The Journal of arthroplasty
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Randomized Controlled Trial
Is femoral nerve block necessary during total knee arthroplasty?: a randomized controlled trial.
There remains a lack of randomized controlled trials comparing methods of perioperative analgesia for total knee arthroplasty. To address this deficiency, a blinded, randomized controlled trial was conducted to compare the use of femoral nerve block (group F) and local anesthetic (group L). A sample of 55 patients who met the inclusion criteria were randomized to either group. ⋯ However, the Knee Society score was significantly higher in group F. In addition, group F used significantly fewer micrograms of intravenous fentanyl in the first 24 hours. Balancing the risks of femoral nerve block with those of increased systemic narcotic delivery should be performed on a case-by-case basis.
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We evaluated the impact of metabolic syndrome (MetS) on perioperative outcomes in patients undergoing total joint arthroplasty. Using the Nationwide Inpatient Sample, patients with MetS were identified if they had at least 3 of 4 component comorbidities (obesity, dyslipidemia, hypertension, and diabetes). Patient demographics, in-hospital outcomes, and cost were compared between patients with and patients without MetS. ⋯ Metabolic syndrome was overproportionately prevalent among female total knee arthroplasty recipients, male total hip arthroplasty recipients, and patients in the minority race group. In the regression analysis, MetS was an independent risk factor for the development of major complications, nonroutine discharge, and increased hospital cost. Given the increasing rates of MetS and its association with higher risk for major complications among total joint arthroplasty recipients, further research into the impact of this disease complex is warranted.
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We reviewed the revision rate and functional outcome of all patients who had a total knee arthroplasty (TKA) after an osteotomy or unicompartmental knee arthroplasty (UKA) on the New Zealand Joint Registry. We used these data to compare the results with primary TKA scores, including comparison of age-matched subgroups. There were 711 patients who had undergone TKA as salvage for a failed osteotomy with a revision rate of 1.33 per 100 component years and a mean 6-month Oxford Knee Score (OKS) of 36.9. ⋯ There was no significant difference in mean OKS between primary TKA and TKA for a failed osteotomy, even among patients younger than 65 years. Revision of a failed osteotomy to a TKA has improved functional results compared with revision of a failed UKA. However, both yield poorer survivorship rates compared with primary TKA.
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Randomized Controlled Trial
Combined femoral and sciatic nerve block vs combined femoral and periarticular infiltration in total knee arthroplasty: a randomized controlled trial.
This study tests the null hypothesis that there is no difference between sciatic nerve block (SNB) and periarticular anesthetic infiltration (PI) as adjuncts to femoral nerve blockade (FNB) in total knee arthroplasty in terms of postoperative opioid requirements. Fifty-two patients undergoing total knee arthroplasty were randomized to receive either (a) combined FNB-SNB or (b) combined FNB-PI. Average morphine consumption in the first 24 (20 vs 23 mg) and 48 hours (26 vs 33 mg) showed no significant difference. ⋯ Anesthetic time, surgical time, and length of hospital stay (5.5 vs 6 days) were similar. This study showed no significant difference between the 2 groups. The PI offers a practical and potentially safer alternative to SNB.
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In this study, we evaluated the hemostatic effects of tranexamic acid (TNA), an antifibrinolytic drug, by examining the timing of its administration during total hip arthroplasty. One hundred seven patients being treated for osteoarthritis of the hip joint were randomly divided into 5 groups based on the timing of TNA administration. ⋯ We found that the intraoperative blood loss in the preoperative TNA administration groups was significantly lower than both control and postoperative TNA administration groups. Furthermore, 1 g TNA 10 minutes before surgery and 6 hours after the first administration was most effective for the reduction of blood loss during total hip arthroplasty.