The Journal of arthroplasty
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Gender, preoperative function, and other variables were explored as predictors of recovery after total hip and knee arthroplasty. One hundred fifty-two subjects (63.8 +/- 10.2 years) were repeatedly assessed in the first 4 postoperative months. Average recovery curves for the Western Ontario and McMaster Universities Osteoarthritis Index, 6-minute walk test, and timed up and go test were characterized using hierarchical linear modeling. ⋯ Thereafter, men and women had similar rates of improvement. Preoperative score was a significant predictor (P < or= .001) in all models. Patients' and surgeons' expectations of outcome need to take preoperative function into account.
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A highly effective comprehensive multimodal pain protocol has evolved at our institution for both primary and revision hip and knee arthroplasty. At the center of this protocol are peripheral nerve blocks to deliver postoperative pain relief. Total hip arthroplasty patients receive a lumbar plexus block with an indwelling catheter. ⋯ Before surgery, patients are given a long-acting oral narcotic medication and a nonsteroidal anti-inflammatory. After surgery, oral medications are given on a set schedule and include acetaminophen, a nonsteroidal anti-inflammatory, and a long-acting oral narcotic. Outstanding pain control is achieved without parenteral narcotics and allows early physical therapy, early return to self-care, and improved patient satisfaction.
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High-Flexion knee designs are emerging to allow a safe prosthetic environment to facilitate higher ranges of motion than designs of the past. Early biochemical and clinical data support this effort.