The journal of knee surgery
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Comparative Study
Liposomal Bupivacaine Suspension Can Reduce Lengths of Stay and Improve Discharge Status of Patients Undergoing Total Knee Arthroplasty.
The purpose of this study was to use a large hospital database to assess: (1) length of hospital stay (LOS) and (2) discharge status among patients undergoing total knee arthroplasty (TKA) with or without the use of a liposomal bupivacaine suspension injection. We utilized an all-payer hospital administrative database from July 1, 2013 to June 30, 2014. We then selected patients age 18 years or older who had an inpatient stay for TKA in the data window based on International Classification of Diseases, Ninth Revision (ICD-9) procedure codes (ICD-9-CM = 81.54), which resulted in 103,152 TKA patients. ⋯ Patients who underwent TKA with liposomal bupivacaine had a significantly shorter LOS and a higher likelihood of being discharged to home. These results suggest that liposomal bupivacaine may represent a promising addition to current pain management regimens. Furthermore, it may limit pain following surgery, which may allow patients to ambulate earlier and have improved outcomes.
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Unicompartmental medial knee arthritis can be successfully treated with either unicompartmental or total knee arthroplasty (UKA or TKA). Active patients often inquire about the relative likelihood of returning to a sport-related activity after surgery. ⋯ We identified 33 patients with UKA and 39 patients with TKA with minimum 2-year follow-up (4 ± 1.2 years) who had similar preoperative clinical and radiographic examinations. Clinical evaluation revealed no difference in the number of patients who returned to sports or their satisfaction, but patients with UKA returned to sports more quickly and exhibited better postoperative knee scores than TKA patients.
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Optimal pain control in patients undergoing total knee arthroplasty (TKA) is imperative for good rehabilitation and functional outcomes. However, despite technological advancements, surgeons continue to struggle with adequate pain management in their patients. Current modalities in use, such as patient-controlled analgesia, opioids, and epidural anesthetics, provide good pain relief but can be associated with side effects and serious complications. ⋯ Evidence suggests that analgesics, such as newer oral medications, peripheral nerve blocks, and periarticular injections, may improve pain management, rehabilitation, and patient satisfaction, as well as reduce opioid consumption. The literature has also highlighted that a multimodal approach to pain management may provide the best results. However, determining which modalities provide superior pain control is still being extensively studied, and further research is needed.
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Fractures involving the posterior aspect of the tibial plateau are challenging fractures to treat. Articular depression in tibial plateau fractures is usually addressed by elevation of the fragment(s), filling the residual defect with bone graft or bone substitute, and "raft" support of the articular fracture reduction with screws through a medially and/or laterally based plate. ⋯ To obtain the goals of anatomic reduction and stable fixation, a thorough understanding of the fracture, specific approaches, reduction techniques, and stabilization strategies is needed. This article reviews the most current strategies for treating tibial plateau fracture patients with posterior articular depression.
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Tibial plateau fractures involving the posterolateral articular surface present a unique challenge to treating surgeons due to the complex anatomy of the region. The posterolateral corner complex and the proximity of the common peroneal nerve restrict both the exposure of the joint surface and the ability to distract across the joint using a varus force. Further, injury to the soft tissue envelope may prevent use of the optimal surgical incision. ⋯ In this article, we highlight five surgical approaches that can be utilized to improve visualization and access to the posterolateral tibial plateau. These include three separate osteotomies performed through an anterolateral approach: lateral femoral epicondyle osteotomy, fibular head resection osteotomy, and a novel digastric fibular osteotomy. In addition, we will discuss a posterolateral approach and a direct posterior approach.