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LETTER TO THE EDITOR
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 183-184

Periarticular Injections After Bipolar Hemiarthroplasty


Department of Orthopaedic Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India

Date of Submission08-Sep-2021
Date of Decision12-May-2022
Date of Acceptance28-Jun-2022
Date of Web Publication23-Aug-2022

Correspondence Address:
Sumit Arora
MS (Ortho), DNB (Ortho), MRCPS Glasgow, MNAMS, C/o Mr Raj Kumar Arora, B-253, Second floor, Derawal Nagar, Delhi 110009
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mamcjms.mamcjms_100_21

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How to cite this article:
Wadhawan A, Khan Y, Arora S. Periarticular Injections After Bipolar Hemiarthroplasty. MAMC J Med Sci 2022;8:183-4

How to cite this URL:
Wadhawan A, Khan Y, Arora S. Periarticular Injections After Bipolar Hemiarthroplasty. MAMC J Med Sci [serial online] 2022 [cited 2022 Sep 25];8:183-4. Available from: https://www.mamcjms.in/text.asp?2022/8/2/183/354340



Sir,

We read with great interest the article by Phruetthiphat et al.[1] published in reputed Journal of Arthroplasty, in which the authors presented randomized controlled trial on the effectiveness of periarticular injection after bipolar hemiarthroplasty for displaced femoral neck fractures in elderly patients. There is a sparsity of literature on the pain relief after hip arthroplasty and the authors should be congratulated for realizing the need to do research on this topic. However, we would like to make the following points or raise concerns for the benefit of the readership of this journal so that the technique may be employed widely:
  1. The authors have mentioned that they injected 30 mL of cocktail mixture into the joint capsule after capsular repair. It is difficult for us to understand whether they injected the mixture into the joint after capsular closure or injected in the substance of capsule. If they intended to do capsular infiltration, it would have been better to do this step before the insertion of prosthesis or the final reduction when anterior capsule is there under vision in posterolateral approach to hip. Kim and Azuma[2] demonstrated that free nerve endings were found in the superior and anterior quarters of the labrum. Thus, in our opinion, the capsular infiltration with cocktail mixture should be done before insertion of the prosthesis and all the quarters of the labrum should be injected for better pain relief
  2. The authors have additionally mentioned that they injected 20 mL of cocktail mixture into muscles after capsular repair. The readership will be benefitted more if the authors could enumerate the names of the muscles and sequence of their respective infiltration. Ranawat and Ranawat[3] suggested that iliopsoas tendon and insertion site should be infiltrated before final reduction. In our opinion also, it becomes very difficult to inject iliopsoas tendon after final reduction/capsular repair which is otherwise quite amenable before that
  3. The authors have injected 20 mL of cocktail mixture (ketorolac, levobupivacaine, and epinephrine) into labrum after bipolar stem insertion. In our opinion, a tough structure like labrum is not likely to accommodate 20 mL of injected fluid
  4. Lastly, the authors have used an invalidated “satisfaction score” to evaluate the patients, where the minimum score (0) was given to completely unsatisfied patient, and the maximum score (10) was given to completely satisfied one.[1] However, they have not detailed about this score between these extremes which makes it completely subjective and unsuitable for use in high-level research activities like randomized controlled trial.


We sincerely hope that these suggestions from our side and addressal of other unanswered concerns from authors’ side will be helpful for the betterment of the patients and widespread acceptability of this technique.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Phruetthiphat O, Lawanprasert A, Khuangsirikul S, Heebtamai D, Chotanaphuti T. Effectiveness of periarticular injection after bipolar hemiarthroplasty for displaced femoral neck fracture in elderly patients: a double blinded randomized, controlled study. J Arthroplasty 2021;36:2006-11.  Back to cited text no. 1
    
2.
Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Rel Res 1995;320:176-81.  Back to cited text no. 2
    
3.
Ranawat AS, Ranawat CS. Pain management and accelerated rehabilitation for total hip and total knee arthroplasty. J Arthroplasty 2007;22(7 Suppl 3):12-5.  Back to cited text no. 3
    




 

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