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repOrt – Periodico online di SICOOP – 16/06

Sito ufficiale della Società Italiana Chirurghi Ortopedici dell'Ospedalità Privata.

Periodico online di SICOOP – 16/06

Extended Follow-up of a Randomized Clinical Trial of Open vs Endoscopic Release Surgery for Carpal Tunnel Syndrome

This study uses follow-up data from a randomized trial comparing open and endoscopic release surgery for carpal tunnel syndrome to compare outcomes 11 to 16 years after surgery. In the United States, carpal tunnel release (open or endoscopic) was performed more than 577 000 times in 2006.1 A survey of hand surgeons found 52% used only open release, 36% used mostly endoscopic release, and 12% used both in 2011.2 Randomized trials have shown these methods have similar short-term efficacy, but no previous studies have adequate follow-up beyond 5 years.3 Longer-term follow-up is important because disease progression or scar formation could occur.
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Follow-up telephone calls to patients discharged after undergoing orthopaedic surgery: double-blind, randomised controlled trial of efficacy.

To evaluate the effectiveness of a follow-up telephone call to reduce the number of issues after hospital discharge. Double-blind, randomised controlled trial.
The participants included medium or low-intensity orthopaedic patients. We implemented a structured telephone follow-up call conducted by a senior orthopaedic nurse to provide educational support to the intervention group (n = 110), while the control group (n = 109) received routine care after being discharged.
The intervention group had a statistically significant reduction in all postdischarge problems except for pain and mobilisation; the group also had a lower chance of experiencing frequent or severe problems. The educational intervention and prior poor health had a strong correlation with problems after discharge. Patients who received a telephone follow-up call believed the information provided was valuable.
This nurse-led follow-up intervention significantly contributed to solving or reducing postdischarge health problems and contributed to reduce unnecessary burden on the community health system.
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Is postoperative cell salvage necessary in total hip or knee replacement?

Are there hematological or clinical differences with the use of postoperative cell salvage after total knee (TKR) and hip replacement (THR)?.
A systematic literature review based on PubMed, EMBASE, the Cochrane Library Database in any language regarding postoperative cell salvage following TKR or THR was performed. High quality of randomized controlled trials were identified.
Postoperative cell salvage significantly reduced the allogeneic blood transfusion requirement after TKR (RR = 0.46, 95% CI = 0.30 to 0.72) and THR (RR = 0.46, 95%CI = 0.32 to 0.68). It also demonstrated a higher level of postoperative Hemoglobin (MD = 0.26 g/dL, 95%CI = 0.15 to 0.37) with the use of postoperative cell salvage. No significant differences were detected regarding length of hospital stay, the incidence of febrile reaction, wound infection and deep vein thrombosis.
The results strengthen the fact that postoperative cell salvage is effective and safe to reduce the rate of transfusion after TKR and THR. As the relatively poor methodological quality and heterogeneity, further research is needed to confirm its safety and cost-effectiveness.
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The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee.

This is a prospective, randomized study in which 93 patients (119 knees) were followed up for a minimum of 2 years. Fifty knees were randomly selected prior to the first injection, to receive a second cycle at the completion of 1 year. A cycle consisted of three injections, each given at a monthly interval.
At 12 months, both groups showed similar and significant improvement. At 18 months, except for KOOS (Symptoms) and Tegner score, all other parameters showed a significant difference between the two groups in favour of the patients who had received the second cycle (p < 0.001). At 2 years, the scores declined in both groups but remained above the pre-treatment value with no significant difference between the groups despite the patients with two cycles showing higher mean values for all the scores.
Intra-articular PRP injections into the knee for symptomatic early stages of OA are a valid treatment option. There is a significant reduction in pain and improvement in function after 12 months, which can be further improved at 18 months by annual repetition of the treatment.
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Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients.

Gabapentin was investigated as a single-dose adjunct to morphine for postoperative pain management. The study group included 102 patients aged 19-90 years who were undergoing primary THA in a single joint with no contraindications to the study medications, no chronic pain syndrome, and no chronic opioid use. Intervention group patients (n = 48) received gabapentin 600 mg po preoperatively and 200 mg postoperatively on the day of surgery.  They were continued on gabapentin at 200 mg three times daily for two days. Control group patients (n = 54) received placebo in a similar fashion. Preoperatively, all patients were given 30 mg of ketorolac intravenously and acetaminophen 1000 mg po. Postoperatively, they received intravenous patient-controlled analgesia with morphine, along with ketorolac 15 mg iv and acetaminophen 1000 mg po every six hours.
Patient satisfaction on day 3 was more favourable in the placebo group. Length of hospitalization was marginally shorter in the placebo group.This trial indicated that gabapentin treatment had no clinically important reduction in postoperative morphine consumption at 72 hr in patients undergoing THA.
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