The Journal of arthroplasty
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Blood management for simultaneous bilateral total knee arthroplasty (TKA) patients is more challenging than in unilateral arthroplasty. We examined if administration of tranexamic acid (TXA) to patients undergoing simultaneous bilateral TKA would reduce blood loss and decrease allogeneic blood transfusion requirements. ⋯ There was also a decrease in the transfusion incidence with administration of TXA (17.4% versus 57.9%, P<0.0001). In conclusion, we have shown that TXA is an effective tool in reducing the transfusion rates by almost 70% in simultaneous bilateral total knee arthroplasty.
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Comparative Study
Better Axial Stiffness of a Bicortical Screw Construct Compared to a Cable Construct for Comminuted Vancouver B1 Proximal Femoral Fractures.
The aim of this study was to biomechanically evaluate the Locking attachment plate (LAP) construct in comparison to a Cable plate construct, for the fixation of periprosthetic femoral fractures after cemented total hip arthroplasty. Each construct incorporated a locking compression plate with bi-cortical locking screws for distal fixation. ⋯ The LAP construct was significantly stiffer than the cable construct under axial load with a bone gap (P=0.01). The LAP construct offers better axial stiffness compared to the cable construct in the fixation of comminuted Vancouver B1 proximal femoral fractures.
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There is general agreement that femoral nerve blocks (FNB) provide adequate immediate postoperative analgesia after total knee arthroplasty (TKA), although the effect of this technique on hospital readmission and other complications has not been quantified in a large sample. The Medicare 5% sample was used to identify TKA patients who were grouped according to postoperative FNB administration: FNB via injection; FNB via pain pump; and no FNB. ⋯ Both FNB groups were associated with a lower risk of readmission (30, 90 and 365 days, P<0.001). Future clinical studies may help elucidate whether the lower hospital readmissions may be associated with more effective pain control with the use of FNB.
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Our study aimed at developing clinical thresholds (cut-off scores) for the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index, EQ-5D and Knee Society Score for discriminating between patients with and without treatment success following total knee arthroplasty (TKA). We performed a retrospective analysis of 1055 patients 2 months after TKA and 765 patients 1 year after TKA. We considered treatment successful if the patient reported high levels of satisfaction and pain relief, functional increase, and a willingness to undergo the same procedure again. Based on this criterion we identified cut-off scores that will facilitate interpretation of the WOMAC, the EQ-5D and the KSS in TKA patients.
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Randomized Controlled Trial
Sleep Quality Effects Recovery After Total Knee Arthroplasty (TKA) - A Randomized, Double-Blind, Controlled Study.
This study examined the effects of sleep quality on early recovery after total knee arthroplasty. A total of 148 patients were randomized 1:1 to receive either zolpidem or placebo for 2 weeks. VAS pain scores (rest, ambulation and night), range of motion (ROM), total amount of opioid analgesics and antiemetics taken, postoperative nausea and vomiting (PONV), sleep efficacy and satisfaction were recorded. ⋯ Patients in the intervention group had lower pain score and took less antiemetics. Moreover, a significant correlation between sleep quality and ROM was detected. These results demonstrated that improved sleep quality is beneficial to patients' post-TKA recovery.