The Journal of 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.
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Randomized Controlled Trial
Multimodal Analgesia in Total Knee Arthroplasty: A Randomized, Double-Blind, Controlled Trial on Additional Efficacy of Periarticular Anesthesia.
Pain management is a main determinant of functional recovery after total knee arthroplasty (TKA). We performed a randomized, controlled, double blind study to evaluate additive efficacy of periarticular anesthesia in patients undergoing TKA in reducing post-operative pain, operated limb edema and improving post-operative mobility. ⋯ The results show no statistical differences in any of the variable evaluated. Our data suggest that additive periarticular anesthetic protocol with ropivacaine 1% 20 mL is not superior to oral and intravenous analgesia alone in patients undergoing TKA, regarding post-operative pain control, operated limb edema reduction and post-operative mobility improvement.
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Comparative Study
Reduced Blood Loss and Transfusion Rates: Additional Benefits of Local Infiltration Anaesthesia in Knee Arthroplasty Patients.
We hypothesised that local infiltration of anaesthesia (LIA) containing adrenaline may reduce peri-operative blood loss and transfusion requirements in primary total knee arthroplasty patients (TKA) when compared to simple patient control analgesia (PCA). In this retrospective cohort study there were 22 TKAs in the PCA group and 27 TKAs in the LIA group. ⋯ Patients receiving PCA were 4.3 times more likely to require blood transfusion. Using the LIA technique reduces blood loss and risk of blood transfusion.
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Consecutive patients undergoing knee arthroplasty completed questionnaires: FJS, Knee Injury and Osteoarthritis Outcome Score (KOOS) and WOMAC Score (mean 39 months after surgery), and were mailed a repeat questionnaire after 4 to 6 weeks. The test-retest reliability was almost perfect for the FJS (ICC = 0.97), and the FJS subdomains (ICC > 0.8). ⋯ The FJS demonstrates high test-retest reliability and construct validity compared to the Normalised WOMAC and KOOS Subscales. The FJS does not demonstrate the ceiling effect of the WOMAC or KOOS pain scores so may have greater discriminatory ability following TKR.
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The purpose of this study was to determine if TKA patients with pain between 60 and 120 days are more likely to be dissatisfied at mid-term follow-up. At the 60-120 day follow-up, moderate to severe movement-elicited pain (MEP) and pain at rest (PAR) were reported by 25/316 TKAs (7.9%) and 44/316 TKAs (13.9%), respectively. A greater proportion of those with MEP at 60-120 days were dissatisfied at midterm follow-up (24% vs. 6.5%, P = .01), and those with MEP early after surgery were 4.5 times more likely to be dissatisfied at mid-term follow-up (P = .004). Similarly, those with PAR 60-120 days after surgery were 4.1 times more likely to be dissatisfied at mid-term follow-up (P = .002).