Continuous wound infiltration after Hallux valgus surgery

Hintergrund: Hallux valgus Operationen sind mit signifikanten postoperativen Schmerzen verbunden. Das Ziel dieser Arbeit war es, die Wirksamkeit der kontinuierlichen Wundinfiltration (CWI) im Rahmen einer multimodalen Schmerztherapie nach Hallux valgus Operation zu überprüfen. Methoden: In dieser prospektiv-randomisierten, doppel-blinden und Placebo-kontrollierten Single-Center Studie wurden 50 Patienten mit distaler Metatarsale-1 Korrekturosteotomie bei idiopathischem Hallux valgus in 2 Gruppen mit CWI mittels Ropivacain oder Placebo für 24 Stunden randomisiert. Als primäre Outcome-Parameter wurden mittlerer und maximaler Schmerz innerhalb der ersten 48 Stunden nach der Operation erhoben. Sekundäre Outcome-Parameter waren Opiatverbrauch, klinisches Outcome, Komplikationsrate und Patientenzufriedenheit. Resultate: 39 Patienten beendeten die Studie vollständig, bei 42 Patienten konnten die primären Outcome-Parameter erhoben werden. Es zeigte sich kein signifikanter Unterschied zwischen den beiden Gruppen hinsichtlich mittlerem (p=0.596) und maximalem (p=0.353) postoperativen Schmerz. Weiters konnte kein signifikanter Unterschied zwischen beiden Gruppen hinsichtlich aller sekundärer Outcome-Parameter gefunden werden. In der Ropivacain Gruppe war jedoch ein Trend hinsichtlich eines niedrigeren Opiat-Verbrauchs zu verzeichnen (1.4 mg 1.7 vs. 2.5 mg 2.5). 2 schwerwiegende Komplikationen (lokale Dysästhesie, eingenähter Wundkatheter) und 5 Katheterdislokationen wurden beobachtet. Schlussfolgerung: CWI nach Hallux valgus Operation führte zu keiner signifikanten Schmerzreduktion. Es war jedoch ein Trend hinsichtlich eines geringeren Opiat-Verbrauches zu verzeichnen. Weitere Studien sind notwendig, um den Einsatz der CWI und anderer Regionalanästhesietechniken im Rahmen der multimodalen Schmerztherapie nach Fußoperationen beurteilen zu können.Introduction: Hallux valgus surgery is usually associated with significant pain during the early postoperative period. The aim of this study was to investigate the use of continuous wound infiltration (CWI) for multimodal pain management after hallux valgus surgery. Material and Methods: In this prospective, randomized, double-blind and placebo-controlled single-center trial, 50 patients undergoing distal metatarsal osteotomy with lateral release of the metatarsophalangeal joint for idiopathic hallux valgus were allocated to CWI with ropivacaine or placebo for 24 hours postoperatively. Average and peak pain levels on the verbal numeric rating scale (NRS; 1-10) during the first 48 hours after surgery were recorded as primary outcome parameters. Secondary outcome parameters included consumption of narcotics, clinical outcome, incidence of postoperative complications, and patient satisfaction. Results: Follow-up was completed by 39 patients, while primary outcome parameters were analyzed in 42 patients. No significant difference in mean (p=0.596) and peak (p=0.353) postoperative pain level was found for CWI with either ropivacaine (mean NRS 1.9 0.8; peak NRS 3.5 2.0) or placebo (mean NRS 2.0 0.7; peak NRS 3.9 1.7) during the early postoperative course. Furthermore, no significant difference between both groups was detected regarding narcotic consumption (p=0.354) and all other secondary outcome parameters. Need for rescue medication (hydromorphone) was lower in the treatment group (1.4 mg 1.7 vs. 2.5 mg 2.5). Two severe complications (local dysesthesia while CWI, catheter accidentally fixed by a suture), and five catheter dislocations were observed. Conclusion: CWI after hallux valgus surgery did not reduce postoperative pain level in an inpatients setting. However, there was a trend towards a lower need for rescue medication. Further studies are needed to elucidate the use of CWI or other regional anesthesia techniques for multimodal pain management after foot and ankle surgery.applicant: Dr. Matthias BraitoAbweichender Titel laut Übersetzung der Verfasserin/des VerfassersMedical University of Innsbruck, Dissertation, 2017OeBB(VLID)192854

Knee Extensor Strength and Gait Characteristics After Minimally Invasive Unicondylar Knee Arthroplasty vs Minimally Invasive Total Knee Arthroplasty: A Nonrandomized Controlled Trial

AbstractBackgroundIn light of the existing lack of evidence, it was the aim of this study to compare gait characteristics and knee extensor strength after medial unicondylar knee arthroplasty (MUKA) with those after total knee arthroplasty (TKA), given the same standardized minimally invasive surgery (MIS) approach in both groups.MethodsPatients scheduled for MIS-MUKA or MIS-TKA as part of clinical routine were invited to participate. A posterior cruciate ligament-retaining total knee design was used for all MIS-TKA. A 3-dimensional gait analysis was performed preoperatively with a VICON system and at 8 weeks postoperative to determine temporospatial parameters, ground reaction forces, joint angles, and joint moments. At the same 2 times, isokinetic tests were performed to obtain peak values of knee extensor torque. A multivariate analysis of variance was conducted and included the main effects time (before and after surgery) and surgical group and the group-by-time interaction effect.ResultsFifteen MIS-MUKA patients and 17 MIS-TKA patients were eligible for the final analysis. The groups showed no differences regarding age, body mass index, sex, side treated, or stage of osteoarthritis. We determined neither intergroup differences nor time × group interactions for peak knee extensor torque or any gait parameters (temporospatial, ground reaction forces, joint angles, and joint moments).ConclusionIt is concluded that MUKA is not superior to TKA with regard to knee extensor strength or 3-dimensional gait characteristics at 8 weeks after operation. As gait characteristics and knee extensor strength are only 2 of the various potential outcome parameters (knee scores, activity scores…) and quadriceps strength might take a longer time to recover, our findings should be interpreted with caution

Radiological predictors of outcomes in hip arthroscopy for femoroacetabular impingement.

AIMS Hip arthroscopy has gained prominence as a primary surgical intervention for symptomatic femoroacetabular impingement (FAI). This study aimed to identify radiological features, and their combinations, that predict the outcome of hip arthroscopy for FAI. METHODS A prognostic cross-sectional cohort study was conducted involving patients from a single centre who underwent hip arthroscopy between January 2013 and April 2021. Radiological metrics measured on conventional radiographs and magnetic resonance arthrography were systematically assessed. The study analyzed the relationship between these metrics and complication rates, revision rates, and patient-reported outcomes. RESULTS Out of 810 identified hip arthroscopies, 359 hips were included in the study. Radiological risk factors associated with unsatisfactory outcomes after cam resection included a dysplastic posterior wall, Tönnis grade 2 or higher, and over-correction of the α angle. The presence of acetabular retroversion and dysplasia were also significant predictors for worse surgical outcomes. Notably, over-correction of both cam and pincer deformities resulted in poorer outcomes than under-correction. CONCLUSION We recommend caution in performing hip arthroscopy in patients who have three positive acetabular retroversion signs. Acetabular dysplasia with a lateral centre-edge angle of less than 20° should not be treated with isolated hip arthroscopy. Acetabular rim-trimming should be avoided in patients with borderline dysplasia, and care should be taken to avoid over-correction of a cam deformity and/or pincer deformity