The Journal of arthroplasty
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The wear of 8 femoral and 2 acetabular components of the Birmingham Hip Resurfacing (Midland Medical Technologies Ltd, Birmingham, UK) was measured using a coordinate measuring machine (CMM5; SIP, Geneva, Switzerland). After a median in situ time of 13 months, measurements of the Birmingham Hip Resurfacing femoral heads revealed a median volumetric wear of 2.9 mm(3). ⋯ The 2 acetabular components showed volumetric wear of 5.4 and 27.6 mm(3) after 14 and 15 months in vivo. The wear rates of the investigated femoral components were somewhat, but not significantly, higher than the previously investigated 28-mm Metasul heads (median, 0.8 mm(3); Zimmer GmbH, Winterthur, Switzerland).
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Randomized Controlled Trial
Posterior capsular injections of ropivacaine during total knee arthroplasty: a randomized, double-blind, placebo-controlled study.
We investigated the hypothesis that a posterior capsular injection of ropivacaine would improve pain and accelerate functional recovery after total knee arthroplasty in a randomized, double-blind, placebo-controlled study design. Sixty-six patients received a standardized multimodal anesthesia protocol that included a femoral nerve block. Twenty milliliters of either saline (control) or ropivacaine (study group) was injected into the posterior capsule. ⋯ In addition, significantly more patients in the control group had a numeric pain score higher than 7/10 (severe pain) at the 12-hour evaluation. Other parameters of pain or functional recovery were not significantly different between the 2 groups. Posterior capsular injection did not improve the pain or accelerate the functional recovery after 12 hours in patients also receiving a femoral nerve block for pain control after total knee arthroplasty.
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Injection of local anesthetic during total knee arthroplasty (TKA) has been shown to aid postoperative pain relief. Reinfusion drains have also proven useful in decreasing allogenic blood transfusion. Combined use carries the risk of reinfusion of local anesthetic from drainage bag. ⋯ The average amount of ropivacaine reinfused was 1.9 mg, a fraction of the injected dose (150 mg), and venous plasma concentrations reached peaks of 0.5 to 1.5 microg/mL, well below demonstrated levels of toxicity. Patients tolerated the treatment well, with no adverse outcomes. This study demonstrates the safety of combining these 2 techniques in TKA.
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Adverse events from 2033 total knee arthroplasty patients were documented by nonphysician abstractors. The annual rate of adverse events from 2002 to 2004 was 9.2%, 6.4%, and 5.8%, respectively. Congestive heart failure (odds ratio, 2.1; 95% confidence interval, 1.2-3.5; P < .01) and chronic obstructive pulmonary disease (odds ratio, 1.8; 95% confidence interval, 1.2-2.7; P < .01) were associated with a significantly increased risk of experiencing any adverse event during the index hospitalization. ⋯ The 30-day postprocedure mortality rate was 0.3%. Experiencing any adverse event was associated with an increased 30-day postprocedure mortality (P < .001). Compared with previous studies of Medicare claims, these data reveal a substantial decrease in the mortality rate, an increased readmission rate, and no substantial change in the rate of venous thromboembolism.
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The use of aspirin for venous thromboembolism (VTE) prophylaxis after major orthopaedic surgery is controversial. The hypothesis of the present study is that aspirin will decrease the rate of operative site bleeding without increasing thromboembolic events when aspirin is used for VTE prophylaxis after major orthopaedic surgery. ⋯ The operative site bleeding relative risks of VKA, LMWH, and pentasaccharides versus aspirin, are 4.9, 6.4, and 4.2, respectively. A pooled analysis of RCTs supports the use of aspirin for VTE prophylaxis after major orthopaedic surgery.