-look arthroscopic score at 1 year postoperatively. Correlation coefficients between patient characteristics, postoperative clinical scores or second-look arthroscopic score and the change in MME (ΔMME) were evaluated. Multiple regression analysis was performed on the ΔMME to evaluate the effects of patient characteristics and second-look arthroscopic scores. No significant correlation was observed between patient characteristics and ΔMME. In contrast, a significant correlation was found between the second-look arthroscopic score and ΔMME (p < 0.001) and visual analogue scale pain score (p = 0.016) at 3 years postoperatively. In the subitems of the second-look arthroscopic score, width (p < 0.001) and stability (p = 0.009) scores also showed significant correlations with ΔMME. Multiple regression analysis showed a significant association between the second-look arthroscopic score and ΔMME (p = 0.001). The second-look arthroscopic score at 1 year postoperatively correlated with the ΔMME and clinical score at 3 years postoperatively. Second-look arthroscopic scores predict midterm meniscal function after pullout repair of MMPRTs. Level IV.

Low-dose naltrexone for post-COVID fatigue syndrome: a study protocol for a double-blind, randomised trial in British Columbia

IntroductionA significant proportion of individuals suffering from post COVID-19 condition (PCC, also known as long COVID) can present with persistent, disabling fatigue similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and...

Postoperative pain score does not correlate with injury severity in isolated tibial plateau fractures.

Appropriate management of acute postoperative pain is critical for patient care and practice management. The purpose of this study was to determine whether postoperative pain score correlates with injury severity in tibial plateau fractures. A retrospective review of prospectively collected data was completed at a single academic level one trauma center. All adult patients treated operatively for tibial plateau fractures who did not have concomitant injuries, previous injury to the ipsilateral tibia or knee joint, compartment syndrome, inadequate follow-up, or perioperative regional anesthesia were included (n = 88). The patients were split into groups based on the AO/OTA fracture classification (B-type vs C-type), energy mechanism, number of surgical approaches, need for temporizing external fixation, and operative time as a proxy for injury severity. The primary outcome measure was the visual analog scale (VAS) pain score (average in the first 24h, highest in the first 24h, two- and six-week postoperative appointments). Psychosocial and comorbid factors that may affect pain were studied and controlled for (history of diabetes, neuropathy, anxiety, depression, PTSD, and previous opioid prescription). Additionally, opioid use in the postoperative period was studied and controlled for (morphine milligram equivalents (MME) administered in the first 24h, discharge MME/day, total discharge MME, and opioid refills). VAS scores were similar between groups at each time point except the two-week postoperative time point. At the two-week postoperative time point, the absolute difference between the groups was 1.3. The groups were significantly different in several injury and surgical variables as expected, but were similar in all demographic, comorbid, and postoperative opioid factors. There was no clinical difference in postoperative pain between AO/OTA 41B and 41C tibial plateau fractures. This supports the idea of providers uncoupling nociception and pain in postoperative patients. Providers should consider minimizing extended opioid use, even in more severe injuries.

Comparison of the effect of A-PRF and L-PRF application to the palatal donor sites on quality of life and wound healing after free gingival graft surgery.

This study compared the effects of L-PRF and A-PRF on patients' quality of life and the healing of palatal wounds after free gingival graft harvesting. After FGG harvesting, palatal donor sites of 36 patients were assigned one of the three group: 1)L-PRF group, 2) A-PRF group and 3) Palatal stent+periodontal pack group (control group).Wound healing was evaluated by H2O2 test. Pain was evaluated by visual analog scale (VAS)and number of analgesics consumed. For patient quality of life, the Oral Health Impact Profile-14 (OHIP-14) questionnaire was utilized. Complete epithelialization was higher in thecontrol group on the 7th day than test groups (p< 0.05). Complete epithelization was achievedin all groups 14th day postoperatively. VAS scores for pain and the number of analgesic tabletsconsumed were similar in all groups (p >0.05). OHIP-14 total scores were similar in all studygroups at 7th day postoperatively (p>0.05). OHIP-14 total and physical pain scores was lowerin L-PRF group than A-PRF group at 14th day postoperatively (p< 0.05). Asidefrom the slight superiority of L-PRF over A-PRF, it can be concluded that both PRF procedureshave similar effects on palatal wound healing and quality of life.

A clinical evaluation of low-level laser therapy for pain reduction in early treatment stages: A pilot study

Objectives: This study aimed to clinically evaluate the efficacy of low-level laser therapy (LLLT) in reducing pain associated with orthodontic movement during the early stages of treatment. Material and Methods: A randomized controlled trial was conducted with 20 participants undergoing non-extraction orthodontic treatment. The laser group (LG, n = 10) received LLLT (808 nm, 100 mW) immediately after appliance installation, while the control group (CG, n = 10) received no pain control intervention. Pain levels were assessed using a visual analog scale (VAS) at 6, 24, 48, and 72 h till 7 days with an interval of 24 h. Statistical analyses included Chi-square tests and Mann–Whitney tests. Results: The LG consistently demonstrated significantly lower pain scores during chewing and at rest compared to the CG. After 6 h post-treatment, the median pain score on chewing in the LG was markedly lower than the CG (P &lt; 0.001), a trend observed at each subsequent interval till 7 days. The comparison of spontaneous pain also favored the LG at various time points. Lower median VAS scores for pain on chewing among the LG and CG were zero and two, respectively, with a significant difference. The maximum median VAS scores for pain on chewing among the LG and CG were five and seven, respectively, with a significant difference. Conclusion: This study provides robust evidence supporting the effectiveness of LLLT in reducing orthodontic pain during the early stages of treatment. The sustained and significant reduction in pain scores, coupled with rigorous statistical analyses, emphasizes the potential of LLLT as a valuable adjunctive therapy in orthodontic practice.

Comparison of Lateral and Central Achilles Tendon-Splitting Approaches in the Treatment of Haglund Deformity.

This study aimed to compare the complications and outcomes of lateral and central Achilles tendon-splitting approaches for the treatment of Haglund syndrome. Patients who underwent surgery for Haglund syndrome between June 2012 and June 2022 were included in the study. Patients undergoing lateral approach surgery were included in group 1, whereas patients undergoing central Achilles tendon-splitting approach surgery were included in group 2. Surgical outcomes of the patients were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale, visual analog pain scale (VAS), and Victorian Institute of Sport Assessment-Achilles (VISAA) scores. In addition, preoperative and final follow-up scores were compared. The study included 66 patients: 32 (14 females, 18 males) underwent surgery using the lateral approach in group 1, whereas in group 2, 34 patients (18 females, 16 males) underwent surgery using the central Achilles tendon-splitting approach. There was a significant statistical difference in the AOFAS, VISAA, and VAS scores between preoperative and final follow-up for both group 1 and group 2 (P < .001, P < .001, P < .001, P < .001, respectively). Group 1 had a small (0.76) relative increase in VAS score compared with group 2 (P = .033). There was no significant difference between the complication rates of group 1 and group 2. In our study, we found the lateral approach and central Achilles tendon-splitting approaches to be safe and effective in the surgical treatment of Haglund syndrome without clinically meaningful differences in outcomes or complication rates. Level III, retrospective cohort study.

Enhancing patient comfort in varicose vein treatment through combined lidocaine and ropivacaine tumescent anesthesia

ObjectiveTo compare the analgesic effects of specific tumescent anesthetic solutions composed of lidocaine, ropivacaine, or a combination of lidocaine and ropivacaine during endovenous radiofrequency ablation for the treatment of great saphenous vein varicosities.MethodThis study included 149 patients with lower limb varicose veins who were admitted to our department between 2019 and 2023. The patients were randomly assigned to three groups: the lidocaine group (Group I), the ropivacaine group (Group II), and the lidocaine + ropivacaine group (Group III). Intraoperative vital signs, intraoperative and postoperative visual analog scale (VAS) pain scores, and long-term treatment outcomes were assessed using the venous clinical severity score (VCSS) based on clinical performance.ResultsThere were no significant differences in age, body mass index, operative time, or blood loss among the three groups (P ≥ 0.05). The differences in the mean arterial pressure and heart rate during surgery in Group II were significantly greater than those in Groups I and III (P &amp;lt; 0.05). The intraoperative VAS scores in Group II were higher than those in Groups I and III (P &amp;lt; 0.05) and at 8 and 12 h postoperatively. There were no significant differences in VCSS among the groups (P ≥ 0.05).ConclusionThe use of a tumescent anesthetic solution composed of lidocaine and ropivacaine significantly improved patient comfort during the perioperative period without affecting surgical outcomes. This formulation can be considered safe and reliable for preparing tumescent anesthesia solutions.

Effect of needle-free injection on psychological insulin resistance and insulin dosage in patients with type 2 diabetes

Background and objectivePsychological insulin resistance (PIR), which refers to the reluctance of diabetic patients to use insulin, is a frequently encountered clinical issue. Needle-free injection (NFI) offers advantages in terms of expediting insulin absorption and mitigating adverse reactions related to injection. To evaluate the effects of subcutaneous injection of insulin aspart 30 with NFI on PIR and insulin dosage in patients with type 2 diabetes mellitus (T2DM).MethodsSixty-four patients with T2DM participated in this randomized, prospective, open, crossover study. Insulin aspart 30 was administered subcutaneously to each subject via QS-P NFI and Novo Pen 5 (NP) successively. The effects of NFI on PIR were analyzed. Differences in insulin dosage, glycemic variability, and injection safety were compared at similar levels of glycemic control.ResultsAfter the administration of NFI, the insulin treatment attitude scale score decreased (53.7 ± 7.3 vs. 58.9 ± 10.7, p&amp;lt;0.001), the insulin treatment adherence questionnaire score increased (46.3 ± 4.9 vs. 43.8 ± 7.1, p&amp;lt;0.001), and the insulin treatment satisfaction questionnaire score increased (66.6 ± 10.5 vs. 62.4 ± 16.5, p&amp;lt;0.001). At the same blood glucose level, NFI required a smaller dosage of insulin aspart 30 compared with that of NP (30.42 ± 8.70 vs. 33.66 ± 9.13 U/d, p&amp;lt;0.001). There were no differences in glycemic variability indices (standard deviation, mean amplitude of glycemic excursion or coefficient of variation) between the two injection methods. Compared with NP, NFI did not increase the incidence of hypoglycemia (17.2% vs. 14.1%, p=0.774), and it decreased the incidence of induration (4.7% vs. 23.4%, p=0.002) and leakage (6.3% vs. 20.3%, p=0.022) while decreasing the pain visual analog scale score (2.30 ± 1.58 vs. 3.11 ± 1.40, p&amp;lt;0.001).ConclusionNFI can improve PIR in patients with T2DM and be used with a smaller dose of insulin aspart 30 while maintaining the same hypoglycemic effect.Clinical trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2400083658.

Association of Poor Bone Quality with Pseudarthrosis and Poor Clinical Outcomes in Single-Level Instrumented Lumbar Arthrodesis Using Local Autologous Bone Graft.

Although osteoporosis and low bone mineral density is thought to lead to poor fusion outcomes, few studies have adequately addressed the correlation, and they were limited by small sample size at a single institution. We completed a secondary analysis of 182 patients enrolled at 26 spine centers across the United States in the EXO-SPINE FDA-approved clinical trial with 12-month CT-based fusion status determined by two independent, blinded radiologists. Using previously described CT-based techniques, we measured local and global Hounsfield units (HU) and examined the relationship with radiographic and clinical outcomes. CT scans were available for review from 95 patients, with a mean age of 56.2 years and mean global density of 153.0 HU. No relationship was observed between HU and radiographic fusion status or clinical outcomes. Although 12% of patients had lumbar vertebral body HU measurements consistent with osteoporosis, this classification had no relation with fusion or clinical outcomes. Patients with pseudarthrosis had higher Oswestry Disability Index (22.2 vs. 16.6, P = 0.037) and back pain visual analog scale (7.0 vs. 4.9, P = 0.014) scores than patients with at least unilateral fusion at the 12-month follow-up. In this large, multicenter study, lower vertebral body HU was not associated with worse fusion status after single-level instrumented posterolateral lumbar fusion using only local autologous bone graft. However, there was an association between radiographic fusion status and clinical outcomes, validating the importance of determining predictors of successful fusion. Assessment of fusion status with CT scans yielded a much lower fusion success rate with local bone graft than previously reported and may warrant additional investigation.

SIMULATED WEIGHT REDUCTION WITH AN ANTI-GRAVITY TREADMILL: A PILOT STUDY TO ASSESS PAIN REDUCTION IN FOOT AND ANKLE ARTHRITIS

IntroductionOsteoarthritis in the foot and ankle affects approximately 30,000 patients annually in the UK. Evidence has shown that excess weight exacerbates foot pain, with significant increases in joint forces. However, despite the current trend for Clinical Commissioning Groups to ration surgery for obese patients, studies have not yet determined the effect of weight loss in obese patients with foot and ankle arthritis.AimPilot study to investigate the effect of simulated weight loss on pain scores in obese patients with symptomatic foot and ankle arthritis.MethodsFollowing ethical approval, a prospective study of 17 obese patients (mean BMI 39.2, range 31.2 – 50.3) with foot and ankle arthritis was undertaken (BOFAS funded). Under physiotherapist supervision, patients walked for one minute on an anti-gravity treadmill, which allowed simulated weight reduction. Following baseline assessment, reduced BMI was simulated, starting at 20, rising in increments of 5, until each patient's usual BMI was reached. Pain was assessed using a Visual Analogue Scale (VAS). Repeated measures ANOVA was used to assess for significant changes in pain, comparing baseline with each simulated BMI category (significance set at p&lt; 0.05).ResultsSimulated weight loss caused a significant reduction in pain (p=0.005, power 0.91). Mean VAS pain scores improved by 24% (p=0.003) and 17% (p=0.040) for BMI categories 20 and 25, compared with baseline. Pain scores were not significantly different comparing BMI categories of 25 and 20.ConclusionSimulated weight loss to normal BMI significantly decreased pain in obese patients with foot and ankle arthritis. The use of the anti-gravity treadmill to demonstrate the feeling of normal BMI has also provided motivation to several patients to lose weight. The current study could be used to power future studies to investigate the effects of weight loss in foot and ankle patients.

Mid-term Clinical Outcomes of "Light Bulb" Core Decompression with Arthroscopic Assistance in Peri-collapse Osteonecrosis of the Femoral Head: A Retrospective Comparative Study.

Nontraumatic osteonecrosis of the femoral head (ONFH) is commonly encountered in orthopedics. Without early clinical intervention, most patients with peri-collapse of the ONFH will develop femoral head necrosis and eventually require hip replacement surgery. The aim of this study is to evaluate clinical outcomes in patients with ONFH who underwent "light bulb" core decompression (CD) with arthroscopic assistance and to compare them with the outcomes of those treated with traditional procedures. A retrospective review of patients with Stage II and IIIA (Peri-collapse) radiographic findings based on the Association Research Circulation Osseous (ARCO) stage for ONFH who underwent "light bulb" CD with or without arthroscopic assistance by a single-surgeon team between March 2014 and December 2018 was performed. All patients were followed up for a minimum of 2 years. The visual analogue scale (VAS) pain score, Harris hip score (HHS), and radiological imaging were evaluated. The categorical parameters were analyzed by chi-square test and the continuous variables conforming to a normal distribution were analyzed by Student's t-test. The study included a total of 39 patients (18 and 21 patients in the with and without arthroscopic assistance groups, respectively), with a mean age of 40.3 years and a mean follow-up of 22.2 months. Overall, there was a better VAS score in the arthroscopic assistance group than in the control group (p < 0.05), There was a significant difference in HHS (80.1 ± 9.2 vs 75.1 ± 12.7) at the last follow-up (p < 0.05). The rate of good and excellent outcomes was 94%. Similarly, there was no significant difference in the total rate of complications or conversion to THA. With arthroscopic assistance, "light bulb" CD could be achieved via hip arthroscopy with less trauma, and it offered the opportunity for more precise evaluation and monitoring for therapy and yielded better VAS scores after surgery and better hip function outcomes at the last follow-up.

[Evaluation of the efficacy of medial open wedge high tibial osteotomy combined with anterior cruciate ligament reconstruction in the treatment of varus knee osteoarthritis with anterior cruciate ligament injury].

Objective: To evaluate the efficacy of medial open wedge high tibial osteotomy (MOWHTO) combined with anterior cruciate ligament (ACL) reconstruction in the treatment of varus knee osteoarthritis (OA) with ACL injury. Methods: A follow-up study. The study retrospectively analyzed the patients underwent MOWHTO combined with ACL reconstruction for treatment of varus knee OA with ACL injury in Tianjin Hospital between April 2018 and September 2022. The preoperative and postoperative posterior slope angle (PSA), hip-knee-ankle angle (HKA), visual analog scale (VAS) pain scores, Lysholm score, International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Tegner score were compared. The follow-up indicators were recorded at 6 weeks, 3 months and 1 year after operation, and the complications were recorded. Results: The study included 32 patients (23 males, 9 females) with a mean age of (50.7±8.4) years. The mean follow-up time was (21.2±4.8) months. PSA increased from 9.2°±1.8° preoperatively to 11.1°±2.4° postoperatively, and HKA increased from 168.7°±2.2° to 181.5°±2.2° (both P<0.01). The indicators such as VAS score (6.8±1.1 vs 1.8±0.4), Lysholm score (52.6±7.1 vs 82.0±6.4), IKDC score (64.7±6.2 vs 80.3±10.0), WOMAC score (51.8±6.3 vs 81.8±6.5), and Tegner score (1.9±0.6 vs 5.0±1.0) were all improved after the operation (all P<0.01). Complications occurred in 5 patients (15.6%), including hematomas, sensory abnormalities, intermuscular vein thrombosis and correction angle loss. Conclusion: MOWHTO combined with ACL reconstruction is a safe and effective approach for the treatment of varus knee OA with ACL injury.

Efficiency of pulsed electromagnetic field and neuromuscular electrical stimulation on painful shoulder following stroke

Efficiency of pulsed electromagnetic field and neuromuscular electrical stimulation on painful shoulder following stroke

Clinical effect of digitalized designed and 3D-printed repositioning splints in the treatment of anterior displacement of temporomandibular joint disc

ObjectiveTo compare the treatment effectiveness of digitized and 3D-printed repositioning splints with that of conventional repositioning splints in the treatment of anterior displacement of the temporomandibular joint disc.MethodsThis retrospective study included 96 patients with disc displacement of the anterior temporomandibular joint. They were treated with either digitally designed and 3D-printed repositioning splints or traditional splints and followed up for at least six months. Changes in signs and symptoms such as pain and mouth opening before and after treatment were recorded to evaluate treatment outcomes.ResultsDuring the first month of treatment, both the digitally designed and 3D-printed repositioning splint groups (Group B) and the traditional repositioning splint group (Group A) showed significant increases in mouth opening, with increases of 4.93 ± 3.06 mm and 4.07 ± 4.69 mm, respectively, and there was no significant difference between the two groups. Both groups had a significant reduction in visual analog scale (VAS) pain scores, with Group B showing a greater reduction of 1.946 ± 1.113 compared to 1.488 ± 0.978 in Group A (P < 0.05). By the sixth month, Group B’s mouth opening further improved to 38.65 ± 3.22 mm (P < 0.05), while Group A’s mouth opening did not significantly improve. Regarding pain, Group A’s VAS score decreased by 0.463 ± 0.778 after one month, and Group B’s score decreased by 0.455 ± 0.715; both groups showed significant reductions, but there was no significant difference between the two groups.ConclusionCompared with traditional repositioning splints, digitally designed and 3D-printed repositioning splints are more effective at reducing patient pain and improving mouth opening. 3D-printed repositioning splints are an effective treatment method for temporomandibular joint disc displacement and have significant potential for widespread clinical application.

Acute coronary syndrome in elderly and senile diabetic patients

Acute coronary syndrome (ACS) remains a common cause of hospitalization in diabetes mellitus (DM) patients. It is believed that diabetic neuropathy patients have a high atypical course incidence of acute coronary syndrome, because of the frequent neuropathy development in diabetes patients, but the data on this are quite contradictory. Aim: The study aimed to determine the features of the pain syndrome and its severity in ACS and concomitant diabetes patients. Materials and Methods: The study involved 36 diabetes patients (22 men and 14 women) aged 62-86 years, hospitalized urgently for ACS. Pain syndrome was assessed during hospitalization and immediately after coronary artery revascularization using the following criteria: visual analogue scale (VAS), Numerical Rating Scale (NRS), clinical data, and biochemical markers. Results: Most of the patients (91.67%) complained of chest pain at the time of hospitalization, the rest were not bothered by any pain. Patients described pain as “burning” (30.56 %), “squeezing” (30.56 %), “tightness” (25.0 %), and “tingling” (5.56 %). There were also complaints of difficulty breathing (13.89 %), shortness of breath (11.1 %), and palpitations (41.67 %). The appearance of excessive sweating was noticed by 16.67% of patients. There was no statistically significant difference between the results of VAS and NRS pain scores (p &gt; 0.1). The mean blood glucose level at hospitalization was 8.19±3.45 mmol/l (in men – 8.17±3.61 mmol/l, in women – 8.28±3.13 mmol/L). Glycemia level higher than 10.0 mmol/l was detected in 8 patients, which accounted for 22.22% of all patients. Severe pain syndrome patients dominated in this category (62.5 %). Conclusions: In patients with myocardial infarction and diabetes, the typical clinical picture of ACS prevailed (91.67% of patients) over the painless form. Before revascularization, moderate to severe pain occurred with equal frequency; there were no statistical differences between blood pressure, heart rate, and blood glucose level (p&gt; 0.1) in patients with severe and moderate pain. Hyperglycemia (≥10.0 mmol/l) was detected in 22.22% of patients, among whom severe pain syndrome patients prevailed. _________________________________________________________________________________________ Keywords: elderly patients; diabetes mellitus; acute coronary syndrome; pain syndrome

Defining Minimal Clinically Important Difference, Patient Acceptable Symptomatic State and Substantial Clinical Benefit for the Visual Analog Scale Pain Score After Arthroscopic Rotator Cuff Repair

IntroductionPatient satisfaction after arthroscopic rotator cuff repair (RCR) is commonly assessed with patient-reported outcome measures (PROMs), and there is an increased need to establish clinical relevance within these measures. The purpose of this study was to (1) define Minimal Clinically Important Difference (MCID), Patient Acceptable Symptomatic State (PASS) and Substantial Clinical Benefit (SCB) for the visual analog scale (VAS) pain score in patients undergoing arthroscopic RCR, and (2) identify preoperative predictors of achieving each of these threshold values. MethodsData from consecutive patients who underwent primary arthroscopic rotator cuff repair study between 2010 and 2016 were prospectively collected. Baseline data and VAS pain scores were collected preoperatively and at 1 year and 2 years postoperatively. MCID, PASS and SCB were determined using an anchor-based approach, with anchor questions assessing postoperative satisfaction and expectation fulfilment. Multivariate logistic regression analysis was also used to identify preoperative predictors for achieving MCID, PASS and SCB. ResultsA total of 286 patients were included in the final analysis, with an average age of 60.2 ± 10.4 and the majority being female (61.2%). The values for VAS pain score identified to represent MCID, PASS, and SCB, respectively at 1-year postoperatively were: 5, 2 and 1. The rates of achieving clinically significant improvement based on VAS were 60.5%, 63.3% and 57.2% respectively. A higher preoperative VAS was predictive for achieving MCID (odds ratio [OR], 1.84; P<0.01). ConclusionThis study identified threshold VAS pain scores of 5, 2 and 1 for achieving MCID, PASS, and SCB, respectively, at 1-year follow-up after arthroscopic rotator cuff repair. A higher preoperative VAS pain score was also identified as a statistically significant predictor of attaining MCID after arthroscopic rotator cuff repair. Level of evidenceII

Single Dose IV Tranexamic Acid is Safe for use in Hip Arthroscopy

The primary purpose of this study was to determine if TXA is safe to administer preoperatively for patients undergoing hip arthroscopy by comparing the rate of VTE and complications between patients who did and did not receive TXA pre-operatively. This is a multicenter consecutive cohort series of patients that underwent arthroscopic hip surgery from 2014-2021. The two cohorts were patients who did and did not receive TXA preoperatively (single dose of 1-2g) after a practice change. Data was collected via chart review. Surgical outcomes included: days until follow up, Visual Analog Scale (VAS) pain scores at first follow-up, total operating room time, number of arthroscopic fluid bags (3 liters/bag), complications and revision operations up to 1 year after surgery. A Mann-Whitney U test was performed for continuous variables and chi square test for categorical variables. A total of 862 patients were identified: 449 (52%) did receive TXA and 413 (48%) did not. Patient demographics including age, sex, height, weight, BMI, smoking status, procedures performed, number of anchors used (no TXA: 3.5 anchors; TXA 3.7 anchors), and traction time (no TXA: 38 minutes; TXA: 40 minutes) did not significantly differ between groups. Significantly more patients had a prior hip arthroscopy in the group that received TXA (primary n=404; prior hip arthroscopy n=45) compared to the group that did not receive TXA (primary n=388; prior hip arthroscopy n=25) (p=0.03). VAS pain scores at the first follow up visit (no TXA: 2.61; TXA: 2.62 TXA) (p=0.62) and need for subsequent revision surgery were not significantly different (n=24 no TXA and n=18 TXA) (p=0.68). TXA use was associated with less arthroscopic fluid utilization (no TXA: 5.9 bags of 3L fluid; TXA: 5.3 bags of 3L fluid) (p<0.01) and less total operating room (OR) time (no TXA: 99.5 minutes; TXA: 90.0 minutes) (p<0.01). There was a higher overall complication rate in the no TXA group (n=27) compared to the TXA group (n=10) (p=0.01). However, if lateral femoral cutaneous nerve neuropraxia was excluded, then no difference in complication rate was observed (p=0.24). There was no difference in the incidence of VTE complications between patients that did and did not receive TXA preoperatively. We observed a lower overall complication rate in patients who received TXA preoperatively; however, this normalized between the two groups when LFCN neuritis was excluded. No difference in early pain control or revision surgery rates were observed between groups. While there was statistically less arthroscopic fluid utilization and less total OR time in the group that received TXA, further studies are needed to clarify whether this is clinically meaningful. In conclusion, preoperative administration of TXA is a safe adjunct medication for patients undergoing arthroscopic hip surgery.

Effects of a Modified Long-Acting Cocktail on Analgesia and Enhanced Recovery After Total Hip Arthroplasty: A Double-Blinded Randomized Clinical Trial

BackgroundWe compared the efficacy and safety of a modified cocktail for postoperative analgesia and early functional rehabilitation in patients undergoing total hip arthroplasty (THA). MethodsA prospective, double-blind randomized controlled trial was conducted with 200 patients who underwent unilateral primary THA at our hospital. Magnesium sulfate and sodium bicarbonate were added to a traditional cocktail of ropivacaine, epinephrine, and dexamethasone. Primary outcome measures were visual analogue scale (VAS) pain scores at various intervals after surgery; morphine consumption for rescue analgesia after surgery; and time to first rescue analgesia. Secondary outcomes were hip function after surgery, daily walking distance, and quadriceps muscle strength. The third index was the incidence of postoperative adverse reactions. ResultsMorphine consumption was significantly lower in the modified cocktail group than in the control group in the first 24 hours after surgery (6.2 ± 6.0 versus 14.2 ± 6.4 mg, P < 0.001), as was total morphine consumption (10.0 ± 8.6 versus 19.2 ± 10.1 mg, P < 0.001). The duration of the first rescue analgesia was significantly prolonged (23.7 ± 10.3 versus 11.9 ± 5.8 mg, P < 0.001). Morphine consumption was also significantly reduced in the magnesium sulfate and sodium bicarbonate groups over a 24-hour period compared with that in the control group (9.4 ± 6.5 versus 14.2 ± 6.4 mg, P < 0.001, 9.6 ± 6.4 versus 14.2 ± 6.4 mg, P < 0.001). The modified cocktail group had significantly lower resting VAS pain scores than the control group at 6, 12, and 24 hours after surgery (P = 0.036, P = 0.010, and P = 0.017, respectively). The VAS pain scores during movement at 6 and 12 hours after surgery were also significantly lower than those in the control group (P = 0.045, P < 0.001, respectively). The modified cocktail, magnesium sulfate, and sodium bicarbonate groups showed better hip range of motion (P < 0.001, P = 0.013, P = 0.046, respectively) and longer walking distance (P < 0.001, P = 0.014, P = 0.019, respectively) on the first postoperative day, and levels of inflammatory markers were significantly reduced. The incidence of postoperative adverse reactions was similar among the four groups. ConclusionThe modified cocktail with a new adjuvant can prolong the duration of postoperative analgesia, reduce the dosage of rescue analgesics, and accelerate early postoperative functional recovery in patients undergoing THA.

Comparison of Clinical Outcomes After Different Surgical Approaches for Lateral Epicondylitis: A Systematic Review and Meta-analysis.

Lateral epicondylitis (LE) is one of the most common causes of lateral elbow pain. When nonoperative treatment fails, 1 of the 3 surgical approaches-open, percutaneous, or arthroscopic-is used. However, determining which approach has the superior clinical outcome remains controversial. To review the outcomes of different operative modalities for LE qualitatively and quantitatively. Systematic review; Level of evidence, 4. This review was performed and reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies published in PubMed, Medline (via EBSCO), and ScienceDirect databases that treated LE with open, percutaneous, or arthroscopic approaches with at least 12 months of follow-up were included. Study quality was assessed using the Cochrane Risk of Bias 2 tool and the Methodological Index for Non-Randomized Studies score. The primary outcome was the success rate of each operative treatment approach-open, percutaneous, and arthroscopic. From an initial search result of 603 studies, 43 studies (n = 1941 elbows) were ultimately included. The arthroscopic approach had the highest success rate (91.9% [95% CI, 89.2%-94.7%]) compared with the percutaneous (91% [95% CI, 87.3%-94.6%]) and open (82.7% [95% CI, 75.6%-89.8%]) approaches for LE surgery with changes in the mean visual analog scale pain score of 5.54, 4.90, and 3.63, respectively. According to the Disabilities of the Arm, Shoulder and Hand score, the functional outcome improved in the arthroscopic group (from 54.11 to 15.47), the percutaneous group (from 44.90 to 10.47), and the open group (from 53.55 to 16.13). The overall improvement was also found in the Mayo Elbow Performance Score, the arthroscopic group (from 55.12 to 90.97), the percutaneous group (from 56.31 to 87.65), and the open group (from 64 to 93.37). Arthroscopic surgery had the highest rate of success and the best improvement in functional outcomes among the 3 approaches of LE surgery.

Total Shoulder Arthroplasty for Glenohumeral Arthritis Associated with Posterior Glenoid Bone Loss: Midterm Results of an All-Polyethylene, Posteriorly Augmented, Stepped Glenoid Component

BackgroundThe purpose of this study is to report the minimum 5-year clinical and radiographic outcomes of patients undergoing anatomic total shoulder arthroplasty (aTSA) with a posteriorly augmented glenoid component. MethodsThirty-five shoulders with minimum 5-year follow-up underwent aTSA using a posteriorly augmented glenoid component for the treatment of glenohumeral osteoarthritis with posterior glenoid bone loss. Clinical outcomes included range of motion (ROM), Visual Analog Scale (VAS) for pain, and patient reported outcomes scores (PROS). Radiographs (XR) and computed tomography (CT) scans were obtained to assess glenoid morphology, retroversion, central peg osseous integration (CPOI) via Wirth score, Lazarus scores, and Yian scores. Postoperative outcomes were measured at minimum 2- and 5-year follow-up. Kaplan-Meier survival analysis was calculated. ResultsTwo patients experienced prosthetic instability requiring revision, leaving 33 shoulders with an average follow-up of 6.6 years. Average preoperative glenoid retroversion was 21.6˚. A significant improvement in pain, ROM, and PROS was noted at minimum 2-year and 5-year follow-up. Additionally, VAS pain, American Shoulder and Elbow Surgeons (ASES), and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) scores improved between minimum 2-year and 5-year follow-up. The average Lazarus and Yian scores at final follow-up were 0.73 and 2.6, respectively. There was an increase in Lazarus score and decrease in Wirth score between 2- and 5-year follow-up. A significant correlation was identified between VAS pain scores and both Lazarus and Wirth scores. Survivorship free from revision was 92% at 8.8 years postoperatively. ConclusionsMidterm results of aTSA with a posteriorly augmented, stepped glenoid component demonstrate sustained improvements in clinical outcomes with low rates of radiographic loosening. Continued improvement in pain and function, as well as a minor progression of radiographic osteolysis, may be expected between 2- and 5-year follow-up. Additionally, the severity of radiographic loosening correlates with subjective pain levels.