Objective To review the application and research progress of dexamethasone in the perioperative period of joint arthroplasty and arthroscopic surgery. Methods The relevant domestic and foreign literature in recent years was extensively reviewed. The application status and therapeutic effect of dexamethasone in the perioperative period of joint arthroplasty and arthroscopic surgery were summarized. Results Studies have shown that intravenous administration of 10-24 mg dexamethasone before or/and within 24-48 hours after operation can reduce the incidence of nausea and vomiting, and reduce the consumption of opioids in patients after hip and knee arthroplasties with high safety. The duration of nerve block during arthroscopic surgery can be prolonged by perineural injecting local anesthetics and 4-8 mg dexamethasone, but the effect of postoperative analgesia is still controversial. Conclusion Dexamethasone is widely used in joint and sports medicine. It has the effects of analgesia, antiemetic, and prolonging the time of nerve block. In the future, high-quality clinical studies on the application of dexamethasone in shoulder, elbow, and ankle arthroplasties and arthroscopic surgery are needed, and more attention should be paid to the long-term safety of dexamethasone.
Objective To investigate the effectiveness of arthroscopic distal clavicle resection for the symptomatic acromioclavicular joint arthritis. MethodsThe clinical data of 14 patients with symptomatic acromioclavicular joint arthritis treated by arthroscopic indirect distal clavicle resection between January 2020 and March 2021 were retrospectively analyzed. There were 5 males and 9 females with an average age of 46.3 years (range, 18-57 years). The 4 cases of left shoulder and 10 cases of right shoulder were accompanied with acromial impingement, without the history of shoulder trauma. The average disease duration was 20.4 months (range, 9-48 months), and the average visual analogue scale (VAS) score was 7.6 (range, 5-9) preoperatively. The results were evaluated using the University of California Los Angeles (UCLA) shoulder rating score before and after operation, further, the patient satisfaction rate was also calculated. Results All 14 patients were followed up 5-18 months, with an average of 13 months. There was no postoperative pain of acromioclavicular joint in 12 patients; 1 case had occasional mild pain, which could be controlled by painkillers. Moreover, there was only 1 acromioclavicular joint subluxation due to early fitness training at 2 weeks postoperatively, and the symptoms gradually relieved after 1 month of conservative treatments. The UCLA score was 22.1±6.2 preoperatively, which improved to 30.2±3.4 at last follow-up, showing significant difference (t=5.359, P<0.001). The patient satisfaction rate was 92.9%, with 12 excellent cases, 1 good case, and 1 fair case. Conclusion Arthroscopic distal clavicle resection for symptomatic acromioclavicular arthritis is a safe, reliable, and repeatable procedure.
ObjectiveTo investigate the effectiveness of arthroscopic iliopsoas tendon tenotomy at the labral level for iliopsoas cyst complicated with internal snapping hip. Methods A retrospective analysis was conducted on the clinical data of 9 patients diagnosed with iliopsoas cyst and internal snapping hip admitted between April 2021 and June 2023. The cohort consisted of 3 males and 6 females, aged 23-58 years with a mean age of 40.7 years. The disease duration ranged from 11 to 24 months, with an average of 16.7 months. Preoperative MRI showed that 9 cases were complicated with glenoid labrum tear, iliopsoas muscle cyst extended from the glenoid level to the proximal end of the lesser trochanter, and compressed the femoral artery and vein. The iliopsoas tendons were cut at the level of glenoid labrum under arthroscopy. Pincer plasty (7 cases), glenoid labrum repair (6 cases), or glenoid labrum debridement (3 cases) was performed according to the lesions during operation, and the cyst drainage and cyst wall debridement were completed. Imaging examinations were performed before operation and at 2 days after operation to measure the lateral central-edge angle (LCE), α angle, off-set value, and the distance from femoral artery and vein to acetabular rim. The modified Harris Hip Score (mHHS), the 12-item International Hip Outcome Tool (iHOT-12), and the visual analogue scale (VAS) score were used to assess hip function before operation and at last follow-up, and the hip flexion and external rotation muscle strength in supine position were compared. ResultsAll patients completed the surgery successfully. The operation time ranged from 50 to 92 minutes (mean, 67.3 minutes), and intraoperative blood loss was 10-25 mL (mean, 18.9 mL). Pain and snapping symptoms resolved immediately after operation, and no complications such as femoral nerve injury, femoral arteriovenous injury, or incision infection occurred. Imaging examinations at 2 days postoperatively showed that the α angle, LCE, and the distances from the femoral artery and vein to the acetabular rim significantly decreased when compared with preoperative values, while the offset value significantly increased, with all differences significant (P<0.05). All the 9 patients were followed up 22-45 months (mean, 35.0 months). During the follow-up, no recurrence of hip snapping was observed; hip pain, daily living ability and activity function were markedly improved. At last follow-up, the mHHS score, iHOT-12 score, VAS score, as well as hip external rotation muscle strength were all significantly improved when compared with preoperative values (P<0.05), but there was no significant difference in hip flexion strength between before and after operation (P>0.05). ConclusionArthroscopic iliopsoas tendon tenotomy at labral level complicated with internal snapping hip can effectively relieve the pain and snapping symptoms of iliopsoas cyst combined with medial snapping hip, and promote the recovery of hip function, which is a safe and effective minimally invasive operation.