The Journal of arthroplasty
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Pain control after arthroplasty has been a key concern for orthopedic surgeons. After total knee arthroplasty (TKA), a small group of patients developed a painful joint with suboptimal range of motion. Manipulation under anesthesia increases flexion and extension while decreasing pain in most cases. ⋯ Group A had an incidence of manipulation of 4.75% (37/778). Of 357 patients, 8 required manipulation in group B, which is an incidence of 2.24%. We recommend that orthopedic surgeons consider using a multimodal pain management protocol for TKA.
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Injury of the infrapatellar branch of the saphenous nerve (ISN) may be caused by a surgical laceration or trauma about the knee and can result in formation of a painful neuroma. There has been no report of knee stiffness after a total knee arthroplasty secondary to a painful neuroma of the ISN. ⋯ A neuroma of the ISN was resected, and the pain as well as the stiffness of the knee resolved. A source of pain such as a neuroma should be considered as a cause of reversible knee stiffness or "pseudoarthrofibrosis" after a total knee arthroplasty.
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Randomized Controlled Trial
Multimodal analgesia without parenteral narcotics for total knee arthroplasty.
Use of parenteral narcotics after total knee arthroplasty is considered by most orthopedic surgeons to be the standard of care. This study tested the hypothesis that a multimodal oral pain medication protocol could control pain and minimize complications of parenteral narcotics. ⋯ The average daily pain score was less than 4 out of 10, nausea occurred in 15 patients (21%), emesis in 1 patient (1.4%), and there were no severe complications. This study proved the hypothesis that pain after total knee arthroplasty could be effectively managed without routine use of parenteral opioids.
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This study was designed to assess the risk of hematoma related to the combination of peripheral nerve blocks and thromboprophylaxis. A total of 3588 patients undergoing joint arthroplasty were included. Blocks performed included continuous lumbar plexus, continuous femoral, and continuous or single sciatic. ⋯ A total of 6935 blocks were performed in patients receiving warfarin (50.0%), fondaparinux (12.8%), deltaparin (11.6%), enoxaparin (1.8%), and aspirin (23.8%). In this patient population, no perineural hematoma was recorded. Our data provide evidence that continuous/single peripheral nerve blocks can be safely performed before thromboprophylaxis initiation, and perineural catheters can be safely removed while the patient is receiving thromboprophylaxis and/or aspirin.
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This retrospective analysis examines the outcome of total joint arthroplasty for severe arthritis in patients with synovial chondromatosis. All 11 patients treated with total hip arthroplasty (n = 7) or total knee arthroplasty (n = 4) returned for follow-up at a mean of 10.8 years after surgery. Pain and functional scores improved significantly in all patients. ⋯ Total joint arthroplasty is a valuable treatment option for these patients with predictable improvement in pain and function. Knee range of motion is likely to improve but may be less than expected for primary total knee arthroplasty. Patients remain at risk for recurrence.