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repOrt – Periodico online di SICOOP – 16/10

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

Why is my knee still stiff and mobility limited 8 weeks after meniscus surgery?
Dr. Alan M. Reznik
Hamden, Connecticut 
The Orthopaedic Group, a division of Connecticut Orthopaedic Specialists

Why is my knee still stiff and mobility limited 8 weeks after meniscus surgery?

Extended Follow-up of a Randomized Clinical Trial of Open vs Endoscopic Release Surgery for Carpal Tunnel Syndrome
Isam Atroshi, MD, PhD1; Manfred Hofer, BSc2; Gert-Uno Larsson, MD3; Jonas Ranstam, PhD4







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 577000 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.3Longer-term follow-up is important because disease progression or scar formation could occur.
Follow-up telephone calls to patients discharged after undergoing orthopaedic surgery: double-blind, randomised controlled trial of efficacy.
Clari M, et al. J Clin Nurs. 2015.

The postdischarge period is often a time of uncertainty and risk. The decreasing length of hospital stays has increased the need for specific instructions about the postdischarge period. A telephone follow-up could be a valuable tool to fill this information gap.
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.
Is postoperative cell salvage necessary in total hip or knee replacement? A meta-analysis of randomized controlled trials.
Xie J, et al. Int J Surg. 2015.

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. The data was analyzed using Rev Man 5.2.
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.
The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee.
Gobbi A, et al. Knee Surg Sports Traumatol Arthrosc. 2015.

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.
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. Although the beneficial effects are ill sustained at 2 years, the results are encouraging when compared to the pre-treatment function.
Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients.
Paul JE, et al. Can J Anaesth. 2015.

The primary objective was to determine if gabapentin given preoperatively and for two days postoperatively as part of multimodal analgesia would decrease postoperative morphine consumption in patients undergoing primary total hip arthroplasty (THA).
The primary outcome was mean (SD) postoperative morphine consumption at 72 hr which was 55.8 (39.2) mg in the gabapentin groups vs 60.7 (37.2) mg for the control group (mean difference, -4.91 mg, 95% confidence intervals [CI]: -21.2 to 11.35; P = 0.550). There were no significant differences between the groups regarding secondary outcomes: pain scores, side effects, range of motion. 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.
Effect of one-year post-operative alendronate treatment on periprosthetic bone after total knee arthroplasty. A seven-year randomised controlled trial of 26 patients.
Jaroma AV, et al. Bone Joint J. 2015.

Dual energy X-ray absorptiometry (DEXA) measurements were performed post-operatively, and at three months, six months, one, two, four, and seven years post-operatively. Mean femoral metaphyseal BMD was significantly higher in the bisphosphonate group compared with controls, up to four years following surgery in some areas of the femur (p = 0.045). BMD was observed to increase in the lateral tibial metaphysis in the bisphosphonate group until seven years (p = 0.002), and was significantly higher than that observed in the control group throughout (p = 0.024). There were no significant differences between the groups in the central femoral metaphyseal, tibial medial metaphyseal or diaphyseal regions of interest (ROI) of either the femur or tibia. Bisphosphonate treatment after TKA may be of benefit for patients with poor bone quality.
Clinical and biochemical characteristics after intra-articular injection for the treatment of osteoarthritis of the knee: prospective randomized study of sodium hyaluronate and corticosteroid.
Shimizu M, et al. J Orthop Sci. 2010.

Some studies have discussed the effectiveness of intra-articular drug injection therapy in terms of the clinical results, but no cohort studies have performed evaluations of effectiveness based on changes in joint biomarkers. This prospective randomized study compared the efficacy of Na-HA and CS injections based on clinical scores and levels of biochemical markers for osteoarthritis.
The results of this prospective randomized study suggest that the clinical effects of Na-HA and CS as local therapies for OA are comparable and that both drugs are useful. Considering the results of the measurement of biomarkers, compared with CS injection therapy Na-HA injection therapy may have protective effects on the articular cartilage by increasing the HA concentration in synovial fluid, as well as inhibitory effects on the catabolism of articular cartilage by reducing the MMP-9 concentration.