|LETTER TO THE EDITOR
|Year : 2022 | Volume
| Issue : 2 | Page : 183-184
Periarticular Injections After Bipolar Hemiarthroplasty
Akhil Wadhawan, Yasim Khan, Sumit Arora
Department of Orthopaedic Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India
|Date of Submission||08-Sep-2021|
|Date of Decision||12-May-2022|
|Date of Acceptance||28-Jun-2022|
|Date of Web Publication||23-Aug-2022|
MS (Ortho), DNB (Ortho), MRCPS Glasgow, MNAMS, C/o Mr Raj Kumar Arora, B-253, Second floor, Derawal Nagar, Delhi 110009
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Wadhawan A, Khan Y, Arora S. Periarticular Injections After Bipolar Hemiarthroplasty. MAMC J Med Sci 2022;8:183-4
We read with great interest the article by Phruetthiphat et al. 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:
- 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 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
- 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 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
- 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
- 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. 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
Conflicts of interest
There are no conflicts of interest.
| References|| |
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.
Kim YT, Azuma H. The nerve endings of the acetabular labrum. Clin Orthop Rel Res 1995;320:176-81.
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.