The Journal of arthroplasty
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The relevance of wound complications in association with acute prosthetic joint infection (PJI) is well known. However, whether a successfully treated superficial infection can result in a chronic deep infection remains unclear. The aim of this study was to determine the prevalence, treatment and late complications of superficial wound infections following TKA. ⋯ None of the cases developed deep chronic PJI at 70 months of follow-up. Three cases were in need of a TKA exchange due to aseptic loosening. A successfully treated superficial wound infection does not result in a chronic deep TKA infection.
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The pathophysiology of rapidly destructive osteoarthritis (OA) of the hip is unknown. This study documented cases of inversion of the acetabular labrum, which has clinicoradiologic features similar to those of initial-stage rapidly destructive hip OA. ⋯ Subchondral insufficiency fractures of the femoral heads were seen just under the inverted labra in 8 of the 9 patients. Inversion of the acetabular labrum may be involved in rapid joint-space narrowing and subchondral insufficiency fracture in rapidly destructive hip OA.
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Randomized Controlled Trial
Intra-articular bupivacaine reduces postoperative pain and meperidine use after total hip arthroplasty: a randomized, double-blind study.
One hundred patients receiving unilateral total hip arthroplasty (THA) were randomized to receive an intra-articular injection of 300mg bupivacaine or normal saline after completion of surgery. Pain scores of the bupivacaine group were significantly lower than those of the control group the first 12hours postoperatively (all, P<0.001). ⋯ Nineteen patients in the study group required meperidine the first day after surgery, as compared to 45 patients in the control group. We conclude that intra-articular injection of bupivacaine after THA reduces pain and meperidine use in the first 12hours after surgery.
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Randomized Controlled Trial Comparative Study
Comparison of local infiltration of analgesia and sciatic nerve block in addition to femoral nerve block for total knee arthroplasty.
We conducted a prospective randomized controlled trial to test the null hypothesis that there is no difference between sciatic nerve block (SNB) and local infiltration of analgesia (LIA) regarding postoperative analgesia after total knee arthroplasty (TKA), when administrated in addition to femoral nerve block (FNB). Forty-six patients scheduled for TKA were randomized into two groups: concomitant administration of FNB and SNB or FNB and LIA. ⋯ There was no significant difference in the need for adjuvant analgesics, patient satisfaction level, the time to achieve rehabilitation goals, and length of hospital stay. The LIA offers a potentially safer alternative to SNB as an adjunct to FNB.
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Randomized Controlled Trial
Combination of intravenous and topical application of tranexamic acid in primary total knee arthroplasty: a prospective randomized controlled trial.
This study was aimed to determine the efficacy and safety of combined intravenous (IV) and topical application of tranexamic acid (TXA) in unilateral total knee arthroplasty (TKA) compared with the IV-TXA. One hundred eight-four patients were enrolled. ⋯ The results revealed that compared with the 3g IV-TXA, adding 1.5g topical TXA to 1.5g IV-TXA in unilateral TKA can have the similar effectiveness in reducing transfusion rate and total blood loss without sacrificing safety. The most important is that by adding topical TXA, patients can gain a smaller maximum decline of hemoglobin (Hb), less drainage volume, less postoperative knee pain, less knee swelling, shorter length of hospital stays and higher short-term satisfaction.