Israel Medical Association Journal

Background: Pain following arthroscopic partial meniscectomy (APM) varies considerably among patients. Previous studies have suggested that gender and ethnicity may influence postoperative pain after orthopedic procedures. However, limited evidence exists regarding pain differences between Arab and Jewish patients after APM.

Objectives: To evaluate the association of gender and ethnicity with postoperative pain and analgesic consumption during the first month after APM.

Methods: Patients who underwent primary APM between 2018 and 2019 were retrospectively identified and stratified by gender and ethnicity. Intraoperative findings, including meniscal tear type and cartilage injury, were recorded. Postoperative pain was assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), analgesic consumption was quantified in grams, and pain sensitivity was evaluated with the Pain Sensitivity Questionnaire (PSQ). Outcomes were analyzed weekly during the first postoperative month.

Results: In total, 99 patients were included (65 men, 34 women; 39 Arabs, 60 Jews), comprising 22 Arab men, 43 Jewish men, 17 Arab women, and 17 Jewish women. Women reported lower KOOS scores and consumed more analgesics during weeks 3 and 4. Arab patients also demonstrated lower KOOS scores, higher PSQ scores, and greater analgesic consumption at selected postoperative intervals. Combined analysis showed an additive effect of gender and ethnicity, with Arab women reporting the poorest pain outcomes.

Conclusions: Female gender and Arab ethnicity were associated with greater postoperative pain and increased analgesic requirements after APM. These factors should be considered when tailoring postoperative pain management, although baseline differences and cultural influences may partially explain the associations.

Background: Several approaches are used to access the hip joint; most common are the direct lateral and posterior. Little consensus exists on which to use when treating hip fractures.

Objectives: To compare short-term complications, postoperative ambulation, and patient-reported outcome measures (PROMS) of direct lateral vs. posterior approaches in hemiarthroplasty for acute hip fractures.

Methods: We conducted a retrospective clinical trial with 260 patients who underwent bipolar hemiarthroplasty in the direct lateral or posterior approach (166 and 94, respectively) between January 2017 and December 2018. The clinical data included short-term complications: prosthetic dislocation, periprosthetic fractures, and infection. Postoperative ambulation was collected 6 weeks postoperatively; PROMS were collected for 173 patients at 2 years follow-up.

Results: There were six dislocations overall, average time to dislocation was 22 days postoperative (range 4–34). Five dislocations were after the posterior approach (5.3%) and one after direct lateral (0.6%) (P = 0.01). At 6 weeks follow-up, inability to walk was found in 16.9% of the direct lateral group and 6.4% of the posterior approach group (P = 0.02). In the posterior approach group, 76% could walk more than 20 meters; only half of the direct lateral group could (P = 0.0002). At 2 years follow-up, PROMS did not show a statistically significant difference between the groups.

Conclusions: Posterior approach for hemiarthroplasty following femoral neck fractures allows superior ambulation to the direct lateral approach only for the short-term. However, no long-term clinical advantage was found. This short-term benefit does not justify the increased dislocation rate in the posterior approach.