Radiofrequency ablation prior to total knee arthroplasty does not improve post-surgical pain or recovery: a double-blinded, multi-center, randomized clinical trial.

Background: Radiofrequency ablation (RFA) targeting the genicular nerves is an effective treatment for knee pain due to osteoarthritis. The aim of this study was to determine the effects of two RFA interventions delivered preoperatively on early postoperative pain management and subjective outcomes after total knee arthroplasty (TKA). Methods: One hundred forty-three participants were enrolled in this double blinded, sham-controlled prospective randomized trial. Participants assigned at random to traditional RFA (t-RFA) (n=50), cooled RFA (c-RFA) (n=49), or sham (n=44) procedures prior to TKA. Outcomes were recorded at postoperative day 3, week 1, week 2, week 12, month 6, and month 12 following TKA. Primary outcomes included hospital length of stay (LOS), opioid consumption (reported as MEQ, or daily morphine equivalents), time to narcotic cessation (reported in days), and pain scores (reported as NRS, or Numeric Rating Scale). Secondary outcomes included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) measures. All side effects and complications were reported. Participants were followed for a year to detect any unexpected side effects. Results: Compared with sham controls, t-RFA and c-RFA did not affect inpatient LOS, pain scores, or opioid consumption. There were no reductions in time to opioid cessation, pain scores, or WOMAC scores at any time point post-TKA. Conclusions: RFA of the genicular nerves prior to TKA did not affect opioid use or time to cessation, pain, or WOMAC scores, following TKA. Current techniques of t-RFA and c-RFA of these specific geniculate nerves preoperatively are not indicated as routine interventions to improve short-term surgical recovery after TKA. Trial Registration: The trial was registered on ClinicalTrials.gov (NCT02925442).

Response of Chondrocytes to Local Mechanical Injury in an Ex Vivo Model.

BACKGROUND: Our goal was to set up an ex vivo culture system to assess whether cartilage wounding (partial-thickness defects) can induce morphological changes in neighboring chondrocytes and whether these cells can translocate to the surface of the defect. METHODS: Two-millimeter partial-depth defects were created in human osteochondral explants followed by culture for up to 4 weeks. Frozen sections of defects and defect-free regions were labeled using immunofluorescence for a plasma membrane protein, CD44, and actin with TRITC-phalloidin. Viable nuclei were detected with Hoechst 33342. Differential interference contrast (DIC), confocal, and transmission electron microscopy (TEM) were used to examine process extension. RESULTS: Significant changes in cell morphology occurred in response to wounding in the superficial and deep cartilage zones. These included cell flattening, polarization of the actin cytoskeleton, extension of pseudopods projecting towards the edge of the defect, and interactions of these filopodia with collagen fibers. Cell density decreased progressively in the 300-µm zone adjacent to the defect to an average of approximately 25% to 35% after 3 weeks. Concomitant increases in cell density in the defect margin were observed. By contrast, minimal changes were seen in the middle cartilage zone. CONCLUSIONS: These novel observations strongly suggest active cartilage cell responses and movements in response to wounding. It is proposed that cartilage cells use contact guidance on fibrillated collagen to move into and populate defect areas in the superficial and deep zones.

A modified judet approach to the scapula.

Operative treatment of scapula fractures is uncommon, but is indicated for significantly displaced fractures or intra-articular fractures. This modified Judet approach for exposure of scapula fractures combines several important goals: 1) exposure of all bony elements of the scapula which have adequate bone stock for internal fixation; 2) minimal trauma to the rotator cuff musculature; and 3) protection of the major neurologic structures (suprascapular nerve superiorly and axillary nerve laterally). The main advantage of the exposure is limiting muscular dissection, which can potentially improve rehabilitation and limit morbidity of the operation.

Hip arthroplasty after extracapsular hip fracture: a matched pair cohort analysis.

Eighteen patients with a prior intertrochanteric or basicervical hip fracture had a total or bipolar hip arthroplasty. The clinical and radiographic results of these patients were compared to a control group of patients (matched for age, gender, associated diagnoses, and length of follow-up) who had a primary total hip arthroplasty. There was a significant increase in intraoperative blood loss, operative time, and number of units of blood transfused in the fracture group compared to the primary arthroplasty group. The mean preoperative Harris hip scores were not significantly different between the two groups, but the postoperative scores were significantly lower for the fracture group (p < .001). There was no notable difference in the rates of radiographic loosening or heterotopic ossification between the two groups. The results of this study suggest that patients should be counseled preoperatively that the functional outcome of hip arthroplasty after internal fixation of extracapsular hip fractures is decreased compared to control patients with a primary total hip arthroplasty.