The Journal of arthroplasty
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Randomized Controlled Trial
Impact of Melatonin on Sleep and Pain After Total Knee Arthroplasty Under Regional Anesthesia With Sedation: A Double-Blind, Randomized, Placebo-Controlled Pilot Study.
This pilot study explores sleep disruption after total knee arthroplasty and the impact of melatonin on sleep and postoperative pain. Sleep time was decreased on the last preoperative night and first two postoperative nights. ⋯ Melatonin appeared to have no effect on subjective sleep quality or daytime sleepiness, pain at rest or pain with standardized activity. In conclusion, sleep quality is impaired after total knee arthroplasty and exogenous melatonin does not appear to improve postoperative sleep or pain to a significant degree.
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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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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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Thirty one patients were treated with salvage total hip arthroplasty (THA) for failed internal fixation of intertrochanteric fracture. After a mean follow-up of 47.5 months, all patients reported remarkable pain relief and return to ambulation. Twenty five patients had no pain, and 6 patients complained of residual trochanteric low-grade pain without compromise of activities. ⋯ Seven patients had intraoperative or early complications and were treated successfully. There was no infection, re-fracture, loosening, or revision for any reason. Salvage THA using non-modular cementless long-stem prosthesis represents an effective procedure after failed intertrochanteric fixation.