The Journal of arthroplasty
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To estimate the accuracy of regional cerebral oxygen saturation (rSO(2)) in predicting postoperative cognitive dysfunction (POCD) for patients undergoing total hip arthroplasty, 46 patients aged more than 50years old were enrolled. We measured the patients' cognitive function by using a battery of six neuropsychological tests before surgery and then 7days after surgery again. rSO(2) was continuously monitored by near-infrared spectroscopy during surgery. ⋯ The area under the receiver operating characteristic curve of rSO(2%max) was 0.833 [95% confidence interval (CI) 0.615-1.051] at cutoff value of 11%. The specificity and sensitivity of rSO(2%max) >11% in predicting POCD were 77.8% and 86.5%, respectively. rSO(2%max) more than 11% was a potential predictor for POCD.
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Data of hospitalizations for THA or TKA were analyzed for each year between 1998 and 2007 from the National Inpatient Sample. Demographics, comorbidities, incidence of morbidity and mortality, length of hospital stay (LOS), and overall cost were compared for infected and non-infected patients. Perioperative SSI rates were 0.36% for THA and 0.31% for TKA (412,356 and 784,335 patient entries, respectively). ⋯ Average cost of in-hospital care was double for SSI versus non-SSI patients. Independent risk factors for perioperative SSI included male gender, minority race, a diagnosis for cancer, liver disease, coagulopathies, fluid and electrolyte disorders, congestive heart failure, and pulmonary circulatory disease. Data relied on coded information and could not differentiate between superficial or deep infection, or capture patients readmitted for SSI, and therefore may have underestimated the true incidence of SSI.
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Randomized Controlled Trial
Continuous infusion of bupivacaine following total knee arthroplasty: a randomized control trial pilot study.
An RCT pilot-study was conducted to assess efficacy of a 48-h continuous local infiltration of intra-articular bupivacaine (0.5% at 2 cc/h) versus placebo (0.5% saline at 2 cc/h) in decreasing PCA morphine consumption following TKA. Secondary outcomes included 48-h VAS pain, opioid side effects, length of stay, and knee function scores up to 1-year postoperatively. ⋯ The intervention did not improve pain scores, or any other outcome studied. Given study results we would conclude that analgesia outcomes with a multimodal analgesia regimen are not significantly improved by adding 48 h of 0.5% bupivacaine infiltration at 2 cc/h.
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Between June 2007 and May 2008, 21 patients with bilateral osteonecrosis of the femoral head were surgically treated with implantation of free vascularized fibula obtained from the unilateral donor site. All patients were followed up clinically and radiographically for an average of 3.5 years. The evaluation included operative duration, blood loss, Harris hip score, incidence of complications, and radiological examinations. ⋯ Blood loss averaged 300ml. All transplanted fibula integrated well to the femoral head 3.5years postoperatively with no severe complications observed. The results revealed that unilateral free vascularized fibula is effective for the treatment of bilateral osteonecrosis of the femoral head.