Individual Factors Modifying Postoperative Pain Management in Elective Total Hip and Total Knee Replacement Surgery

Effect of postoperative hydrocodone analgesia on inflammatory factors, NSE levels, and cognitive function in elderly patients undergoing hip arthroplasty

AIMS

To explore the effect of postoperative hydrocodone analgesia on inflammatory factors, NSE levels, and cognitive function in elderly patients undergoing hip arthroplasty.

METHODS

A retrospective analysis was conducted on elderly patients undergoing hip arthroplasty from January 2020 to December 2023. Among them, 43 patients with postoperative hydrocodone analgesia were included in an observation group, and 57 patients without postoperative hydrocodone analgesia in a control group. We compared the differences of general clinical data, inflammatory factors (CRP, WBC and PCT), NSE levels, and cognitive function.

RESULTS

After surgery, the VAS scores decreased in both groups compared to before treatment, and the decrease was more significant in the observation group than the control group (P < 0.05). The NSE, WBC, CRP, and PCT level in the control group were significantly higher than those in the observation group at one day, 3 days, and 7 days after surgery (P < 0.05). Moreover, the MMSE score and the serum S100β protein concentration significantly improved in the observation group at one day, 3 days and 7 days after surgery compared to the control group (P < 0.05).

CONCLUSION

Postoperative hydrocodone analgesia can reduce the release of inflammatory factors after elderly hip replacement surgery, alleviating postoperative pain, and reducing the incidence of early postoperative cognitive impairment.

Influencing factors of chronic pain after total knee replacement in osteoarthritis patients: a nomogram prediction model

OBJECTIVES

To analyze the factors influencing chronic pain in patients with knee osteoarthritis after total knee replacement surgery (TKRS) and to construct a nomogram risk prediction model, providing an economically effective screening method for clinical use.

METHODS

This retrospective study included 100 consecutive patients at the Jinan Central Hospital, with knee osteoarthritis who underwent TKRS from January 2023 to December 2023. Patients were divided into the observation group (n=55) and the control group (n=45) based on the presence of chronic pain. Logistic regression was performed to explore factors associated with chronic pain, including medical records, laboratory data, previous history, and independent clinical risk factors. The identified independent factors were then incorporated to construct a nomogram for chronic pain prediction.

RESULTS

Six variables were identified as independent predictors of chronic pain after TKRS: age, BMI, diabetes, severity of preoperative pain, severity of postoperative acute pain, and postoperative wound infection (P<0.05). The area under the curve (AUC) of this nomogram was 0.836 [95% confidence interval (CI): 0.615-0.884], demonstrating good calibration and clinical practicability.

CONCLUSION

Age, BMI, diabetes, severity of preoperative pain, severity of postoperative acute pain, and postoperative wound infection are risk factors for chronic pain after TKRS. The predictive nomogram developed in this study shows good prediction ability and accuracy for chronic pain in patients with knee osteoarthritis after surgery.

Arthroscopic debridement improves range of motion for heterotopic ossification after total knee replacement: a retrospective cohort study

The presence of heterotopic ossification (HO) after primary total knee replacement (TKR) is rare and associated with limited mobility and stiffness of the knee. This study aimed to identify if the arthroscopic debridement after TKR could decrease HO and improve the function and range of motion. Thirty HO patients after TKR were retrospectively separated into 2 cohorts. 15 patients of group A accepted the arthroscopic debridement, while 15 patients of group B only had non-operative treatment, mainly including oral nonsteroidal anti-inflammatory drugs (NSAIDs) and rehabilitative treatment. Visual analog scale (VAS) scores, knee society knee scores (KSS), range of motion (knee flexion and knee extension) were obtained before treatment and at 1 month, 3 months, and 6 months after treatment. Radiography of after-treatment was also evaluated to assess the changes in HO. There were 3 males and 27 females with a mean age of 67.4 ± 0.8 years in group A and 68.2 ± 1.3 in group B. The onset time of HO was 3-6 months. The maximum size of the ossification was < 2 cm in 23 knees, 2 cm < heterotopic bone < 5 cm in 6 knees and > 5 cm in 1 knee. The size of HO decreased gradually in all knees by X-ray film at the last follow-up. There were no significant differences in VAS scores after replacement between two groups (p > 0.05). The average range of motion preoperatively in group A was - 15.2-90.6°, which postoperatively increased to - 4.2-110.0°. Meanwhile, the KSS scores and average range of motion of the group A were better than those of the group B at each follow-up time after treatment. Arthroscopic debridement can decrease HO seen from postoperative X-rays, improve the function and range of motion, as well as the pain remission between two groups are comparable. Consequently, arthroscopic resection of HO after TKR is recommended as soon as there is aggravating joint stiffness.