The Journal of arthroplasty
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Review Meta Analysis Comparative Study
Comparison of Periarticular Multimodal Drug Injection and Femoral Nerve Block for Postoperative Pain Management in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
The analgesic efficacy and safety of periarticular multimodal drug injection (PMDI) compared with femoral nerve block (FNB) for postoperative pain management in total knee arthroplasty (TKA) still remains controversial. We therefore conducted a meta-analysis to quantitatively compare PMDI to FNB in TKA. 10 randomized controlled trials (RCTs) with 744 TKAs in 728 patients were included in this study. ⋯ No significant difference was seen in regard to the complications between the two groups. However, due to the variation of the included studies, no firm conclusions can be drawn.
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We analyzed the records of 29,895 high tibial osteotomies (HTOs), 12,589 unicompartmental knee arthroplasties (UKAs) and 363,386 total knee arthroplasties (TKAs) performed from 2009 to 2013 in Korea. They were compared with the latest nationwide registry reports of seven Western countries. ⋯ Females commonly had a three- to seven-fold higher rate in all procedures. Worldwide, the use of HTO and UKA decreased or remained stable, whereas that of TKA increased steadily, even in younger patients.
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The purpose of this study was to evaluate the economic attributes of private practice adult reconstruction (AR) offices. 458 AAHKS surgeons responded; 65% were in private practice (fee-for-service, non-salaried, non-employed AR surgeons). 54% had considered hospital employment in the past two years. The average group employs 13.4 orthopedic surgeons (3.4 AR), and 105 other employees. The average total budget is $12.5 million per year with $4 million in salaries, and $238,000 in tax revenue generated. Co-management joint ventures are a better model than hospital employment for aligning AR surgeons and hospitals and realizing the cost effectiveness and quality improvement goals of PPACA and AARA while preserving the economic impact of AR private practice.
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Randomized Controlled Trial
The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty.
The purpose of this study is to investigate the effect of preoperative intravenous (IV) and intraoperative topical administration of tranexamic acid (TXA) in total knee arthroplasty (TKA). A total of 120 patients were and randomly allocated to either topical group, combined group, or control group. ⋯ The postoperative hemoglobin drop and total drain amount were significantly less in the combined group compared to other groups. In conclusion, combining preoperative IV injection and topical administration of TXA can effectively reduce blood loss and transfusion rate.