This study aimed to evaluate the effect of a peripheral nerve block (PNB) on immediate postoperative analgesia and the early functional outcomes for patients who underwent total hip arthroplasty (THA). From January 2016 to August 2021, 353 patients who underwent THA were divided into two groups: the patient-controlled analgesia (PCA) group (n = 217) who received only intravenous (IV) analgesia, and others who received IV PCA and PNB (PCA + PNB group) (n = 136). After propensity score matching for age and sex, 136 patients from each group were included in the study. Primary outcomes were the visual analogue scale (VAS) at rest, activity status at postoperative 6, 24, 48 h. Secondary outcomes were functional scores by the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Harris Hip Score (HHS) and rescue medications used. The postoperative VAS at 6, 24, 48 h at rest and 6 h at activity were significantly lower in the PCA + PNB group (p = 0.000, 0.001, 0.000, 0.004 in order). There was no significant difference for postoperative 3-month HHS (p = 0.218), except for 3-month WOMAC index (p = 0.001). There were no significant differences for VAS between the PNB methods except femoral nerve block (FNB) and fascia iliaca compartment block (FICB) at postoperative activity 48 h (p = 0.028). There was no significant difference in the total count and amount of rescue medication (p = 0.091, 0.069) and difference in the quadriceps weakness was not noted. Therefore, PNB is beneficial for patients who undergo THA as it provides sufficient postoperative analgesia, especially during immediate postoperative resting pain without quadriceps weakness.

Park JY, et al. Yonsei Med J. 2022 Sep;63:e10. https://doi.org/10.3349/ymj.2022.0184

Cho HS, et al. Yonsei Med J. 2024 Dec;66:e12. https://doi.org/10.3349/ymj.2024.0098

Background: Therapy using anabolic and antiresorptive agents in sequence is reportedly effective for severe osteoporosis management. However, evidence for this approach in osteoporotic hip fracture patients remains limited. This study aimed to evaluate the effectiveness of sequential therapy using short-term anabolic agents followed by antiresorptive treatment on bone mineral density (BMD) and bone turnover markers (BTMs) in patients with osteoporotic hip fractures. Methods: We retrospectively reviewed 330 patients with osteoporotic hip fractures between February 2022 and December 2023 and selected 113 patients. The patients were categorized into a sequential group (n = 68), who received an anabolic agent (teriparatide or romosozumab) for three to six months, followed by two doses of denosumab administered at six-month intervals, and a non-sequential group (n = 45), who received anabolic agent monotherapy. The primary outcome was mean change in BMD at the lumbar spine (LS), femoral neck (FN), and total hip (TH) at one-year postoperatively. Secondary outcomes were the osteoporosis medication profile and mean change of 25-hydroxyvitamin D₃ (25(OH)D₃) and BTMs including C-terminal telopeptide (CTX) and procollagen type 1 N-terminal propeptide (P1NP). Results: The sequential group showed significant increases in LS-, FN-, and TH-BMD at one-year follow-up (3.6 ± 3.7%, 4.4 ± 7.9%, and 1.9 ± 4.1%, respectively; p < 0.001 for all). In contrast, the non-sequential group showed non-significant changes in BMD at all sites. In the sequential group, CTX levels decreased significantly (0.57 ± 0.39 to 0.32 ± 0.30 ng/ml, p < 0.001), whereas the non-sequential group showed a non-significant increase in CTX levels (0.73 ± 0.47 to 0.90 ± 0.56 ng/ml, p = 0.44). P1NP levels decreased significantly in the sequential group (88.2 ± 65.7 to 66.2 ± 62.8 µg/L, p < 0.001). The 25(OH)D₃ levels improved in both groups but were higher in the sequential group (20.7 ± 11.1 to 37.2 ± 13.6 ng/mL). Conclusion: Sequential therapy with short-term anabolic agents followed by antiresorptive therapy significantly improved BMD and normalized BTMs in patients with osteoporotic hip fractures. This treatment approach may be an effective strategy to enhance bone health and potentially reduce subsequent fracture risk in this high-risk population.

Park JY, et al. Yonsei Med J. 2021 May;62(5):439-445. https://doi.org/10.3349/ymj.2021.62.5.439