Objectives Intra-articular injections of local anaesthetics (LA), glucocorticoids (GC), or hyaluronic acid (HA) are used to treat osteoarthritis (OA). Contrast agents (CA) are needed to prove successful intra-articular injection or aspiration, or to visualize articular structures dynamically during fluoroscopy. Tranexamic acid (TA) is used to control haemostasis and prevent excessive intra-articular bleeding. Despite their common usage, little is known about the cytotoxicity of common drugs injected into joints. Thus, the aim of our study was to investigate the effects of LA, GC, HA, CA, and TA on the viability of primary human chondrocytes and tenocytes in vitro . Methods Human chondrocytes and tenocytes were cultured in a medium with three different drug dilutions (1:2; 1:10; 1:100). The following drugs were used to investigate cytotoxicity: lidocaine hydrochloride 1%; bupivacaine 0.5%; triamcinolone acetonide; dexamethasone 21-palmitate; TA; iodine contrast media; HA; and distilled water. Normal saline served as a control. After an incubation period of 24 hours, cell numbers and morphology were assessed. Results Using LA or GC, especially triamcinolone acetonide, a dilution of 1:100 resulted in only a moderate reduction of viability, while a dilution of 1:10 showed significantly fewer cell counts. TA and CA reduced viability significantly at a dilution of 1:2. Higher dilutions did not affect viability. Notably, HA showed no effects of cytotoxicity in all drug dilutions. Conclusion The toxicity of common intra-articular injectable drugs, assessed by cell viability, is mainly dependent on the dilution of the drug being tested. LA are particularly toxic, whereas HA did not affect cell viability. Cite this article : P. Busse, C. Vater, M. Stiehler, J. Nowotny, P. Kasten, H. Bretschneider, S. B. Goodman, M. Gelinsky, S. Zwingenberger. Cytotoxicity of drugs injected into joints in orthopaedics. Bone Joint Res 2019;8:41–48. DOI: 10.1302/2046-3758.82.BJR-2018-0099.R1.
Background Periacetabular osteotomy is a successful treatment for hip dysplasia. The results are influenced, however, by optimal positioning of the acetabular fragment, femoral head morphology and maybe even femoral version as well as combined anteversion have an impact. In order to obtain better insight on fragment placement, postoperative acetabular orientation and femoral morphology were evaluated in a midterm follow-up in regard to functional outcome and osteoarthritis progression. Methods A follow-up examination with 49 prospectively documented patients (66 hips) after periacetabular osteotomy (PAO) was performed after 62.2 ± 18.6 months. Mean age of patients undergoing surgery was 26.7 ± 9.6 years, 40 (82%) of these patients were female. All patients were evaluated with an a.p. pelvic x-ray and an isotropic MRI in order to assess acetabular version, femoral head cover, alpha angle, femoral torsion and combined anteversion. The acetabular version was measured at the femoral head center as well as 0.5 cm below and 0.5 and 1 cm above the femoral head center and in addition seven modified acetabular sector angles were determined. Femoral torsion was assessed in an oblique view of the femoral neck. The combined acetabular and femoral version was calculated as well. To evaluate the clinical outcome the pre- and postoperative WOMAC score as well as postoperative Oxford Hip Score and Global Treatment Outcome were analyzed. Results After PAO acetabular version at the femoral head center (31.4 ± 9.6°) was increased, the anterior cover at the 15 o’clock position (34.7 ± 15.4°) was reduced and both correlated significantly with progression of osteoarthritis, although not with the functional outcome. Combined acetabular and femoral torsion had no influence on the progression of osteoarthritis or outcome scores. Conclusion Long-term results after PAO are dependent on good positioning of the acetabular fragment in all 3 planes. Next to a good lateral coverage a balanced horizontal alignment without iatrogenic pincer impingement due to acetabular retroversion, or insufficient coverage of the anterior femoral head is important.
Summary. Background: Bleeding complications are common side effects of vitamin-K antagonist (VKA) therapy. Data on the in-hospital management and outcomes of these bleeding events are scarce and information is mostly derived from trial cohorts. Objectives: The objective was to collect data on the management and clinical outcome of hospitalizations owing to VKA-related bleeding in real-world practice. Patients and methods: We performed a multicenter observational cohort study involving 21 secondary and tertiary care hospitals in the administrative district Dresden, Saxony, Germany throughout the year 2005. All consenting patients presenting with VKArelated bleeding complications were included. No exclusion criteria applied. Data were collected at admission, at discharge and at 90 days to evaluate resource consumption, length of hospital stay and risk factors for in-hospital-and 3-month mortality. Results: Two hundred and ninety patients were included (median age 74 years; 50.7% male). The main indications for VKA therapy were atrial fibrillation (63.4%), prior thromboembolism (18.6%) and mechanical heart valves (11.4%), and most common bleeding localizations were large hematoma (23.1%), upper gastrointestinal (GI) tract (17.9%) and intracranial bleeding (14.1%). On hospital admission, the median International Normalized Ratio (INR) was 3.0 (range 0.9-12.5, interquartile range [IQR] 2.1-3.9). Inhospital mortality was 7.6% with impaired renal function as the most relevant risk factor. At 90 days mortality was 14.1% and 15.3% of survivors were help-dependent. Conclusions: VKA-related bleeding leading to hospitalization is associated with long hospitalization, relevant resource utilization, high mortality or persistent sequlae. Patientrelated factors such as impaired renal function, chronic cardiac or pulmonary disease and dementia are predictive of in-hospital and 3-month mortality.
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