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Question: In patients undergoing hip or knee arthroplasty, what is the effectiveness of intravenous (IV) versus oral acetaminophen as part of a standard perioperative pain regimen? Design: Randomized (unclear allocation concealment), blinded (unclear), controlled trial with 24 hours of follow-up. Setting: A hospital in Columbus, Ohio. Patients: 120 patients who were undergoing hip or knee arthroplasty. Exclusion criteria included known hypersensitivity, hepatic impairment, or liver disease. 100% of patients completed follow-up. Intervention: Patients were allocated to IV (n = 63) or oral (n = 57) acetaminophen, 1 g preoperatively and then every 6 hours postoperatively for 24 hours as part of a standard pain regimen, which included preoperative celecoxib, Oxycontin, and anti-nausea medication; intraoperative dexamethasone, tranexamic acid, and injection of bupivacaine with epinephrine at the surgical site; and postoperative hydropmorphone, oxycodone, Oxycontin, dexamethasone, celecoxib, and anti-nausea medication. Main outcome measures: Total narcotic use (hydromorphone-equivalents) and pain (visual analog scale [VAS]) were assessed every 4 hours for 24 hours after surgery. A sample size of 102 patients was needed to detect a difference of 0.5 on the pain VAS (80% power, α = 0.05). Main results: The IV and oral acetaminophen groups did not differ with regard to average hydromorphone-equivalents at 24 hours (3.71 versus 3.49, p = 0.76) or at any of the 4-hour intervals. The IV and oral acetaminophen groups did not differ with regard to average VAS pain scores in the first 24 hours (3.01 versus 3.40, p = 0.06) or when assessed at 4, 8, 12, 16, 20, or 24 hours; however, the IV acetaminophen group had lower VAS pain scores during the first 4 hours after surgery (3.38 versus 4.40, p = 0.03). Conclusions: In patients undergoing hip or knee arthroplasty, intravenous acetaminophen added to a standard pain regimen did not differ from oral acetaminophen for pain in the first 24 hours after surgery, except for the first 4 hours; intravenous and oral acetaminophen did not differ for total narcotic use in the first 24 hours. Source of funding: Not stated. [ABSTRACT FROM AUTHOR]

Unlabelled: Although the published studies on the outcomes of total hip arthroplasty (THA) performed with currently available ceramic components show high survivorship and low bearing wear at midterm followup, concern over ceramic fracture and squeaking persist. For these reasons, the use of ceramic is limited. Recently, a new alumina matrix composite material (Delta ceramic) with improved material properties was developed to address these concerns. We report the early outcomes and complications of a prospective, randomized, multicenter trial of 263 patients (264 hips) at eight centers, comparing a Delta ceramic-on-ceramic (COC) articulation with a Delta ceramic head-crosslinked polyethylene bearing combination (COP). There were 177 COC hips and 87 COP hips. Complications were reported for all patients, whereas clinical and radiographic results were provided for the 233 patients with minimum 2-year followup (average, 31.2 months; range, 21-49 months). The Harris hip scores and clinical, radiographic, and survivorship outcomes were similar in both groups. There were four (2%) revisions in the COC group and two (2%) in the COP group. We encountered three intraoperative ceramic liner-related events. In addition, one patient receiving the COC underwent revision for chipping of the ceramic liner, and a second had ceramic fragmentation on followup radiographs but has not undergone revision. These liner related complications remain a concern. No patient reported squeaking in either group; this leaves us hopeful the new material will lessen the frequency of squeaking. In the short term, the Delta COC articulation provided similar functional scores and survivorship and complication rates with the ceramic head mated with crosslinked polyethylene.Level Of Evidence: Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]