Patients Undergoing Hip Replacement Research Articles

Comparison of Analgesia Produced by preoperative Ultrasound-guided Femoral Nerve Blocks and Postoperative Intravenous Administration of Opioids in Patients Undergoing Hip Replacement Surgery

Background: Perioperative pain management can improve surgery results and patient outcomes. Moreover, multimodal methods for pain control have been advised so this study was conducted to assess the beneficial impact of preoperative ultrasound-guided femoral nerve blocks in hip replacement surgery. Methods: This study is a double-blinded clinical trial including 60 individuals who were candidates for joint replacement surgery. The intervention group (n = 30) received a femoral nerve block prior to general anesthesia. Results: After surgery, patients received morphine, Apotel, and morphine + Apotel, all of which were administered at lower doses in the intervention group (femoral nerve block) than in the control group. Pain intensity in first hour (P= 0.01), 4 hours (P= 0.003), 8 hours (P= 0.01), 12 hours (P= 0.001), and 24 hours (P= 0.01) after surgery and average pain 4 hours (P= 0.01), 8 hours (P = 0.01), 12 hours (P = 0.02), and 24 hours (P= 0.01) after surgery was significantly less in the intervention group (femoral nerve block) than in the control group. Conclusion: The findings of our investigation demonstrated the efficacy of ultrasound-guided femoral nerve blocks in the improvement of pain control following hip replacement surgery.

Comparison of Analgesia Produced by preoperative Ultrasound-guided Femoral Nerve Blocks and Postoperative Intravenous Administration of Opioids in Patients Undergoing Hip Replacement Surgery

Background: Perioperative pain management can improve surgery results and patient outcomes. Moreover, multimodal methods for pain control have been advised so this study was conducted to assess the beneficial impact of preoperative ultrasound-guided femoral nerve blocks in hip replacement surgery. Methods: This study is a double-blinded clinical trial including 60 individuals who were candidates for joint replacement surgery. The intervention group (n = 30) received a femoral nerve block prior to general anesthesia. Results: After surgery, patients received morphine, Apotel, and morphine + Apotel, all of which were administered at lower doses in the intervention group (femoral nerve block) than in the control group. Pain intensity in first hour (P= 0.01), 4 hours (P= 0.003), 8 hours (P= 0.01), 12 hours (P= 0.001), and 24 hours (P= 0.01) after surgery and average pain 4 hours (P= 0.01), 8 hours (P = 0.01), 12 hours (P = 0.02), and 24 hours (P= 0.01) after surgery was significantly less in the intervention group (femoral nerve block) than in the control group. Conclusion: The findings of our investigation demonstrated the efficacy of ultrasound-guided femoral nerve blocks in the improvement of pain control following hip replacement surgery.

Association between inflammation-based prognostic markers and mortality after hip replacement

We aimed to evaluate the association between inflammation-based prognostic markers and mortality after hip replacement. From March 2010 to June 2020, we identified 5,369 consecutive adult patients undergoing hip replacement with C-reactive protein (CRP), albumin, and complete blood count measured within six months before surgery. Receiver operating characteristic (ROC) curves were generated to evaluate predictabilities and estimate thresholds of CRP-to-albumin ratio (CAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Patients were divided according to threshold, and mortality risk was compared. The primary outcome was one-year mortality, and overall mortality was also analyzed. One-year mortality was 2.9%. Receiver operating characteristics analysis revealed areas under the curve of 0.838, 0.832, 0.701, and 0.732 for CAR, NLR, PLR, and modified Glasgow Prognostic Score, respectively. The estimated thresholds were 2.10, 3.16, and 11.77 for CAR, NLR, and PLR, respectively. According to the estimated threshold, high CAR and NLR were associated with higher one-year mortality after adjustment (1.0% vs. 11.7%; HR = 2.16; 95% CI 1.32–3.52; p = 0.002 for CAR and 0.8% vs. 9.6%; HR = 2.05; 95% CI 1.24–3.39; p = 0.01 for NLR), but PLR did not show a significant mortality increase (1.4% vs. 7.4%; HR = 1.12; 95% CI 0.77–1.63; p = 0.57). Our study demonstrated associations of preoperative levels of CAR and NLR with postoperative mortality in patients undergoing hip replacement. Our findings may be helpful in predicting mortality in patients undergoing hip replacement.

Evaluation of patient reported outcome measures and costs of managing osteoarthritis of the hip.

The number of hospital admissions for a hip prosthesis increased by more than 91% between 2002 and 2019 in Belgium (1), making it one of the most common interventions in hospitals. The objective of this study is to evaluate patient-report- ed outcomes and hospital costs of hip replacement six months after surgery. Both generic (EQ-5D) and specific (HOOS) PROMs of general hospital patients undergoing hip replacement surgery in 2021 were conducted. The results of these PROMs were then combined with financial and health management data. The mean difference (SD) in QALYs between the preoperative and postoperative phases is 0.20 QALYs (0.32 QALYs). The average cost (SD) of all stays is €4,792 (€1,640). Amongst the five dimensions evaluated in the EQ-5D health questionnaire, the 'pain' dimension seems to be associated with the greatest improvement in quality of life. As regards Belgium, the 26,066 arthroplasties performed in 2020 might constitute a gain of 123,000 years of life in good health. The relationship between QALYs and costs described in this study posits a ratio of €23,960 per year of life gained in good health. Given that in Belgium more than 3% of the hospital healthcare budget is devoted to hip prostheses, it would seem relevant to us to apply PROM tools to the entire patient population to assess treatment effectiveness more broadly, identify patient needs and, also, monitor the quality of care provided.

Single-cell analysis of immune and stroma cell remodeling in clear cell renal cell carcinoma primary tumors and bone metastatic lesions

BackgroundDespite therapeutic advances, once a cancer has metastasized to the bone, it represents a highly morbid and lethal disease. One third of patients with advanced clear cell renal cell carcinoma (ccRCC) present with bone metastasis at the time of diagnosis. However, the bone metastatic niche in humans, including the immune and stromal microenvironments, has not been well-defined, hindering progress towards identification of therapeutic targets.MethodsWe collected fresh patient samples and performed single-cell transcriptomic profiling of solid metastatic tissue (Bone Met), liquid bone marrow at the vertebral level of spinal cord compression (Involved), and liquid bone marrow from a different vertebral body distant from the tumor site but within the surgical field (Distal), as well as bone marrow from patients undergoing hip replacement surgery (Benign). In addition, we incorporated single-cell data from primary ccRCC tumors (ccRCC Primary) for comparative analysis.ResultsThe bone marrow of metastatic patients is immune-suppressive, featuring increased, exhausted CD8 + cytotoxic T cells, T regulatory cells, and tumor-associated macrophages (TAM) with distinct transcriptional states in metastatic lesions. Bone marrow stroma from tumor samples demonstrated a tumor-associated mesenchymal stromal cell population (TA-MSC) that appears to be supportive of epithelial-to mesenchymal transition (EMT), bone remodeling, and a cancer-associated fibroblast (CAFs) phenotype. This stromal subset is associated with poor progression-free and overall survival and also markedly upregulates bone remodeling through the dysregulation of RANK/RANKL/OPG signaling activity in bone cells, ultimately leading to bone resorption.ConclusionsThese results provide a comprehensive analysis of the bone marrow niche in the setting of human metastatic cancer and highlight potential therapeutic targets for both cell populations and communication channels.

Effect of White Noise Intervention Combined with Multi-dimensional Nursing Mode on Sleep Quality and Incidence of Nosocomial Infection in Patients Undergoing Hip Replacement.

To investigate the clinical effects of white noise intervention combined with multi-dimensional nursing mode in patients receiving hip replacement (HR). The study selected the clinical data of 161 patients who underwent HR in our hospital from February 2020 to February 2022 for retrospective analysis. According to patients' willingness, they were divided into the study group (n = 77, receiving white noise intervention combined with multi-dimensional nursing mode) and the control group (n = 84, receiving routine nursing). Pittsburgh sleep quality index (PSQI) scale was used to evaluate patients' sleep quality in the two groups, and the incidence of nosocomial infection in the both groups was counted. Before nursing and white noise intervention, the PSQI scores of patients' sleep quality in the two groups were all lower, with no obvious difference (P > 0.05). After nursing and white noise intervention, the sleep quality of the two groups was all improved, and the study group had overtly lower PSQI score and score of psychological status than the control group (P < 0.05). After nursing and white noise intervention, the study group had remarkably lower incidence of nosocomial infection than the control group (p < 0.05). White noise intervention combined with multi-dimensional nursing mode can effectively improve the sleep quality of patients undergoing HR and reduce the incidence of nosocomial infection, which is of positive significance for promoting the recovery of postoperative limb function.

The effect of perioperative cardiac risk factors on postoperative outcomes in the elderly patients undergoing hip replacement surgery

Purpose: Cardiac risk factors are among the most important determinants of postoperative outcomes in elderly surgical patients. This study aimed to determine the effect of perioperative cardiac risk factors on postoperative adverse outcomes in elderly patients undergoing total hip replacement surgery.&#x0D; Materials and Methods: Patients aged 65 and older who underwent total hip replacement surgery at Cukurova University Hospital between 2014 and 2019 were analyzed retrospectively. The primary outcome measures were postoperative adverse outcomes and mortality rate.&#x0D; Results: Two hundred twenty-three patients with total hip replacement surgery within five years of experience in our hospital were screened. 34.5% had postoperative cardiac, pulmonary, cerebral, and infectious morbidity and systemic inflammatory response syndrome, and the in-hospital mortality rate was 2.2%. On multivariate analysis, perioperative risk factors associated with postoperative adverse outcomes included American Society of Anesthesiologists (ASA) II physical status (aOR 5.63, 95% CI 1.75-18.11), preoperative poor functional capacity (aOR 9.50, 95% CI 3.14-28.79), traumatic fracture (aOR 2.75, 95% CI 1.22-6.24), preoperative anemia (aOR 2.15, 95% CI 1.05-4.37), and prolonged surgery (aOR 1.02, 95% CI 1.01-1.02).&#x0D; Conclusion: A significant relationship was determined between preoperative poor functional capacity, pre-existing anemia, traumatic hip fracture, ASA II physical status, prolonged case duration and the risk of postoperative complications in elderly patients undergoing total hip replacement surgery.

Post-discharge occurrence of surgical site infections after hip or knee arthroplasty surgery in Poland, a population-based study

Arthroplasty is a common procedure improving functioning of patients and their quality of life. Infection is a serious complication that determines subsequent management of the prosthesis and the patient. The aim of the study was to investigate the incidence of post-discharge surgical site infections (SSI) and their risk factors. A retrospective analysis of an anonymized database from the National Health Found for 2017 of 56,068 adult patients undergoing hip replacement surgery (HPRO) and 27,457 patients undergoing knee replacement surgery (KPRO). The cumulative incidence of post-discharge SSI was 0.92% for HPRO and 0.95% for KPRO. The main risk factors for hip SSI were male gender, diseases of hematopoietic, musculoskeletal and nervous system. The risk factor for knee SSI was male gender. All comorbidities significantly increased the risk of SSI. The ICU stay and antibiotics administered at discharge in studied population increased the risk of detection of SSI after HPRO and KPRO by up to four and seven times, respectively. For both procedures rehabilitation after surgery and total endoprosthesis decreased incidence of SSIs. The lower experience of the center was related to higher SSI incidence in HPRO in primary (1.5% vs. 0.9%) and in revision surgeries (3.8% vs. 2.1%), but in KPRO, lower experience only in primary surgeries was significantly associated with SSI. The cumulative incidence of post-discharge SSI in Poland is higher than in other European countries. Special attention should be paid to patients with chronic diseases.

Postoperative Enteral Nutrition-Based Diversified Nursing and Postoperative Complications and Nutritional Status of Hip Replacement in Elderly Femoral Neck Fracture Patients

We explored the impacts of postoperative enteral nutrition-based diversified nursing on postoperative complications and the nutritional status of hip replacement for elderly femoral neck fracture patients. A total of 86 patients undergoing total hip replacement in our hospital between January 2021 and December 2022 were enrolled in this study. While the patients in the control group received routine nursing intervention, those in the treatment group received postoperative enteral nutrition-based diversified nursing intervention. Compared to the control group, the first time of getting out of bed and the hospital stay in the treatment group were shorter. After nursing, the Harris score in the treatment group was higher than the control group, and the visual analog scale, self-rating anxiety scale, and self-rating depression scale scores, as well as the incidence of complications, were lower. The Barthel index in the treatment group was higher when compared with the control group. Also, serum albumin and total protein levels in the treatment group were higher when compared with the control group. Patient’s satisfaction with nursing in the treatment group was higher than in the control group. To conclude, postoperative enteral nutrition-based diversified nursing intervention can lessen the incidence of postoperative complications as well as elevate the nutritional status of elderly femoral neck fracture patients undergoing hip replacement.

Anterior Total Hip Arthroplasty With Gluteus Medius Repair: A Novel Technique

Introduction: Proper function of the gluteus medius muscle is crucial to performance and outcomes following total hip arthroplasty. Gluteus medius tears are reported in up to 20% of patients undergoing hip replacements. The combination of increasing notoriety for the direct anterior approach and the potential for improved patient outcomes necessitates a technique to address gluteus medius tears in conjunction with total hip arthroplasty. Therefore, we present the following novel technique for transtendinous gluteus medius repair in conjunction with a direct anterior approach for total hip arthroplasty. Technique: The patient is placed supine with the operative leg in slight external rotation. An incision is made to the fascia overlying the tensor fascia latae. Blunt dissection is performed to the tensor fascia latae-sartorius interval. The deep rectus fascia is split, identifying the anterior capsule. Arthroplasty is then performed in the usual manner. Once the arthroplasty is completed, the hip capsule is closed, and the gluteus medius is exposed through an anterolateral approach. Once found, the tear is classified. A split in line with the tendon fibers is made in the mid aspect of the tear. Once visualized, the greater trochanter is decorticated, and suture anchors are placed. Sutures are passed and tied sequentially from distal to proximal. Expected Outcomes: Gluteus medius repair patients experience excellent outcomes, with multiple studies showing decreased pain and restoration in the strength of the abductor complex. In the setting of total hip arthroplasty, most patients display adequate abductor strength and no Trendelenburg gait at 5 years postoperative.

Remimazolam dosing for intraoperative sedation in elderly patients undergoing hip replacement with combined spinal-epidural anesthesia.

The aim of the study was to investigate the 50% and 95% effective doses (ED50 and ED95) of remimazolam for intraoperative sedation in elderly patients undergoing hip replacement with combined spinal-epidural anesthesia (CSEA). We retrospectively analyzed the clinical data of 50 patients who underwent hip replacement with CSEA in our hospital from October 2021 to June 2022. There were 29 males and 21 females, aged 60-80 years old, with body mass indexes (BMI) ranging from 18 to 24 kg/m2, and American Society of Anesthesiologists (ASA) classifications of I or II. The modified Dixon sequential method was used to determine the dose of remimazolam for each patient. Each patient's initial dose was 0.1 mg/kg/h, and the dose gradient was 0.01 mg/kg/h. The bispectral index (BIS) and the modified observer's assessment of alertness/sedation score (MOAA/S) were used to evaluate the sedation of the patient. An MOAA/S score ≤3 and a BIS <85 at three or more time points during surgery indicated the sedation was satisfactory. The induction dose of the next patient was adjusted by 0.01 mg/kg/h based on the level of sedation achieved, and the study was terminated after eight crossovers. The ED50 and ED95 of remimazolam for sedation of elderly patients undergoing hip replacement with CSEA are 0.212 mg/kg/h (95% CI: 0.121-0.231 mg/kg/h) and 0.288 mg/kg/h (95% CI: 0.254-0.884 mg/kg/h), respectively. Two patients experienced transient bradycardia, five experienced hypoxemia, three experienced postoperative nausea, and three experienced postoperative delirium. No patients experienced adverse reactions such as injection pain, hypotension, vomiting, delayed awakening, or emergence agitation. The ED50 and ED95 of remimazolam for sedation of elderly patients undergoing hip replacement with CSEA are 0.212 mg/kg/h and 0.288 mg/kg/h, respectively.

Study on the association of the microstructure and bone metabolism in the osteoporotic femoral head

BackgroundWe compared the bone microstructure and metabolism of the femoral heads in patients with osteoporosis (OP) and non-OP patients to investigate the pathologic mechanism of OP and guide clinical treatment.Methods and resultsFrom January 2020 to June 2021, we obtained femoral head samples from 30 patients undergoing hip replacement due to femoral neck fracture. All patients were women aged approximately 67 to 80 years (mean age, 74 years). According to the dual-energy X-ray results, the femoral head samples were divided into the OP (T< − 2.5) and non-OP (T > − 1.5) groups. Microcomputed tomography scanning, bone metrology analysis, hematoxylin and eosin staining, and Masson’s trichrome staining were used to compare the local bone trabecular microstructure changes. Quantitative reverse transcription PCR was performed to identify changes in the osteogenesis-related genes and the osteoclast-related genes in specific regions to reflect osteogenic and osteoclastic activities. Femoral heads with OP showed significant changes in the local bone microstructure. Bone density, bone volume fraction, and the number and thickness of the bone trabeculae decreased. Local bone metabolism was imbalanced in the areas with microstructural changes in femoral heads with OP, with increased osteoclast activity and decreased osteoblast activity.ConclusionsDeterioration of bone microstructure is closely related to abnormal bone metabolism associated with the activity of osteoblasts and osteoclasts in osteoporotic femoral heads. Promoting bone formation by improving local bone metabolism, enhancing osteogenic activity and inhibiting osteoclast activity may be a promising way of preventing local OP and osteoporotic fractures.

Ascorbic acid reduces Ropivacaine-induced myotoxicity in cultured human osteoporotic skeletal muscle cells

BackgroundOsteoporosis is a worldwide health issue. Loss of bone mass is a potential risk factor for fragility fractures, and osteoporotic fractures place a considerable burden on society. Bone and muscle represent a functional unit in which the two tissues are intimately interconnected. Ropivacaine is a potent local anesthetic used in clinical practice for intraoperative anesthesia and postoperative pain management, in particular for hip surgery. When injected, Ropivacaine can diffuse locally through, in particular in surrounding skeletal muscle tissue, causing dose-dependent cytotoxicity, oxidative stress and myogenesis impairment. Based on those evidences, we focused our attention on Ropivacaine-induced cytotoxicity on cultured human myoblasts.MethodsPrimary human myoblasts and myotubes from healthy subjects, osteoarthritic and osteoporotic patients (OP) were cultured in the presence of Ropivacaine. In some experiments, ascorbic acid (AsA) was added as a potent antioxidant agent. Cell viability and ROS levels were evaluated to investigate the myotoxic activity and Real-Time PCR and Western blot analysis carried out to investigate the expression of proliferation and myogenic markers.ResultsA dose-dependent decrease of cell viability was observed after Ropivacaine exposure in both OP myoblasts and myotubes cultures, whereas those effects were not observed in the presence of Propofol, a general anesthetic. The adding of AsA reduced Ropivacaine negative effects in OP myoblast cultures. In addition, Ropivacaine exposure also increased ROS levels and upregulated Nox4 expression, an enzyme primarily implicated in skeletal muscle ROS generation. AsA treatment counteracted the oxidant activity of Ropivacaine and partially restored the basal condition in cultures. Positive myogenic markers, such as MyoD and Myf5, were downregulated by Ropivacaine exposure, whereas myostatin, a negative regulator of muscle growth and differentiation, was upregulated. The phenotypic deregulation of myogenic controllers in the presence of Ropivacaine was counteracted by AsA treatment.ConclusionsOur findings highlight the oxidative stress-mediated myotoxic effect of Ropivacaine on human skeletal muscle tissue cell cultures, and suggest treatment with AsA as valid strategy to mitigate its negative effects and allowing an ameliorated functional skeletal muscle recovery in patients undergoing hip replacement surgery for osteoporotic bone fracture.

Femoral offset restoration affects the early outcome of revision in patients with periprosthetic femoral fractures of Vancouver B2 - a single-center retrospective cohort study

BackgroundFemoral offset (FO) restoration plays an important role in improving the prognosis and quality of life of patients undergoing hip replacement. However, it is not given enough attention in revisions among patients with periprosthetic femoral fractures (PPFFs); instead, more attention is given to reduction, fixation of fractures and stabilizing prostheses. The primary objective of this study was to evaluate the effect of FO restoration on the function of the hip joint in revisions of patients with PPFF of Vancouver B2. Moreover, we studied whether there is a difference in FO restoration between modular and nonmodular stems.MethodsA retrospective review of 20 patients with PPFF of Vancouver B2 revised with a tapered fluted modular titanium stem and 22 patients with PPFF of Vancouver B2 revised with a tapered fluted nonmodular titanium stem from 2016 to 2021 was conducted. Based on the difference between the FO of the affected side and that of the healthy side, 26 patients were allocated into Group A (difference ≤ 4 mm), and 16 patients were allocated into Group B (difference > 4 mm). The postoperative Harris Hip Score (HHS), range of motion of the hip joint, length of both lower limbs and dislocation were compared between Group A and Group B. The proportions of patients with FO restoration (difference ≤ 4 mm) and stem subsidence were compared between the modular and nonmodular groups.ResultsThe mean follow-up time was 34.3 ± 17.3 months, and all cases achieved fracture healing at the last visit. Patients in Group A had a higher HHS, larger range of abduction, fewer dislocations and less limb length discrepancy (LLD). Patients in the modular group had a higher proportion of FO restoration and less subsidence.ConclusionFO restoration improves postoperative hip joint function and reduces dislocation and LLD in revisions of patients with PPFF of Vancouver B2. Compared with nonmodular prostheses, modular prostheses tend to be easier for FO restoration under complex circumstances.

Comparison Study between Three Analgesic Techniques in Ischemic Heart Disease Patients Undergoing Hip Replacement Surgeries

Comparison Study between Three Analgesic Techniques in Ischemic Heart Disease Patients Undergoing Hip Replacement Surgeries

Effects of dexmedetomidine at different dosages on perioperative haemodynamics and postoperative recovery quality in elderly patients undergoing hip replacement surgery under general anaesthesia: a randomized controlled trial

BackgroundDexmedetomidine could provide some advantages to prevent postoperative complications in elderly patients undergoing under general anaesthesia. However, dexmedetomidine inhibits haemodynamics to some extent due to its sympathetic inhibition.ObjectiveTo evaluate the effects of different doses of dexmedetomidine on haemodynamics during surgery and recovery after general anaesthesia in elderly patients undergoing hip replacement.MethodsThis was a prospective randomized double-blind controlled clinical trial. Eligible patients were randomly allocated into comparative groups (normal saline (NS) and midazolam (MD), n = 30) and dexmedetomidine groups at different doses (D0.25/D0.5/D0.75, n = 30). In the D0.25/D0.5/D0.75 groups, dexmedetomidine was administered at different initial loading doses (0.25/0.5/0.75 μg/kg for 15 min) following 0.5 μg/kg/h continuous infusion until the end of the operation. In the MD group, patients were administered 0.03 mg/kg midazolam at the beginning of anaesthesia induction.ResultsCompared to the MD and NS groups, there were significant decreases in MAP in the D0.5 and D0.75 groups at many time points, such as skin incision, end of operation, and from extubation until 30 min after extubation (P < 0.05); there were also significant decreases in HR in the D0.5 and D0.75 groups at time points including anaesthesia induction, end of operation, and from extubation to 2 h after operation (P < 0.05). In the D0.25 group, there were few differences in the changes in MAP and HR compared to the MD and NS groups during the entire perioperative period (P > 0.05). Moreover, the percentage of patients whose MAP and HR decreased > 20% of baseline was higher in the D0.75 and D0.5 groups than that in all other groups. Compared to the NS group, from the beginning to the end of the operation, the 95% confidence interval (CI) of RR for MAP below > 20% of baseline in the D0.5 and D0.75 groups was greater than 1. In particular, the CI of the RR in the D0.75 group was greater than 1 until the patient awoke from general anaesthesia (P < 0.05). In addition, the CI of the RR for HR below > 20% of baseline in the D0.5 group was greater than 1 compared to the NS group at the time of induction and extubation (P < 0.05). There was no significant difference in the possibility of developing hypotension or bradycardia in the MD or D0.25 groups compared to the NS group (P > 0.05). The recovery quality of patients during the post-anaesthesia period was also observed. No differences were observed among all the groups in the time to awakening or extubation after general anaesthesia (P > 0.05). According to the Riker Sedation-agitated Scale, dexmedetomidine significantly alleviated emergency agitation or delirium compared to NS (P < 0.05). In addition, the scores in the D0.5 and D0.75 groups were lower than those in the D0.25 group (P < 0.05).ConclusionDexmedetomidine could alleviate the agitation of elderly patients undergoing hip replacement after intravenous general anaesthesia combined with inhaled sevoflurane without delayed recovery. However, it is necessary to be vigilant about the haemodynamic inhibition of the drug at high dosages throughout the perioperative period. Dexmedetomidine 0.25–0.5 μg/kg as the initial loading dose followed by 0.5 μg/kg/h continuous infusion might provide comfortable recovery after general anaesthesia with slight haemodynamic inhibition.Trail registrationClinicalTrial.gov, No. NCT05567523. Registered 05 October 2022, https://clinicaltrials.gov/ct2/show/NCT05567523?term=NCT05567523&draw=2&rank=1.

Dexmedetomidine-induced anesthesia in elderly patients undergoing hip replacement surgery.

A femoral neck fracture is a common and frequently reported issue in orthopedics, with a greater rate of incidence among the elderly. Due to their advanced age and the presence of some primary diseases, both anesthesia and surgery are increasingly difficult in elderly patients with a femoral neck fractures. In fact, general anesthesia can easily induce complications such as cognitive dysfunction, which is not conducive to postoperative recovery. To analyze the efficacy of dexmedetomidine in inducing anesthesia for elderly patients undergoing hip replacement surgery. A total of 98 elderly patients undergoing hip replacement in our hospital from June 2020 to June 2021 were randomly divided into control group (49 cases) and observation group (49 cases). The control group was given general anesthesia, and the observation group was combined with dexmedetomidine for anesthesia on the basis of the control group. Both groups were observed until the patients were discharged. The vital signs, serum inflammatory factors and renal function indexes of the two groups were compared before, during and 6 h after operation. The postoperative recovery and adverse events of the two groups were statistically analyzed. Compared with the mean arterial pressure of the two groups, the intraoperative and postoperative 6 h was higher than that before the operation, the intraoperative was lower than the postoperative 6 h (P < 0.05); the blood oxygen saturation of the two groups was higher than that before operation and 6 h after operation, and the observation group was higher than the control group 6 h after operation (P < 0.05). The heart rate of the two groups was lower during and 6 h after operation than that before operation, and higher at 6 h after operation than that during operation (P < 0.05). The levels of serum C-reactive protein, tumor necrosis factor-α, interleukin-1β and kidney injury molecule-1 in the two groups were higher during operation and 6 h after operation than those before operation (P < 0.05). The level of serum urea nitrogen in the two groups was higher than that before operation, and that in the observation group was lower than that in the control group (P < 0.05). During hospitalization, the first time of getting out of bed, recovery time of grade II muscle strength, recovery time of grade III muscle strength and hospitalization time in the observation group were shorter than those in the control group (P < 0.05). Dexmedetomidine can effectively improve the vital signs of elderly patients undergoing hip replacement surgery, reduce the body's inflammatory response and renal function damage, and promote postoperative recovery. Meanwhile, dexmedetomidine showcased a good safety profile and a good anesthetic outcome.

Effect of Pre and Postoperative Nursing Intervention on Pain and Postoperative Complications among Patients undergoing Hip Replacement

Effect of Pre and Postoperative Nursing Intervention on Pain and Postoperative Complications among Patients undergoing Hip Replacement

Effect of Pre and Postoperative Nursing Intervention on Activities of Daily Living and Quality of life among Patients undergoing Hip Replacement

Effect of Pre and Postoperative Nursing Intervention on Activities of Daily Living and Quality of life among Patients undergoing Hip Replacement

The impact of patient safety incidents during hip and knee replacements on patients' health related quality of life: a before and after study using longitudinal data linked to patient-reported outcome measures.

The burden of patient safety incidents (PSIs) is often characterized by their impact on mortality, morbidity, and treatment costs. Few studies have attempted to estimate the impact of PSIs on patients' health-related quality of life (HRQoL) and the studies that have made such estimates primarily focus on a narrow set of incidents. The aim of this paper is to estimate the impact of PSIs on HRQoL of patients undergoing elective hip and knee surgery in England. A unique linked longitudinal data set consisting of patient-reported outcome measures for patients with hip and knee replacements linked to Hospital Episode Statistics (HES) collected between 2013/14 and 2016/17 was examined. Patients with any of nine US Agency for Healthcare Research and Quality (AHRQ) PSI indicators were identified. HRQoL was measured using the general EuroQol five dimensions questionnaire (EQ-5D) before and after surgery. Exploiting the longitudinal structure of the data, exact matching was combined with difference in differences to estimate the impact of experiencing a PSI on HRQoL and its individual dimensions, comparing HRQoL improvements after surgery in similar patients with and without a PSI in a retrospective cohort study. This design compares the change in HRQoL before and after surgery in patients who experience a PSI to those who do not. The sample comprised 190697 and 204649 observations for patients undergoing hip replacement and knee replacement respectively. For six out of nine PSIs, patients who experienced a PSI reported improvements in HRQoL that were 14-23% lower than those who did not experience a PSI during surgery. Those who experienced a PSI were also more likely to report worse health states after surgery than those without a PSI on all five dimensions of HRQoL. PSIs are associated with a substantial negative impact on patients' HRQoL.