The Journal of arthroplasty
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Randomized Controlled Trial
Selective patellar resurfacing in total knee arthroplasty: a prospective, randomized, double-blind study.
350 knees were evaluated in a prospective, randomized, double-blinded study of selective patellar resurfacing in primary total knee arthroplasty. Knees with exposed bone on the patellar articular surface were excluded. 327 knees were evaluated at a mean follow-up of 7.8years. 114 knees followed for greater than 10 years were analyzed separately. Satisfaction was higher in patients with a resurfaced patella. ⋯ No complications of patellar resurfacing were identified. The vast majority of patients with remaining patellar articular cartilage do very well with total knee arthroplasty regardless of patellar resurfacing. Patient satisfaction may be slightly higher with patellar resurfacing.
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Randomized Controlled Trial
Buprenorphine added to bupivacaine prolongs femoral nerve block duration and improves analgesia in patients undergoing primary total knee arthroplasty-a randomised prospective double-blind study.
The aim of the study was to determine whether the addition the long-acting opioid buprenorphine as an adjuvant to the local anaesthetic agent would improve quality and prolong duration of femoral nerve blockade in post-operative analgesia following primary total knee arthroplasty. The study involved 48 patients. ⋯ The duration of the sensory block and analgesic effect was assessed according to NRS scale at 12, 24, 36, 48, 60 and 72 hours post-surgery. Patients who received buprenorphine as an adjuvant to the local anaesthetic had significantly longer sensory blockade and lower NRS-rated pain intensity with the difference reaching statistical significance at 12 hours post-surgery.
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Peri-operative tranexamic acid (TXA) significantly reduces the need for allogeneic blood transfusion in total hip arthroplasty (THA) and thus hospital costs are reduced. Before employing TXA in primary THA at our institution, facility costs were $286.90/THA for blood transfusion and required 0.45 man-hours/THA (transfusion rate 19.87%). After incorporating TXA, the cost for intravenous application was $123.38/THA for blood transfusion and TXA medication and 0.07 man-hours/THA (transfusion rate 4.39%) and the cost for topical application was $132.41/THA for blood transfusion and TXA and 0.14 man-hours/THA (transfusion rate 12.86%). TXA has the potential to reduce the facility cost per THA and the man-hours/THA from blood transfusions.
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Randomized Controlled Trial Comparative Study
The use of exparel (liposomal bupivacaine) to manage postoperative pain in unilateral total knee arthroplasty patients.
Efforts continue to improve pain after total knee arthroplasty (TKA) in order to allow for accelerated rehabilitation. The purpose of this study was to evaluate pain control after TKA. A randomized prospective study of 80 consecutive patients was performed comparing Exparel versus femoral nerve block (FNB). ⋯ There were no statistically significant differences between the groups with regard to pain, nausea and vomiting, and narcotic consumption. The FNB group had greater flexion but the Exparel group had improved early ambulation and decreased LOS. Exparel provided similar pain relief to a FNB after TKA without compromising early rehabilitation.
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There is an association between obesity, osteoarthritis and total knee arthroplasty (TKA), but little is known about how postoperative weight change influences outcomes. Primary TKA patients were identified from an institutional arthroplasty registry. BMI and patient reported outcome measures (PROMs, specifically WOMAC and SF36) were recorded for 1545 patients preoperatively and up to 3 years postoperatively. ⋯ However, weight gain over 10% had a negative impact on SF36 pain and functional scores although postoperative weight loss was not associated with improved PROMs. Men showed greater improvement in postoperative SF36 function and pain scores, whilst older patients were slower to improve. Postoperative weight gain has a negative association with SF36 pain and function.