The Journal of arthroplasty
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Randomized Controlled Trial Comparative Study
A Randomized Controlled Trial Comparing Adductor Canal Catheter and Intraarticular Catheter After Primary Total Knee Arthroplasty.
Multimodal analgesia, including peripheral nerve blocks, is recommended for postoperative pain relief after total knee arthroplasty (TKA). To date, no randomized controlled trial has compared the efficacy of adductor canal catheters (ACCs) and intraarticular catheters (IACs) in patients undergoing TKA. ⋯ ACC should be considered as part of a multimodal pain regimen after primary, unilateral TKA and provides a better option for pain control after discharge.
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Comparative Study
Postoperative Pain After Primary Total Knee Arthroplasty: Comparison of Local Injection Analgesic Cocktails and the Role of Demographic and Surgical Factors.
It has been reported that pain-related outcomes after total knee arthroplasty (TKA) may vary with different analgesic techniques and with patient demographics. The purposes of this study were to compare local infiltration of regular bupivacaine (periarticular infiltration [PAI] group) vs liposomal bupivacaine (LBUP group) and to examine the effect of patient characteristics on postoperative pain after TKA. ⋯ This multivariate regression analysis study showed that in patients undergoing primary TKA, postoperative pain was lower in males, older patients, and those treated with LBUP. Awareness of these factors may assist in developing patient-specific multimodal postoperative pain and education protocols that reduce opioid reliance and related adverse events.
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Randomized Controlled Trial
Closed Suction Drainage Has No Benefits in Anterior Hip Arthroplasty: A Prospective, Randomized Trial.
Many studies have challenged routine drain placement in patients undergoing total hip arthroplasty. Some studies suggest increased transfusion rate with the use of closed suction drains. The use of tranexamic acid to control surgical bleeding and aspirin for venous thromboembolism prophylaxis has gained popularity. No study has evaluated the use of drains in patients undergoing direct anterior total hip arthroplasty under these conditions. ⋯ Our study showed no clinical benefit or disadvantage to closed suction drainage in anterior hip arthroplasty with the concomitant use of tranexamic acid for surgical hemostasis and aspirin for venous thromboembolism prophylaxis.
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Total joint arthroplasty (TJA) utilization continues to increase, and optimizing efficiency while reducing complications is critical to provide a sustainable product. Recent policy has defined several hospital-acquired conditions (HACs) that are the target of reducing complications with significant financial implications. The present study defines the incidence of HACs after TJA as well as patient and hospital factors associated with HACs. ⋯ The incidence of HACs after TJA is 1.3%. Many of the patient factors associated with HACs are nonmodifiable, and risk adjustment should be considered to provide a sustainable product to a diverse patient population.
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In the emerging fiscal climate of value-based decision-making and shared risk and remuneration, outpatient total joint arthroplasty is attractive provided the incidence of costly complications is comparable to contemporary "fast-track" inpatient pathways. ⋯ Outpatients experience higher rates of post-discharge complications, which may countermand cost savings. Surgeons wishing to implement outpatient total joint arthroplasty clinical pathways must focus on preventing post-discharge medical complications to include blood management strategies.