The Journal of arthroplasty
-
Little information exists on national trends in the utilization of femoral nerve blocks (FNBs) in total knee arthroplasties (TKAs). We sought to describe the variations in anesthetic practice for FNB using the National Anesthesia Clinical Outcomes Registry. ⋯ There is considerable practice variation in the use of FNB for TKA, which is associated with various factors such as geographic location, time of day, and patient-specific comorbidities. Approximately one fourth of TKA cases include FNB. Overall, our study supports the clinical utility of FNB in TKA. As more data are compiled, it will be important to examine how national trends shift in the future.
-
Patient optimization is receiving increasing attention as outcomes monitoring and bundled payments have been introduced in joint arthroplasty. Optimization of nutrition is an important aspect of perioperative management. ⋯ Nutritional assessment and optimization should be a part of the perioperative management of patients undergoing lower extremity arthroplasty.
-
Numerous series have documented short-term successes with cementless total hip arthroplasty (THA) and subtrochanteric shortening osteotomy for Crowe IV developmental dysplasia of the hip (DDH). However, data are lacking regarding long-term implant fixation and patient function. In this study, we aimed to evaluate the 10-year results of cementless THA with simultaneous subtrochanteric shortening osteotomy for Crowe IV DDH. ⋯ In the longest series to date, cementless THA combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to dysplasia was associated with high rates of successful implant fixation and stable clinical improvement.
-
Lack of fracture movement could be a potential cause of periprosthetic femoral fracture (PFF) fixation failures. This study aimed to test whether the use of distal far cortical locking screws reduces the overall stiffness of PFF fixations and allows an increase in fracture movement compared to standard locking screws while retaining the overall strength of the PFF fixations. ⋯ The results indicate that far cortical locking screws can reduce the overall effective stiffness of the locking plates and increase the fracture movement while maintaining the overall strength of the PFF fixation construct. However, in unstable fractures, alternative fixation methods, for example, long stem revision might be a better option.