Pain in Non-Athlete Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement and Hip Labral Tears: A Longitudinal Study

Background: Pain in patients with orthopedic problems is an important aspect of surgical evaluation. However, the effect on the quality of life depends not only on the degree of pain but also on its type. Hip arthroscopy has been performed for hip joint symptoms caused by femoroacetabular impingement (FAI) and hip labrum tears. However, the degree and type of pain after hip arthroscopy remains unknown. Objective: This study aimed to clarify the degree and type of pain during 6 months after hip arthroscopy. Methods: Non-athlete patients aged 20 - 65 years who underwent hip arthroscopy between December 2018 and October 2019 participated in a questionnaire survey before hospitalization and at 1, 3, and 6 months after surgery. The questionnaire comprised the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ) for quality of life, International Physical Activity Questionnaire (IPAQ) for activities, and the Short-Form McGill Pain Questionnaire (SF-MPQ-2) for pain. Results: The analysis included 10 patients (men: 4, women: 6, mean age: 38 ± 8.6 years, FAI: 6 cases, hip labrum tears: 4 cases). The average time from symptom onset to surgery was 26.9 ± 19.0 months. The analysis from before surgery to 6 months after surgery showed improvement over time in all scale scores (JHEQ, IPAQ, and SF-MPQ-2). The degree of pain was significantly improved based on the JHEQ visual analog scale evaluation (P = 0.019) 3 months after surgery. Significant improvement in intermittent pain (P = 0.011) based on SF-MPQ-2 was noted 3 months after surgery;however, no significant improvement in continuous pain was noted. Conclusions: Patients who underwent hip arthroscopy showed significant improvements in the degree of pain and type of intermittent pain from before surgery to 3 months after surgery, however, no change was observed in continuous pain.

Can bedside needle arthroscopy of the ankle be an accurate option for intra-articular delivery of injectable agents?

BACKGROUND Bedside needle arthroscopy of the ankle under local anesthesia has been proposed for intra-articular delivery of injectable agents.Accuracy and tolerability of this approach in the clinical setting–including patients with end-stage ankle pathology and/or a history of prior surgery–is not known.AIM To assess clinical accuracy and tolerability of bedside needle arthroscopy as a delivery system for injectable agents into the tibiotalar joint.METHODS This was a prospective study that included adult patients who were scheduled for an injection with hyaluronic acid to the tibiotalar joint.In our center,these injections are used as a last resort prior to extensive surgery.The primary outcome was injection accuracy,which was defined as injecting through the arthroscopic cannula with intra-articular positioning confirmed by a clear arthroscopic view of the joint space.Secondary outcome measures included a patientreported numeric rating scale(NRS,0-10)of pain during the procedure and willingness of patients to return for the same procedure.NRS of ankle pain at rest and during walking was collected at baseline and at 2-wk follow-up.Complications were monitored from inclusion up to a 2-wk control visit.RESULTS We performed 24 inspection-injections.Eleven(46%)participants were male,and mean age was 46.8±14.5 years.Osteoarthritis was the indication for injection in 20(83%)cases,of which 8(33%)patients suffered from osteoarthritis Kellgren-Lawrence grade IV,and 10(42%)patients from Kellgren-Lawrence grade III.An osteochondral defect was the indication for injection in 4(17%)cases.A history of ankle surgery was present in 14(58%)participants and a history of multiple ankle surgeries in 11(46%)participants.It was possible to confirm accuracy in 21(88%)procedures.The 3(12%)participants where needle arthroscopy did not reach a clear view of the joint space all suffered from Kellgren-Lawrence grade IV osteoarthritis.Pain during the procedure was reported with a median of 1[interquartile ranges(IQR):0–2].Willingness to return was 100%.Pain in rest decreased from a median NRS of 4(IQR:2–7)at baseline to a median of 3(IQR:1–5)at follow-up(P<0.01).Pain during walking decreased from a median NRS of 8(IQR:6–9)to a median of 7(IQR:4–8)(P<0.01).Infections or other complications were not encountered.CONCLUSION Clinical accuracy and tolerability of bedside needle arthroscopy of the ankle as a delivery system for injectable agents are excellent.Accuracy was 100%in patients without total ventral joint obliteration.

Arthroscopy combined with unicondylar knee arthroplasty for treatment of isolated unicompartmental knee arthritis: A long-term comparison

BACKGROUND Knee osteoarthritis is the most prevalent form of osteoarthritis and is becoming the main reason for progressive pain in knee joints. Arthroscopy combined with unicondylar knee arthroplasty(UKA) is one of the effective methods for the treatment of severe unicompartmental knee arthritis. This surgical approach gives us the capacity to explore all the articular cavities and plays a vital role in UKA patient selection. However, some scholars think that the surgical procedure is traumatic and may increase the rate of surgical infection, and its clinical efficacy needs further study.AIM To compare the clinical effect of arthroscopy combined with UKA and UKA alone for patients suffering from unicompartmental osteoarthritis(OA).METHODS A retrospective study was conducted on patients who were diagnosed with unicompartmental OA(Kellgren–Laurence grade ≥ III) and underwent UKA between October 2012 and November 2006. The patients were followed at 3, 6,and 12 mo and every 2 years thereafter. During each follow-up, the radiographic materials, the range of motion of knee and hospital for special surgery(HSS)score, knee society score and knee function score as recorded, and the modes and time of failure and revision details were collected as well.RESULTS Data on 104 patients(118 knees), including 54 patients(60 knees) in the arthroscopy combined with UKA group(group A) and 51(58 knees) in UKA alone group(group B) were collected during an average follow-up duration of 7.25 years, excluding the cases who were lost to follow-up. At the final follow-up,3(5.0%) of 60 knees in group A compared with 4(6.9%) of 58 knees in group B failed and converted to total knee arthroplasty, with no statistically significant difference between the two groups(P = 0.933). The percentage of patients receiving blood transfusion was 40% in group A, significantly lower than that in group B(67.2%;P = 0.003). Total volume of blood transfusion in group A was also significantly lower than that of group B(P = 0.001). Both groups improved significantly after operation in clinical symptoms and functions. HSS score, knee society score, and knee function score increased significantly at the latest followup compared to pre-operation in group A, from 59.6 ± 10.9 to 82.7 ± 9.3(mean difference [MD], 23.2;95%CI: 19.3-27.0;P = 0.000), 47.3 ± 6.3 to 76.2 ± 13.1(MD,28.9;95%CI: 25.1-32.7;P = 0.000), and 57.5 ± 6.3 to 75.1 ± 19.6(MD, 17.5;95% CI:12.1-23.0;P = 0.000);and in group B, from 59.3 ± 15.6 to 84.3 ± 10.1(MD, 23.7;95%CI: 18.9-28.5;P = 0.000), 49.1 ± 9.2 to 75.1 ± 13.2(MD, 24.7;95%CI: 19.9-29.5;P= 0.000), and 59.3 ± 9.0 to 77.4 ± 13.8(MD, 17.2;95%CI: 12.8-21.6;P = 0.000).CONCLUSION Arthroscopy combined with UKA and UKA alone both provide benefits in clinical symptom improvement and alignment correction. Arthroscopy combined with UKA does not increase the infection probability and surgical complications,and has an advantage in reducing the total volume of blood transfusion and the percentage of patients receiving blood transfusion.

Arthroscopy with subscapularis upper one-third tenodesis for treatment of recurrent anterior shoulder instability independent of glenoid bone loss

BACKGROUND Recurrent anterior shoulder instability is a common traumatic injury,the main clinical manifestation of which is recurrent anteroinferior dislocation of the humeral head.The current follow-up study showed that the effect of arthroscopic Bankart repair is unreliable.AIM To evaluate the clinical efficacy of arthroscopy with subscapularis upper one-third tenodesis for treatment of anterior shoulder instability,and to develop a method to further improve anterior stability and reduce the recurrence rate.METHODS Between January 2015 and December 2018,male patients with recurrent anterior shoulder instability were selected.One hundred and twenty patients had a glenoid defect<20%and 80 patients had a glenoid defect>20%.The average age was 25 years(range,18–45 years).Patients with a glenoid defect<20%underwent arthroscopic Bankart repair with a subscapularis upper one-third tenodesis.The patients with a glenoid defect>20%underwent an arthroscopic iliac crest bone autograft with a subscapularis upper one-third tenodesis.All patients were assessed with Rowe and Constant scores.RESULTS The average shoulder forward flexion angle was 163.6°±8.3°and 171.8°±3.6°preoperatively and at the last follow-up evaluation,respectively.The average external rotation angle when abduction was 90°was 68.4°±13.6°and 88.5°±6.2°preoperatively and at the last follow-up evaluation,respectively.The mean Rowe scores preoperatively and at the last follow-up evaluation were 32.6±3.2 and 95.2±2.2,respectively(P<0.05).The mean Constant scores preoperatively and at the last follow-up evaluation were 75.4±3.5 and 95.8±3.3,respectively(P<0.05).No postoperative dislocations were recorded by the end of the follow-up period.CONCLUSION Arthroscopy with subscapularis upper one-third tenodesis was effective for treatment of recurrent anterior shoulder instability independent of the size of the glenoid bone defect,enhanced anterior stability of the shoulder,and did not affect postoperative range of motion of the affected limb.

Other Possible Causes of a Well-Publicized Outbreak of <i>Pseudomonas aeruginosa</i>Following Arthroscopy in Texas

Background: Seven patients at a hospital in Houston, TX, were diagnosed during a two-week period in 2009 with joint space infection of pansusceptible P. aeruginosa following arthroscopic procedures of the knee or shoulder. Tosh et al. (2011), who investigated and published the principal report discussing this bacterial outbreak, conclude that its most likely cause was the improper reprocessing of certain reusable, physically-complex, heat-stable arthroscopic instruments used during these arthroscopic procedures. These reusable instruments reportedly remained contaminated with remnant tissue, despite diligent efforts by the hospital to clean their internal structures. This retained bioburden presumably shielded the outbreak’s strain of embedded P. aeruginosa from contact with the pressurized steam, reportedly resulting in ineffective sterilization of these arthroscopic instruments and bacterial transmission. Objectives: First, to clarify which specific sterilization methods, in addition to steam sterilization, Methodist Hospital employed to process its reusable arthroscopic instrumentation at the time of its outbreak, in 2009;second, to evaluate Tosh et al.’s (2011) conclusion that ineffective steam sterilization due to inadequate cleaning was the most likely cause of this hospital’s outbreak;third, to consider whether any other hitherto unrecognized factors could have plausibly contributed to this outbreak;and, fourth, to assess whether any additional recommendations might be warranted to prevent disease transmission following arthroscopic procedures. Methods: The medical literature was reviewed;some of the principles of quality assurance, engineering and a root-cause analysis were employed;and Tosh et al.’s (2011) findings and conclusions were reviewed and compared with those of other published reports that evaluated the risk of disease transmission associated with the steam sterilization of physically-complex, heat-stable, soiled surgical instruments. Results and Conclusion: Reports documenting outbreaks of P. aeruginosa or another vegetative bacterium associated with the steam sterilization of inadequately cleaned surgical or arthroscopic instruments are scant. This finding—coupled with a number of published studies demonstrating the effective steam sterilization of complex instruments contaminated with vegetative bacteria mixed with organic debris, or, in one published series of tests, with resistant bacterial endospores coated with hydraulic fluid—raises for discussion whether Methodist Hospital’s outbreak might have been due to one or more factors other than, or in addition to, that which Tosh et al. (2011) conclude was its most likely cause. An example of such a factor not ruled out by Tosh et al. (2011) findings would be the re-contamination of the implicated arthroscopic instruments after sterilization. The specific methods that Methodist Hospital employed at the time of its outbreak to sterilize some of its arthroscopic instrumentation remain unclear. A number of additional recommendations are provided to prevent disease transmission following arthroscopic procedures.

Ankle Arthroscopy: A Complimentary Adjunct in the Diagnosis and Management of Ankle Fractures

Ankle fractures are one of the most common injuries treated by orthopaedic surgeons. A minority of patients with ankle fractures go on to develop persistent pain following anatomical reduction. These sequelae may arise as a result of untreated ligamentous or chondral injuries. This study aims to correlate acute arthroscopic ankle findings with the Lauge-Hansen fracture pattern classification. We further aim to compare subjective functional outcomes at least one year following surgery between patients who have received Open Reduction and Internal Fixation (ORIF) alone, versus ORIF plus arthroscopy. This is a retrospective case series of patients who have undergone ankle fracture ORIF +/- arthroscopy from July 2014 to July 2017 inclusive. Each patient’s presenting radiograph was classified according to the Lauge-Hansen ankle fracture classification with subsequent correlation to intra-operative arthroscopic findings. Functional outcome at a minimum of one year was evaluated with the American Academy of Orthopaedic Surgeons (AAOS) metric. Twenty two patients underwent ankle ORIF plus arthroscopy (Group A) with a further 26 patients receiving ORIF alone (Group B). 1 in 3 supination-external-rotation type II (SER II) injuries possessed a concomitant syndesmosis injury or osteochondral lesion (OCL) on arthroscopy. 1 in 3 patients with an SER IV injury had an osteochondral lesion. The mean AAOS score achieved for Group A was 89.6 (±7.9) with the mean score for Group B being 82.0 (±13.7). In conclusion, ankle arthroscopy aids the diagnosis and treatment of ligamentous and osteochondral injuries not evident on plain film with subsequent superior short-term outcomes.

Tips to avoid nerve injury in elbow arthroscopy

Elbow arthroscopy is a technical challenging surgical procedure because of close proximity of neurovascular structures and the limited articular working space. With the rising number of elbow arthroscopies being performed nowadays due to an increasing number of surgeons performing this procedure and a broader range of indications, a rise in complications is foreseen. With this editorial we hope to create awareness of possible complications of elbow arthroscopy, particularly nerve injuries, and provide a guideline to avoid complications during elbow arthroscopy.

Subtalar arthroscopy:When,why and how

Technique of subtalar arthroscopy is rapidly evolving. Increasing number of traditional open procedures for the subtalar joint can now be done arthroscopically. It is hoped that less wound complications, faster rehabilitation and better cosmetic outcomes can be achieved with this minimally invasive technique.

Hoffa's fracture in a five-year-old child diagnosed and treated with the assistance of arthroscopy:A case report

BACKGROUND Hoffa’s fracture is a coronal-oriented fracture of the femoral condyle.It is rarely observed in pediatric patients that isolated coronal fracture of the medial femoral condyle accompanies an intact lateral femoral condyle.Only a few cases involving Hoffa’s fracture of the medial femoral condyle have been reported in patients with undeveloped skeletons.Such a fracture cannot be observed by routine imaging examinations,thus resulting in possible misdiagnosis and further treatment challenges.CASE SUMMARY A 5-year-old boy with Hoffa’s fracture of the medial femoral condyle suffered from right knee pain and severe swelling after being hit by a heavy object.The patient was misdiagnosed and initially treated in a local primary healthcare center.No improvement in his right knee’s extension was observed following conservative treatment for 2 wk.The patient was transferred to our hospital,rediagnosed using arthroscopy,and underwent open reduction and internal fixation.The therapeutic outcome was satisfactory with the screws removed 7 mo after fixation.At the final follow-up of 40 mo,the range of motion in the knee had recovered.There was no varus-valgus instability.CONCLUSION Hoffa’s fracture is rarely seen in children aged 5 years,let alone in the medial condyle,and can easily be misdiagnosed due to limited physical and imaging examinations.Suspected Hoffa’s fracture in preschool children should be confirmed based on arthroscopic findings.Open reduction and internal fixation should be performed to protect the articular surface and prevent long-term complications.

Meta-analysis of the clinical efficacy of Chinese herbal decoction combined with arthroscopy in the treatment of gouty arthritis

Objective:To systematically evaluate the efficacy of traditional Chinese medicine decoction combined with arthroscopy in the treatment of gouty arthritis.Methods:A systematic search of CNKI,CBM,WanFang,VIP,PubMed,Cochrane Library,and EMBASE databases,and the receipt of the database until February 2021.Randomized controlled trials(RCTs)of traditional Chinese medicine(TCM)decoction combined with arthroscopy in the treatment of gouty arthritis.Two researchers independently read the title and abstract to screen and them read the full text to clarify whether it should be included.The method of Cochrane systematic review was used to evaluate the quality of the literature,and the RevMan 5.3 software was used to conduct meta-analysis of the data.Results:Nineteen RCTs were finally included.A total of 1383 patients,697 cases in the treatment group were treated with traditional Chinese medicine decoction combined with arthroscopy,and 686 cases in the control group were treated with arthroscopy alone or combined with western medicine.Meta-analysis results showed that the total clinical effective rate(P<0.00001)of the treatment group was better than that of the control group.Visual analogue scoring(VAS)score(P=0.0005,P<0.00001,P=0.03)and erythrocyte sedimentation rate(ESR)level(P<0.00001,P<0.00001,P<0.00001)reduction in each subgroup was better than that of the control group.The Lysholm score of the treatment group increased(P<0.00001,P<0.00001,P=0.19),while for blood uric acid(UA)level(P<0.00001,P=0.18,P<0.0001)and C-reactive protein(CRP)levels(P<0.0001,P<0.00001,P=0.23)two subgroups were better than the control group,but there was no significant difference in one subgroup.Conclusion:Traditional Chinese medicine decoction combined with arthroscopy is effective in treating gouty arthritis,which can relieve pain,improve joint function,and reduce body inflammation and uric acid levels.However,in the future,clinical studies with larger sample sizes,more reasonable designs,and higher quality are still needed to demonstrate this conclusion.

Allergic dermatitis after knee arthroscopy with repeated exposure to Dermabond Prineo^(TM) in pediatric patients:Two case reports

BACKGROUND Allergic contact dermatitis(ACD)secondary to Dermabond Prineo^(TM) is rare,but documented.To our knowledge,there are no described reports of this ACD reaction within the pediatric population following arthroscopic surgery.CASE SUMMARY We report two cases of pediatric ACD upon second exposure to Dermabond Prineo^(TM) after knee arthroscopy.Both cases presented within two weeks of the inciting second exposure.The cases resolved with differing described combinations of sterile cleaning,diphenhydramine,and antibiotic administration.No long-term sequelae were found.CONCLUSION This case report elucidates the rare complication of allergic dermatitis secondary to Dermabond Prineo^(TM) repeat exposure use in pediatric arthroscopy.

Integrity of the hip capsule measured with magnetic resonance imaging after capsular repair or unrepaired capsulotomy in hip arthroscopy

BACKGROUND Current literature shows no clear answer on the question how to manage the capsule after hip arthroscopy.Regarding patient reported outcome measures there seems to be no difference between capsular repair or unrepaired capsulotomy.AIM To evaluate and compare the integrity of the hip capsule measured on a magnetic resonance imaging(MRI)scan after capsular repair or unrepaired capsulotomy.METHODS A case series study was performed;a random sample of patients included in a trial comparing capsular repair vs unrepaired capsulotomy had a postoperative MRI scan.The presence of a capsular defect and gap size were independently evaluated on MRI.RESULTS A total of 28 patients(29 hips)were included.Patient demographics were comparable between treatment groups.There were 2 capsular defects in the capsular repair group and 7 capsular defects in the unrepaired capsulotomy group(P=0.13).In the group of patients with a defect,median gap sizes at the acetabular side were 5.9 mm(range:2.7-9.0)in the repaired and 8.0 mm(range:4.5-18.0)in the unrepaired group(P=0.462).At the muscular side gap sizes were 6.6 mm(range:4.1-9.0)in the repaired group and 11.5 mm(range:3.0-18.0)in the unrepaired group(P=0.857).The calculated Odds ratio(OR)for having a capsular defect with an increasing lateral center-edge(CE)angle was 1.12(P=0.06).The OR for having a capsular defect is lower in the group of patients that underwent a labral repair with an OR of 0.1(P=0.05).CONCLUSION There is no significant difference in capsular defects between capsular repair or unrepaired capsulotomy.Regarding clinical characteristics our case series shows that a larger CE angle increases the likelihood of a capsular defect and the presence of a labral repair decreases the likelihood of a capsular defect.

A Retrospective Study of Anesthetic Considerations in Hip Arthroscopy: Regional versus General

Purpose: Hip arthroscopy is a surgery with favorable outcomes to treat labral tears of the hip. This retrospective review was conducted to identify an optimal anesthetic technique for hip arthroscopy to minimize postoperative pain and decrease opioid consumption. Methods: A retrospective analysis was performed for 92 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) with labral tear under general anesthesia (G) with fascia-iliaca block (64 patients) or regional anesthesia (R) with fascia-iliaca block (28 patients) from March 9, 2016 to April 9, 2018. Data collected included: demographics, diagnosis, ASA status, time in surgery, medications administered, type of anesthesia administered, pain scores, use of straight catheter, and time in PACU. Results: Patients who underwent hip arthroscopy under regional anesthesia reported significantly less first (G: 3.4 (3.9), R: 1.3 (3.0), p = 0.0085) and average (G: 3.8 (2.5), R: 2.0 (2.2), p = 0.0038) pain post-operatively. Patients under regional anesthesia also received less total morphine milligram equivalents (MME) intraoperatively and post-operatively (G: 40.8 (21.7) MME, R: 24.9 (17.8), p = 0.004 MME). Patients under regional anesthesia had a significantly higher incidence of urinary retention (G: 3.1%, R: 28.6%, p = 0.009) and increased time spent in PACU (G = 181.9 (86.3), R: 251.4 (80.4), p = 0.0001). Conclusions: The administration of regional anesthesia resulted in significantly lower pain scores and perioperative opioid consumption compared to general anesthesia in patients undergoing hip. This may be the optimal anesthetic technique for pain control;however, incidence of urinary retention and time to discharge are significantly increased. Prospective randomized control trials are needed to compare general anesthesia and regional anesthesia for hip arthroscopy.

Hip Arthroscopy in Children under the Age of Ten

Arthroscopic hip surgery has become an established diagnostic and therapeutic method for addressing different hip pathologies. This paper focuses on hip arthroscopy for treating hip disorders in children under the age of 10. Arthroscopic hip surgery was performed 30 times on 24 children to address various hip pathologies. Indications were septic arthritis, benign soft tissue tumors, traumatic and congenital hip dislocation, juvenile idiopathic arthritis and osteochondroma of the acetabulum. Diagnostic arthroscopy was technically feasible in all cases. All cases of septic arthritis were successful treated using arthroscopic lavage and antibiotics. In the miscellaneous cases (benign fibrous tumor, juvenile idiopathic arthritis, osteochondroma congenital hip dislocations and traumatic hip dislocation) 4 hips had additional open surgery including surgical dislocation with synovectomy, open reduction and stabilization of the fractured posterior rim of the acetabulum, acetabulopasty and open resection of an osteochondroma with acetabuloplasty. In conclusion arthroscopic hip surgery is an additional diagnostic and therapeutic method that is suitable for treating different hip pathologies in children under the age of 10. Primary treatment of septic arthritis can be done easy by hip arthroscopy. Using cannulated mini arthroscopic hip instruments (2.7 mm), the range of application can be expanded to include treatment of very young infants. Hip arthroscopy can reduce the need of open surgery but cannot replace bony procedures in hip surgery.

Comparison of a Pain Pump versus Injectable Medication for Analgesia in Knee Arthroscopy

As arthroscopic knee procedures have evolved, so has the management of post-operative pain. Traditional pain management included intravenous narcotics, which often resulted in nausea and increased sedation. In an effort to reduce post-operative pain and minimize complications, the concept of multimodal analgesia evolved, including subcutaneous infiltration of local anesthetic, ketorolac and/or narcotic. We studied the effect upon post-operative pain of combining ropivacaine, ketorolac and morphine injected as a one-time dose compared to the same mixture plus an intraarticular pump administering ropivacaine for 24 hours. Our findings showed that a single subcutaneous and intraarticular injection of ketorolac, morphine and ropivacaine was as effective as this solution plus a 24-hour intraarticular ropivacaine pain pump for post-operative pain relief after outpatient arthroscopic knee surgery. No clinical or radiographic signs of chondrolysis were seen in the knee with the use of intraarticular ropivacaine at an average of 18 months post-operatively.

Experience of Patients Undergoing Mini-Arthroscopy Compared to MRI in the Earliest Phases of Arthritis

Objective: To evaluate the expectations and experience of patients undergoing mini-arthroscopy compared to contrast enhanced MRI for research purposes. Methods: Seventeen patients with early, active arthritis (Group A) and 21 autoantibody-positive individuals without any evidence of arthritis upon physical examination (Group B) were included. All subjects underwent both contrast enhanced MRI and synovial biopsy sampling by mini-arthroscopy of the same joint within one week. At inclusion and after both procedures, subjects filled in questionnaires with items about expectations and experience with regard to the procedures. Results: Before procedures, subjects in group B had a higher fear of and reluctance to undergo mini-arthroscopy compared to MRI (p < 0.0001 and p = 0.001, respectively). Before procedures, 42% of the subjects preferred MRI, 11% of the subjects preferred mini-arthroscopy and 47% had no preference for either procedure. After both procedures, subjects preferences changed to 39% for MRI, 32% for mini-arthroscopy and 29% for no preference for one or the other procedure. When comparing Group A with Group B, there were no significant differences in preference before and after the procedures. Conclusion: Synovial biopsy sampling by mini-arthroscopy for analysis of synovial inflammation is a well-experienced procedure when compared to contrast enhanced MRI. These results support the use of mini-arthroscopy in a research setting from a patient perspective.

Case report of suspected intra-articular infection after total hip arthroplasty using hip arthroscopy technique

Objective: Hip arthroscopy technique application of diagnosis and treatment of suspected intra-articular infection cases after total hip arthroplasty. Methods: After femoral prosthesis side debridement processing thoroughly, we do skin preparation and draping again for exploring intra-articular using hip arthroscopy technique. Results: Though hip arthroscopy we can see a lot of scar hyperplasia and no obvious signs of infection. Conclusion: Minimally invasive techniques of hip arthroscopy can be applied to the detection of intra-articular infection after total hip arthroplasty.

Therapeutic Effect of Single-row Technique and Nocompression Sputum in the Treatment of Post Small and Medium Rotator Cuff Injury under Shoulder Arthroscopy

Objective.To investigate the clinical effect of single-row fixation and non-conjunction compression in the treatment of post small and medium rotator cuff injuries under arthroscopy.Methods.Forty-five patients admitted to our department from June 2018 to May 2019 were enrolled in the study.32 patients in the single-row fixed-group and 13 patients in the non-conjunctival group were randomly assigned.The VAS,ASES,and UCLA scores of the two groups were compared before surgery,one month,three months,and six months after surgery[1].Results.The VAS,ASES,and UCLA scores were significantly higher in those two groups other than the preoperative group.The scores of the two groups were gradually improved from one month,three months,and six months respectively after surgery.At one month,the scores of those two groups were statistically significant(P<0.05),but there was no significant difference between the two groups at three months and six months(P>0.05).Conclusion.Under arthroscopy,the single-row fixation technique and the non-conjunction compression method were used to treat post small and medium rotator cuff injuries.The effect is very significant.In particular,the no-knot sputum method has a significant improvement in restoring postoperative pain,joint activity and joint strength.

Comparison between intrathecal hyperbaric bupivacaine and levobupivacaine for ambulatory knee arthroscopy

AIM: To compare the effect of hyperbaric levobupivacaine and bupivacaine on the quality of the block, patient satisfaction, and discharge time in patients undergoing arthroscopic knee surgery under unilateral spinal anesthesia.METHODS: One hundred and thirty-two patients, American Society of Anaesthesiologists Ⅰ or Ⅱ, scheduled for elective ambulatory knee arthroscopy were randomly assigned to four double-blind groups. To achieve a unilateral spinal block, Group BF received 5 mg of hyperbaric bupivacaine plus 20 μg of fentanyl intrathecally, Group LF received 5 mg of hyperbaric levobupivacaine plus 20 μg of fentanyl intrathecally, Group B received 5 mg of hyperbaric bupivacaine intrathecally, and Group L received 5 mg of hyperbaric levobupivacaine intrathecally. The level and duration of the sensory block, the intensity and duration of the motor block, the time to first analgesic requirement, and the time elapsed until the patient's discharge were recorded. Hemodynamic values and adverse effects were also recorded. RESULTS: The duration of time needed to reach the T12 dermatome level was significantly longer in Group L [7(3-20) min] than in Group B [6(3-12) min](P = 0.006). The maximum sensory level reached on the side undergoing the operation was significantly higher in Group BF than in Group B(P < 0.05). The intensity of the motor blockade was greater in Group BF than in Group LF and L. Complete recovery from motor blockade occurred earlier in Groups LF [75(45-165) min] and L [63(35-120) min] than in Group BF [115(60-180) min](P < 0.05). The length of time needed for the sensory block to regress to the level of S2 was shorter in Group L(154 ± 50) than in Group BF(192 ± 66)(P < 0.05). The quality of the block was significantly lower in Group L than in Groups BF, LF and B(P = 0.012, P = 0.003, and P < 0.001, respectively). The time elapsed until Visual Analog Scale ≥ 4 was significantly shorter in Group L(110 ± 48) than in Groups BF(200 ± 60), LF(156 ± 61) and B(162 ± 52)(P < 0.05). The time elapsed until the patient's discharge was shorter in Groups B(244 ± 54) and L(229 ± 55) than in Group BF(288 ± 64)(P = 0.021 and P = 0.001, respectively). There were no differences among the groups regarding hemodynamic parameters and adverse events, except for pruritus. The occurrence of pruritus was significantly more frequent in Groups BF and LF than in other groups. CONCLUSION: In conclusion, 5 mg of hyperbaric bupivacaine and 5 mg of hyperbaric levobupivacaine plus 20 μg of fentanyl provided a better spinal anesthesia than 5 mg of hyperbaric levobupivacaine alone.

Efficacy of Intravenous versus Intrathecal Meperidine on Post-Spinal Shivering after Knee Arthroscopy: A Randomized Controlled Study

Background and Aims: Hypothermia is considered a common problem with anesthesia. Spinal anesthesia, affects the process of temperature regulation. The aim of this study was to compare the prophylactic effect of intravenous (IV) meperidine with intrathecal (IT) meperidine on the prevention of shivering during spinal anesthesia in patients underwent knee arthroscopy. Aim of the Study: The aim of this work is to study the effect of meperidine either intravenous (IV) vs intrathecal (IT) on controlling postoperative shriving after knee arthroscopy. Materials and Methods: This study will be conducted in accordance with the principles of the ethics committee Benha University hospitals. Full written informed consent will be obtained from all patients before inclusion in the study, and a prospective randomized double-blinded study was conducted in adult patients undergoing knee arthroscopy under spinal anesthesia. Cases are divided into three equal groups (20 patients in each). Group IT: will receive spinal anesthesia (12.5 mg heavy bupivacaine) with intrathecal meperidine (25 mg). Group IV: will receive spinal anesthesia (12.5 mg heavy bupivacaine) with intravenous meperidine (25 mg). Group C: will receive spinal anesthesia (12.5 mg heavy bupivacaine) only postoperatively. Incidence and degree of shivering (SS), sedation score (RSS), pain score (VAS), hemodynamics, and PONV will be measured at the following intervals: 0 min (once arrived at PACU), 20 min later, 40 min later, 80 min later. Results: Shivering was observed in 0%, 0%, and 10.5% of patients in Groups IT, IV, and C, respectively. There was a significant difference between Group IT and IV compared to Group C (P Conclusion: We concluded that IT meperidine and IV meperidine comparably can decrease intensity and incidence of shivering compared to control group as well as decrease the requirement for additional doses of meperidine for shivering control without any hemodynamic side effect. And intrathecal meperidine showed better postoperative pain control and less postoperative nausea and vomiting (PONV).