Conservative non-pharmacological treatment options are not frequently used in the management of hip osteoarthritis.

Osteoarthritis (OA) is the most frequent joint disorder in seniors. Systematic reviews suggest that conservative treatment is effective and preferred in mild-moderate cases. The objective of this study was to examine the proportion of patients receiving physiotherapy, exercise or walking aids, and to explore factors associated with their prescription. We conducted a retrospective survey of patients about to undergo total hip arthroplasty for hip osteoarthritis. Patients were asked about past prescriptions for cane use, physiotherapy and exercise. Of 161 patients (36.6% male, mean age 68.7+/-10.1 years), 76% were prescribed a cane (adherence=86.2%). The main reason for not using a cane was vanity. Of the 28.0% patients prescribed physiotherapy, 73.3% received exercises compared to only 2.6% of non-physiotherapy patients. Patients who were older or worked in manual labour were more likely to be prescribed a cane and less likely to be prescribed physiotherapy or exercises. Men were less likely than women to be prescribed all three, but only cane use was statistically significant across genders. In conclusion, physiotherapy and exercise are not commonly prescribed in patients with hip OA.

Characterization of the prostaglandin receptors in human osteoblasts in culture.

Prostaglandins have complex actions on bone metabolism that depend on interactions with different types and subtypes of receptors. Our objective was to characterize the prostaglandins receptors present in primary cultures of human osteoblasts. RT-PCR analysis revealed the presence of DP, EP(4), IP, FP and TP receptor mRNA in primary cultures of human osteoblasts. FP receptor mRNA was detected only after 3 weeks of confluency, all the others were detected at every culture time tested. To verify the functionality of these receptors we challenged the cells with the prostanoids and synthetic analogues and determined the intracellular levels of cAMP. All receptors found by RT-PCR were coupled to second messengers except for the DP subtype. These results clearly show the presence of functional EP(4), IP, FP and TP receptors in human osteoblasts in culture.

Induction of cyclooxygenase-2 by parathyroid hormone in human osteoblasts in culture.

OBJECTIVE: Parathyroid hormone (PTH) induced bone resorption by osteoclasts depends on the presence of osteoblasts. PTH induced production of prostaglandins by osteoblasts and induction of bone resorption by prostaglandins suggest that these autacoids may be implicated in the effects of PTH on bone. Our objective was to determine if the increase in prostaglandin production induced in human osteoblasts by PTH is due to an increase in cyclooxygenase-2 (COX-2) expression. METHODS: Primary cultures of human osteoblasts were obtained from specimens of trabecular bone. Confluent cells were treated with PTH, dexamethasone or compound NS-398, a specific COX-2 inhibitor. The concentration of prostaglandin E2 (PGE2) in the supernatants was determined by radioimmunoassay and COX-2 mRNA levels evaluated by Northern blot. RESULTS: PTH induced COX-2 mRNA expression and PGE2 production. These effects were time and concentration dependent and were inhibited by dexamethasone. Compound NS-398 reduced PGE2 production to the same extent as dexamethasone, and neither compound had an additive effect on this variable. CONCLUSION: These results show that PTH induces COX-2 expression in human osteoblasts in culture and suggest that this isoenzyme is the main factor in the control of prostaglandin synthesis in these experimental conditions.

Expression of prostaglandin endoperoxide synthase-1 and prostaglandin endoperoxide synthase-2 in human osteoblasts.

A Prostaglandin endoperoxide synthase isoenzyme was recently identified in several cell lines. Osteoblasts possess Prostaglandin endoperoxide synthase activity, but it is not known which isoenzymes are present in these cells. Our objective was to identify these isoenzymes in human osteoblasts. Resting cells in culture did not produce measurable amounts of PGE2 and did not express Prostaglandin endoperoxide synthase-1 or Prostaglandin endoperoxide synthase-2 mRNAs detectable by Northern blot. Treatment with rhIL-1 alpha or rhTNF alpha induced both the expression of Prostaglandin endoperoxide synthase-2 mRNA and the synthesis of PGE2, rhIL-1 alpha being more potent on an equimolar basis than rhTNF alpha. Dexamethasone inhibited the increase in Prostaglandin endoperoxide synthase-2 mRNA and the production of PGE2 induced by both cytokines. These results suggest that Prostaglandin endoperoxide synthase-2 may be the relevant isoenzyme for prostanoid production in human osteoblasts in culture.

[Axillary plexus block by simultaneous blockade of several nerves. I. Influence of the volume of the anesthetic solution]. / Bloc axillaire par blocage simultané de plusieurs nerfs. I. Influence du volume de la solution anesthésique.

The influence of the volume of local anaesthetic solution on axillary blockade was investigated in a prospective randomized double-blind study including 120 patients presenting for upper limb surgery. A peripheral nerve stimulator was used to carry out the axillary block with a multiple injection technique. The musculocutaneous, radial, median and ulnar nerves were routinely stimulated. Four criteria were monitored: quality of sensory blockade, degree of motor blockade, time of onset and duration of anaesthesia. The patients were randomly allocated into two groups (n = 60 each). In the first, patients received 25 ml per m2 of body surface area of carbonated 1% lignocaine, 0.25% bupivacaine or a 1 to 1 mixture of both. Patients in the other group were given the same amount of local anaesthetic in half the volume, i.e. 12.5 ml.m-2 of carbonated 2% lignocaine, 0.5% bupivacaine or a 1 to 1 mixture of both these. Adrenaline (1 in 400,000) was added to half the anaesthetic solutions used in each group. The data demonstrated that, for a same amount of local anaesthetic, the larger volumes provided better quality sensory blockade than the smaller ones (p < 0.03). However, the volume of solution used affected neither the time of onset nor the duration of anaesthesia, nor the degree of motor blockade. It is concluded that, despite the use of a neurostimulator and simultaneous infiltration of several nerve trunks, the volume required to ensure a reliable degree of sensory block with the technique of axillary block is comprised between 40 and 50 ml (25 ml.m-2).

[Axillary plexus block by simultaneous blockade of several nerves. II. Evaluation of lidocaine-bupivacaine combination]. / Bloc axillaire par blocage simultané de plusieurs nerfs. II--Evaluation du mélange lidocaïne-bupivacaïne.

A mixture of carbonated lignocaine and bupivacaine for axillary blocks was assessed prospectively in a randomized double-blind study including 60 patients scheduled for upper limb surgery. A peripheral nerve stimulator was used to carry out the axillary block with a multiple injection technique. The musculocutaneous, radial, median and ulnar nerves were routinely stimulated. Four criteria were monitored: quality of sensory blockade, degree of motor blockade, time of onset and duration of anaesthesia. The patients were randomly assigned to three groups (n = 20 each). Patients received 25 ml per m2 of body surface area of either carbonated 1% lignocaine (group 1) or 0.25% bupivacaine (group 2) or a 1 to 1 mixture of both (group 3). Adrenaline (1 in 400,000) was added to half the anaesthetic solutions used in each group. The onset of anaesthesia was faster with the mixture (15 +/- 9 min) than will bupivacaine alone (23 +/- 14 min) (p < 0.02). It lasted longer in the mixture group (264 +/- 111 min) than in the lignocaine group (193 +/- 83 min). The longest duration was in the bupivacaine group (476 +/- 276 min) (p < 0.03). Adrenaline only affected significantly the duration of anaesthesia in the lignocaine group (252 min vs 135 min with and without adrenaline, respectively) (p < 0.03). In axillary blocks, the mixture of carbonated lignocaine and bupivacaine has a faster onset of action than bupivacaine alone, and a longer duration of action than lignocaine alone. Both agents provided a quality of sensory and motor blockade similar to that obtained with the mixture.