No abstract

Background In 2012, Medicare began to tie reimbursements to inpatient complications, unplanned readmissions, and patient satisfaction, including satisfaction with pain management. Questions/purposes We aimed to identify factors that correlate with (1) pain intensity during a 24-hour period after surgery; (2) less than complete satisfaction with pain control; (3) less than complete satisfaction with staff attention to pain relief while in the hospital; and we also wished (4) to compare inpatient and discharge satisfaction scores. Methods Ninety-seven inpatients completed measures of pain intensity (numeric rating scale), satisfaction with pain relief, self-efficacy when in pain, and symptoms of depression days after operative fracture repair. The amount of opioid used in oral morphine equivalents taken during the prior 24 hours was calculated. Through initial bivariate One of the authors (AGJB) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period from ''AnnaFonds Travel grant'' (Dutch Orthopaedic travel grant), Leiden, the Netherlands (less than USD 10,000); ''VSBfonds'', Utrecht, the Netherlands, a nonmedical study grant (less than USD 10,000); and ''Prins Bernhard Cultuurfonds, Banning-de Jong fonds'', Amsterdam, the Netherlands, a nonmedical study grant (less than USD 10,000). One of the authors (SB) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than 10,000 USD from a VU University ''Faculty Fund'', Amsterdam, the Netherlands. One of the authors (PMA) has received funding from Connell Nursing Research Scholarship (less than USD 10,000); the Nurse Practitioner Healthcare Foundation (less than USD 10,000); the American Pain Society and the American Association of Nurse Practitioners (less than USD 10,000); the Nurse Practitioner Healthcare Foundation (less than USD 10,000); and F.D. Davis Publishers (less than USD 10,000). One of the authors (DR) certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period from a study-specific grant from Skeletal Dynamics (USD 10,000-100,000) (Miami, FL, USA); is a consultant for Wright Medical (Memphis, TN, USA), Skeletal Dynamics, and Biomet (Warsaw, IN, USA) (less than USD 10,000); received honoraria from AO North America (Paoli, PA, USA), and AO International (less than USD 10,000); and received royalties from Wright Medical (less than USD 10,000). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. and then multivariate analysis, we identified factors that we...

IntroductionThis study aimed to determine whether, as in osteoarthritis, increased levels of interleukin-6 (IL-6) are present in the synovial fluid of patients with symptomatic cartilage defects and whether this IL-6 affects cartilage regeneration as well as the cartilage in the degenerated knee.MethodsIL-6 concentrations were determined by ELISA in synovial fluid and in conditioned media of chondrocytes regenerating cartilage. Chondrocytes were obtained from donors with symptomatic cartilage defects, healthy and osteoarthritic donors. The effect of IL-6 on cartilage regeneration and on metabolism of the resident cartilage in the knee was studied by both inhibition of endogenous IL-6 and addition of IL-6, in a regeneration model and in osteoarthritic explants in the presence of synovial fluid, respectively. Readout parameters were DNA and glycosaminoglycan (GAG) content and release. Differences between controls and IL-6 blocked or supplemented samples were determined by univariate analysis of variance using a randomized block design.ResultsSynovial fluid of patients with symptomatic cartilage defects contained more IL-6 than synovial fluid of healthy donors (P = 0.001) and did not differ from osteoarthritic donors. IL-6 production of osteoarthritic chondrocytes during cartilage regeneration was higher than that of healthy and defect chondrocytes (P < 0.001). Adding IL-6 increased GAG production by healthy chondrocytes and decreased GAG release by osteoarthritic chondrocytes (P < 0.05). Inhibition of IL-6 present in osteoarthritic synovial fluid showed a trend towards decreased GAG content of the explants (P = 0.06).ConclusionsOur results support a modest anabolic role for IL-6 in cartilage matrix production. Targeting multiple cytokines, including IL-6, may be effective in improving cartilage repair in symptomatic cartilage defects and osteoarthritis.

Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.