The Orthopedic clinics of North America
-
Orthop. Clin. North Am. · Oct 2015
ReviewLiposomal Bupivacaine: A Comparative Study of More Than 1000 Total Joint Arthroplasty Cases.
Pain after total joint arthroplasty (TJA) can be severe and difficult to control. A single-dose local analgesic delivers bupivacaine in a liposomal time-release platform. ⋯ Pain scores were significantly lower for patients in the Post group for both hip and knee procedures. A large series of patients who had TJA experienced pain relief after the introduction of liposomal bupivacaine as part of an established multimodal protocol.
-
Modern anesthetic agents have allowed for the rapid expansion of ambulatory surgery, particularly in hand surgery. The choice between general anesthesia, peripheral regional blocks, regional intravenous anesthesia (Bier block), local block with sedation, and the recently popularized wide-awake hand surgery depends on several variables, including the type and duration of the procedure and patient characteristics, coexisting conditions, location, and expected length of the procedure. This article discusses the various perioperative and postoperative analgesic options to optimize the hand surgical patients' experience.
-
Total hip arthroplasty can be a very effective salvage treatment for both failed fracture surgery and hip arthritis that may occur after prior fracture surgery. The rate of complications is significantly increased including especially infection, dislocation, and loosening. ⋯ The best predictor of infection is a prior infection. Long-term outcomes can be comparable to outcomes in other conditions if complications are avoided.
-
Patellar instability is a common problem, and medial patellofemoral ligament (MPFL) injury is inherent with traumatic patellar dislocations. Initial nonoperative management is focused on reconditioning and strengthening the dynamic stabilizers of the patella. ⋯ A technique of MPFL reconstruction is outlined. This procedure may also be performed in combination with other realignment procedures.