The Journal of arthroplasty
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Randomized Controlled Trial
Effect of Periarticular Morphine Injection for Total Knee Arthroplasty: A Randomized, Double-Blind Trial.
The periarticular multimodal cocktail injection including morphine is currently commonly used to treat postoperative pain after total knee arthroplasty (TKA). Despite its analgesic effect, it is frequently reported to cause nausea and vomiting, which are adverse effects of opioids. This study aimed to assess the efficacy of morphine as a component of a multimodal cocktail injection for providing postoperative analgesia and alleviating swelling in patients who underwent TKA. ⋯ The results of this study suggested that addition of morphine to the multimodal cocktail injection is not effective for relieving postoperative pain, alleviating swelling, or improving range of motion, and results in nausea and vomiting.
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Poorly controlled postoperative pain may adversely affect total joint arthroplasty (TJA) patients' outcomes and associated healthcare cost. Understanding effective pain management after surgery is important to patients, surgeons, and hospitals. We evaluated patient-reported receipt of preoperative pain management information in a national prospective cohort evaluating postoperative pain and function following elective TJA. ⋯ Forty-four percent of the patients reported that they did not receive/received unhelpful information regarding postoperative pain management, highlighting a need for improved patient education. In this sample, the lack of pain management information was associated with poorer 6-month postoperative function.
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Comparative Study
Comparison of Outpatient vs Inpatient Total Knee Arthroplasty: An ACS-NSQIP Analysis.
There has been a recent surge of interest in performing primary total knee arthroplasty (TKA) in the outpatient setting to reduce cost and increase patient satisfaction. Detailed information on the safety of outpatient TKA in large sample sizes is scarce. ⋯ Based on the perioperative outcome measures studied here, outpatient TKA can be appropriately considered in select patients based on rates of overall perioperative adverse events and readmissions. However, higher surveillance of these patients postdischarge may be warranted.
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The relationship between intra-articular injections and complication rates after total knee arthroplasty (TKA) remains controversial. This study's purpose was to determine the relationship between the number and timing of intra-articular injections with complications and outcomes after TKA from a single surgeon's database. ⋯ Our data suggest that there is no relationship between timing and number of intra-articular injections with complication rate, infection, or poor short-term functional outcomes. Further larger studies are needed to confirm these findings.
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We hypothesized that postoperative anteroposterior (AP) stability of the knee correlates with patient-reported clinical outcome and knee function after total knee arthroplasty (TKA). ⋯ We found that the AP laxity at 60° knee flexion in this study significantly correlated with patient-reported pain. The observed AP laxity can be considered as a register of normal AP translations after arthroplasty.