The Journal of arthroplasty
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Randomized Controlled Trial
Combined continuous "3-in-1" and sciatic nerve blocks provide improved postoperative analgesia with no correlation to catheter tip location after unilateral total knee arthroplasty.
This study assessed the efficacy and duration of postoperative analgesia after continuous sciatic nerve block with and without continuous "3-in-1" block with bupivacaine after unilateral total knee arthroplasty and determined catheter tip correlation with analgesia. Thirty patients were randomized into 2 groups. ⋯ The percentage of catheters in the ideal position was 53.3% for 3-in-1 and 93.3% for sciatic nerve. In conclusion, continuous sciatic nerve block when added to continuous 3-in-1 block provides a better quality of analgesia with lesser requirements of rescue analgesics without the need for routine radiographic conformation.
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Optimizing the operating room environment is necessary to minimize the prevalence of arthroplasty infection. Reduction of bacterial contamination in the operating room should be a primary focus of all members of the operating room team. ⋯ The purpose of this review is to highlight important considerations for optimizing the operating room environment. These principles should be actively promoted by orthopedic surgeons in their operating rooms as part of a comprehensive approach to minimizing arthroplasty infection.
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Improved pain management techniques and accelerated rehabilitation programs are revolutionizing our patients' postoperative experience after total hip and knee arthroplasty. The process involves regional anesthesia with multimodal pain control using local periarticular injections in combination with enhanced patient education and accelerated rehabilitation provided by a dedicated team of surgeons, physicians, anesthesiologists, physician assistants, physical therapists, and social workers. ⋯ Although this is not always the case, it was unheard of in prior years. It is our hope that future research into this area will make painful, difficult recoveries after total hip arthroplasty and total knee arthroplasty a distant memory.
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Improvements in materials and fixation have addressed many of the limitations of resurfacing total hip arthroplasty (THA). The functional demands and the longevity of arthroplasty patients are increasing. Many patients have embraced the functional capacity, bone conservation, and revision options of hip resurfacing. ⋯ The procedure is now also conservative on the acetabular side, and revision of the cementless acetabular component is rare. The operative parameters of femoral resurfacing revisions (conversion to a THA) are similar to that of a primary THA. Bearing technology will continue to evolve.
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In the last 10 years, resurfacing hip arthroplasty has become a popular option again for treating hip disorders in younger, active patients in some parts of the world. We report the Australian experience with this operation based on the Australian National Joint Replacement Registry and the literature available on the Australian experience in Resurfacing.