Osteoarthritis surgery

The first two selective COX-2 inhibitors to be marketed and subjected to in depth clinical trials were celecoxib and rofecoxib. Both compounds are as effective as standard NSAIDs in rheumatoid arthritis, osteoarthritis and for pain following orthopaedic or dental surgery. Gastrointestinal side effects were far fewer than with comparator diugs and in fact were no... 

Hip replacement surgery is now routinely used to relieve pain and restore mobility in patients suffering from osteoarthritis. In this condition the surfaces of bone in contact with each other within the joint become worn and the layer of lubricating cartilage disappears. This makes movement of the joint both difficult and painful. By replacing the hip with an artificial joint patients stop experiencing pain and are once again able to move freely. 

Empirical Investigation , Psychological Science 7, no. 3 (1996) 174-76 Moseley, J. Bruce, K. O Malley, N. J. Petersen, T. J. Menke, B. A. Brody, D. H. Kuykendall, J. C. Hollingsworth, C. M. Ashton and Nelda P. Wray, A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee , New England Journal of Medicine 347 (2002) 81-88 Myers, M. G., J. A. Calms andj. Singer, The Consent Form as a Possible Cause of Side Effects , Clinical Pharmacology dr Therapeutics 42 (1987) ... 

Wray, Nelda P., J. Bruce Moseley and K. O Malley, Arthroscopic Surgery for Osteoarthritis of the Knee [Letter] , New England Journal of Medicine 234 (2002) 1718-19... 

It is indicated in the treatment of a variety of painful inflammatory conditions, including osteoarthritis, oncology, postopera-tively, trauma, sports injuries, ear, nose and throat disorders, dental surgery, bursitis/ tendinitis, thrombophlebitis, upper airways inflammation and gynaecological disorders. Nimesulide has shown to be well tolerated even by aspirin sensitive asthmatic patients. 

It is indicated in spasticity due to neurological disorders e.g., multiple sclerosis, chronic myelopathy, degenerative diseases of the spinal cord, cerebrovascular accidents and cerebral palsy painful muscle spasm associated with static and functional disorders of the spine (cervical and lumbar syndromes) painful muscle spasm following surgery e.g., for herniated intervertebral disc or for osteoarthritis of the hip. 

Brief History. B.W., a 75-year-old woman, fell at home and experienced a sudden sharp pain in her left hip. She was unable to walk and was taken to a nearby hospital where x-ray examination showed an impacted fracture of the left hip. The patient was alert and oriented at the time of admission. She had a history of arteriosclerotic cardiovascular disease and diabetes mellitus, but her medical condition was stable. The patient was relatively obese, and a considerable amount of osteoarthritis was present in both hips. Two days after admission, a total hip arthroplasty was performed under general anesthesia. Meperidine (Demerol) was given intramuscularly as a preoperative sedative. General anesthesia was induced by intravenous administration of thiopental (Pentothal) and sustained by inhalation of halothane (Fluothane). The surgery was completed successfully, and physical therapy was initiated at the patient s bedside on the subsequent day. 

The efficacy of flurbiprofen at dosages of 200-400 mg/d is comparable to that of aspirin and other NSAIDs in clinical trials for patients with rheumatoid arthritis, ankylosing spondylitis, gout, and osteoarthritis. It is also available in a topical ophthalmic formulation for inhibition of intraoperative miosis. Flurbiprofen intravenously has been found to be effective for perioperative analgesia in minor ear, neck, and nose surgery and in lozenge form for sore throat. 

Celebrex (celecoxib) and Vioxx (rofecoxib) have progressed to registration and have established the utility of this class of drugs in treating the pain associated with surgery, osteoarthritis, rheumatoid arthritis, and muscle pain. 

The clinical results with both Celebrex and VicKx suggest that inhibition of COX-2 is an effective treatment for the pain that is associated with surgery, osteoarthritis, and rheumatoid arthritis. 

Dieppe R Basler H-D, Chard J, et al. Knee replacement surgery for osteoarthritis Effectiveness, practice variations, indications and possible determinants of utilization. Rheumatology 1999 38 73-38. 

Lanes SF, Lanza LL, Radensky PW, et al. Resource utilization and cost of care for rheumatoid arthritis and osteoarthritis in a managed care setting The importance of drug and surgery costs. Arthritis Rheum 1997 40 1475-1481. 

Celecoxib is a selective COX-2 inhibitor/GI agent that reduces inflammation (e.g., pain, redness, swelling, heat), fever, and pain by inhibiting chemicals in the body that cause inflammation, fever, and pain. This is probably caused by the inhibition of prostaglandin synthesis, primarily via inhibition of cyclooxygenase-2 (COX-2) isoenzyme. Celecoxib is indicated in relief of symptoms of osteoarthritis relief of symptoms of rheumatoid arthritis in adults management of acute pain in adults treatment of primary dysmenorrhea and reduction of the number of adenomatous colorectal polyps in familial adenomatous polyposis (FAP), as an adjunct to usual care (e.g., endoscopic surveillance, surgery). 

Diclofenac decreases inflammation, pain, and fever, probably through inhibition of cyclooxygenase activity and prostaglandin synthesis. It is indicated in the treatment of rheumatoid arthritis, ankylosing spondylitis, and osteoarthritis. Potassium salt is approved for management of mild to moderate pain and primary dysmenorrhea when prompt pain relief is needed. Ophthalmic used for treatment of postoperative inflammation after cataract removal temporary relief of pain and photophobia following corneal refractive surgery. Topical used for treatment of actinic keratosis. 

Valdecoxib is approved for the relief of the signs and symptoms of osteoarthritis and adult rheumatoid arthritis and for the treatment of primary dysmenorrhea. Valdecoxib is contraindicated for the treatment of postoperative pain immediately following coronary artery bypass graft surgery. 

Plasma MMP-3, TIMP-1 levels, and the MMP-3 TIMP-1 ratios have been reported to be significantly higher in rheumatoid arthritis patients than osteoarthritis patients before hip surgery. In rheumatoid arthritis patients, the plasma MMP-3 and the MMP-3 TIMP-1 ratio decreased after total joint replacement, whereas C-reactive protein and erythrocyte sedimentation rate did not change. Omura et al. (05) concluded that C-reactive protein and erythrocyte sedimentation rate reflect systemic inflammation. In contrast, plasma MMP-3 and the MMP-3 TIMP-1 ratio reflect inflammation and/or degeneration of the aifected joint. 

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