In 2020, the American Association of Hip and Knee Surgeons (AAHKS), the American Society of Regional Anesthesia and Pain Medicine (ASRA), the American Academy of Orthopaedic Surgeons (AAOS), the American Hip Society (THS), the American Knee Society (TKS) have worked together to develop clinical practice guidelines on the use of Opioids in primary total joint arthroplasty (TJA). This clinical practice guideline formulates recommendations for common and important questions related to the efficacy and safety of Opioids in primary TJA. This article interprets the guideline to help doctors make clinical decisions.
Objective To explore the influencing factors of muscle calf vein thrombosis (MCVT) after hip and knee arthroplasty. Methods Convenience sampling method was used to select patients who underwent hip or knee arthroplasty in 4 hospitals in Beijing, Jiangsu and Hainan between March 2021 and May 2022 as the research subjects. They were divided into MCVT group and non-MCVT group according to whether the lower limb MCVT occurred on the 3rd postoperative day. Generalized linear mixed model was used to analyze the influencing factors of MCVT. Results A total of 278 patients were included, including 47 patients in the MCVT group, accounting for 16.91%, and 231 patients in the non-MCVT group, accounting for 83.09%. Generalized linear mixed model analysis showed that the ambulation on the first postoperative day [odds ratio=0.364, 95% confidence interval (0.159, 0.832), P=0.017] and preoperative activated partial thromboplastin time [odds ratio=0.884, 95% confidence interval (0.785, 0.994), P=0.040] were protective factors for MCVT after hip and knee arthroplasty. Conclusions The ambulation on the first postoperative day and preoperative activated partial thromboplastin time are protective factors for MCVT after hip and knee arthroplasty. The relationship between hypertension, drainage and MCVT needs to be further explored. Clinical medical staff should pay close attention to the postoperative ambulation of patients undergoing hip and knee arthroplasty, encourage and guide patients to get out of bed early, comprehensively assess the patients’ condition and the risk of postoperative MCVT, and flexibly formulate individualized prevention and treatment plans to avoid the occurrence of MCVT and improve the prognosis.
Objective To review the research progress on the correlation between sarcopenia and osteoarthritis (OA). Methods The basic and clinical studies at home and abroad in recent years on sarcopenia and OA were extensively reviewed. The correlation between sarcopenia and OA was analyzed and summarized from five aspects: epidemiological status, risk factors, pathogenesis, clinical treatments, and the impact on joint arthroplasty. Results Sarcopenia and OA are common diseases in the elderly with high prevalence and can increase the ill risk of each other. They share a set of risk factors, and show negative interactive and influence on pathogenesis and clinical treatments, thus participating in each other’s disease process and reducing the treatment benefits. Clinical studies show that sarcopenia can affect the rehabilitation effect and increase the risk of postoperative complications after total joint arthroplasty in many ways. ConclusionCurrent research results show that sarcopenia and OA are related and can be mutually affected in the above 5 aspects, but more studies are needed to further clarify the relationship between them, so as to provide more theoretical basis for the understanding, prevention, diagnosis, and treatments of the two diseases.