Ultrasound-Guided Anterior Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Related Side Effects in Patients Undergoing Total Hip Replacement Arthroplasty: A Propensity Score-Matched Cohort Study

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24–48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

Outcomes of Surface Replacement Arthroplasty in Metacarpophalangeal Joints Affected by Noninflammatory Arthritis

Background The purpose of this study was to investigate the outcomes of surface replacement arthroplasty (SRA) for noninflammatory arthritis of the metacarpophalangeal (MCP) joint. Methods Records from 20 SRAs performed between 1995 and 2017 in 17 patients with noninflammatory arthritis affecting the MCP joint were retrospectively reviewed. The mean follow up was 6.6 years. Results Three arthroplasties (15%) underwent 4 revision operations. The 2-, 5-, 10-, and 15-year rates of survival from surface replacement implant revision were 90%, 90%, 79%, and 79%, respectively. Major complications occurring in revised joints included arthrodesis (n = 1) and amputation (n = 1). The overall reoperation rate was 35%. The 2-, 5-, 10-, and 15-year rates of overall reoperation-free survival were 75%, 69%, 60%, and 60%, respectively. Conclusions Pain ratings and MCP arc of motion significantly improved following arthroplasty. Metacarpophalangeal SRA for noninflammatory arthritis can improve arc of motion and pain. Revision is uncommon; however, 1 in 3 joints requires reoperation.

The results of replacement arthroplasty in the treatment of bone chondrosarcoma

This article reports on the results of replacement arthroplasty in the treatment of bone chondrosarcoma. As a result of replacement arthroplasty in 28 patients, post-surgical complications were observed in two (7.1 %) patients, and tumor recurrence was observed in two (7.1 %) patients. Infectious post-surgical complications were observed in one patient after replacement arthroplasty of coxofemoral joint; the endoprosthesis in this patient was removed, and cement spacer was implanted; six months later the replacement arthroplasty was repeated. The aseptic loosening of the endoprosthetic stem of the joint was observed in one patient after knee arthroplasty; the replacement arthroplasty was repeated. The chondrosarcoma recurrence was identified in two patients between 18 to 53 months; lower extremity amputation was performed in one patient at the level of the mid-third of the femur; lower extremity amputation was performed in one patient at the level of the lower third of the femur, and polychemotherapy courses, including further metastasectomy, were performed in three patients having dedifferentiated and mesenchymal chondrosarcoma with metastases in the lungs. The functional result in the extremity, depending on the tumor site (based on MSTS scoring system) after the endoprosthetic procedure constituted 68.4 to 89.2 %. The quality of life of patients, according to the EORTC QLQ-30 questionnaire, was 40–50 scores before the arthroplasty, while after the arthroplasty the score went up and constituted 85–90 on average. The overall three-year survival rate of patients with chondrosarcoma constituted 95.3 ± 1.7 % and the five-year survival rate was 89.7 ± 2.1 %. The survival rate for patients with mesenchymal and dedifferentiated chondrosarcoma constituted 0 %.

Aquatic Exercise and Land Exercise Treatments after Total Knee Replacement Arthroplasty in Elderly Women: A Comparative Study

Background and Objectives: Early intensive exercise after total knee replacement arthroplasty (TKRA) has become increasingly popular due to its ability to enhance knee physical function and reduce pain. When implemented exclusively, aquatic exercise (AE) appears to be more advantageous than land exercise (LE), particularly in the early phase after TKRA. Our study aimed to compare the clinical efficacy of AE and LE with respect to their effects on pain and physical function after TKRA. Materials and Methods: Between February 2008 and January 2020, 100 female patients who underwent TKRA were enrolled in this retrospective study. We measured the range of motion (ROM) of the knee, the isokinetic strength of the knee joint (function), and pain both initially and one month after TKRA. Two weeks after TKRA, the participants were enrolled in either the AE or the LE program for a total of two weeks. Two 30 min sessions of intensive ROM and knee strengthening exercises and balance training were provided to the AE and LE groups for 10 days. The home exercise group (HE) only received information on ROM and strengthening exercises. There were 33, 21, and 46 patients allocated to the AE, LE, and HE groups, respectively. Results: The ROM of the side on which surgery was performed improved significantly in all groups, as did the pain scores. In the AE group, the knee flexor strength showed a tendency toward improvement. Contrastingly, there was no significant improvement in the knee extensor strength in the AE group. Conclusions: Overall, the AE and LE groups showed superior outcomes compared with HE. In addition, the AE group demonstrated some improvement in knee muscle strength even with a short hospital stay. Further study with long-term follow-up should be performed to better define the outcomes.

OP0113 FEMALE REPRODUCTIVE FACTORS AND RISK OF JOINT REPLACEMENT ARTHROPLASTY OF KNEE AND HIP DUE TO OSTEOARTHRITIS IN POSTMENOPAUSAL WOMEN: A NATIONWIDE COHORT STUDY OF 1.36 MILLION WOMEN

Background:Previous studies on the link between female reproductive factors and osteoarthritis (OA) have shown conflicting results.Objectives:This study attempted to explore the association between reproductive factors and joint replacement arthroplasty of knee (TKRA) and hip (THRA) in a large nationwide population-based cohort of postmenopausal women.Methods:1,218,257 subjects who participated in national health examination in 2009 were included in the study. The study outcomes is incident THRA or TKRA due to severe hip or knee OA. The association of reproductive factors and THRA or TKRA was evaluated using a multivariate-adjusted proportional hazards model.Results:During the mean follow-up duration of 8.2 years, 1,733 incident THRA cases and 65,108 incident TKRA cases were observed. Later age at menarche (aHR 1.12 in 13-14 years; aHR 1.24 in 15-16 years; aHR 1.32 in ≥ 17 years), longer breastfeeding (aHR 1.24 in < 6 months; aHR 1.24 in 6-12 months; aHR 1.50 in ≥ 12 months), HRT (aHR 1.06 in < 2 years; aHR 1.11 in 2-5 years; aHR 1.21 ≥ 5 years) and OC use (aHR 1.11 in < 1 year; aHR 1.17 ≥ 1 year) was associated with increased risk of TKRA for severe knee OA, while later age at menopause (aHR 0.93 in 45-49 years; aHR 0.89 in 50-54 years), longer reproductive span (aHR 0.91 in 30-34 years; aHR 0.87 in 35-39 years; aHR 0.91 in ≥ 40 years) was associated with decreased risk. With regard to THRA for severe hip OA, later menarche (aHR 1.21 ≥ 17 years), longer breastfeeding (aHR 1.39 in < 6 months; aHR 1.31 in ≥ 12 months), and HRT more than 5 years (aHR 1.49) were associated with higher risk. The association between reproductive factors and severe OA was more pronounced in underweight and younger subjects.Conclusion:Our study found that shorter estrogen exposure was associated with higher risk of joint replacement therapy due to severe OA, and such association was more pronounced in underweight and younger subjects.Disclosure of Interests:None declared