Arnica 30DH after knee surgery – three randomised double‐blind clinical trials

Recent Advances in Venous Thromboembolic Prophylaxis in Major Orthopedic Surgery: A Regional Perspective

The use of preoperative erythropoiesis-stimulating agents (ESAs) in patients who underwent knee or hip arthroplasty: a meta-analysis of randomized clinical trials.

Deep vein thrombosis and pulmonary embolism are collectively called venous thromboembolism (VTE) and are a major cause of morbidity and mortality in the United States and Europe. March is deep vein thrombosis awareness month in the United States, and each year Arteriosclerosis, Thrombosis, and Vascular Biology marks this event with a series of reviews on VTE. This year we have 3 excellent articles on (1) mouse models of venous thrombosis, (2) risk factors for VTE in humans, and (3) the new generation of oral anticoagulants that are available to treat VTE. See accompanying articles on pages 556, 563, and 569 The first review, by Diaz et al1 describes how the use of mouse models has increased our understanding of the mechanisms of initiation, propagation, and resolution of venous clots. The obvious advantage of mice is that we can determine the effect of the loss or mutation of any given gene on thrombosis. Indeed, work with P-selectin knockout mice suggested a role for P-selectin in venous thrombosis that was subsequently confirmed in nonhuman primates. It will be interesting to see whether P-selectin inhibitors will be successfully developed as anticoagulant drugs. Mice have several disadvantages, however, including their small size, their resistance to thrombosis, and the surgical challenges of working with small vessels. Diaz et al1 evaluate 4 inferior vena cava (IVC) thrombosis models. The ferric chloride model induces oxidative damage to the vessel wall that produces an occlusive thrombosis. The advantage of this model is that it is …

Validation Studies on Coagulation Laboratory Assays Useful for Assessing the Plasma Levels of Apixaban

Aims: The objective of this study was to evaluate the cost–effectiveness of rivaroxaban versus the low-molecular-weight heparins (LMWH) enoxaparin and dalteparin for the prevention of venous thromboembolism (VTE) after total hip replacement and total knee replacement in Sweden. Methods: The model included acute venous thromboembolic events and long-term complications over a 5-year time horizon represented by an acute and a chronic phase with 1-year cycles. Transition probabilities were derived from the Regulation of Coagulation in Orthopaedic Surgery to Prevent Deep Vein Thrombosis and Pulmonary Embolism (RECORD) clinical trials. Results: In patients undergoing total hip replacement, the incremental cost per additional quality-adjusted life-year of extended prophylaxis for 35 days with rivaroxaban versus 14 days of prophylaxis with enoxaparin or dalteparin was SEK29,400 and SEK35,400, respectively. In total knee replacement patients, 14 days of rivaroxaban dominated 14 days of LMWH as prophylaxis for VTE. Conclusion: The results of the economic model consistently showed that, over a 5-year period, rivaroxaban is a cost-effective alternative to 14 days of LMWH for VTE prophylaxis in Sweden.

What's New in Sports Medicine.

Adding compression to mobilization in a rehabilitation program after knee surgery. A preliminary clinical observational study

Fondaparinux: A new antithrombotic agent

Lornoxicam is a member of the oxicam group of nonsteroidal antiinflammatory drugs (NSAIDs). Oxicams have potent antiinflammatory and analgesic effects, but their use is associated with a high risk of gastrointestinal adverse effects. Lornoxicam has been shown to be at least as effective as comparative NSAIDs and more effective than 10 mg morphine when used at doses > or = 8 mg to control pain after oral surgery. In addition, oral doses of lornoxicam of 16-24 mg daily have been more effective than tramadol 300 mg daily in pain following knee surgery. Lornoxicam combines the high therapeutic potency of oxicams with an improved gastrointestinal toxicity profile as compared to naproxen, for example. This is probably due to the short half-life of lornoxicam as compared to the other oxicams. The clinical trials published so far, mostly comparative, clearly do- cument the efficacy of lornoxicam as a potent analgesic with excellent antiinflammatory properties in a range of painful and/or inflammatory conditions, including postoperative pain and rheumatoid arthritis.

A review of the use of fentanyl analgesia in the management of acute pain in adults.

Current Opinion in Pediatrics was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The fields of pediatrics are divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editors for this issue. EDITOR Philip A. PizzoPhilip A. PizzoPhilip A. Pizzo, MD, is the David and Susan Heckerman Professor and Founding Director of the Stanford Distinguished Careers Institute, USA. Dr Pizzo served as Dean of the Stanford School of Medicine from April 2001 to December 2012, where he was also the Carl and Elizabeth Naumann Professor of Pediatrics and of Microbiology and Immunology. Dr Pizzo has devoted much of his distinguished medical career to the diagnosis, management, prevention and treatment of childhood cancers and the infectious complications that occur in children whose immune systems are compromised by cancer and AIDS. He has also been a leader in academic medicine, championing programs and policies to improve the future of science, education and healthcare in the US and beyond. Dr Pizzo received his MD degree with Honors and Distinction in Research from the University of Rochester, USA in 1970, and completed an internship and residency at Children's Hospital Medical Center in Boston, USA, a teaching fellowship at Harvard Medical School, USA, and a clinical and research fellowship in pediatric oncology at the National Cancer Institute. Pizzo served as Head of the Institute's Infectious Disease Section, Chief of the NCI's Pediatric Department, and Acting Scientific Director for NCI's Division of Clinical Sciences between 1973 and 1996. Before joining Stanford in 2001, he was the Physician-in-Chief of Children's Hospital in Boston and Chair of the Department of Pediatrics at Harvard Medical School, where he was also the Thomas Morgan Rotch Professor of Pediatrics. Dr Pizzo is the author of more than 615 scientific articles and 16 books and monographs, including Principles and Practice of Pediatric Oncology, the Seventh Edition of which was published in 2015. He co-led a multidisciplinary committee for the Institute of Medicine (IOM) that resulted in the 2011 report Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research; he also co-chaired the IOM report Dying in America: Improving Quality and Honoring Individual Preferences at the End of Life, which was published in 2015. Dr Pizzo has received numerous awards and honors, among them the Public Health Service Outstanding Service Medal in 1995, the Barbara Bohen Pfiefer Award for Scientific Excellence in 1991, the Elizabeth Kubler-Ross Award in 2008, the Ronald McDonald Charities Award of Excellence in 2009, and the John and Emma Bonica Public Service Award in 2013. He is the 2012 recipient of the John Howland Award, the highest honor for lifetime achievement bestowed by the American Pediatric Society. He has been elected to a number of prestigious organizations and societies, including the Association of American Physicians, the American Society of Clinical Investigation, the American Pediatric Society and the Institute of Medicine of the National Academy of Sciences, where he was also elected to the Governing Council. The IOM became the National Academy of Medicine in 2015. Dr Pizzo has served as Chair of the Association of Academic Health Centers, and Chair of the Council of Deans of the Association of American Medical Colleges, and was elected to the Board of Directors of the American Society for Clinical Oncology and the Infectious Diseases Society of America. He was President of the International Immunocompromised Host Society (1998–2011). He served on the Governing Board for the California Institute of Regenerative Medicine from 2004–2012. In 2009 he was elected to the Board of Trustees of the University of Rochester and the Board of Overseers of Koc University in Istanbul, Turkey. He is also a member of the Board of Directors of MRI Interventions and the Academic Advisory Council for Merritt Hawkins. In 2014 he was elected to the Board of Directors of the Ludwig Institute for Cancer Research and in 2015 he was elected to the Board of Directors of Global Blood Therapeutics. SECTION EDITORS Susan M. BlaneySusan M. BlaneySusan M. Blaney, MD, is a Professor and Executive Vice Chair for the Department of Pediatrics at Baylor College of Medicine, USA and the Director of Texas Children's Cancer Center at Texas Children's Hospital, USA. She is a board-certified pediatric oncologist whose career over the past 25 years has focused on the development of new agents and therapeutic strategies for children with recurrent or refractory cancer, particularly for those with malignancies of the central nervous system. She has extensive experience in clinical translational research and currently serves as the Vice Chair for the Children's Oncology Group (COG), an NCI-funded cooperative effort of 200 leading children's hospitals across North America. Dr Blaney has played a leadership role in the development of numerous early phase clinical trials of novel agents for the treatment of childhood cancer over the course of her career. Dr Blaney has also served as a mentor to many pediatric medical students, residents, fellows and faculty who are current or developing leaders in the field of pediatric oncology. Her influence in the field also extends to numerous advisory roles that she has held including an service on the National Cancer Institute's Clinical Trial Advisory Committee, as a member of the Investigational Drug Steering Committee for the National Cancer Institute, as a regular consultant for the FDA's Pediatric Oncology Drug Advisory Committee, as well as for other leading cancer organizations such as the American Association for Cancer Research and the American Society of Clinical Oncology. She also directs or has served on the scientific advisory boards for many not-for-profit foundations for childhood cancer research. Dr Blaney has published more than 200 articles in peer-reviewed journals, has authored numerous book chapters, and is an editor for Rudolph's Pediatrics as well as an Associate editor for Pizzo and Poplack's Principles and Practice of Pediatric Oncology, the leading textbook in the field of pediatric oncology. Daniel W. GreenDaniel W. GreenDr Daniel W. Green has been practicing at the Hospital for Special Surgery, USA since 1998 and is currently the Director of the Pediatric Sports Program for the Division of Pediatric Orthopedic Surgery. While he thoroughly enjoys caring for patients from birth into early adulthood, he has a special interest in pediatric sports injuries and pediatric knee injuries, in addition to pediatric orthopedic trauma. He provides emergency treatment for pediatric fractures and other orthopedic emergencies at New York Presbyterian Hospital-Manhattan, USA and the Hospital for Special Surgery. His focus is to provide the finest, most advanced orthopedic care available and is devoted to advancing treatments in order to improve patient outcomes and the overall patient experience. His research focuses on pediatric knee surgery, cartilage repair and restoration, pediatric ACL surgery, pediatric growth plate surgery, pediatric fracture care, and osteogenesis imperfecta. He has extensively studied the surgical options for patellar dislocations, evaluating both conservative and surgical approaches to stabilizing the patella. He has also investigated surgical techniques for ACL reconstruction in the skeletally immature. Dr Green is a clinical professor of orthopedic surgery at the Weill Cornell Medical College, USA. Yvonne J. BrysonYvonne J. BrysonDr Yvonne J. Bryson is a Distinguished Professor and recent past Chief of Global Pediatrics Infectious Diseases at David Geffen School of Medicine at UCLA, Mattel Children's, USA. She is a world-renowned leader, researcher, virologist and clinician in the field of HIV pathogenesis, prevention, and treatment of maternal-fetal and pediatric HIV-1, and is an active member of the HIV CURE Scientific Committee of International Maternal Pediatric and Adolescent AIDS Clinical trials network (IMPAACT) and the Adolescent trials network for identification and treatment of HIV acute infection. She is past Chair of the NIH Network IMPAACT PMTCT Committee (Prevention of Mother-to-Child Transmission of HIV) as well as a previous past chair. She has served a national and international leadership role for the past 25 years in studies of prevention and treatment of pediatric HIV. She has served on the HIV Therapeutics Trans NIH panel to set the NIH agenda for the past eleven years. Dr Bryson was influential in the development of CDC and Public Health guidelines for the diagnosis and treatment of HIV-infected pregnant women and has been involved in the planning and execution of national cooperative studies of maternal-fetal HIV transmission. She has made significant contributions to the development of the original studies of the use of Zidovudine and Nevirapine for the prevention of perinatal HIV. She published studies of maternal risk factors for vertical transmission of HIV including viral load and autologous neutralizing antibody, as well as advances in the early diagnosis of HIV in newborns. Her research at UCLA has been funded by NIH for over twenty-five years. She has over 190 original peer-reviewed publications and is a sought-after lecturer and reviewer. She was founding advisor and one of the original health board advisors of the Elizabeth Glaser Pediatric AIDS Foundation, with co-founders Elizabeth Glazer, Susie Zeegan and Susan Delorentis, and colleagues Dr Richard Stiehm and Phil Pizzo. She participated and helped plan the EGPAF thinktanks, the Ariel Project, the Elizabeth Glazer Scientist Award, and fundraising strategies for the foundation and the role of NIH in promoting new investigators in the field. She also was involved in political activism in Washington DC and California with Elizabeth and cofounders to focus attention on children. Dr Bryson has served on numerous NIH study section reviews and panels. She had significant experience in global health issues related to reduction of maternal infant mortality and morbidity and meeting the millennium goals. Dr Bryson has had significant leadership and field experience setting up NIH funded clinical trials, laboratories and infrastructure in Brazil over the past 13 years. She has trained a large number of students and post-doctoral MD, PhD scholars and junior faculty who are now national and international leaders as academic faculty or public health professionals in the US and around the world. Dr Bryson is a strong advocate for mothers and children for the prevention and treatment of infectious disease and is now committed to the CURE for HIV. She still has active NIH RO1 grants for studies of HIV remission and cure in infants and children, collaboration on an infant maque monkey model, and most recently, studies in adolescents in Los Angeles and New Orleans. She is an expert in perinatal infections, pediatric infectious disease, antivirals herpes infections, and other viral, bacterial, and opportunistic infections, and serves as a pediatric infectious disease consultant. Henry H. BernsteinHenry H. BernsteinDr Bernstein is a Professor of Pediatrics at Hofstra Northwell School of Medicine in New York, USA. He taps into his extensive 32-year experience as a general pediatrician in private practice and in academia at urban, suburban, and rural children's hospitals to promote the health and wellbeing of children, their families, and their communities. His private, community-based primary care (generalist) experiences in combination with academic experiences have provided him with a value-added, translational science perspective, unique from many others in academia. This tacit knowledge enables him to fulfill a lifelong passion of communicating, educating, and translating science into clinical settings, educational venues, policy-making, and media interactions to advance the health of children. Research is consistently woven into the fabric of Dr Bernstein's clinical practice, which has served as a “laboratory” for his active studies. His research and quality improvement initiatives focus on issues important to Academic General Pediatrics and community-based practice, including immunizations, postpartum newborn discharge, childhood obesity, breastfeeding, health promotion, preventive health screening in primary care, technology, and medical education. His commitment, innovative spirit, and enthusiasm also encompass many facets of medical education along the continuum, from training and mentoring future physicians to fostering lifelong learning, to supporting the continuous professional development of practicing pediatricians. Hank is an ex-officio member of the American Academy of Pediatrics’ Committee on Infectious Diseases (Red Book Committee), Associate Editor of Red Book Online, and AAP liaison to the CDC Advisory Committee on Immunization Practices’ Influenza Workgroup, spearheading both seasonal and pandemic influenza preparedness and policy for children. In addition, he is Editor-in-Chief Emeritus of PediaLink, the AAP's online home for lifelong learning and chair of the interdisciplinary Bright Futures Health Promotion Workgroup, which has created a distinctive health promotion curriculum, videos, and a companion educational website (www.pediatricsinpractice.org). He regularly shares his knowledge and expertise by educating the public, writing for health information websites, and participating in media interviews on a variety of pediatric health care issues including immunization, diagnosis and treatment of common childhood infectious diseases and illnesses, and practical information for parents, teachers and caregivers. In the spirit of lifelong learning, Hank earned a masters in healthcare management at Harvard School of Public Health, USA, in 2013. He actively maintains his certification by the American Board of Pediatrics. He completed his residency training in pediatrics at St Christopher's Hospital for Children in Philadelphia, USA, after earning his medical degree from the University of Medicine and Dentistry of New Jersey - School of Osteopathic Medicine, USA. Hank and his wife, Sophie, have been married for 36 years and are extremely proud of their 31-year-old daughter, Lauren, and 26-year-old son, David.

The introduction of new products in the medical devices market is a critical activity. However, launches are not always accompanied by clinical or economic evidence to support the products' use, and, as a consequence, a company's commercial strategy is sometimes hampered. Using a real-life example, we propose a methodology that can generate relevant information with a goal of increasing product penetration. The product is an antiseptic suture that could reduce the rate of surgical infection. Although preclinical data for the product are positive, generating efficacy data through high-quality, prospective, randomized clinical trials is a technically difficult task. This results in a lack of evidence to support the claim of surgical site infection reduction at the time of product launch. To address this, we designed two animal models replicating orthopedic surgery (knee replacement) and, in parallel, we prepared an economic analysis. Our results could be used to support commercial activities and to accelera...

This systematic review and meta-analysis aimed to evaluate the analgesic efficacy and adverse effects of celecoxib after total knee arthroplasty. Keywords in the PubMed and Scopus databases were used to find article abstracts. Each included clinical trial was assessed using the Cochrane Collaboration risk of bias tool, and we extracted data on postoperative pain assessment using the Visual Analogue Scale (VAS) at rest, ambulation, and active range of motion, rescue analgesic intake, and adverse effects. Inverse variance tests with mean differences were used to analyze the numerical variables. The Mantel-Haenszel statistical method and the odds ratio were used to evaluate the dichotomous data. According to this qualitative assessment (n = 482), two studies presented conclusions in favor of celecoxib (n = 187), one showed similar results between celecoxib and the placebo (n = 44), and three clinical trials did not draw conclusions as to the effectiveness of celecoxib versus the placebo (n = 251). Moreover, the evaluation of the rescue analgesic intake showed that the patients receiving celecoxib had a lower intake compared to patients receiving a placebo (n = 278, I2 = 82%, p = 0.006, mean difference = -6.89, 95% IC = -11.76 to -2.02). In conclusion, the pooled analysis shows that administration of celecoxib alone results in a decrease in rescue analgesic consumption compared to a placebo after total knee surgery.

Introduction: Acute postoperative pain following knee arthroscopy is common in orthopedic surgeries. Managing pain postoperatively combines usage of opioids and non-steroidal anti-inflammatory drugs. The aim of this clinical study was to assess the efficacy of two different analgesic treatment regimens: intravenous (IV) ibuprofen and IV ketorolac for the treatment of postoperative pain pertaining to arthroscopic knee surgery.Methods: This was a single center, randomized, double-blind, parallel, active comparator clinical pilot study. Subjects were randomized to receive either IV ibuprofen, administered as two 800 mg doses or IV ketorolac, administered as a single 30 mg dose. Subjects in the ibuprofen group received 800 mg of IV ibuprofen within 2 h prior to surgery and a repeated second dose 4 h after the initial dose if they had not been discharged. Subjects in the ketorolac group received IV ketorolac 30 mg at the end of surgery, as per the manufacturer's recommendations. Pain assessments and opioid consumption data were collected up to 24 h postoperatively.Results: Of 53 randomized subjects, 51 completed the study. There were 20 subjects in the ibuprofen group and 31 subjects in the ketorolac group. The median (IQR) visual analog scale (VAS) pain score at resting upon post-anesthesia care unit (PACU) arrival was 33 (12, 52) vs. 9 (2, 25) (p = 0.0064) for the ketorolac and ibuprofen group, respectively. The median (IQR) visual analog scale (VAS) pain score at movement upon PACU arrival was 38 (20, 61) vs. 15 (6, 31) (p = 0.0018) for the ketorolac and ibuprofen group, respectively. Median VAS pain scores during movement taken at subsequent 30 min intervals in the ibuprofen group were less than half that of those reported in the ketorolac group for up to 90 min after arriving in PACU. The median VAS pain scores at rest and movement in the course of 120 min−24 h after PACU arrival was not statistically significant in both groups. Rescue opioid medication during PACU stay was required in 55.0% (N = 11) and 83.9% (N = 26), with a mean amount of narcotic consumption (oral morphine conversion) of 5.53 ± 5.89 mg vs. 19.92 ± 15.63 mg for the ibuprofen and ketorolac group, respectively (P < 0.001). However, opioid consumption during the first 24 h after PACU discharge was not statistically significant (p-value = 0.637). The mean time to first rescue medication was 77.62 ± 33.03 and 55.78 ± 35.37 for the ibuprofen and ketorolac group, respectively (p-value = 0.0456). There were no significant differences in patient satisfaction and documented adverse events during the first 24 h.Conclusion: This pilot study showed that the use of preemptive IV ibuprofen 800 mg could be considered to reduce postoperative pain and opioid consumption. Future prospective clinical trials using similar regimens should be conducted in order to gain a better understanding of how to best provide perioperative analgesic regimens.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT01650519.