Archive for month: August, 2024

The study found that intraoperative periarticular glucocorticoid injections provide comparable pain relief to IV injections during the postoperative period following TKA and may offer enhanced effectiveness by the second postoperative day. Additionally, periarticular injections do not present any increased risk or complications for patients.

Total knee arthroplasty is a common surgical procedure aimed at relieving pain and restoring function in patients with severe knee arthritis. The use of glucocorticoids, known for their anti-inflammatory properties, is a well-established practice to enhance postoperative outcomes. However, the best protocols for administering glucocorticoids are still debated. Considering this, Qingtian Li, Southern Medical University, Guangzhou, China, and colleagues aimed to compare the efficacy of glucocorticoids between intravenous and periarticular injection on clinical outcomes.

A total of 114 patients were randomly divided into two groups: the intravenous (IV) group (n = 57) and the periarticular injection (PI) group (n = 57). The IV group received 10 mg of dexamethasone intravenously, while the PI group received a 10 mg periarticular injection of dexamethasone during the procedure. Clinical outcomes were evaluated using the visual analogue scale (VAS), knee society score (KSS), range of motion (ROM), knee swelling, inflammation markers, and post-TKA complications.

The following were the key findings of the study:

• The VAS score during walking on 2nd day postoperatively was lower in the PI group compared with the IV group (2.08 ± 1.45 versus 2.73 ± 1.69), and there was no significant difference at the other time points of VAS score in the two groups.
• The inflammation markers, knee swelling, knee ROM, and KSS score were not statistically different.
• The occurrence of vomiting and other complications was not significantly different between the two groups.

The study had limitations, including its single-center design, short duration, and lack of a placebo group. Additionally, the adductor nerve block used for pain management may have masked early postoperative pain. However, the researchers noted that this block was necessary to reduce pain and nausea after TKA for ethical reasons.

“The study demonstrates that intraoperative periarticular glucocorticoid injections offer comparable pain relief to IV injections following TKA, with potential added effectiveness on the second postoperative day. Additionally, periarticular glucocorticoid injections do not introduce extra risks or complications for patients,” the researchers concluded.

Reference:

Li, Q., Fang, G., Liao, W., Chen, B., Yang, Y., Liao, J., Fu, G., Ma, Y., & Zheng, Q. (2024). Intraoperative intravenous versus periarticular injection of glucocorticoids in improving clinical outcomes after total knee arthroplasty: A prospective, randomized and controlled study. Journal of Orthopaedic Surgery. https://doi.org/10.1177_10225536241256554

Basilar artery occlusion is a severe form of ischemic stroke with high disability and mortality rates. Whereas earlier trials have shown that EVT improves functional outcomes at 90 days compared to medical therapy alone, information on long-term outcomes beyond this period is scant. The ATTENTION trial provided pivotal evidence for the use of EVT within 12 hours from symptom onset. This extended study assessed whether benefits derived from EVT at 90 days were maintained or increased at 1 year.

The ATTENTION extension study followed-up patients with acute basilar artery occlusion treated within 12 hours of symptom onset from 36 comprehensive stroke centers. In all, 342 patients were randomized, of whom 330 [96.5%] had complete 1-year follow-up. Patients were treated in two conditions: EVT [thrombectomy group receiving mechanical endovascular thrombectomy] and best medical treatment, that is, the control group. The primary outcome was a favorable functional outcome defined as a modified Rankin Scale of 0 to 3 at 1 year. The secondary outcomes assessed functional independence, excellent outcome, level of disability across the full range of mRS scores, mortality, and health-related quality of life.

Key Findings

Primary Outcome (mRS 0-3 at 1 Year):

• Thrombectomy group: 44.6% (99/222)

• Control group: 19.4% (21/108)

• The adjusted rate ratio was 2.23 (95% CI, 1.51-3.29), with statistical significance of the thrombectomy group.

Excellent Outcome (mRS 0-1 at 1 Year):

• Thrombectomy group: 27.9% [62/222] v 19.9% at 90 days; Control group: 8.3% [9/108] v 7.9% at 90 days

Mortality

• Thrombectomy group: 45.5% [101/222] at 1 year v 36.7% at 90 days; Control group: 63.9% [69/108] at 1 year v 55.3% at 90 days

Secondary Outcomes:

• All mRS scores showed lower levels of disability in the thrombectomy group at 1 year.

• The benefit of EVT was particularly magnified in those patients who achieved an excellent outcome-e.g., mRS 0-1-only, further underlining the sustained and enhanced treatment effect.

The extended analysis herein of the 1-year follow-up data reinforces long-term benefits of EVT for patients with basilar artery occlusion. In contrast with the rates at 90 days, mortality rates increased for both groups; however, EVT patients maintained better functional outcomes and further improved in achieving excellent recovery. The findings of this study point toward the importance of EVT in the management of acute basilar artery occlusion, where a considerable proportion of patients are able to achieve favorable outcomes even at 1 year post-stroke.

In conclusion, EVT establishes ongoing benefits in patients with acute basilar artery occlusion along with superior functional and improved survival at 1-year outcomes compared to best medical treatment. These results assure that timely EVT intervention is indeed associated with an improvement in the long-term prospects for the recovery of stroke patients.

Reference: