Preoperative Pain Control in Arthroscopic Rotator Cuff Repair: Does It Matter?

BACKGROUND: The purpose of this study was to clarify the importance of preoperative pain control using corticosteroid injections in patients with persistent rest pain (RP) before arthroscopic rotator cuff repair (ARCR). METHODS: A total of 360 patients (374 shoulders) who underwent primary ARCR and were followed up for at least 2 years were enrolled. After one-to-one propensity score matching, 266 patients (145 men and 128 women, 273 shoulders) were included in the study. Their mean age was 65.2 ± 7.7 years (range, 42 to 88 years) at the time of surgery. The patients were divided into three groups: those who required several intra-articular or subacromial bursa corticosteroid injections preoperatively for refractory RP (group A+), those in whom RP was resolved preoperatively (group A−), and those who had no RP and did not require any injections (group B). The incidence of postoperative RP and preoperative and final follow-up American Shoulder and Elbow Surgeons (ASES) scores were compared among the three groups. RESULTS: The incidence of postoperative RP was significantly higher in group A+ (35/91 cases, 38.5%) than in group A− (10/91, 11.0%) and group B (7/91, 7.7%, p < 0.001 for both). The preoperative ASES score was significantly lower in group A+ (33.2 ± 14.2) than in group A− (53.9 ± 11.9) and group B (62.3 ± 11.2, p < 0.001 for both), and it was significantly lower in group A− than in group B (p = 0.000). The final follow-up ASES score was significantly lower in group A+ (92.1 ± 8.4) than in group A− (97.6 ± 5.4) and group B (99.0 ± 2.5, p < 0.001 for both). There was no significant difference in the final follow-up ASES score between group A− and group B (p = 0.242). CONCLUSIONS: Patients in whom preoperative RP could be resolved before surgery achieved postoperative outcomes comparable to those in patients who had no RP before surgery, whereas the outcomes in patients with refractory preoperative RP were inferior. The results suggest that preoperative pain control is important in patients undergoing ARCR.

Hydroxyapatite-Coated total knee arthroplasty in rheumatoid artritis patients: a short-term follow-up study

To determine the outcome of cementless hydroxyapatite-coated total knee prosthesis in rheumatoid patients. Analytical. University of Yamanashi Hospital, Japan, from October 1999 to September 2002. Twenty total knee arthroplasties using HA-coated Scorpio Superflex CR and Delta 7000 series were performed in 17 rheumatoid patients. Pre and postoperative results were compared using JOA scores. Male: female ratio was 16:1, average age was 67 years and mean duration of follow-up was two years. JOA scores improved significantly [p<0.05] postoperatively from an average of 37 to 80. Varus and valgus angular deformities improved significantly and 90% of the knees had alignment between zero and 5 degrees of valgus angulation with an average tibiofemoral angle [FTA] of 172. The radiographic findings revealed no radiolucent lines at two years follow-up. Distal femur osteolysis was not observed. The clinical results were excellent at 2-year follow-up, which are in agreement with other reports using hydroxyapatite-coated knee prosthesis