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D'Amore T, Cozzarelli NF, Sutton R, Lonner JH, Fillingham YA. Low-Dose Enteric-Coated and Chewable Aspirin Are Not Equally Effective in Preventing Venous Thromboembolism in Total Knee and Hip Arthroplasty. J Arthroplasty 2024; 39:S129-S133. [PMID: 38889809 DOI: 10.1016/j.arth.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 06/10/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Low-dose aspirin is an effective venous thromboembolism (VTE) prophylactic medication in primary total joint arthroplasty, but the efficacy and safety of the formulations of chewable and enteric-coated aspirin have not been compared. The purpose of this study was to investigate the VTE and gastrointestinal (GI) complication rates of chewable and enteric-coated 81 mg aspirin bis in die for VTE prophylaxis in primary total joint arthroplasty. METHODS A retrospective, single-institution cohort study was performed on patients who underwent primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2017 to 2021. Comparisons were made between 4,844 patients who received chewable, noncoated aspirin 81 mg and 4,388 patients who received enteric-coated 81 mg aspirin. Power analysis demonstrated 1,978 and 3,686 patients were needed per group to achieve a power of 80% for 90-day VTE rates (using inferiority testing) and GI complications (using superiority testing), respectively. Patients had similar baseline characteristics. Statistical analyses were done using t-tests and Chi-squared tests, with statistical significance defined as a P value < .05. RESULTS There were no significant differences in the incidences of postoperative VTE (0.31% versus 0.55%; P = .111) or GI complications (0.14% versus 0.14%; P = 1.000) between patients who received either chewable or enteric-coated 81 mg aspirin bis in die in the overall comparison that included both THA and TKA patients combined, or THA patients alone. However, the VTE incidence for TKA patients alone was significantly lower with chewable than enteric-coated aspirin (0.22% versus 0.62%; P = .037), with no difference in GI complications (0.13% versus 0.19%; P = .277). CONCLUSIONS Low-dose aspirin in enteric-coated formulation is inferior to chewable aspirin for VTE prophylaxis in primary TKA, but not inferior in THA patients. Both formulations have a similar GI complication rate. Therefore, it is reasonable to consider a transition from enteric-coated to uncoated chewable low-dose aspirin.
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Affiliation(s)
- Taylor D'Amore
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicholas F Cozzarelli
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ryan Sutton
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jess H Lonner
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yale A Fillingham
- Department of Orthopedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Lin Y, Jiang M, Liao C, Wu Q, Zhao J. Duloxetine reduces opioid consumption and pain after total hip or knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2024; 19:181. [PMID: 38481321 PMCID: PMC10936099 DOI: 10.1186/s13018-024-04648-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
PURPOSE There is no consensus in the current literature on the analgesic role of duloxetine after total hip arthroplasty (THA) or total knee arthroplasty (TKA). Thus, we designed this meta-analysis to reveal the analgesic effectiveness and safety of duloxetine in TKA or THA. METHODS As of October 2022, two authors (L.C. and W.Q.J.) independently searched five main databases (EMBASE, Web of Science, PubMed, Cochrane Library, and Google Scholar) to find relevant studies. Duloxetine vs. placebo in randomized controlled trials (RCTs) for THA or TKA were included. We set perioperative total opioid consumption as the primary outcome. Secondary outcomes included resting or dynamic pain scores over time, gastrointestinal adverse events, neurological adverse events, and other adverse reactions. RESULTS Eight RCTs with 695 patients were incorporated in our study. This meta-analysis showed high evidence that duloxetine was effective in reducing perioperative opioid consumption (Standard mean difference [SMD] = - 0.50, 95% confidence intervals [CI]: -0.70 to - 0.31, P < 0.00001) and low to moderate evidence that duloxetine could reduce pain within three weeks after surgery. Low to high evidence showed no differences between the two groups for most adverse events. Substantial evidence suggests that duloxetine can reduce nausea and vomiting after surgery (Risk ratio [RR] = 0.69, 95% CI: 0.50 to 0.95, P = 0.02, I2 = 4%). However, moderate evidence suggested that duloxetine might be associated with increased postoperative drowsiness (RR = 1.83, 95% CI: 1.08 to 3.09, P = 0.02, I2 = 0%). CONCLUSION Duloxetine reduced overall opioid consumption in the perioperative period and relieved pain within three weeks after surgery without increasing the risk of adverse drug events. Duloxetine can be part of a multimodal management regimen in patients with THA and TKA.
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Affiliation(s)
- Yicai Lin
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Mingyang Jiang
- Department of Bone and Joint Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Chun Liao
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Qingjian Wu
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China
| | - Jinmin Zhao
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, 530021, China.
- Department of Trauma Orthopedic and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.
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Bull T, Erzen A, O'Donnell J, Rafla M, Georgy D, Bailey M, Takla A. Hypertrophy Training Following A Total Hip Replacement: A Literature Review. Int J Sports Phys Ther 2024; 19:337-350. [PMID: 38439777 PMCID: PMC10909313 DOI: 10.26603/001c.93075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/04/2023] [Indexed: 03/06/2024] Open
Abstract
Hip OA is becoming more common, with a greater number of younger individuals undergoing total hip arthroplasty (THA). These individuals have the desire to return to considerable loading and in some instances return to sport. The purpose of this review was to investigate the current guidelines and/or protocols for hypertrophy or strengthening in individuals who have undergone total hip arthroplasty. A total of 16 papers were identified, some of which also addressed total knee arthroplasty. There is no consensus for the best practice for a hypertrophy program following THA especially regarding when a direct anterior approach was used during hip arthroplasty. Further research is needed as this is a growing area in rehabilitation. This review aims to bridge the gap by offering a comprehensive synthesis of the available literature on postoperative rehabilitation after THA, with a specific emphasis on identifying the most effective muscular strengthening and hypertrophy training programs for patients undergoing anterior approach hip surgery.
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Affiliation(s)
| | | | | | | | | | | | - Amir Takla
- Hip Arthroscopy Australia
- Department of Health professions Swinburne University of Technology
- Australian Sports Physiotherapy
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Zhao B, Liu H, Du K, Zhou W, Li Y. Effectiveness and safety of outpatient rehabilitation versus home-based rehabilitation after knee arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:704. [PMID: 37726800 PMCID: PMC10510230 DOI: 10.1186/s13018-023-04160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Rehabilitation post-knee arthroplasty is integral to regaining knee function and ensuring patients' overall well-being. The debate over the relative effectiveness and safety of outpatient versus home-based rehabilitation persists. METHODS A thorough literature review was conducted adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across four databases. Two researchers independently identified eligible studies centering on knee arthroplasty patients undergoing either outpatient or home-based rehabilitation. Study quality was assessed using the Cochrane Collaboration's risk of bias tool, while continuous outcomes were subject to meta-analyses using Stata 17 software. RESULTS Our analysis identified no significant differences in primary outcomes, including Range of Motion, Western Ontario and McMaster Universities Arthritis Index, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, and the Knee Society Score, between home-based and outpatient rehabilitation across different follow-up points. Adverse reactions, readmission rates, the need for manipulation under anesthesia, reoperation rate, and post-surgery complications were also similar between both groups. Home-based rehabilitation demonstrated cost-effectiveness, resulting in substantial annual savings. Furthermore, quality of life and patient satisfaction were found to be comparable in both rehabilitation methods. CONCLUSIONS Home-based rehabilitation post-knee arthroplasty appears as an effective, safe, and cost-efficient alternative to outpatient rehabilitation. Despite these findings, further multicenter, long-term randomized controlled trials are required to validate these findings and provide robust evidence to inform early rehabilitation choices post-knee arthroplasty.
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Affiliation(s)
- BiXia Zhao
- Department of Nursing, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, 28 Changsheng West Road, Hengyang, 421001, Hunan Province, China
| | - Hui Liu
- Department of Nursing, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, 28 Changsheng West Road, Hengyang, 421001, Hunan Province, China
| | - Ke Du
- Department of Supervision Office, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, 28 Changsheng West Road, Hengyang, 421001, Hunan Province, China
| | - Wei Zhou
- Department of Emergency, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, 28 Changsheng West Road, Hengyang, 421001, Hunan Province, China.
| | - Ying Li
- Department of Hand and Foot Surgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, 28 Changsheng West Road, Hengyang, 421001, Hunan Province, China.
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Kugelman DN, Mahure SA, Feng JE, Rozell JC, Schwarzkopf R, Long WJ. Total knee arthroplasty is associated with greater immediate post-surgical pain and opioid use than total hip arthroplasty. Arch Orthop Trauma Surg 2022; 142:3575-3580. [PMID: 33991234 DOI: 10.1007/s00402-021-03951-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND As greater emphasis is being placed on opioid reduction strategies and implementation of multimodal analgesia, we sought to determine whether immediate post-surgical opioid consumption was different between THA and TKA. METHODS A single-institution total joint arthroplasty database was used to identify patients who underwent elective THA and TKA from 2016 to July 2019. Baseline demographic data, operative time (defined by incision time), and American Society of Anesthesiologist (ASA) class were collected. Morphine milligram equivalents (MME) were calculated and derived from prospectively documented nursing opioid administration events, while visual analog scale (VAS) scores represented pain levels, both of which were collected as part of our institution's standard protocols. Activity Measure for Post-Acute Care (AMPAC) was used to determine physical therapy progress. RESULTS A total of 11,693 cases were identified: 5,909 THA (50.53%) and 5784 (49.47%) TKA. THA patients tended to be slightly younger (63.38 years, SD 11.61 years, vs 65.72 years, SD 9.56 years; p < 0.01) and have lower BMIs (28.92 kg/m2 vs 32.52 kg/m2; p < 0.01). THA patients had lower ASA scores in comparison to TKA patients (p < 0.01). Aggregate opioid consumption (93.76 MME vs 147.55 MME; p < 0.01) along with first 24-h and 48-h usage was significantly less for THA as compared to TKA. Similarly, mean pain scores (4.15 vs 5.08; p < 0.01) were lower for THA, while AMPAC mobilization scores were higher (20.88 vs 19.29; p < 0.01) when compared to TKA. CONCLUSION THA patients reported lower pain scores and were found to require less opioid medication in the immediate post-surgical period than TKA patients.
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Affiliation(s)
- David N Kugelman
- New York University Langone Orthopaedic Hospital, 301 East 17 St, Manhattan, New York, NY, 10003, USA
| | - Siddharth A Mahure
- New York University Langone Orthopaedic Hospital, 301 East 17 St, Manhattan, New York, NY, 10003, USA
| | - James E Feng
- New York University Langone Orthopaedic Hospital, 301 East 17 St, Manhattan, New York, NY, 10003, USA
| | - Joshua C Rozell
- New York University Langone Orthopaedic Hospital, 301 East 17 St, Manhattan, New York, NY, 10003, USA
| | - Ran Schwarzkopf
- New York University Langone Orthopaedic Hospital, 301 East 17 St, Manhattan, New York, NY, 10003, USA
| | - William J Long
- New York University Langone Orthopaedic Hospital, 301 East 17 St, Manhattan, New York, NY, 10003, USA.
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Assessing the Efficacy of the Early Rehabilitation Pathway in Combination with Morita Therapy after Hip and Knee Arthroplasty. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4285197. [PMID: 35368944 PMCID: PMC8970862 DOI: 10.1155/2022/4285197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/23/2022]
Abstract
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective methods for the treatment of end-stage osteoarthritis. Furthermore, rehabilitation training and psychological interventions play significant roles in the recovery of hip and knee joint function after THA and TKA. A total of 46 patients who received hip replacement and knee replacement are equally divided into two groups, with the control group being prescribed routine rehabilitation intervention and the observation group prescribed an early rehabilitation pathway with Morita therapy intervention. According to the results, the observation group displayed a significantly decreased incidence of deep venous thrombosis, while simultaneously reducing the recovery time of lower limb function (P < 0.05), including straight leg raising time, walking time, and vertical knee flexion time. In addition, the treatment program demonstrates a significant ability to improve the joint function score, pain score, quality of life score, and range of motion score (P < 0.05). Moreover, serum D-dimer, fibrin degradation products (FDP), and femoral vein blood flow peak also are significantly reduced (P < 0.05). Therefore, we have determined that an early rehabilitation pathway combined with Morita therapy can effectively reduce stress pain, improve the recovery process of joint motor function, and reduce the incidence of thrombosis. However, an increased sample size would facilitate the confirmation of the safety and efficacy of the program. In addition, the overall financial expenditure and feasibility of the treatment need to be considered.
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Najafi F, Zare Z, Javad Mortazavi SM, Lundberg M, Shahsavari H. Overcoming fear of movement resulting from knee replacement; strategies used by patients: An interview study. Int J Orthop Trauma Nurs 2021; 45:100904. [PMID: 35181253 DOI: 10.1016/j.ijotn.2021.100904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS Fear of movement is among the main concerns of patients following knee replacement surgery and a determining factor in the success of surgery. The strategies adopted by patients to overcome this fear have not yet been identified, but once pin pointed, these strategies can be strengthened and modified through intervention. The aim of the present study was to explore the personal strategies adopted by patients following knee replacement to overcome fear of movement. MATERIALS AND METHODS Interviews were conducted with 15 patients who had undergone knee replacement, selected by purposive sampling. Data were collected through in-depth semi-structured interviews and analyzed using inductive content analysis. RESULTS The patients' strategies as depicted in their narratives were classified into three categories: 1) Movement based on awareness; 2) Movement based on support; and 3) Movement based on hope. These three categories are described in eight subcategories and show what strategies the patients used to overcome their fear of movement. CONCLUSION These findings can help to increase awareness about strategies to overcome fear of movement in patients following knee replacement and to develop and support tailored treatment strategies with the aim of reducing such fear of movement and increasing physical activity among the patients.
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Affiliation(s)
- Fatemeh Najafi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Zare
- Department of Operating Room, School of Allied Medical Science, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Javad Mortazavi
- Joint Reconstruction Research Center (JRRC), Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mari Lundberg
- Department of Health Promoting Science, Sophiahemmet Unviersity, Stockholm, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Hooman Shahsavari
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
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