The journal of knee surgery
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Proton density and T2-weighted sagittal, axial, coronal, and inversion recovery fat suppression magnetic resonance imaging (MRI) sequences were reviewed in 21 adults (10 men and 11 women) with 22 tibial eminence fractures. Average patient age was 43 years (range: 19-62 years). There were 3 type I, 3 type II, 12 type III, and 4 type IV fractures. ⋯ Discrete osteochondral fractures were present in 7 (32%) knees. Significant osseous, cartilaginous, meniscal, and ligamentous damage was discovered in all patients. Based on these findings, we recommend MRI evaluation of all tibial eminence fractures to accurately detect all knee damage.
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Randomized Controlled Trial Comparative Study
Postoperative pain management following total knee arthroplasty: a randomized comparison of continuous epidural versus femoral nerve infusion.
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Varus or valgus malalignment of the knee may be either a cause or a consequence of unicompartmental knee arthritis in young, active adults. Proximal tibial osteotomy for the varus knee and distal femoral osteotomy for the valgus knee have been used for decades to manage this condition; however, their use has decreased significantly in recent years as the popularity of unicompartmental and total knee arthroplasty has grown. ⋯ In addition, in the face of cruciate ligamentous instability with or without posterolateral corner instability coupled with varus malalignment, high tibial osteotomy with and without ligament reconstruction provides a solution to complex orthopedic problems. Recent long-term follow-up studies have concluded osteotomy allows for improved function and pain relief in properly selected young patients.
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Randomized Controlled Trial Clinical Trial
Continuous intra-articular infusion of bupivacaine for postoperative pain following total knee arthroplasty.
This study assessed the efficacy of local, continuous infusion of bupivacaine for pain control following total knee arthroplasty. Eleven men and 19 women with an average age of 65 years (range: 43-83 years) randomly received either 0.25% bupivacaine or normal saline by local infusion pump. Standard wound drainage also was implemented. ⋯ Drug lost to drainage was estimated to be 27%. These findings suggest continuous local analgesic infusion after total knee arthroplasty does not offer significant improvements in either pain relief or medication use. Drug loss from drainage may exceed 25% and may compromise analgesic effectiveness.
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Randomized Controlled Trial Comparative Study Clinical Trial
Bedside femoral block performed on the first postoperative day after unilateral total knee arthroplasty: a randomized study of 49 patients.
This randomized study compared the effectiveness of a femoral nerve block with other methods of pain control on the first postoperative day after total knee arthroplasty. The femoral block consisted of a single injection administered at patients' bedside during the surgeon's hospital rounds. Compared with control group patients, femoral block patients reported less pain on a visual analog scale and required one half the amount of oxycodone (P = .021). ⋯ Thus, pain management with femoral blocks resulted in less work for nursing staff (P = .004). Performing a femoral nerve block as needed during the surgeon's hospital rounds is quick and requires minimal additional time without any special equipment. Bedside femoral block is a useful adjunct to other pain control methods following primary total knee arthroplasty.