The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 2007
ReviewPreventing the development of chronic pain after orthopaedic surgery with preventive multimodal analgesic techniques.
The prevalences of complex regional pain syndrome, phantom limb pain, chronic donor-site pain, and persistent pain following total joint arthroplasty are alarmingly high. Central nervous system plasticity that occurs in response to tissue injury may contribute to the development of persistent postoperative pain. ⋯ The rationale for this strategy is the achievement of sufficient analgesia due to the additive effects of, or the synergistic effects between, different analgesics. Effective multimodal analgesic techniques include the use of nonsteroidal anti-inflammatory drugs, local anesthetics, alpha-2 agonists, ketamine, alpha(2)-delta ligands, and opioids.
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J Bone Joint Surg Am · Jun 2007
Randomized Controlled TrialEarly pain relief and function after posterior minimally invasive and conventional total hip arthroplasty. A prospective, randomized, blinded study.
Few prospective randomized studies have demonstrated benefits of minimally invasive total hip arthroplasty when compared with conventional total hip arthroplasty. We hypothesized that patients treated with a posterior mini-incision would have better results than those treated with a posterior long incision with regard to the achievement of established goals for pain relief and functional recovery permitting hospital discharge by the second postoperative day. ⋯ Therapeutic Level I.
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The Musculoskeletal Function Assessment (MFA) is a validated, reliable, self-administered questionnaire that is useful for determining functional status. The Merle d'Aubigné score is a clinical measure of hip function. The purpose of the present study was to evaluate the outcome information provided by these two instruments after operative treatment of elementary posterior wall fractures of the acetabulum. ⋯ The total MFA scores for patients with a posterior wall fracture of the acetabulum were significantly worse than normative reference values. Thus, complete recovery after a posterior wall fracture of the acetabulum is uncommon, with residual functional deficits involving wide-ranging aspects of everyday living that do not necessarily have an obvious direct connection to hip function. Although the modified Merle d'Aubigné score may be useful for evaluating isolated hip function in patients who have been treated for an acetabular fracture, its shortcomings limit its usefulness as a method for evaluating functional outcome in these patients. Research efforts should be directed toward the identification of the psychosocial and other underlying determinants of functional outcome and potential related treatment interventions.
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J Bone Joint Surg Am · Jun 2007
Multicenter StudyImpact of psychological distress on pain and function following knee arthroplasty.
Preoperative psychological distress has been reported to be an important risk factor for poor outcome following lower-extremity arthroplasty. We determined the independent impact of preoperative psychological distress on three, twelve, and twenty-four-month WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) pain and function scores and on change scores over those time periods. ⋯ Prognostic Level I.