Operative approach influences functional outcome after DAIR for infected total hip arthroplasty

Aims To compare the functional outcome, health-related quality of life (HRQoL), and satisfaction of patients who underwent primary total hip arthroplasty (THA) and a single debridement, antibiotics and implant retention (DAIR) procedure for deep infection, using either the transgluteal or the posterior surgical approach for both procedures. Methods The study was registered at clinicaltrials.gov (ID: NCT03161990) on 15 May 2017. Patients treated with a single DAIR procedure for deep infection through the same operative approach as their primary THA (either the transgluteal or the posterior approach) were identified in the Norwegian Arthroplasty Register and given a questionnaire. Median follow-up after DAIR by questionnaire was 5.5 years in the transgluteal group (n = 87) and 2.5 years in the posterior approach group (n = 102). Results Patients in the posterior approach group were less likely to limp after the DAIR procedure (17% vs 36% limped all the time; p = 0.005), had a higher mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function score (80 vs 71; p = 0.013), and were more likely to achieve a patient acceptable symptom state for the WOMAC function score (76% vs 55%; p = 0.002). In a multivariable analysis, the point estimate for the increase in WOMAC function score using the posterior approach was 10.2 (95% CI 3.1 to 17.2; p = 0.005), which is above the minimal clinically important improvement. The patients in the posterior approach group also reported better mean HRQoL scores and were more likely to be satisfied with their hip arthroplasty (77% vs 55%; p = 0.001). Conclusion In patients treated with a single, successful DAIR procedure for deep infection of a primary THA, the use of the posterior approach in both primary surgery and DAIR was associated with less limping, better functional outcome, better HRQoL, and higher patient satisfaction compared with cases where both were performed using the transgluteal approach. The observed differences in functional outcome and patient satisfaction were clinically relevant. Cite this article: Bone Joint J 2020;102-B(12):1662–1669. </jats:sec

Comparative analysis of visual analogue scale and the new scale of efficacy and safety of postoperative analgesia for orediction of pain during the early postoperative period

Modern postoperative analgesia - is an individual selection of optimal doses of analgesics in order to obtain high efficiency of analgesia with minimal side effects. The quality and safety of postoperative pain is largely dependent on the severity of pain immediately after the operation. The aim of the study was to compare the efficacy of visual analogue scale (VAS) and the new scale of efficiency and safety (ESS) of postoperative analgesia in predicting of the severity of pain and postoperative complications. The study was conducted in 209 patients (mean age (66-77) years), in which a major surgery on the abdominal organs were routinely performed. Patients were randomized into two groups, depending on the method of evaluating of the quality of analgesia: in group 1 is controlled via ESS (n = 102), the 2nd group - by VAS (n = 105). Postoperative complications were recorded: nausea and vomiting, respiratory failure (need for noninvasive or invasive ventilation), delirium, cardiac arrhythmias, ileus. ESS and VAS demonstrated good prediction of the effectiveness of pain relief (AUROC 0,973, [0,913-0,996] and 0.976 [0,913-0,997], respectively). ESS showed a good prediction of the complicated postoperative period (AUROC = 0,924, [0,856-0,967]), as opposed to the VAS (AUROC = 0,649, [0,548-0,741]). Baseline ESS and VAS score equally effective in predicting the intensity of pain in the early postoperative period. ESS advantage, compared to VAS, is the ability to predict complicated postoperative period and postoperative complications. ESS score for more than 17 is a risk factor for postoperative complications associated with inadequate analgesia.</jats:p