The effect of cemented acetabular component geometry on the risk of revision for instability or loosening

2021 ◽  
Vol 103-B (11) ◽  
pp. 1669-1677
Author(s):  
Hiren M. Divecha ◽  
Terence W. O'Neill ◽  
Mark Lunt ◽  
Tim N. Board
Keyword(s):  
Acetabular Component ◽  
Posterior Wall ◽  
Revision Thas ◽  
Joint Registry ◽  
Binomial Regression ◽  
Prosthetic Head ◽  
Group A ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Acetabular Components

Aims To determine if primary cemented acetabular component geometry (long posterior wall (LPW), hooded, or offset reorientating) influences the risk of revision total hip arthroplasty (THA) for instability or loosening. Methods The National Joint Registry (NJR) dataset was analyzed for primary THAs performed between 2003 and 2017. A cohort of 224,874 cemented acetabular components were included. The effect of acetabular component geometry on the risk of revision for instability or for loosening was investigated using log-binomial regression adjusting for age, sex, American Society of Anesthesiologists grade, indication, side, institution type, operating surgeon grade, surgical approach, polyethylene crosslinking, and prosthetic head size. A competing risk survival analysis was performed with the competing risks being revision for other indications or death. Results The distribution of acetabular component geometries was: LPW 81.2%; hooded 18.7%; and offset reorientating 0.1%. There were 3,313 (1.5%) revision THAs performed, of which 815 (0.4%) were for instability and 838 (0.4%) were for loosening. Compared to the LPW group, the adjusted subhazard ratio of revision for instability in the hooded group was 2.31 (p < 0.001) and 4.12 (p = 0.047) in the offset reorientating group. Likewise, the subhazard ratio of revision for loosening was 2.65 (p < 0.001) in the hooded group and 13.61 (p < 0.001) in the offset reorientating group. A time-varying subhazard ratio of revision for instability (hooded vs LPW) was found, being greatest within the first three months. Conclusion This registry-based study confirms a significantly higher risk of revision after cemented THA for instability and for loosening when a hooded or offset reorientating acetabular component is used, compared to a LPW component. Further research is required to clarify if certain patients benefit from the use of hooded or offset reorientating components, but we recommend caution when using such components in routine clinical practice. Cite this article: Bone Joint J 2021;103-B(11):1669–1677.

The effect of uncemented acetabular liner geometry and lip size on the risk of revision for instability or loosening

2021 ◽  
Vol 103-B (12) ◽  
pp. 1774-1782
Author(s):  
Hiren M. Divecha ◽  
Terence W. O'Neill ◽  
Mark Lunt ◽  
Tim N. Board
Keyword(s):  
Surgical Approach ◽  
Lower Risk ◽  
National Joint Registry ◽  
Institution Type ◽  
Joint Registry ◽  
Significant Difference ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Hip Arthroplasties ◽  
Acetabular Components

Aims The aim of this study was to determine if uncemented acetabular polyethylene (PE) liner geometry, and lip size, influenced the risk of revision for instability or loosening. Methods A total of 202,511 primary total hip arthroplasties (THAs) with uncemented acetabular components were identified from the National Joint Registry (NJR) dataset between 2003 and 2017. The effect of liner geometry on the risk of revision for instability or loosening was investigated using competing risk regression analyses adjusting for age, sex, American Society of Anesthesiologists grade, indication, side, institution type, surgeon grade, surgical approach, head size, and polyethylene crosslinking. Stratified analyses by surgical approach were performed, including pairwise comparisons of liner geometries. Results The distribution of liner geometries were neutral (39.4%; 79,822), 10° (34.5%; 69,894), 15° (21.6%; 43,722), offset reorientating (2.8%; 5705), offset neutral (0.9%; 1,767), and 20° (0.8%; 1,601). There were 690 (0.34%) revisions for instability. Compared to neutral liners, the adjusted subhazard ratios of revision for instability were: 10°, 0.64 (p < 0.001); 15°, 0.48 (p < 0.001); and offset reorientating, 1.6 (p = 0.010). No association was found with other geometries. 10° and 15° liners had a time-dependent lower risk of revision for instability within the first 1.2 years. In posterior approaches, 10° and 15° liners had a lower risk of revision for instability, with no significant difference between them. The protective effect of lipped over neutral liners was not observed in laterally approached THAs. There were 604 (0.3%) revisions for loosening, but no association between liner geometry and revision for loosening was found. Conclusion This registry-based study confirms a lower risk of revision for instability in posterior approach THAs with 10° or 15° lipped liners compared to neutral liners, but no significant difference between these lip sizes. A higher revision risk is seen with offset reorientating liners. The benefit of lipped geometries against revision for instability was not seen in laterally approached THAs. Liner geometry does not seem to influence the risk of revision for loosening. Cite this article: Bone Joint J 2021;103-B(12):1774–1782.

scholarly journals Management of Pain During Propofol Injection Using Intravenous Nitroglycerine

KYAMC Journal ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 202-205
Author(s):  
Muhammad Sazzad Hossain ◽  
Mohammad Mamunur Rashid ◽  
Md Anisur Rahman Babu ◽  
Afsana Sultana ◽  
Md Sirajul Islam Mahfuz ◽  
...  
Keyword(s):  
Placebo Group ◽  
Venous Occlusion ◽  
Saline Group ◽  
Injection Pain ◽  
Group A ◽  
American Society ◽  
Group B ◽  
Double Blinded ◽  
American Society Of Anesthesiologists ◽  
To Receive

Background: Propofol is an intravenous (IV) anesthetic agent, can irritate the skin, mucous membrane and venous intima. The main drawback is the pain at injection site following its intravenous injection. Objectives: This study was performed to evaluate the effect of intravenous nitroglycerine on pain in patients following propofol injection. Materials and Methods: Eighty adult patients of both sexes, aged 20-50 years, according to American Society of Anesthesiologists (ASA) physical status were divided into two equal groups (n=40) to receive 200 mcg intravenous nitroglycerine diluted in 10 ml saline (group A) and 10 ml normal saline as placebo (group B) at an ambient operating room temperature in a randomized and double blinded fashion to compare the pain-relieving effects of the drugs during propofol injection before the patients lost consciousness. The pain on propofol injection was assessed according to the Mc Crirrick and Hunter scale. Results: The overall incidence and severity of pain were significantly less in Groups A (nitroglycerine group) than group B (placebo group) (p< 0.05). The incidence of mild and moderate pain in Group A versus group B was 25% vs 45% and 15% vs 30% respectively (p<0.05). The incidence of score '0' (no pain) was higher in Group A (60%) than Group B (25%) (p<0.05). Conclusion: Pretreatment with 200 mcg nitroglycerine with venous occlusion for one minute is effective pretreatment in alleviating propofol injection pain when compared to placebo. KYAMC Journal Vol. 10, No.-4, January 2020, Page 202-205

scholarly journals The study of oropharyngeal pack soaked in lignocaine with dexamethasone in patients undergoing nasal surgeries

2020 ◽  
Vol 8 (1) ◽  
pp. 22
Author(s):  
Mahendra Agrawal ◽  
Pushpal Gandhi ◽  
Bhavika Agrawal ◽  
Simarn Behl
Keyword(s):  
Blood Pressure ◽  
Retrospective Study ◽  
Systolic Blood Pressure ◽  
Sore Throat ◽  
Pressure Pulse ◽  
Postoperative Sore Throat ◽  
Significant Difference ◽  
Group A ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: The aim of this study determines the efficacy of lignocaine lignocaine with dexamethasone used topically in form of oropharyngeal pack in reducing postoperative sore throat (POST), hoarseness and throat irritation.  Methods: This retrospective study total of 70 adult patients included in the lignocaine and dexamethasone (LD) group. LD group patients received combination of 5 ml lignocaine 2% and 2 ml (8 mg) dexamethasone in oropharyngeal packing.Results: There is no significant difference in age, gender, and American society of anesthesiologists (ASA) grade I and II. There was no significant difference the studied group in term of measured hemodynamic indices Systolic blood pressure, diastolic blood pressure, pulse rate, and respiratory rate. Post extubation incidence of mild sore throat was occurred in patients 11 (31.4%) at 30 min, 13 (37.1%) at 2 hours, 6 (17.1%) at 6 hours, and 5 (14.2%) at 5 (14.2%). Moderate sore throat and severe sore throat was not present. Hoarseness of voice was present only 4 (11.4%) at 30 min. There was significant deference in throat irritation. A decrease in incidence of hoarseness was also seen in group LD.  Conclusions: In LD group a positive benefit is seen in form of reduction of POST, hoarseness and throat irritation helping in better recovery of patients.

Dual mobility canine total hip prosthesis: Implant characteristics and surgical procedure

2012 ◽  
Vol 25 (06) ◽  
pp. 506-510 ◽  
Author(s):  
A. Autefage ◽  
S. Palierne ◽  
T. Dembour ◽  
J.-L. Chancrin ◽  
P. Guillaumot
Keyword(s):  
High Risk ◽  
Acetabular Component ◽  
Hip Replacement ◽  
Surgical Procedure ◽  
Hip Prosthesis ◽  
The Other ◽  
Total Hip Prosthesis ◽  
Dual Mobility ◽  
Prosthetic Head ◽  
Acetabular Components

SummaryProsthetic dislocation is one of the most common complications after canine hip replacement. The use of dual mobility acetabular components has been shown to reduce the rate of dislocation in first intent hip replacement in human patients who are at high risk for dislocation. In such implants, a mobile polyethylene liner articulates on one side with a metallic acetabular component and on the other side with a metallic prosthetic head. A dual mobility cemented acetabular component has been designed for use in dogs, and is available for use in association with a previously designed modular femoral component. This report describes the characteristics and the procedure for implantation of this implant combination.

scholarly journals EFFICACY OF ATRACURIUM VERSUS CISATRACURIUM IN PATIENTS UNDERGOING RETROGRADE CHOLANGIOPANCREATOGRAPHY PROCEDURE UNDER GENERAL ANAESTHESIA – A COMPARATIVE STUDY

2020 ◽  
pp. 197-201
Author(s):  
ALISHA SAHU ◽  
SAMBEET SWAIN ◽  
SOUMYA SAMAL ◽  
SIBANARAYAN MOHANTY
Keyword(s):  
Adverse Effects ◽  
Rapid Onset ◽  
Hemodynamic Parameters ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Group A ◽  
American Society ◽  
Group B ◽  
Time Required ◽  
American Society Of Anesthesiologists

Objectives: The objectives of the study were to compare the efficacy of injection atracurium 0.5 mg/kg intravenous (IV) versus injection cisatracurium 0.2 mg/kg IV for intubation in patients undergoing endoscopic retrograde cholangiopancreatography procedure (ERCP). Methods: Hundred adult patients of both sexes in the age group of 18–60 years belonging to the American Society of Anesthesiologists I/II category posted for ERCP procedures under general anesthesia were randomly allocated into two groups of 50 each. Group A received injection atracurium besylate 0.5 mg/kg intravenously and Group B received injection cisatracurium besylate 0.2 mg/kg intravenously. Parameters observed were time to the maximum blockade, intubating condition, time required for intubation, duration of action, hemodynamic parameters during intubation, and after 1, 2, 3, 5, and 15 min and any adverse effects. Results: Demographic profile was comparable between the groups. Intubating condition as per Cooper et al. score was excellent in 36 patients in cisatracurium group as compared to 19 patients in atracurium group. The overall intubating condition was found to be better in Group B (p=0.00001). Time to the maximum blockade was significantly high with atracurium as compared to cisatracurium. The mean of intubation time was less with cisatracurium (135±11.1) than that of atracurium (144±9.48) in seconds, which was statistically significant. Duration of neuromuscular blockade was found to be prolonged in Group B as compared to Group A (p=0.000). Hemodynamic parameters during intubation and after 1, 2, 3, 5, and 15 min were comparable between the groups. No adverse effect was seen in both groups. Conclusion: Cisatracurium 0.2 mg/kg provides excellent intubating conditions with rapid onset of action, longer duration of action, and no significant hemodynamic changes as compared with atracurium 0.5 mg/kg for ERCP procedures without any adverse effects.

scholarly journals Comparison of oxycodone hydrochloride and sufentanil used in painless fiberbronchoscopy

2018 ◽  
Vol 16 ◽  
pp. 205873921877420
Author(s):  
Ke Zhang ◽  
Tianke Xiao ◽  
Zuqi Chen ◽  
Shuguang Xiong ◽  
Xiaohong Wang
Keyword(s):  
Heart Rate ◽  
Recovery Time ◽  
Adverse Reactions ◽  
Vital Signs ◽  
Fiberoptic Bronchoscopy ◽  
Group A ◽  
Oxycodone Hydrochloride ◽  
American Society ◽  
Group B ◽  
American Society Of Anesthesiologists

The study was designed to understand the effects of oxycodone hydrochloride and sufentanil used in painless fiberoptic bronchoscopy. A total of 90 patients aged 3–84 years undergoing painless fiberoptic bronchoscopy were selected, American Society of Anesthesiologists (ASA): I–III criteria—the equal number of subjects were randomly divided into sufentanil group (group A) and oxycodone hydrochloride group (group B). The vital signs, surgical examination and anesthesia, the effect of anesthesia, and adverse reactions were compared between the two groups during the operation. The change of heart rate and changes of hemodynamics in group B were found to be lower than in group A. The number of breaths was significantly lower than group B. The decrease of SpO2 in group A was higher than in group B. Cases of SpO2 <90% was higher in group A than in group B. The dosage of propofol and the recovery time in group A was significantly higher than in group B. The incidence of nausea and vomiting in group A was higher than in group B. Oxycodone hydrochloride combined with propofol used in painless fiberoptic bronchoscopy could improve the safety and efficiency of analgesia compared to sufentanil combined with propofol. The effect was found to have stable hemodynamics and fewer adverse reactions.

scholarly journals PERBANDINGAN PEMBERIAN LIDOKAIN 2% INTRAVENA DENGAN FENTANIL INTRAVENA SETELAH ANESTESI UMUM DIHENTIKAN TERHADAP KEJADIAN BATUK SAAT EKSTUBASI SADAR

2020 ◽  
Vol 8 (2) ◽  
pp. 256
Author(s):  
Dedy Hendra Gunawan
Keyword(s):  
General Anesthesia ◽  
Abdominal Pressure ◽  
Physical Status ◽  
Oral Intubation ◽  
Patient Discomfort ◽  
Group A ◽  
Coronary Ischemia ◽  
American Society ◽  
Group B ◽  
American Society Of Anesthesiologists

Cough after extubation not only causes patient discomfort, but can also cause hypertension, tachycardia, increased intracranial, intraocular, and intra-abdominal pressure, which can cause coronary ischemia, arrhythmia, or surgical difficulties. Cough after extubation can be prevented with several drugs. The purpose of this study is to compare the effects of lidocaine 2% 1.5 mg / kg intravenously compared to fentanyl 1 mcg / kg intravenously in reducing the incidence of cough during conscious extubation. Research conducted on 36 patients aged 18-65 years with the physical status of the American Society of Anesthesiologists (ASA) I and II who performed operations with general anesthesia using oral intubation in a position during supine surgery and correctly extubated. Patients were divided into 2 groups: group A received fentanyl 1 mcg / kg and group B received lidocaine 2% 1.5 mg / kg. The results of the study concluded that 2% lidocaine at a dose of 1.5 mg / kg better in coughing and rejected haemodynamics compared to fentanyl at a dose of 1 mcg / kg at the time of extubation was understood to be moderate.

EFFICACY OF INTRAVENOUS LIGNOCAINE VERSUS TOPICAL LIGNOCAINE IN ATTENUATION OF HAEMODYNAMIC SURGE DURING LARYNGOSCOPY AND INTUBATION IN PATIENTS UNDERGOING SURGERY UNDER GENERALANAESTHESIA - A SINGLE BLIND RANDOMIZED CONTROL STUDY

2021 ◽  
pp. 59-61
Author(s):  
Gautam Piplai ◽  
Amrita Roy ◽  
Dipanjan Dutta ◽  
Sayantan Mukhopadhyay
Keyword(s):  
Elective Surgery ◽  
Haemodynamic Response ◽  
Randomized Control Study ◽  
Group A ◽  
Randomized Control ◽  
American Society ◽  
Group B ◽  
American Society Of Anesthesiologists ◽  
Single Blind ◽  
Control Study

The present study was undertaken to evaluate the efcacy of intravenous lignocaine versus topical lignocaine for attenuating haemodynamic response during laryngoscopy and intubation in patients undergoing surgery under general anaesthesia. This single blind randomized control study was done on sixty patients of either sex aged between 18 to 55 years, of American Society of Anesthesiologists (ASA) status class I undergoing elective surgery under general anesthesia with endotracheal intubation. Patients were randomly allocated into two groups (group A and group B). Group A and Group B received intravenous preservative free lignocaine hydrochloride 2% 2 mg/kg and topical (nebulized) lignocaine hydrochloride 4% at 2mg/kg. Heart rate, systolic, diastolic and mean blood pressure was documented before administering premedication (T0), at time of intubation (TI) and 1 min (T-1), 2 min (T-2) & 5 min (T- 5) after intubation. Attenuation in the HR , SBP, DBP, MBPwere found statistically signicant (P<0.05) in group B in comparison to the group A. So, to conclude, topical lignocaine 4% blunts haemodynamic response to laryngoscopy and intubation better than intravenous lignocaine 2% when other confounding factors are eliminated.

scholarly journals Combination of Dexmedetomidine and Bupivacaine for Caudal Anesthesia In Children

2021 ◽  
Vol 15 (7) ◽  
pp. 1999-2000
Author(s):  
Nasibova E.M. ◽  
Poluxovr. SH
Keyword(s):  
Pain Relief ◽  
Caudal Block ◽  
Caudal Anesthesia ◽  
Caudal Analgesia ◽  
Provide Pain Relief ◽  
Group A ◽  
American Society ◽  
The Moment ◽  
Group B ◽  
American Society Of Anesthesiologists

Background: Caudal anesthesia is one of the most popular, reliable and safe methods of pain relief in children and can provide pain relief for various surgical procedures below the navel. Aim: To evaluate the efficacy and safety of the caudal use of dexmedetomidine in caudal anesthesia in children. Methods: The subject of the study was 46 children with physical status I and II class of the American Society of Anesthesiologists (ASA), aged 0 to 12 years, who underwent elective surgeries below the navel, such as hernia repair, orchiopexy, hypospadias repair, epispadias, etc. Results: The duration of caudal analgesia was determined from the moment the anesthetic was injected until the moment the child first complained of pain or the time when the first postoperative analgesia was required. The average duration of postoperative caudal analgesia in patients of group A was 4.21 ± 0.88, while in patients of group B this duration was 10.18 ± 0.85 hours. Conclusions. Our results show that the addition of dexmedetomidine to the local anesthetic for caudal block significantly increases the duration of analgesia and reduces the need for analgesics. More data is also needed on the neurological safety of dexmedetomidine. Key words: dexmedetomidine,caudal block, bupivacaine.

scholarly journals Pain management and bupivacaine

2021 ◽  
Vol 10 (9) ◽  
pp. 1083
Author(s):  
Anupam Nath Gupta ◽  
Paras Nath
Keyword(s):  
Tissue Injury ◽  
Control Group ◽  
Intraoperative Care ◽  
Background Pain ◽  
Analgesia Requirement ◽  
Group A ◽  
American Society ◽  
Group B ◽  
American Society Of Anesthesiologists

Background: Pain is an unpleasant experience associated with tissue damage. Peripheral tissue injury results in functional disturbances in the nervous system. Modern anaesthesiologists are not only concerned about preoperative and intraoperative care of the patient but also with postoperative welfare of the patient.Methods: In present study we have compared the efficacy of injection bupivacaine 0.25% infiltration preoperatively versus postoperatively on duration of postoperative analgesia, VAS (visual analogue scale) at the onset of pain, total analgesia requirement in 24 hours. 150 patients belonging to ASA (American society of anesthesiologists) class I and II between the age of 15 and 75 who underwent lower abdominal surgeries belonging to either sex were included in the study. The patients were randomly allocated to three groups. Control group (C) received 20 ml normal saline, preoperative group (A) received 0.25% bupivacaine before incision, postoperative group (B) received 0.25% bupivacaine before closure.Results: Duration of analgesia, VAS score at the time of first request of analgesia and total doses of analgesia over 24 hours were recorded. The total analgesia requirement was reduced over 24 hours in the group B in which the infiltration was done postoperatively.Conclusions: The postoperative infiltration with 0.25% bupivacaine produces longer duration and better quality of analgesia as compared to preoperative infiltration.

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