The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Jun 1996
Comparative StudyDifferences between patients' and physicians' evaluations of outcome after total hip arthroplasty.
The purpose of this study was to compare patients' and physicians' evaluations of the results of 147 total hip arthroplasties. The patients and physicians independently evaluated pain and over-all satisfaction with the outcome of the procedure using a 10.0-centimeter visual-analog scale. They also answered a questionnaire with which they assessed general health, functional ability, and pain. ⋯ This study highlights a discrepancy between patients' and physicians' evaluations of the results of total hip arthroplasty. This discrepancy increased when the patient was not satisfied with the outcome. The use of patients' self-administered questionnaires as well as traditional physician-generated assessments may provide a more complete evaluation of the results of total hip arthroplasty.
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J Bone Joint Surg Am · May 1996
Randomized Controlled Trial Clinical TrialIntra-articular injection of bupivacaine in knee-replacement operations. Results of use for analgesia and for preemptive blockade.
The effectiveness of an intra-articular injection of bupivacaine, administered before the incision or after closure of the wound, was studied in an effort to decrease the need for postoperative narcotics and to improve analgesia for patients who have elective knee replacement. Eighty-two patients received two intra-articular injections in a random, double blind fashion. Twenty-eight of them received thirty milliliters of 0.5 percent bupivacaine and 1:200,000 epinephrine in saline solution before the incision and an injection of thirty milliliters of plain saline solution after closure of the wound (Group 1). ⋯ Serum concentrations of bupivacaine were well below toxic levels. It was our conclusion that that and intra-articular injection of thirty milliliters of 0.5 percent bupivacaine and 1:200,000 epinephrine in saline solution after closure of the wound decreases the need for narcotics and increases the range of motion after an elective knee replacement. The clinical importance of the amount of increased motion is questionable and needs long-term monitoring.
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J Bone Joint Surg Am · Feb 1996
Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors.
Thirty-two postoperative peroneal-nerve palsies in thirty patients were documented in a retrospective review of 10,361 consecutive total knee arthroplasties performed at one institution from 1979 through 1992. The mean age of the thirty patients was sixty-five years (range, twenty-eight to seventy-eight years). Four of these patients had had a previous proximal tibial osteotomy and five had had a previous lumbar laminectomy. ⋯ We believe that epidural anesthesia for postoperative control of pain leads to decreased proprioception and sensation postoperatively. It is postulated that positioning of the limb in this unprotected state may be a factor in the late development of palsy. The concept of the so-called double-crush phenomenon may partially explain the palsy seen in the patients who had had a lumbar laminectomy and asymptomatic peripheral neuropathy.
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J Bone Joint Surg Am · Jan 1996
Randomized Controlled Trial Multicenter Study Clinical TrialThe effects of recombinant human erythropoietin on perioperative transfusion requirements in patients having a major orthopaedic operation. The American Erythropoietin Study Group.
Two hundred patients who were scheduled for a major elective orthopaedic operation were enrolled in a prospective study and were randomly assigned to one of three treatment groups. Group 1 consisted of sixty patients who received recombinant human erythropoietin, 300 international units per kilogram of body weight per day; Group 2, seventy-one patients who received recombinant human erythropoietin, 100 international units per kilogram of body weight per day; and Group 3, sixty-nine patients who received a placebo. A total of fifteen doses was given subcutaneously, beginning ten days before the operation and extending through the fourth postoperative day. ⋯ For patients who had a baseline hemoglobin level of more than 130 grams per liter, the two doses of recombinant human erythropoietin produced similar results, with 14 per cent (four) of the patients in Group 1 and 11 per cent (four) in Group 2 needing a transfusion; this was in contrast to a rate of transfusion of 36 per cent (fourteen) in Group 3 (the patients who received the placebo) (p = 0.03). The recombinant human erythropoietin was generally well tolerated, although one patient, who did not have a history of hypertension, had an increase in blood pressure, from a baseline level of 142/78 millimeters of mercury (18.93/10.40 kilopascals) to a level of 220/100 millimeters of mercury (29.33/13.33 kilopascals), after ten days of treatment with the higher dose. These data suggest that recombinant human erythropoietin, administered before and after major orthopaedic operations, can minimize the need for homologous red-blood-cell transfusion.