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Introduction: This study aimed to investigate the prevalence of acute kidney injury (AKI) following hip fracture surgery in geriatric patients and to identify predictors for development of AKI with a focus on possible preventable risk factors. Methods: In this retrospective cohort study, we reviewed electronic medical records of all patients above 65 years of age who underwent hip fracture surgery at Copenhagen University Hospital, Bispebjerg, Denmark, in 2018. Acute kidney injury was assessed according to the Kidney Disease Improving Global Outcomes guidelines. Multivariate logistic regression analyses were used to identify independent risk factors for AKI. Results: Postoperative AKI developed in 28.4% of the included patients (85/299). Acute kidney injury was associated with increased length of admission (11.3 vs 8.7 days, P < .001) and 30-day mortality (18/85 vs 16/214, P = .001). In multivariable analysis, higher age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.08, P = .004), heart disease (OR: 1.78, 95% CI: 1.01-3.11, P = .045), and postoperative blood transfusion (OR: 1.84, 95% CI: 1.01-3.36, P = .048) were associated with AKI. Moreover, a higher postoperative C-reactive protein (199.0 ± 99.9 in patients with AKI, 161.3 ± 75.2 in patients without AKI) and lower postoperative diastolic blood pressure were observed in patients developing AKI. Discussion and Conclusion: Acute kidney injury was common following hip fracture surgery and associated with longer admissions and increased mortality. Patients developing AKI were older and showed several postoperative similarities, including higher C-reactive protein, lower postoperative diastolic pressure, and the need for blood transfusion.

Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA). It is unknown how these exercise variables influence knee pain after TKA. To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. Cross-sectional study. Consecutive sample of patients from the Copenhagen area, Denmark, receiving a TKA, between November 2012 and April 2013. Seventeen patients, no more than 3 weeks after their TKA. In a randomized order, the patients performed 1 set of 4 standardized knee extensions, using relative loads of 8, 14, and 20 repetition maximum (RM), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0-10). Two patients were lost to follow up. Knee pain increased with increasing load (20 RM: 3.1±2.0 points, 14 RM: 3.5±1.8 points, 8 RM: 4.3±2.5 points, P = 0.006), and repetitions to contraction failure (10% failure: 3.2±1.9 points, 100% failure: 5.4±1.6 points, P<0.001). Resting knee pain 60 seconds after the final repetition (2.7±2.4 points) was not different from that recorded before strength training (2.7±1.8 points, P = 0.88). Both loading and repetitions performed to contraction failure during knee- extension strength-training, increased post-operative knee pain during strength training implemented shortly following TKA. However, only the increase in pain during repetitions to contraction failure exceeded that defined as clinically relevant, and was very short-lived. ClinicalTrials.gov NCT01729520.

IntroductionMultimodal analgesia with paracetamol, non-steroidal anti-inflammatory drug and glucocorticoid is recommended for hip arthroplasty, but with uncertain effects of the different combinations. We aim to investigate benefit and harm of different combinations of paracetamol, ibuprofen and dexamethasone following total hip arthroplasty.Methods and analysisRECIPE is a randomised, placebo-controlled, parallel 4-group, blinded trial with 90-day and 1-year follow-up performed at nine Danish hospitals. Interventions are initiated preoperatively and continued for 24 hours postoperatively. Eligible participants undergoing total hip arthroplasty are randomised to:group A: oral paracetamol 1000 mg × 4+oral ibuprofen 400 mg × 4+intravenous placebo; group B: oral paracetamol 1000 mg × 4+intravenous dexamethasone 24 mg+oral placebo; group C: oral ibuprofen 400 mg × 4+intravenous dexamethasone 24 mg+oral placebo; group D: oral paracetamol 1000 mg × 4+oral ibuprofen 400 mg × 4+intravenous dexamethasone 24 mg.Primary outcome is cumulative opioid consumption at 0–24 hours. Secondary outcomes are pain at rest, during mobilisation and during a 5 m walk and adverse events. Follow-up includes serious adverse events and patient reported outcome measures at 90 days and 1 year. A total of 1060 participants are needed to demonstrate a difference of 8 mg in 24-hour morphine consumption assuming an SD of 24.5 mg, a risk of type I errors of 0.0083 and a risk of type 2 errors of 0.2. Primary analysis will be a modified intention-to-treat analysis.With this trial we aim to verify recommendations for pain treatment after total hip arthroplasty, and investigate the role of dexamethasone as an analgesic adjuvant to paracetamol and ibuprofen.Ethics and disseminationThis trial is approved by the Region Zealand Committee on Health Research Ethics (SJ-799). Plans for dissemination include publication in peer-reviewed journals and presentation at scientific meetings.Trial registration numberNCT04123873.

AbstractObjectiveTo investigate the effects of one and two doses of intravenous dexamethasone in patients after total knee arthroplasty.DesignRandomised, blinded, placebo controlled trial with follow-up at 90 days.SettingFive Danish hospitals, September 2018 to March 2020.Participants485 adult participants undergoing total knee arthroplasty.InterventionA computer generated randomised sequence stratified for site was used to allocate participants to one of three groups: DX1 (dexamethasone (24 mg)+placebo); DX2 (dexamethasone (24 mg)+dexamethasone (24 mg)); or placebo (placebo+placebo). The intervention was given preoperatively and after 24 hours. Participants, investigators, and outcome assessors were blinded. All participants received paracetamol, ibuprofen, and local infiltration analgesia.Main outcome measuresThe primary outcome was total intravenous morphine consumption 0 to 48 hours postoperatively. Multiplicity adjusted threshold for statistical significance was P<0.017 and minimal important difference was 10 mg morphine. Secondary outcomes included postoperative pain.Results485 participants were randomised: 161 to DX1, 162 to DX2, and 162 to placebo. Data from 472 participants (97.3%) were included in the primary outcome analysis. The median (interquartile range) morphine consumptions at 0-48 hours were: DX1 37.9 mg (20.7 to 56.7); DX2 35.0 mg (20.6 to 52.0); and placebo 43.0 mg (28.7 to 64.0). Hodges-Lehmann median differences between groups were: −2.7 mg (98.3% confidence interval −9.3 to 3.7), P=0.30 between DX1 and DX2; 7.8 mg (0.7 to 14.7), P=0.008 between DX1 and placebo; and 10.7 mg (4.0 to 17.3), P<0.001 between DX2 and placebo. Postoperative pain was reduced at 24 hours with one dose, and at 48 hours with two doses, of dexamethasone.ConclusionTwo doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain.Trial registrationClinicaltrials.gov NCT03506789.

IntroductionHalf of all patients with a hip fracture (HF) do not recover their pre-fracture mobility after 1 year. Mobility and functional capabilities may be impaired by postoperative low haemoglobin levels and iron deficiency. The primary objective of this trial is to compare the effect of a single postoperative dose of ferric derisomaltose 20 mg/kg body weight relative to placebo on the recovery of functional mobility in patients.Methods and analysisThe IronHip trial is a multicentre, randomised, double-blind, placebo-controlled trial with participants allocated in a 1:1 ratio to receive intravenous iron or placebo. The eligible population is participants aged 65 years or older who have undergone HF surgery and have a haemoglobin concentration below 105 g/L measured between postoperative day 1 and 5. In total, 210 participants will be randomised. Main analyses will be conducted in the intention-to-treat population using a mixed model for repeated measures, including assessments at baseline and at 4, 6 and 12 weeks after randomisation. Treatment effects will be estimated from the treatment-by-time interaction and reported as between-group differences in least-squares mean New Mobility Score with 95% CIs. The secondary outcomes are haemoglobin, red blood cell transfusions, fatigue, quality of life, self-rated health, fear of falls, 30 s sit-to-stand test, activities of daily living, pain, days alive and at home up to 30 days, mortality and serious adverse events. Exploratory outcomes are cost-effectiveness, physical activity, hand grip strength, knee extension strength, cognition, ferritin and transferrin saturation. Recruitment was initiated on 9 June 2025.Ethics and disseminationThe IronHip trial has been approved by the Danish Medicines Agency and the Danish Medical Research Ethics Committee. The protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines, the Declaration of Helsinki and the Good Clinical Practice guidelines. The trial findings will be reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement in peer-reviewed journals.Registration detailsEU CT number: 2024–5 15 116-42-00, authorised 9 February 2025.Clinicaltrials.gov: NCT06898814