The Journal of arthroplasty
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Randomized Controlled Trial
Use of bovine thrombin to reduce blood loss in primary total knee arthroplasty: a controlled randomized trial.
Reducing blood loss during primary total knee arthroplasty (TKA) can improve outcomes by reducing transfusion requirements and wound complications. We examined the use of bovine thrombin to augment hemostasis during primary TKA. A double-blinded randomized trial was performed with 80 primary TKA patients. ⋯ Hemoglobin levels in the study group did decline less than the control group, but no statistically significant difference was found in rates of transfusion, drain outputs, length of stay, or Knee Society scores. This agent does appear to slightly reduce blood loss, but routine use is not cost effective. Thrombin may be considered for patients who would benefit more from greater blood conservation.
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Randomized Controlled Trial
Effects of combined application of muscle relaxants and celecoxib administration after total knee arthroplasty (TKA) on early recovery: a randomized, double-blind, controlled study.
The purpose of this study was to evaluate the effectiveness of application of muscle relaxants and celecoxib in early recovery after total knee arthroplasty (TKA). One hundred and fifty patients were randomized 1:1:1 to receive either both of muscle relaxants and celecoxib or muscle relaxants alone or placebo for 2 weeks (50 patients in each group). ⋯ Group A improved better with reduced VAS pain scores compared with another two groups. These results demonstrated that application of muscle relaxants and celecoxib into patients undergoing TKA for 2 weeks postoperative consequently improved their convalescence.
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Multicenter Study
Revision of unicompartmental arthroplasty to total knee arthroplasty: not always a slam dunk!
As the number of UKA performed in the world continues to increase, so will the number of failures. A better understanding of the outcomes after revision UKAto TKA is warranted. The objective of this study is to report the outcomes of modern UKA revised to TKA in three US centers. ⋯ In the present series, the re-revision rate after revision TKA from UKA was 4.5 % at an average of 75 months or 1.2 revisions per 100 observed component years. Compared to published individual institution and national registry data, re-revision of a failed UKA is equivalent to revision rates of primary TKA and substantially better than re-revision rates of revision TKA. These data should be used to counsel patients undergoing revision UKA to TKA.
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Comparative Study
Multiple cultures and extended incubation for hip and knee arthroplasty revision: impact on clinical care.
The impact on patient care of introducing a protocol of obtaining 5 or more intra-operative separate tissue biopsies that were cultured for 10 days was assessed for hip and knee arthroplasty revision. The charts of seventy-three patients undergoing 77 cases of revision arthroplasty were reviewed one year post-operatively. ⋯ This data demonstrated the new protocol significantly changed patient care, and suggests that 1 or 2 cultures are insufficient. Adopting a similar protocol should be considered by surgeons and institutions as a new minimum standard for management of prosthetic joint infections.
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Comparative Study
Activity, sleep and cognition after fast-track hip or knee arthroplasty.
Optimized perioperative care after total hip and knee arthroplasty (THA/TKA) has decreased length of stay (LOS) but data on activity, sleep and cognition after discharge are limited. We included 20 patients ≥ 60 years undergoing THA/TKA, monitoring them for 3 days preoperatively and 9 days postoperatively with actigraphs for sleep and activity assessment. Pain scores were recorded daily. ⋯ Early postoperatively cognitive decline and increased pain returned to preoperative levels by postoperative day (POD) 5-9. Despite the small sample size the study illustrated that post-discharge activity is decreased and daytime sleep is increased after fast-track THA/TKA, while cognition and pain return to preoperative levels by POD 9. Objective assessment of these recovery parameters may be valuable in future interventional studies to enhance recovery after THA/TKA.