Analgesic effect of femoral nerve block on postoperative pain and ambulation after total knee arthroplasty

Objectives: Determine the analgesic effect of a single injection femoral nerve block on postoperative pain and ambulation, after total knee arthroplasty. Methods: In a prospective study, 84 patients undergoing total knee arthroplasty were randomly assigned to receive: either one single injection femoral nerve block and 100mg paracetamol combined with lornoxicam 4 mg administrated twice intravenously for 5 days (group 1, n=42) or only the aforementioned analgesics without nerve block for the same period (group 2, n=42). Distance walked on 5 first postoperative days and VAS pain score during first 5 days were reported. Patients with bilateral osteoarthritis, previous leg injury or serious cardiovascular disease were excluded. Statistical analysis was performed by statistical packet STATA 8.0 and significance was set at p-value <0.05. Results: Patients of group 1 walked longer distance than patients of group 2 on postoperative day 1, 2 and 3 (p<0.05).The VAS pain score decreased significantly from 7.8/10 to 4.1./10 in Group 1 (P<0.05) and from average 8.1/10 to 5.9/10 in Group 2 (p<0.05) at 5 days after surgery. Patients of group 1 experienced less pain than patients of group2 at 5 days after surgery according to VAS pain score (p<0.05). Conclusion: Single shot of femoral nerve block provides efficient pain relief on early postoperative period after total knee arthroplasty. This is associated with better ambulatory performance. © The Author(s) 2014

Changes of bone turnover markers after marathon running over 245 km

We evaluated bone turn over markers, cortisol and parathyroid hormone (PTH) levels in male athletes after 245 km of marathon running. Sixteen athletes were studied five days before, immediately after, and 1, 3, and 5 days after the run. We used t-test and Pearson correlation for statistical analysis. Osteocalcin levels were significantly decreased from 4.6 μg/lit to 3.8 μg/lit (p < 0.05). Activity of b-ALP was significantly decreased from 66 U/lit to 61.5 U/lit (p < 0.05). PICP levels were also significantly decreased from 168 μg/lit to 153 μg/lit (p < 0.05). Hydroxyproline levels decreased after the run from 70 mmol/min to 65 mmol/min (p < 0.05). ICTP levels increased after the run but without being statistically significant, from 6.62 μg/lit to 7.0 μg/lit. Urine calcium decreased significantly by 68%, immediately after the run. Cortisol increased from 212 ng/ml to 455 ng/ml, and PTH levels increased from 12 pg/lit to 16 pg/lit immediately after the race (p < 0.05). Cortisol levels were significantly negatively correlated with osteocalcin (r = -0.61, p < 0.05) and b-ALP (r = -0.98, p < 0.05). PTH levels were significantly negatively correlated only with serum osteocalcin (r = -0.8, p < 0.05). These findings suggest a transient suppression in osteoblast function during the marathon run probably due to cortisol and PTH levels elevation. © Georg Thieme Verlag KG Stuttgart

The four-year functional result after a displaced subcapital hip fracture treated with three different surgical options

According to the literature, hip function after hip fracture is affected by the type of surgery. Our aim was to determine the correlation between surgical treatment of hip fracture and postoperative function in the elderly. Inclusion criteria were displaced hip fracture and age over 70 years. One hundred and twenty-nine participants were randomly divided into three groups according to the type of the surgical operation they underwent (hemi-arthroplasty [Merete, Berlin, Germany], total arthroplasty [Plus; De Puy, Warsaw, IN, USA] and internal fixation [Richards plate screw; Smith & Nephew, Memphis, TN, USA]). The function of the patients was estimated using the following parameters: the Barthel Index and Harris Hip Score, the range of passive hip motion, the gait speed of individuals, after 1 and 4 years of follow-up. The Barthel Index scores after 4 years of follow-up were 85.3, 82.6, 80.1 after total arthroplasty, hemi-arthroplasty and internal fixation respectively. Similarly, the Harris Hip Scores after 4 years of follow-up were 83.7, 79.5 and 73.6. The range of passive hip motion in the three groups of patients did not differ significantly (p > 0.05). Also, patients of the total arthroplasty and hemi-arthroplasty groups walked faster than the patients of the internal fixation group 4 years after discharge (p < 0.05). In conclusion, we believe that total hip arthroplasty is the treatment of choice for displaced subcapital hip fractures in patients over 70 years old