The influence of obesity on clinical outcomes following primary total knee arthroplasty: A prospective cohort study.

BACKGROUND: The aim of this study was to evaluate the influence of obesity on patients' function, pain, and complications following primary total knee arthroplasty (TKA) with an enhanced-recovery program. METHODS: A total of 157 patients were enrolled into a prospective study and assigned into one of three groups on the basis of their body mass index (BMI): normal (BMI 18.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), or obese (BMI ≥30.0 kg/m2). The primary outcome was knee range of motion (ROM) on postoperative day (POD) 3, 15, 30, and 90, and secondary outcomes were visual analog scale (VAS) on POD 1, 2, 3, 15, 30, and 90, length of stay, and complications. RESULTS: The ROM of patients in the obese group on POD 3 was higher than in the normal (104.4 ±â€¯8.5 vs. 98.9 ±â€¯8.9, P = .010) and overweight (104.4 ±â€¯8.5 vs. 97.7 ±â€¯7.8, P = .001) groups. Similarly, the VAS in the obese group at rest on POD 1 was lower than in the normal (2.0 ±â€¯0.7 vs. 2.2 ±â€¯0.6, P = .043) and overweight (2.0 ±â€¯0.7 vs. 2.3 ±â€¯0.6, P = .010) groups. In addition, the incidence of complications did not differ significantly among the three groups, but the length of hospital stay in the obese group was longer (P = .027). CONCLUSIONS: Obesity may not affect patients' function and pain, and may not increase the incidence of complications following primary TKA. Obese patients may obtain satisfactory functional rehabilitation outcomes, but with a longer duration of rehabilitation.

Intravenous glucocorticoid for pain control after spinal fusion: A meta-analysis of randomized controlled trials.

OBJECTIVE: Postoperative pain was a common symptom after spinal surgery. This meta-analysis aimed to assess whether intravenous glucocorticoids has a beneficial role in reducing pain in patients following spinal fusion. METHODS: We systematically searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Google databases, from inception to March 2, 2018. Randomized controlled trials (RCTs) that comparing intravenous glucocorticoids with control treatment for spinal fusion were included. A meta-analysis was performed to generate pooled risk ratio (RR) and weighted mean difference with corresponding 95% confidence interval (CI) for discontinuous outcomes (the occurrence of nausea and infection) and continuous outcomes (visual analog scale [VAS] at 12, 24, and 48 h; total morphine consumption; and the length of hospital stay), respectively. RESULTS: Eight clinical trials involving 918 patients (glucocorticoid group = 449, control group = 469) were finally included in this meta-analysis. Compared with control, intravenous glucocorticoids had significantly reduced VAS at 12, 24, and 48 hours with statistically significance (P < .05). Intravenous glucocorticoids can decrease the occurrence of nausea (RR = 0.42, 95% CI 0.29-0.62, P = .000; I = 0.0%) and the length of hospital stay. No difference was noticed in the occurrence of infection between glucocorticoids intravenous and control (P > .05). CONCLUSION: Existing evidence indicated that intravenous glucocorticoids have a beneficial role in decreasing early pain and the occurrence of nausea after spinal fusion surgery. In consideration of the limitation in current meta-analysis, more high-quality RCTs were needed to identify the optimal dose of glucocorticoids in spinal fusion patients.

[Current therapy status and research progress of cartilage defects of knees].

To demonstrate the current strategies for treating cartilage defects of knees and the related research. Published papers about cartilage defects were searched and reviewed. The current strategies for the treatment were summarized. Based on the research of our study and others, the conclusion how to treat cartilage defects was made. The current ways for treating cartilage defects include micro-fractures, chondrocytes transplantation, mosaicplasty and tissue engineering; Research on functional magnetic resonance imaging in the early diagnosis of cartilage defects, cartilage degeneration is gradually increasing. There is still no effective treatment of cartilage defects and tissue engineering has brought new hopes for the treatment of cartilage defects , functional magnetic resonance imaging has some significance in early diagnosis of cartilage defects, cartilage degeneration.