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Hip Injection

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3921. Low-molecular-weight heparinoid orgaran is more effective than aspirin in the prevention of venous thromboembolism after surgery for hip fracture. (PubMed)

patients undergoing surgery for hip fracture in seven participating hospitals.Patients received either fixed-dose Orgaran by subcutaneous injection every 12 hours in a dose of 750 anti-Factor Xa units or aspirin 100 mg orally twice daily; both regimens were started 12 to 24 hours after surgery and continued for 14 days or until discharge, if sooner. All patients had postoperative 125I-fibrinogen leg scanning and impedance plethysmography. If the results of one or both tests were positive (...) Low-molecular-weight heparinoid orgaran is more effective than aspirin in the prevention of venous thromboembolism after surgery for hip fracture. The study objective was to determine the relative efficacy and safety of a low-molecular-weight heparinoid (Orgaran) compared with aspirin for the prevention of postoperative venous thromboembolism in patients undergoing surgery for fractured hips. A double-blind, randomized, controlled trial was used to study 251 consecutive eligible and consenting

1996 Circulation Controlled trial quality: predicted high

3922. Markers of hemostatic system activation during thromboprophylaxis with recombinant hirudin in total hip replacement. (PubMed)

Markers of hemostatic system activation during thromboprophylaxis with recombinant hirudin in total hip replacement. Coagulation activation markers were studied in 148 patients undergoing total hip replacement under recombinant-hirudin (Desirudin, Revasc) prophylaxis with the aim of investigating the efficacy and safety of this anticoagulant compared with heparin in terms of biological effects on coagulation variables and bleeding. Hirudin (10, 15 or 20 mg s.c. b.i.d.) or unfractionated heparin (...) (5000 IU s.c. t.i.d.) was administered immediately before surgery and continued for 8-12 days. Activated partial thromboplastin time (aPTT), prothrombin activation fragment F1 + 2 (F1 + 2), thrombin-antithrombin III complexes (TAT) and D-dimer were measured at baseline and on postoperative days 1,3 and 6, immediately before the morning injection. In comparison with baseline values, heparin had little effect on aPTT whereas the three hirudin doses prolonged aPTT significantly with no differences

1996 Thrombosis and haemostasis Controlled trial quality: uncertain

3923. Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty. Evaluation during hospitalization and three months after discharge. (PubMed)

Comparison of enoxaparin and warfarin for the prevention of venous thromboembolic disease after total hip arthroplasty. Evaluation during hospitalization and three months after discharge. Venous thromboembolic disease in the form of deep venous thrombosis and pulmonary embolism is a major risk after a total hip arthroplasty. Enoxaparin, a low-molecular-weight heparin, has been shown to reduce the prevalence of deep venous thrombosis after total hip arthroplasty. Warfarin, an orally administered (...) anticoagulant, has been used historically to reduce the risk of deep venous thrombosis after total hip arthroplasty.We compared enoxaparin and adjusted-dose warfarin with respect to their safety and their efficacy in the prevention of clinically important venous thromboembolic disease, defined as distal or proximal deep venous thrombosis or pulmonary embolism, or both, during hospitalization after total hip arthroplasty. We also evaluated the prevalence of complications and mortality from venous

1999 The Journal of Bone and Joint Surgery. American Volume Controlled trial quality: uncertain

3924. Shortening the discharging time after total hip replacement under combined spinal/epidural anesthesia by actively warming the patient during surgery. (PubMed)

surgery.50 ASA physical status I-III patients, who were scheduled for elective total hip arthroplasty.Patients received combined spinal/epidural anesthesia (CSE) with intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine. All procedures started 8-10 a.m., and operating room temperature was maintained between 21-23 degrees C, with relative humidity ranging between 40-45%. As warming therapy patients received either passive thermal insulation of the trunk, the two upper limbs and the unoperated (...) Shortening the discharging time after total hip replacement under combined spinal/epidural anesthesia by actively warming the patient during surgery. To compare passive thermal insulation by reflective blankets with forced-air active warming on the efficacy of normothermia maintenance and time for discharging from the recovery room after combined spinal/epidural anesthesia for total hip arthroplasty.Prospective, randomized study.Inpatient anesthesia at three University Departments of orthopedic

1999 Minerva anestesiologica Controlled trial quality: uncertain

3925. Postoperative analgesia with "3-in-1" femoral nerve block after prosthetic hip surgery. (PubMed)

Postoperative analgesia with "3-in-1" femoral nerve block after prosthetic hip surgery. To evaluate the efficacy of a single shot "3-in-1" femoral nerve block for prosthetic hip surgery in association with general anaesthesia on post-operative analgesia.Forty patients, ASA 1 to 3, received sham block or "3-in-1" femoral nerve block, following Winnie's landmarks with a nerve stimulator, and 40 ml bupivacaine 0.5% with epinephrine were injected after induction of anaesthesia. Vecuronium, 0.1 (...) requirements in the postoperative periods (24 and 48 hr) were similar.There is a short-term benefit during the first few postoperative hours in using a single shot "3-in-1" femoral nerve block to complement general anaesthesia for elective hip surgery.

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1998 Canadian journal of anaesthesia = Journal canadien d'anesthesie Controlled trial quality: uncertain

3926. Autotransfusion--bacterial contamination during hip arthroplasty and efficacy of cefuroxime prophylaxis. A randomized controlled study of 40 patients. (PubMed)

Autotransfusion--bacterial contamination during hip arthroplasty and efficacy of cefuroxime prophylaxis. A randomized controlled study of 40 patients. 40 patients undergoing primary hip arthroplasty, given autologous processed blood transfusion, were randomized a receive no antibiotic prophylaxis (group A, n 20) or cefuroxime (1.5 g single injection; group B, n 20). Bacterial contamination at various steps in the autotransfusion procedure was assessed in liquid and solid culture media

1997 Acta Orthopaedica Scandinavica Controlled trial quality: uncertain

3927. Propofol patient-controlled sedation during hip or knee arthroplasty in elderly patients. (PubMed)

Propofol patient-controlled sedation during hip or knee arthroplasty in elderly patients. Little information is available regarding the use of patient-controlled sedation (PCS) among the elderly. This study evaluated the safety and efficacy of propofol PCS among elderly patients undergoing hip or knee arthroplasty.Forty patients, aged 65-78 yr, undergoing hip or knee arthroplasty under regional anaesthesia were randomized to receive propofol PCS (dose = 0.3 mg.kg-1, delay = three min; n = 20 (...) of intraoperative complications was also compared.Patient satisfaction was high in each group. Sedation and anxiety VAS were similar in each group. A high incidence of pain with drug injection was noted among patients receiving propofol (80%). Transient deeper levels of sedation (6 vs 1; P = 0.05) were observed more commonly in the propofol PCS group.Propofol PCS provides effective sedation. Using a propofol dose of 0.3 mg.kg-1, transient episodes of deeper sedation were noted more frequently among patients

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1997 Canadian journal of anaesthesia = Journal canadien d'anesthesie Controlled trial quality: uncertain

3928. Diagnostic infiltration of the hip joint with bupivacain in adult acetabular dysplasia. (PubMed)

the injection and for pain relief on a visual analogue scale (VAS) immediately after the injection and after two weeks. There was no statistically significant difference between the two groups for pain relief and duration of pain relief. Duration of pain relief was significantly related to severity of pain before the injection. Diagnostic infiltration of the hip joint with bupivacain in mild and moderate acetabular dysplasia does not prove to be a reliable diagnostic aid in the decision to treat (...) Diagnostic infiltration of the hip joint with bupivacain in adult acetabular dysplasia. The authors performed a double-blind randomized study considering the use of selective infiltration of the hip joint with bupivacain 0.5% as a diagnostic tool in mild and moderate acetabular dysplasia in the adult. In 40 patients with symptomatic acetabular dysplasia the hip joint was infiltrated with either bupivacain 0.5% or placebo in a double-blind setting. Patients were scored for pain before

1997 Acta orthopaedica Belgica Controlled trial quality: uncertain

3929. Postoperative activation of the haemostatic system--influence of prolonged thromboprophylaxis in patients undergoing total hip arthroplasty. (PubMed)

of patients undergoing total hip arthroplasty. The study was part of a multicentre study in which the patients were randomized to receive a subcutaneous injection of low molecular weight heparin (LMWH, dalteparin, Fragmin) once daily for 5 weeks or placebo following a 1-week LMWH treatment (once daily). Bilateral phlebography was performed between days 33 and 35 or before if patients had clinical symptoms of deep vein thrombosis. A lung scan was performed in patients with clinical symptoms of pulmonary (...) Postoperative activation of the haemostatic system--influence of prolonged thromboprophylaxis in patients undergoing total hip arthroplasty. Tissue injury during hip surgery results in the activation of the haemostatic system. The aim of this study was to detect markers of haemostatic activity, i.e. prothrombin fragment 1 and 2 (F1+2), thrombin-antithrombin (TAT) complexes, fibrin degradation products (FbDP), and soluble fibrin monomers (SF), preoperatively, and on days 1, 7 and 35 in plasma

1998 Haemostasis Controlled trial quality: uncertain

3930. Effects of sympathetic blockade on the efficiency of forced-air warming during combined spinal-epidural anesthesia for total hip arthroplasty. (PubMed)

ASA physical status I, II, and III patients, who were scheduled for elective total hip arthroplasty.Patients received CSE with intrathecal injection of 15 mg of 0.5% hyperbaric bupivacaine. All procedures started 8 to 10 AM, and operating room temperature was maintained between 21 degrees and 23 degrees C, with relative humidity ranging between 40% and 45%. For warming therapy, patients received active forced-air warming of either the two upper limbs (Group Upper body, n = 24), or the unoperated (...) Effects of sympathetic blockade on the efficiency of forced-air warming during combined spinal-epidural anesthesia for total hip arthroplasty. To evaluate if active cutaneous warming of the two upper limbs with reflex vasoconstriction is less effective in maintaining intraoperative normothermia than warming the vasodilated unoperated lower limb during combined spinal-epidural anesthesia (CSE).Prospective, randomized study.Inpatient anesthesia at university departments of orthopedic surgery.48

1999 Journal of clinical anesthesia Controlled trial quality: uncertain

3931. Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures. (PubMed)

Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures. The perioperative use of continuous psoas compartment block (CPCB) was compared with traditional pain management for patients with fracture of the femur. The anatomy of CPCB was also tested in cadavers.Forty consecutive patients (range, 67-96 years old) were prospectively randomized either to group A (given local anesthetics using a CPCB) or group B (given perioperative analgesia (...) and 5 of the assessments, respectively. Patient satisfaction was higher in group A in the pre- (P < .05) and postoperative periods (P<.03). The block failed to achieve surgical anesthesia in 85% (17/20) of the patients, and additional anesthesia was needed. The anatomic study failed to support the existence of a defined "psoas compartment" previously described, and supported the clinical findings. Injected dye was found in the region of the origin of the sciatic nerve (essential for the production

1999 Regional Anesthesia and Pain Medicine Controlled trial quality: uncertain

3932. Transesophageal echocardiography and clinical features of fat embolism during cemented total hip arthroplasty. A randomized study in patients with a femoral neck fracture. (PubMed)

Transesophageal echocardiography and clinical features of fat embolism during cemented total hip arthroplasty. A randomized study in patients with a femoral neck fracture. Forty patients suffering from a medial femoral neck fracture participated in a prospective, randomized study. In 20 patients, the femoral component was cemented using a contemporary technique. In the patient group operated on with the bone vacuum technique, the medullary cavity was drained during the insertion of the stem (...) episodes of embolism than patients of the bone vacuum group. Ongoing emboli were first seen during the injection of the cement, and continued during stem insertion. Massive emboli of small particles could be verified in 19 patients (95%) of the control group and in 1 patient (5%) of the bone vacuum group (P < 0.05). During massive emboli, a distinct decrease in the arterial oxygen saturation and the end-expiratory carbon dioxide level was observed. The calculated average pulmonary shunt volume showed

2000 Archives of orthopaedic and trauma surgery Controlled trial quality: uncertain

3933. Occurrence of thrombosis and haemorrhage, relationship with anti-Xa, anti-IIa activities, and D-dimer plasma levels in patients receiving a low molecular weight heparin, enoxaparin or tinzaparin, to prevent deep vein thrombosis after hip surgery. (PubMed)

Occurrence of thrombosis and haemorrhage, relationship with anti-Xa, anti-IIa activities, and D-dimer plasma levels in patients receiving a low molecular weight heparin, enoxaparin or tinzaparin, to prevent deep vein thrombosis after hip surgery. Studies in experimental animal models and in patients receiving low molecular weight heparin (LMWH) to prevent thromboembolic events after surgery have not demonstrated a clear relationship between anti-Xa and anti-IIa activities in plasma and either (...) bleeding or prevention of thrombosis. The relationship between these clinical outcomes and ex vivo anti-Xa and anti-IIa activities, activated partial thromboplastin time (APTT) and D-dimers were evaluated in 440 patients undergoing total hip replacement and given prophylaxis once daily with a LMWH (tinzaparin or enoxaparin) in a multicentre double-blind randomized study. 221 patients received 4500 anti-Xa IU of tinzaparin; 219 patients received 40 mg (4000 anti-Xa IU) of enoxaparin. Both regimens were

1999 British journal of haematology Controlled trial quality: uncertain

3934. Dose response of intravenous heparin on markers of thrombosis during primary total hip replacement. (PubMed)

Dose response of intravenous heparin on markers of thrombosis during primary total hip replacement. Thrombogenesis in total hip replacement (THR) begins during surgery on the femur. This study assesses the effect of two doses of unfractionated intravenous heparin administered before femoral preparation during THR on circulating markers of thrombosis.Seventy-five patients undergoing hybrid primary THR were randomly assigned to receive blinded intravenous injection of either saline or 10 or 20 U (...) of heparin significantly reduced the increase of F1+2 after relocation of the hip joint (P < 0.001). Administration of both 10 and 20 U/kg significantly reduced the increase in FPA during implantation of the femoral component (P < 0.0001). A fourfold increase in FPA was noted in 6 of 25 patients receiving 10 U/kg of heparin but in none receiving 20 U/kg (P = 0.03). Intraoperative heparin did not affect intra- or postoperative blood loss, postoperative hematocrit, or surgeon's subjective assessments

1999 Anesthesiology Controlled trial quality: uncertain

3935. Prevention of deep vein thrombosis after hip replacement--comparison between two low-molecular heparins, tinzaparin and enoxaparin. (PubMed)

Prevention of deep vein thrombosis after hip replacement--comparison between two low-molecular heparins, tinzaparin and enoxaparin. Consecutive patients undergoing total hip replacement in 43 centres were randomly assigned to receive blindly either enoxaparin (40 mg) or tinzaparin (4,500 anti-Factor IU Xa), as once daily subcutaneous injections. The first injection was administered 12 h preoperatively. Efficacy was assessed by bilateral venography performed 12-14 days postoperatively. Efficacy (...) patients) and in 9.5% (21 patients) of the tinzaparin group. No overt major bleeding was observed. One patient in the enoxaparin group developed severe thrombocytopenia and died. The LMWH tinzaparin appears clinically to be as effective and safe as enoxaparin in the prophylaxis of deep vein thrombosis after total hip replacement, at the doses used and under the conditions of this study.

1999 Thrombosis and haemostasis Controlled trial quality: uncertain

3936. Botulinum toxin (Dysport) treatment of hip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study. (PubMed)

by intramuscular injection to these muscles. Patients were assessed at entry, and 2, 4 (primary analysis time-point), 8, and 12 weeks post-treatment.A total of 74 patients were recruited. Treatment groups were generally well matched at entry. The primary efficacy variables-passive hip abduction and distance between the knees-improved for all groups. The improvement in distance between the knees for the 1500 Unit group was significantly greater than placebo (p = 0.02). Spasm frequency was reduced in all groups (...) Botulinum toxin (Dysport) treatment of hip adductor spasticity in multiple sclerosis: a prospective, randomised, double blind, placebo controlled, dose ranging study. To define a safe and effective dose of Dysport for treating hip adductor spasticity.Patients with definite or probable multiple sclerosis, and disabling spasticity affecting the hip adductor muscles of both legs, were randomised to one of four treatment groups. Dysport (500, 1000, or 1500 Units), or placebo was administered

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2000 Journal of neurology, neurosurgery, and psychiatry Controlled trial quality: predicted high

3937. Bone mass continues to increase at the hip after parathyroid hormone treatment is discontinued in glucocorticoid-induced osteoporosis: results of a randomized controlled clinical trial. (PubMed)

Bone mass continues to increase at the hip after parathyroid hormone treatment is discontinued in glucocorticoid-induced osteoporosis: results of a randomized controlled clinical trial. Glucocorticoid-induced osteoporosis is the most common secondary cause of osteoporosis. In this 24-month study, we report changes in bone turnover and bone mass after 12 months of daily injections of human parathyroid hormone 1-34 [hPTH(1-34)] and 12 months off treatment in postmenopausal women (mean age, 63 (...) years) with osteoporosis treated with glucocorticoid and hormone replacement therapy. Response to the treatment was assessed with bone mineral density (BMD) measurements of the lumbar spine by quantitative computed tomography (QCT); BMD measurements of the lumbar spine, hip, and forearm by dual-energy X-ray absorptiometry (DXA); and biochemical markers of bone turnover. The mean (+/-SEM) change in BMD of the lumbar spine by QCT and DXA in the PTH group at 24 months was 45.9+/-6.4% and 12.6+/-2.2% (p

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2000 Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research Controlled trial quality: uncertain

3938. Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. (PubMed)

Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty. The usefulness of peripheral nerve blockade in the anesthetic management of hip surgery has not been clearly established. Because sensory afferents from the hip include several branches of the lumbar plexus, the authors hypothesized that a lumbar plexus block could reduce pain from a major hip procedure.In a double-blind prospective trial, 60 patients undergoing total hip arthroplasty were randomized (...) to receive general anesthesia with (plexus group, n = 30) or without (control group, n = 30) a posterior lumbar plexus block. The block was performed after induction using a nerve stimulator, and 0.4 ml/kg bupivacaine, 0.5%, with epinephrine was injected. General anesthesia was standardized, and supplemental fentanyl was administered per hemodynamic guidelines. Postoperative pain and patient-controlled intravenous morphine use were serially assessed for 48 h.The proportion of patients receiving

2000 Anesthesiology Controlled trial quality: uncertain

3939. Propacetamol versus ketorolac for treatment of acute postoperative pain after total hip or knee replacement. (PubMed)

Propacetamol versus ketorolac for treatment of acute postoperative pain after total hip or knee replacement. We assessed the analgesic efficacy of IV propacetamol and ketorolac in a double-blinded, placebo-controlled study involving patients undergoing total hip or knee replacement procedures. On the first morning after major joint replacement surgery, 164 patients experiencing moderate-to-severe pain were randomly assigned to receive an IV infusion of propacetamol (2 g), ketorolac (15 or 30 mg (...) of analgesia (3.5 [2;5.4] vs 6 [3.3; not estimable] h). Analysis of pain intensity and pain relief scores demonstrated that propacetamol produced a significantly greater improvement in pain relief than saline from 45 min until 5 h after the injection. Propacetamol was not significantly different from ketorolac 15 mg and 30 mg with respect to the main analgesic efficacy variables during the 6-h assessment period. The most frequently reported adverse event with propacetamol was injection site pain (28% vs 19

2001 Anesthesia and analgesia Controlled trial quality: predicted high

3940. A 5-year randomized controlled, double-blind study of glycosaminoglycan polysulphuric acid complex (Rumalon) as a structure modifying therapy in osteoarthritis of the hip and knee. (PubMed)

baseline and follow-up at 5 years. Secondary outcome criteria included Lequesne algofunctional index (LAI), pain on passive motion and consumption of non-steroidal antiinflammatory drugs (NSAIDs). The patients received 10 courses of injections of placebo or GP-C 2 ml intramuscularly in 5 years (two courses each year). Each course included 15 injections administered twice weekly.There were 277 patients with knee OA and 117 patients with hip OA. Control and GP-C treated groups were comparable as to sex (...) A 5-year randomized controlled, double-blind study of glycosaminoglycan polysulphuric acid complex (Rumalon) as a structure modifying therapy in osteoarthritis of the hip and knee. To determine the structure (disease) modifying effect of a glycosaminoglycan polypeptide association complex (GP-C; Rumalon) in patients with knee and hip osteoarthritis (OA).Double-blind, randomized, placebo-controlled five-year study. Primary assessment criterion was change in radiographic joint space width between

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2000 Osteoarthritis and cartilage / OARS, Osteoarthritis Research Society Controlled trial quality: predicted high

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