Total Knee Arthroplasty: Opioid-Free Analgesia in a Patient with Opioid-Induced Hyperalgesia

Total Knee Arthroplasty: Opioid-Free Analgesia in a Patient with Opioid-Induced Hyperalgesia Abstract Case: Controlling pain in total knee arthroplasty (TKA) is important but can be complex. We present a case of a 59-year-old female with opioid-induced hyperalgesia who was referred for left knee pain and end-stage tricompartmental degenerative joint disease after failure of conservative management. We outline an approach to control postoperative pain in patients undergoing TKA who have severe opioid contraindications. Conclusion: TKA and physical rehabilitation with a 2 year follow up period was accomplished using a multimodal non-opioid approach including a combination of gabapentin, acetaminophen, ketorolac, meloxicam, methocarbamol, a tunneled femoral nerve catheter, and peri-articular cocktail injection. Key terms: Total knee arthroplasty, Opioid-free analgesia, Opioid induced hyperalgesi

Malondialdehyde levels of frozen fish, chicken and turkey on sale in Benin City markets

75 samples of frozen turkey, chicken and fish sold in Benin City markets, Nigeria were screened for lipid peroxidation by colorimetric estimation of their malondialdehyde (MDA) contents. All samples contained extremely high levels of MDA. The order of MDA profiles was fish > turkey > chicken. MDAlevels within chicken and turkey samples varied from market to market, while values for each of the 5 fish species studied were fairly comparable. Highest levels of MDA were obtained in oily fishes, Trachurus trecae and Scomber scombrus. These results and their likely implication for consumerhealth are discussed in relation to the well-known mutagenic and cytotoxic effects of MDA

Age Significantly Affects Response Rate to Outcomes Questionnaires Using Mobile Messaging Software

PURPOSE: To investigate the demographic factors that influence time to respond (TTR), time to completion (TTC), and response rate when using a text messaging-based system and to determine the feasibility and applicability of mobile messaging-based services for collection of patient-reported outcomes among orthopaedic sports medicine patients. METHODS: On the day of surgery, patient mobile phone number was collected and the automated mobile messaging service (MOSIO, Seattle, WA) messaged patients for 10 ``days postoperatively. Patient visual analog scale (VAS) scores were collected 3 times daily, side effects were asked each evening, and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PI) Short Form was collected on postoperative day 3 and 7. RESULTS: A total of 177 patients were enrolled in the study. The overall response rate to the survey questions was 75.0%. For all patients, the average TTR of questions was 35.09 ± 12.57 minutes. The TTC was 2.75 ± 3.56 minutes for PROMIS-PI, 3.51 ± 1.26 minutes for VAS, and 3.80 ± 6.87 for side-effect questions. When patients were stratified into age groups, the youngest group, 16 to 32 years, had the greatest response rate of 85.2% and patients in the 49 to 59 years group had the lowest response rate of 68.4% and 69.1%, respectively (P \u3c .001). There was no significant difference in the TTR or TTC for VAS, PROMIS-PI, or side-effect questions when patients were stratified by age or sex groups (P \u3e .05). CONCLUSIONS: Collectively, all age groups successfully achieved a mean response rate of 75%; however, significantly lower response rates were observed for patients \u3e49 years old. Differences in age and sex did not impact the overall TTR or TTC for VAS, PROMIS-PI, or side-effect questions. Mobile-based applications present as an emerging opportunity to track postoperative outcome scores and reduce clinic survey load. LEVEL OF EVIDENCE: Case series, level of evidence IV

The Financial Implication of an Anterior Cruciate Ligament Injury in National Basketball Association Athletes

Background: The financial and professional implications of ACL injuries have been well documented in National Football League athletes. However, despite the prevalence of ACL ruptures in the NBA, there continues to be a paucity of literature delineating the potential detriment imposed on athletes’ careers following injury Purpose: To quantify the financial repercussions subsequent to ACL injuries on NBA players’ careers spanning the years 2000 to 2019. Methods: A retrospective review was performed for all NBA players who experienced an ACL rupture and underwent reconstruction between 2000 and 2019. Players were matched 1:2 to health controls by age, position, BMI, and PER. Season in which players experienced an ACL rupture was set as the index year. Player demographics information, position, team role, draft pick, date of index year (injury year), contract length and earning during index year, and subsequent contract length and earning were collected. Player efficiency rating (PER) and annual earnings were collected for 3 seasons prior to index year and 7 seasons post index year. Result: When evaluating the annual earning of NBA players with histories ACL ruptures, there was no statistically significant difference present at any time point when compared to matched controls. When examining the mean difference in earnings between the first 3 post index seasons and the 3 pre index seasons, both the ACL and control cohorts saw increased salaries as their careers progress, with no significant different present in the earning reported ($,1662,574 ±$4,685,411 vs $2,593,673 ±$5,323,361, p=0.79, respectively). When earnings were examined based on playing position, neither guards, forwards, nor centers experienced significant differences between the control and ACL cohort. It was found that for every additional season of experiences a player had prior to an injury they saw a 14.00% increase in earnings (Beta estimate (standard error), 0.13 (0.03), p Conclusion: Our study found that NBA players did not experience diminished earnings following RTP from an ACL rupture when compared to matched controls. Furthermore, there was no differences seen the time to acquiring new contracts, contract length, or contract earnings between cohorts

Anterior Cruciate Ligament Reconstruction Does Not Impact Career Earnings After Return to Play in National Basketball Association Athletes

PURPOSE: To quantify the financial impact of an anterior cruciate ligament (ACL) injury on the remaining career earnings of National Basketball Association (NBA) players. METHODS: We performed a retrospective review of all NBA players who had an ACL rupture between 2000 and 2019. Players were matched to healthy controls by age, position, body mass index, and player efficiency rating at the time of injury (index year). Player information collected included demographic information, position, team role, draft pick, date of injury, contract length, and earnings during the 3 years before and 7 years after the index year, as well as new contract length and earnings after injury. RESULTS: A total of 12 players (22%) did not return to play (RTP). No statistically significant difference in annual earnings was present at any time point between cohorts. When we examined the mean difference in earnings between the first 3 post-index seasons and the 3 pre-index seasons, both the ACL and control cohorts showed increased salaries as players\u27 careers progressed, without a significant difference in earnings. When comparing cohorts, we found no significant difference in the length and earnings of contracts during the index year. Furthermore, there was no significant difference in the length or earnings of the first new contract signed after the index year between cohorts. Additionally, NBA players who were able to RTP after ACL reconstruction were more likely to experience increased earnings if they had greater experience and performance prior to their injury (P \u3c .01). CONCLUSIONS: Our study found that NBA players did not experience diminished earnings after RTP from an ACL reconstruction when compared with matched controls. Furthermore, no differences were seen in lengths of new contracts or in contract earnings between cohorts. Players with greater experience and performance prior to injury were more likely to have increased earnings after ACL reconstruction. LEVEL OF EVIDENCE: Level III, retrospective case-control study

Staged Correction of Severe Recurrent Clubfoot Deformity With Dislocation of the Chopart Joint Using a Hexapod External Fixator and Unconventional Arthrodesis

Despite success of the Ponseti method, a subset of patients with clubfeet experience residual deformity. Surgical release after unsuccessful serial casting can lead to residual clubfoot deformities, including a flat-top talus. We present a case of a 17-year-old boy with a dysmorphic ankle and a complete dorsal dislocation of the Chopart joint. Because of pain with activities and functional limitations, the patient underwent a staged correction of the dislocation. The deformity was corrected through a staged approach using a Taylor Spatial Frame, navicular excision, talocuneiform arthrodesis, and calcaneocuboid arthrodesis. One year postoperatively, the patient is pain free with notable functional gains

Total Knee Arthroplasty: Opioid-Free Analgesia in a Patient with Opioid-Induced Hyperalgesia: A Case Report

CASE: Pain control after total knee arthroplasty (TKA) remains a significant challenge, especially in the context of certain patient-specific factors. We present a case of a 59-year-old woman with opioid-induced hyperalgesia who was referred for left knee pain and end-stage tricompartmental degenerative joint disease after failure of conservative management. We outline an approach to control postoperative pain in patients undergoing TKA who have severe opioid contraindications. CONCLUSIONS: TKA and rehabilitation with a 6-year follow-up period was accomplished using a multimodal nonopioid approach, consisting of a combination of gabapentin, acetaminophen, ketorolac, meloxicam, methocarbamol, a tunneled femoral nerve catheter, and periarticular injection