Ralph A. DeMasi

Postarthroscopy analgesia with bupivacaine A prospective, randomized, blinded evaluation

The analgesic effect of intraarticular bupivacaine in jected at the conclusion of knee arthroscopy done under general anesthesia was investigated in a pro spective, randomized, and blinded fashion. Pain scores, the use of analgesic medications, crutch use, weight bearing, activity level, and difficulty sleeping the night after surgery were all unaffected by the use of bupiva caine. The apparent lack of effect is most likely due to rapid clearance from the knee, leaving only a transient, 1 to 2 hours of potential benefit. In this study, the patients were already quite comfortable during this time period due to the routine use of intraoperative narcotics. The preoperative level of knee discomfort was found to be a major determinant of postoperative discomfort. Other much less important factors were synovial and chondral shaving, sex of the patient, and experience of the surgeon.

A Prospective Study of a Titanium Femoral Component for Cemented Total Hip Arthroplasty

The authors studied the clinical and radiographic results of a modern titanium-alloy femoral stem with a cobalt-chrome-alloy head for use in cemented total hip arthroplasty. One hundred sixteen hips (102 patients) were operated on using modern cement techniques and prospectively followed using the Hospital for Special Surgery hip rating system and standard radiographic criteria. At a mean follow-up period of 4.8 years (range, 2-8 years), 69 hips were rated excellent, 38 good, 4 fair, and 5 poor. A total of 13 femoral components (11%) were radiographically loose according to the criteria of Harris. In 11 of these loose femoral components, debonding or separation at the cement-prosthesis interface, was the initial cause of failure, with bone-cement interface erosions occurring later in five hips. Revision of a loose femoral component has been performed in three hips and is pending in two other hips (4.3%). Significant calcar resorption was seen in only 17 hips (14.6%), and serial measurements of distal femoral cortical widths showed no distal cortical hypertrophy except in one femur. The incidence of loosening with this cemented titanium-alloy femoral component (with a cobalt-chrome-alloy head) is much higher than published reports of similar cobalt-chrome-alloy stems. The authors have abandoned the use of titanium-alloy femoral components for cemented total hip arthroplasty.

An evaluation of pre- and postoperative nonsteroidal antiinflammatory drugs in patients undergoing knee arthroscopy A prospective, randomized, double-blinded study

The potential benefits of a nonsteroidal antiinflamma tory drug to 67 patients undergoing knee arthroscopy were evaluated in a prospective, randomized, placebo- controlled, double-blinded study. Group A received the drug (diclofenac, 75 mg twice daily) for 3 to 5 days before and for 7 days after surgery. Group B received a placebo preoperatively and the drug postoperatively. Group C received a placebo at both times. Codeine was available postoperatively for all patients if needed. Outcomes reported by the subjects included pain, crutch use, and return to activities. Outcomes assessed by physicians included knee effusion, range of motion, and gait. Knee flexion and extension strengths were measured isokinetically pre- and postoperatively. Pain scores on the 1 st postoperative day were higher in Group C than in Group A. Pain scores at all other time points were not significantly different in the three treatment groups. Groups A and B required less co deine during the first 72 hours after surgery than Group C (mean, 2.9 ± 1.0 versus 6.8 ± 1.0 pills). Recovery of function, recovery of strength, and physical examina tion parameters were not significantly different in the three treatment groups. Diclofenac was an effective analgesic in the immedi ate postoperative period. Recovery from arthroscopy, however, was not enhanced by taking the drug.

Variability in radiographic measurement of bowleg deformity in children.

The tibial metaphyseal-diaphyseal (MD) and tibial-femoral (TF) angles were measured on the radiographs of 33 knees in young children (aged 12-36 months) with bowleg deformity. Four observers of differing experience measured the films in a blinded fashion to determine the intraobserver and interobserver variability of these measurements. The clinical implications of these variabilities are described. Very little instruction and experience is necessary to make these measurements correctly and precisely. Measurement of the MD angle was superior to measurement of the TF angle. Contrary to published opinion, rotation can have a small but potentially significant effect on the measured MD angle.

EFFECT OF RACE AND GENDER ON NEUROLOGICAL LEVEL IN MYELOMENINGOCELE

The association of race and gender with different neurological levels of myelomeningocele was studied in 251 patients. Over‐all, the white to black ratio was 3·6 and the male to female ratio was 0·86. However, the proportions of whites and females were significantly increased in thoracic‐level patients (white to black ratio 13·6, male to female ratio 0·43), whereas the lumbar‐level patients had sex and white to black ratios equivalent to the area population. This supports the concept that thoracic‐level myelomeningocele has a different pathogenesis from lumbar‐level.

Survivorship analysis of cemented high modulus total hip arthroplasty.

Ninety-four high-modulus total hip arthroplasties (THAs) were performed from 1977 to 1982 using the Computer Assist Design (CAD) and HD-2 prostheses. Eighty-six hips were followed for an average of 6.7 years. The cement gun was used throughout the study period, and distal bone or cement plug use was begun in 1979. The results of these arthroplasties were evaluated retrospectively using both survivorship analysis and observed success rates. Using a standard hip rating system, 19 hips were rated as excellent, 44 as good, 15 as fair, and 11 as poor. Failure was defined as definitely visible radiographic migration of either component, or reoperation for revision of one or both components. There was no significant difference between the HD-2 and CAD prostheses. There were five hips revised for aseptic loosening and revision was advised in an additional three hips. One hip with late sepsis required removal of both components. The five- and ten-year survivorships of the acetabular components were 97% +/- 3 and 58% +/- 17, respectively. Those of the femoral components were 93% +/- 5 and 78% +/- 13, respectively. For the components combined, the survivorship at five years was 91% +/- 6 but only 50% +/- 17 at ten years. Survivorship analysis provided a different and more realistic appraisal of the long-term results of the arthroplasties in this series than did the observed success rates. The contemporary cement techniques of the late 1970s and early 1980s may not be sufficient for the long-term survival of high-modulus THAs. Additional techniques may be necessary for improved long-term survival.

Bone mineral content at three sites in normal perimenopausal women.

Bone mineral content (BMC) in 217 healthy white women between the ages of 40 and 55 years was measured using single- and dual-photon absorptiometry. The sites measured included the distal radius, midradius, proximal femur, and lumbar spine. The relationship between BMC and age was constant over the age range studied when the confounding effect of menopause was controlled. Women with low body mass indices (BMIs) had significantly lower BMC than women with average or greater than average BMIs. More active women had higher BMC than less active women at both appendicular and axial sites. A trend suggesting that women with higher calcium intake may have higher BMC was statistically significant only at the midradial site. A trend of postmenopausal women having lower BMC than pre- or perimenopausal women was also statistically significant only at the midradial site. Only modest correlations were found between the various sites. These correlations are too weak to allow accurate clinical predictions of BMC at axial sites from the BMC at an appendicular site in individual patients.