The Journal of arthroplasty
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Common peroneal nerve palsy (CPNP) is a serious complication following total knee arthroplasty (TKA). There is little information regarding the clinical course and prognostic factors for recovery. Between January 2000 and December 2008, 44 patients (0.53%) developed CPNP following TKA and were matched to 100 control patients based on year of surgery, type of surgery and surgeon. ⋯ A significant difference was seen in CPNP patients who were on average younger (62.1 years) and had higher BMI (34.5 kg/m(2)) than those who did not have nerve palsy (67.5 years and 31.8 kg/m(2), respectively). Only 37 patients with palsies could be followed, 32 (62.2%) had incomplete nerve palsy, twenty four (75%) of them fully recovered, while only 1 of patients with complete nerve palsy fully recovered. More severe initial injury was a negative prognostic factor for recovery of palsy (P<0.03).
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Outcome is best assessed with both generic and disease-specific instruments, but using many, lengthy questionnaires increases the burden, quality, and cost of data collection. We evaluated a short, hip-oriented Core Outcome Measures Index (COMI-hip), comprising six items (pain, function, symptom-specific well-being, quality of life, and disability) extracted from established full-length questionnaires; 214 consecutive total hip arthroplasty (THA) patients participated. ⋯ The COMI-hip proved a simple but valid outcome instrument in THA patients. Its brevity renders it a potentially valuable instrument for routine use.
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Multicenter Study
Knee pain during the first three months after unilateral total knee arthroplasty: a multi-centre prospective cohort study.
Many patients have an unfavourable pain outcome post total knee arthroplasty (TKA). This multi-centre prospective cohort study recorded weekly pain scores one week before TKA and 12 weeks post TKA. 96 patients were enrolled into the study. Patients kept a record of their weekly scores pre-operation and post-operation by using the visual acuity score. ⋯ Patients with a pre-operative pain scores ≤ 4 were identified as an at risk group for poor pain outcome. Female gender, age and anaesthetics type were not identified as risk factors for poor pain outcome. Pain trajectory analysis also identified general patterns of pain response post TKA.
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The objective of this study was to determine if tranexamic acid (TXA) applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). Two hundred and ninety consecutive patients from a single surgeon were enrolled. In TKA, TXA solution was injected into the knee after closure of the arthrotomy. ⋯ The mean blood loss was significantly higher in the non-TXA patients in both TKA and THA groups. Postoperative transfusions decreased dramatically with TXA, dropping from 10% to 0%, and from 15% to 1%, in the TKA and THA groups, respectively. Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in TKA and THA.
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Periprosthetic femoral fracture (PFF) fixation failures are still occurring. The effect of fracture stability and loading on PFF fixation has not been investigated and this is crucial for optimum management of PFF. ⋯ In the case of unstable fractures, it is possible for a single locking plate fixation to provide the required mechanical environment for callus formation without significant risk of plate fracture, provided partial weight bearing is followed. In cases where partial weight bearing is unlikely, additional biological fixation could be considered.