The Journal of arthroplasty
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Comparative Study Clinical Trial
Minimal incision protocols for anesthesia, pain management, and physical therapy with standard incisions in hip and knee arthroplasties: the effect on early outcomes.
Dramatic early outcomes with "minimal incision" surgery are attributed to patient selection, perioperative management, and the surgical procedure. This study was one on 50 patients in a single surgeon's practice who underwent total hip and total knee arthroplasties with standard incisions. ⋯ Most patients with the "mini" protocols were ready for discharge within 24 hours. The implications of these results are discussed.
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Review Case Reports
Massive retroperitoneal hematoma during enoxaparin treatment of pulmonary embolism after primary total hip arthroplasty: case reports and review of the literature.
In light of the increasing use of enoxaparin for both prophylaxis and treatment of thromboembolic disease, the number of potential complications from this anticoagulant will also continue to increase. This article presents the first case of massive retroperitoneal hematoma during enoxaparin treatment of pulmonary embolism after a primary total hip arthroplasty and discusses several unique sequelae of the retroperitoneal hematoma. Retroperitoneal hematomas are often fatal, and treatment involves aggressive fluid resuscitation with possible surgical decompression.
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Comparative Study
A pilot study on continuous femoral perineural catheter for analgesia after total knee arthroplasty: the effect on physical rehabilitation and outcomes.
Two techniques of postoperative analgesia for primary total knee arthroplasty were compared retrospectively. Twenty-four patients received a femoral nerve catheter with continuous infusion of ropivacaine (FNC group), whereas 26 patients received intravenous (IV) opioids (IV opioid group). Pain and rehabilitation scores and hospital length of stay (LOS) were compared. ⋯ After 4 sessions of twice-daily rehabilitation, the FNC group used less IV patient-controlled opioids (29.1% vs 84.5%, P = .0001) and demonstrated better performance with knee flexion and mobility. Hospital LOS was significantly less in the FNC group (3.6 vs 4.2 days, P = .034). Femoral nerve catheters with continuous infusion of ropivacaine provide satisfactory analgesia, improve rehabilitation, and shorten hospital LOS.
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Studies have shown that the position of the joint line has a direct effect on postoperative results, including range of motion, functional knee scores, and midflexion stability. Four anatomic landmarks were investigated as references for locating the joint line during a revision knee surgery--the medial femoral epicondyle, the fibular head, the tibial tubercle, and the inferior pole of the patella. ⋯ The instruments were validated on 94 primary total knees. The instrument referencing the medial epicondyle had 99% and 93% accuracy for locating the natural position of the joint line within 5 and 3 mm, respectively.
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A study of 86 patients undergoing total knee arthroplasty (TKA) was performed to evaluate the role of cold compression. The patients were treated with cold compression or epidural analgesia for 3 days after TKA. Pain was measured on a visual analog scale, and total consumption of analgesics was recorded. ⋯ Mean Hb values averaged 120 mmol/L in the cold compression group vs 109 mmol/L in the control group after surgery. Mean time in hospital of patients with cold compression averaged 4.8 days vs 6.2 days in the control group. The study shows that cold compression therapy improves the control of pain and might thus lead to improvement in ROM and shorter hospital stay.