Do Selective COX-2 Inhibitors Affect Pain Control and Healing After Arthroscopic Rotator Cuff Repair? A Preliminary Study.

BACKGROUND: Selective cyclooxygenase (COX)-2 inhibitors are commonly used analgesics that provide similar analgesia as that of other analgesics but with fewer adverse effects. However, few prospective studies have performed comparative analyses in this regard. PURPOSE: To evaluate the efficacy of a selective COX-2 inhibitor in early postoperative pain control, satisfaction with pain management, and incidence of systemic adverse effects in patients undergoing arthroscopic rotator cuff repair. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: This study included 180 patients who underwent arthroscopic rotator cuff repair between September 2011 and August 2012. The patients were randomly assigned to receive celecoxib, ibuprofen, or tramadol (n = 60 each). Visual analog scale (VAS) scores for pain intensity and satisfaction with medication, incidence of adverse effects, and use of rescue medication were recorded and compared between the 3 groups at 3 days and 2 weeks after surgery. Magnetic resonance and ultrasonography images of 82 patients were retrospectively reviewed at least 24 months after surgery, along with the range of motion and pain VAS and functional scores. RESULTS: There were no significant differences among the 3 groups in terms of pain intensity, incidence of adverse effects, or dosage of rescue medication at 3 days or 2 weeks after surgery. Pain VAS and functional scores at the final follow-up were also comparable among the 3 groups. However, the retear rate in the celecoxib group (11/30 [37%]) was significantly higher than those in the ibuprofen (2/27 [7%]) and tramadol (1/25 [4%]) groups ( P = .009). CONCLUSION: Despite having similar postoperative analgesic effects as other nonsteroidal anti-inflammatory drugs and opioids, selective COX-2 inhibitors should not be used for postoperative analgesia because they might negatively affect tendon-to-bone healing after surgical repair. Registration: NCT02850211 ( ClinicalTrials.gov identifier).

Perfusion of the Rotator Cuff Tendon According to the Repair Configuration Using an Indocyanine Green Fluorescence Arthroscope: A Preliminary Report.

BACKGROUND: The disturbance of rotator cuff tendon perfusion has been connected with the suture-bridge configuration repair (SBCR) technique; however, in vivo assessments of the tendon blood supply have been problematic with other modalities. An evaluation of tissue perfusion by an indocyanine green (ICG) fluorescence arthroscope has been developed to counteract this difficulty. PURPOSE: To verify the hindrance of perfusion in SBCR, we used an ICG fluorescence camera to compare parallel-type transosseous repair (PTR) and SBCR in rabbits immediately and at 3 days after rotator cuff repair. STUDY DESIGN: Controlled laboratory study. METHODS: Acute rotator cuff repair was performed on the shoulders of 10 rabbits. Both shoulders were repaired using either PTR or SBCR. For PTR, simple repair was performed through 2 parallel transosseous tunnels created using a microdrill. For SBCR, 2 additional crisscross transosseous tunnels were added to mimic arthroscopic SBCR. Immediately after repair, ICG was injected through the ear vein, and images were recorded using an ICG fluorescence camera. Tendon perfusion was compared by measuring fluorescence intensity using ImageJ software in both methods. At 3 days after rotator cuff repair, a reassessment of ICG fluorescence was performed. In addition, as a subsidiary study, a comparison of each repair method and a healthy tendon was performed (PTR vs healthy tendon and SBCR vs healthy tendon). Six rabbits (3 for each comparison) were included. RESULTS: Immediately after rotator cuff repair, the mean (±SD) grayscale intensity of ICG fluorescence was weaker in SBCR than PTR in 10 specimens (65.9 ± 47.6 vs 84.3 ± 53.4 per pixel, respectively; P = .003). At 3 days after repair, 8 specimens were included in the analysis because suture strands failed in 2 specimens in SBCR. The mean intensity of fluorescence was still weaker in SBCR compared with PTR (52.5 ± 13.7 vs 60.2 ± 22.7 per pixel, respectively; P = .077). The mean fluorescence intensity compared with a healthy tendon was 83.2% ± 9.5% in PTR and 63.2% ± 13.2% in SBCR. CONCLUSION: Our ICG fluorescence camera system was able to detect ICG fluorescence in an acute rabbit rotator cuff repair model. SBCR showed inferior tendon perfusion immediately after repair. At 3 days after repair, SBCR still showed inferior fluorescence intensity, although it did not reach statistical significance. CLINICAL RELEVANCE: In this study, SBCR hindered perfusion at the tendon in the compressed area. This finding may affect rotator cuff tendon healing and failure mode.

Cementless bipolar hemiarthroplasty using a micro-arc oxidation coated stem in patients with displaced femoral neck fractures.

Femoral stem fixation for displaced femoral neck fractures in osteoporotic patients is an ongoing debate. We evaluated the outcome of 136 cementless bipolar hemiarthroplasty using a Micro-arc oxidation (MAO) coated stem. All patients survived the procedure and were discharged from the hospital. Thirty- and 90-day mortality rates were 0.7% and 2.2%, respectively. Ninety-eight hips were followed for a minimum of 2years (mean, 44months) postoperatively. Three stems were revised because of a periprosthetic fracture. Although cortical stress shielding around the stem was observed in 3 hips, there was no loosening or osteolysis. Cementless bipolar hemiarthroplasty using a MAO-coated stem is a useful and safe option to treat displaced femoral neck fractures.