The Effect of Preoperative Intra-Articular Methylprednisolone on Pain After TKA: A Randomized Double-Blinded Placebo Controlled Trial in Patients With High-Pain Knee Osteoarthritis and Sensitization.

In a randomized, double-blind, placebo controlled trial, we investigated the postoperative analgesic effect of a single intra-articular injection of 40 mg methylprednisolone acetate (MP) administered 1 week before total knee arthroplasty (TKA). Forty-eight patients with high pain osteoarthritis (≥5 on a numeric rating scale during walk) and sensitization (pressure pain threshold <250 kPa), aged 50 to 80 years and scheduled for primary unilateral TKA under spinal anaesthesia were included. The primary outcome was the proportion of patients with moderate/severe pain during a 5-m walk test 24 hours postoperatively. Secondary outcomes included pain at 48 hours, during the first 14 days, sensitization (quantitative sensory testing with pressure pain threshold and wind-up from temporal summation), and inflammatory changes (systemic C-reactive protein, intra-articular interleukin [IL]-6). No difference in the proportion of patients with moderate/severe pain was found between MP/placebo groups at 24 hours (67% and 74%, χ2 = .2, P = .63, odds ratio = .7, 95% confidence interval = .2-2.8) or at 48 hours (57% and 68%, χ2 = .5, P = .46, odds ratio = .6, 95% confidence interval = .2-2.3), and no difference between groups in postoperative sensitization was found (P > .4) despite reduced preoperative intra-articular inflammation (IL-6) in the MP group versus placebo (median change in IL-6 = -70 pg/mL, interquartile range = -466 to 0 vs. 32 pg/mL, interquartile range = -26 to 75, P = .029). Alternative central or peripheral analgesic interventions in this high-risk group are required. PERSPECTIVE: Peripherally driven inflammatory pain and nociceptive changes before TKA has been suggested to be a cause for increased acute postoperative pain. However, preoperative intra-articular MP in patients with high pain osteoarthritis and sensitization did not reduce acute post-TKA pain or sensitization despite a preoperative reduction of intra-articular inflammatory markers.

Comparison of a novel porous titanium construct (Regenerex®) to a well proven porous coated tibial surface in cementless total knee arthroplasty - A prospective randomized RSA study with two-year follow-up.

BACKGROUND: Regenerex is a novel porous titanium construct with a three-dimensional porous structure and biomechanical characteristics close to that of normal trabecular bone. The aim of this study was to compare this novel construct to a well-proven porous plasma sprayed tibial (PPS) implant after total knee arthroplasty. METHODS: Sixty-one patients scheduled for an uncemented TKA were randomized to receive either a novel highly porous titanium construct Regenerex or the PPS tibial component. Radiostereometric analysis of the tibial components was performed postoperatively and at three, six, 12, and 24months with measurements of migration (segment motion and maximum total point motion (MTPM)). RESULTS: Knee and function scores improved significantly from preoperatively to two-year follow-up. For both the Regenerex and the PPS the majority of migration appeared during the first three months and then stabilized. No statistically significant differences in MTPM were found in any follow-up between three and 24months. The Regenerex group had a lower migration rate between 12 and 24months compared with the PPS implants (p=0.03) but the PPS group had an initial significantly lower subsidence (p=0.04). CONCLUSION: In conclusion the Regenerex implant could prove an effective scaffold material for coating of uncemented implants but did no better than the PPS component at 24months of follow-up. ClinicalTrials.gov identifier: NCT01936415.

Quality of care and 30 day mortality among patients with hip fractures: a nationwide cohort study.

BACKGROUND: We examined the association between quality of care and 30 day mortality in a nationwide cohort of patients hospitalized with hip fracture. METHODS: We used data from The Danish National Indicator Project, a quality improvement initiative with participation of more than 90% of Danish hospital departments caring for patients with hip fracture between August 16, 2005 and August 15, 2006. Quality of care was measured in terms of meeting five specific criteria: early assessment of the patient's nutritional risk, systematic pain assessment during mobilization, assessment of Activities of Daily Living (ADL) before the fracture, assessment of ADL before discharge, and initiation of treatment to prevent future osteoporotic fractures. The association between meeting each of the quality of care criteria for the patient and 30 day mortality was examined using logistic regression to adjust for potential confounders. RESULTS: 6,266 patients hospitalized with an incident episode of hip fracture were included in the study. For four of the five quality of care criteria, patients who met the criterion had substantially lower 30 day mortality after hip fracture. The adjusted mortality odds ratios (ORs) ranged from 0.42 (95% CI, 0.30 to 0.58) for assessment of ADL before discharge (excluding deaths during hospitalization) to 0.72 (95% CI, 0.52 to 1.00) for systematic pain assessment. We found an inverse dose-response relationship between the number of quality of care criteria met and 30 day mortality; the lowest mortality was found among patients for whom all five quality of care criteria were met, as compared with patients for whom no quality of care criteria were met: adjusted mortality OR 0.18 (95% CI, 0.09 to 0.36). CONCLUSION: Higher quality of care during hospitalization with hip fracture was associated with lowered 30 day mortality.