Quality of life after arthroscopic treatment for initial stages of coxarthrosis
Background. Osteoarthritis is a common disease, more common in the elderly due to involutive changes in musculoskeletal system, but can affect younger working-age patients, which may result in disability. The purpose of the work was to study the impact of technology control of acute postoperative pain on quality of life of patients after arthroscope treatment of early staged coxarthrosis. Materials and methods. The study investigated quality of life of 105 (65 men, 40 women) patients with initial stages of coxarthrosis and femoro-acetabular impingement, the average age of the patients was 42.21 ± 10.99 years (22 to 72 years), mean disease duration was 13.26 ± 8.50 months. All patients were performed arthroscopic partial resection of acetabular labrum and/or osteochondroplasty of the femoral head and/or acetabular osteochondroplasty in terms of spinal anesthesia (3 ml of 0.5% solution of bupivacaine, LIII–IV level, Sprotte spinal needle 25 G (Pancan) with intravenous sedation with propofol). Average period of the studied patients staying in the hospital was 7.23 ± 1.15 (1 to 11) days. Depending on the applied postoperative analgesia the patents were divided into two groups. In the first (control) group planned anesthesia was as follows: dexketoprofen 50 mg intravenously 2–3 times a day, paracetamol 1000 mg intravenously 2–3 times a day, narcotic analgesics (on demand) — 47 patients. The scheme of postoperative analgesia in the second (main) group (n = 58), which was the similar as in the 1st group, additionally included local analgesia in the cavity of the hip joint through an epidural catheter sized 18G with injected local anesthetic Rapacan 0.2% solution (10–15 mg) every 6–8 hours bolus, and before removing the catheter in 2 days the local anesthetic of 2% solution of stabilized hyaluronate sodium 40 mg was added. Results. The patients in the control group had lower values in almost all indicators of SF-36 system with the level of significance of differences p < 0.05, in particular, they had impaired physical functioning, potentially affecting the daily activity after patients’ discharge from hospital. Also mean values of physical health (Physical Component Summary, PCS) statistically significantly (p < 0.05) differed in the control and basic groups (44.6 ± 3,2 % and 59.5 ± 4.0 %, respectively) as well as the average level of psychological health (Mental Component Summary, MCS; 46.5 ± 1.6 % and 49.8 ± 1.4 % in control and basic groups, respectively). The patients of the control group had lower subjective assessment of general well-being and more pronounced pain. Probably, this factor, as well as the later mobilization of patients in the control group as a result of longer postoperative pain syndrome (5.63 ± 2.84 days compared to 1.56 ± 0.27 in the basic group; p < 0.05) were associated with lower levels of role-physical functioning, indicating the presence of significant social problems, primarily everyday activity. In addition, the patients in the control group had markedly impaired emotional state (role of emotional functioning), which usually significantly interfere with the performance of the usual work or other regular daily activities. Conclusions. The technique of an estimation of indicators of quality of life allows not only assess the nature of the influence of coxarthrosis on the life of patients, but also can be used as one of the criteria for evaluating the effectiveness of the prescribed treatment.
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