Comparison between ultrasound-guided pericapsular nerve group block and anterio quadratus lumborum block for total hip arthroplasty: a double-blind, randomized controlled trial.

OBJECTIVE: Peripheral nerve block can provide effective postoperative analgesia to patients undergoing total hip arthroplasty (THA). This study aimed to compare ultrasound-guided pericapsular nerve group (PENG) block against anterior quadratus lumborum (AQL) block for pain management in primary THA. PATIENTS AND METHODS: In this prospective, double-blind, randomized controlled trial, 90 patients undergoing primary THA under general anesthesia were randomly allocated to receive ultrasound-guided PENG block + sham AQL block ("PENG group") or ultrasound-guided AQL block + sham PENG block ("AQL" group). The primary outcome was the highest pain score on a visual analogue scale while the patient was in the recovery room. Secondary outcomes included pain scores after transfer out of the recovery room, morphine consumption, quadricep strength, duration of hospitalization, pain level one year after surgery, and incidence of complications. RESULTS: Patients in the PENG group reported significantly lower maximum pain scores in the recovery room (31.3±9.1 vs. 37.3±7.4, p=0.001), as well as significantly lower pain scores at rest at 3 h after surgery and during motion at 3 and 6 h after surgery. The two groups did not differ significantly in postoperative morphine consumption, length of hospitalization, pain level at one year after surgery, or incidence of complications. Neither block significantly weakened the quadriceps. CONCLUSIONS: PENG block may provide slightly more effective postoperative analgesia than AQL block during the early recovery period after primary THA.

Abnormal hyperplasia of chondrocytes in a rat model of glucocorticoid-induced osteonecrosis of the femoral head.

OBJECTIVE: The aim of our study was to determine whether abnormal hyperplasia of chondrocytes occurs in glucocorticoid-induced osteonecrosis of the femoral head (GC-ONFH) using a well-established rat model. MATERIALS AND METHODS: Rats were injected with lipopolysaccharide and methylprednisolone to induce GC-ONFH, while control animals were injected with saline (12 animals per group). Establishment of the disease model was confirmed using micro-computed tomography and hematoxylin-eosin (HE) staining of femoral head tissue sections. Chondrocyte hyperplasia was detected using HE staining and semi-quantitated using toluidine blue and saffron O staining. Expression of the autophagy marker LC3B was assessed in cartilage tissues of femoral head using immunohistochemistry. RESULTS: GC-ONFH animals showed significantly greater area of abnormal chondrocyte hyperplasia in femoral head tissue sections than control animals. They also showed significantly higher expression of LC3B in articular cartilage of the femoral head. CONCLUSIONS: GC-ONFH may be associated with abnormal chondrocyte hyperplasia in articular surface cartilage, which may be related to glucocorticoid-induced overactivation of autophagy.

[Gait analysis at the early stage after direct anterior approach in total hip arthroplasty].

OBJECTIVE: To evaluate the result of operation and gait analysis at the early stage after direct anterior approach (DAA) in total hip arthroplasty (THA). METHODS: In this study, 20 patients who suffered from necrosis of femoral head or developmental dysplasia of the hip were scheduled to undergo THA. The basic information and visual analogue scale (VAS) score, Harris score before and after surgery were recorded. All of the patients finished the gait analysis before the surgery and 6 weeks and 12 weeks after the surgery, the data were compared with those of normal adult people. RESULTS: Their hospital stay after the operation was 3.3 d, the VAS score after the operation was no more than 4 points, the positions of prosthesis were satisfactory, and there was no dislocation. The gait analysis results contained step speed, stride, the range of motion (ROM) of hip and knee. The step speed before the surgery (preoperation, Pre) was 0.64 m/s, 6 weeks after the surgery (6W) was 0.77 m/s, 12 weeks after the surgery (12W) was 1.07 m/s, and the control group was 1.19 m/s. The stride at Pre, 6W, 12W, and control group were 43.15 steps/min, 51.42 steps/min, 55.52 steps/min, and 57.15 steps/min, respectively. The ROM of hip joint at Pre, 6W, 12W, and control group were 31.00°, 39.62°, 40.40°, and 45.67°, respectively. The ROM of knee joint at Pre, 6W, 12W, and control group were 50.52°, 59.28°, 67.29°, and 70.42°, respectively. The results of the gait analysis showed that the gait recovery after the direct anterior total hip arthroplasty was very fast and at the 12th week after surgery the gait of the patients was close to the normal adult people. CONCLUSION: The direct anterior approach is one of the choosable approach of the THA, and this kind of surgery has a better recovery of gait after the operation, and at the end of 12 weeks after the surgery the gait is very close to the normal adult people. But we also need more studies to prove this conclusion.

The arthropathic and functional impairment features of adult Kashin-Beck disease patients in Aba Tibetan area in China.

OBJECT: The purpose of the study was to analyze the features of arthropathic changes and functional impairments as well as the correlations between them for adult patients suffered with Kashin-Beck disease (KBD) in Aba Tibetan area of Sichuan Province, China. METHOD: Nine hundred and eighty-nine adult KBD patients in Aba KBD prevalence area were investigated. The arthropathic changes including arthritic pain (evaluated by visual analog pain score (VAS)), deformity, limited range of joint motion (ROM), as well as daily living and working function were examined, evaluated and analyzed. RESULTS: Ninety-two percent of patients suffered with multiple affected joints in both upper and lower extremities. The most frequently affected joints were knee (86.1%) and hand (77.2%). The most painful joints were knee (VAS 7.1 ± 1.9) and elbow (VAS 6.8 ± 2.1). Joint deformities most frequently represented as enlargement of interphalangeal joints (93.2%). Limitation of ROM occurred most frequently in hand (76.7%) and elbow (38.4%). Multiple linear regression analysis revealed that only joint pain (regression coefficient: -0.504, 95% confidence interval (CI): -0.820-0.188, P ＜ 0.001) and ROM (regression coefficient: 0.017, 95% CI: 0.011-0.024, P ＜ 0.001) were independent risk factors affecting daily living and working function. CONCLUSION: Most adult patients suffered with multiple affected joints in both upper and lower limbs. The elbow, hand and knee were the most frequently and severely affected joints. The pain and limited ROM were the independent risk factors of daily living and working function.

Is there reduced polyethylene wear and longer survival when using a mobile-bearing design in total knee replacement? A meta-analysis of randomised and non-randomised controlled trials.

The purpose of this study was to undertake a meta-analysis to determine whether there is lower polyethylene wear and longer survival when using mobile-bearing implants in total knee replacement when compared with fixed-bearing implants. Of 975 papers identified, 34 trials were eligible for data extraction and meta-analysis comprising 4754 patients (6861 knees). We found no statistically significant differences between the two designs in terms of the incidence of radiolucent lines, osteolysis, aseptic loosening or survival. There is thus currently no evidence to suggest that the use of mobile-bearing designs reduce polyethylene wear and prolong survival after total knee replacement.

Preventive effects of supplemental selenium and selenium plus iodine on bone and cartilage development in rats fed with diet from Kashin-Beck disease endemic area.

The purpose of this study was to investigate the effects of supplemental selenium and selenium plus iodine on bone and growth plate cartilage histology and serum biochemistic parameters in rats. Ninety-six Wistar rats were randomly divided into the following four groups: group A, the rats fed with normal diet; group B, fed with diet from Kashin-Beck disease (KBD) endemic area; group C, fed with diet from KBD endemic area supplemented with selenium; and group D, fed with diet from KBD endemic area supplemented with selenium and iodine. After 4, 8, and 12 weeks, bone and cartilage samples were collected from the rats and were examined for morphological changes in the tibial growth zone and for changes in the plate cartilage and metaphysic. Compared to the rats fed with diet from the KBD endemic area, the rats fed with the supplemental selenium or selenium plus iodine exhibited diminished necrosis of the chondrocytes in the growth plate. In the groups of rats receiving supplemental selenium and selenium plus iodine, the bone volume/tissue volume ratio (BV/TV), the trabecular thickness (Tb.Th), and the trabecular number were increased, while the trabecular separation was decreased. In the 12th week of the experiment, BV/TV and Tb.Th were significantly increased in the selenium plus iodine group compared to the selenium group. It is concluded that feeding the diet from the KBD endemic area caused necrosis of chondrocytes and dysfunctions of bone development similar to the pathological changes that are seen in KBD. Selenium and iodine protected chondrocytes in growth plate and promoted the formation of trabecular bone. The effects of selenium plus iodine on bone formation were more obvious than those of selenium alone.