The Journal of arthroplasty
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Randomized Controlled Trial
Continuous femoral nerve block in total knee arthroplasty: immediate and two-year outcomes.
We conducted a prospective study to investigate the immediate and 2-year outcomes of total knee arthroplasty patients who received continuous femoral nerve block (FNB) for analgesia. Sixty patients undergoing unilateral total knee arthroplasty were randomized into 3 groups and received high-dose continuous FNB, low-dose continuous FNB, or no FNB. ⋯ Immediately after surgery, there was less pain, higher satisfaction, and lower morphine use among patients on continuous FNB regardless of ropivacaine dosage used. At 2 years, there were no significant differences in functional outcomes.
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Randomized Controlled Trial
Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study.
With a randomized clinical trial, we compared the incidence and severity of heterotopic ossification in cohorts of patients who have undergone either surface replacement arthroplasty or total hip arthroplasty at a minimum follow-up of 1 year. Surface replacement arthroplasty group had a significantly higher rate of severe heterotopic ossification (Brooker grades 3-4) than the total hip arthroplasty group, 12.6% (13/103) vs 2.1% (2/97) respectively (P = .02). ⋯ Patients with severe heterotopic ossification had significantly inferior functional outcome scores. Surgeons offering surface replacement must be aware of this risk and use meticulous surgical technique and consider routine prophylaxis against heterotopic ossification.
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Comparative Study
A comparison of acetate vs digital templating for preoperative planning of total hip arthroplasty: is digital templating accurate and safe?
The purposes of this study were to compare the accuracy of acetate and digital templating for primary total hip arthroplasty (THA) and to determine if digital templating is safe. Preoperative planning was performed on 50 consecutive preoperative radiographs during 2005. Templating results were compared with the actual hip implants used. ⋯ The absolute errors were larger for digital compared with acetate templating; however, mean absolute errors did not differ significantly (acetabulum, P = .090; femur, P = .114). Acetate and digital templating can accurately predict the size of THA implants. Digital templating was determined to be acceptably safe for preoperative planning of primary THA operations.
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We aimed to identify the causes and predictors of patient's dissatisfaction after total knee arthroplasty (TKA). Patient's satisfaction was evaluated in 438 TKAs. ⋯ Multivariate logistic regression analysis revealed that worse preoperative Western Ontario McMaster University Osteoarthritis Index scale pain score and postoperative decrease in range of motion were significantly associated with postoperative dissatisfaction (odds ratio, 7.6 and 2.1, respectively). This study demonstrates that residual symptoms or dysfunctions not directly associated with the replaced knee could be a frequent cause of postoperative dissatisfaction after TKA in osteoarthritic patients.