The Journal of arthroplasty
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This case series describes the use of continuous lumbar plexus block with sciatic nerve block as an alternative anesthetic for total hip arthroplasty (THA). A retrospective chart review was performed on 10 consecutive patients who underwent THA at Walter Reed Army Medical Center using continuous lumbar plexus block and sciatic nerve block for anesthesia. ⋯ Peripheral nerve block may provide superior intraoperative outcomes, as suggested by lower operative blood loss and potentially lower transfusion exposure. Lumbar plexus block with perineural catheter and sciatic nerve block with perioperative sedation is an effective alternative to general anesthesia for THA.
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This study evaluated the improvement in range of motion after revision total knee arthroplasty (TKA) in a consecutive series of patients with TKAs presenting with pain and limited range of motion. Eleven stiff (range of motion <70 degrees ) and painful TKAs were revised with a posterior stabilized condylar prosthesis and reviewed after an average of 37.6 months (range, 24-53 months). ⋯ Pain scores improved from 4.5 to 44.1, and all 11 patients were satisfied. This study shows that knee range of motion can improve significantly after revision TKA.
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Randomized Controlled Trial Clinical Trial
Lumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty: a randomized controlled clinical trial.
The accepted mode of pain management after total hip or knee arthroplasty is patient-controlled analgesia. This study evaluates the efficacy of lumbar paravertebral nerve block in diminishing postoperative pain when used as an adjunct to patient-controlled analgesia. A total of 115 arthroplasty patients received postoperatively a lumbar paravertebral nerve block (block, n = 57) or a sham procedure (control, n = 58). ⋯ Visual analog scale pain score measurements at 4, 8, and 24 hours did not differ significantly between the groups. Paravertebral nerve block of the lumbar plexus is an invasive procedure with some risk. Considering the added risk and minimal benefits, routine use of this procedure is not supported.
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Concern about the safety of allogeneic blood transfusion, including the risk of viral infection and immunosuppression, has led to the development of transfusion options in total joint arthroplasty, including intraoperative and postoperative blood salvage, autologous donation, hemodilution, and the use of epoetin alfa. Intraoperative or postoperative blood salvage has been shown not to be cost-effective at our institution except in revision hip arthroplasties because not enough blood is collected. Autologous donation is not helpful. ⋯ The most efficient way to decrease allogeneic risk in these patients is epoetin alfa. Epoetin alfa decreases allogeneic risk to 12.9%, which is acceptable. Patients with preoperative hemoglobin >14 g/dL undergoing single total knee or total hip arthroplasty do not need anything because their allogeneic risk is minimal.
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The results of cemented total hip arthroplasty (THA) in patients with ankylosing spondylitis were studied to determine the utility of THA for these patients. A total of 103 patients with ankylosing spondylitis underwent 181 THAs; 72 patients (69.9%) had bilateral surgery. The mean follow-up was 10.3 years. ⋯ At final follow-up examination, 173 hips (96%) had an excellent (low) pain score, and 53 hips had a normal or near-normal function score (29.2%). The probability of survival of the implant was 71% at 27 years. THA provides long-term improvement in hip function for patients with ankylosing spondylitis.