The Journal of arthroplasty
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Case Reports
A case of disassociation of a modular femoral neck trunion after total hip arthroplasty.
Modular femoral heads offer the advantages of increased intraoperative flexibility through the adjustment of leg length and offset, whereas a modular femoral neck can also allow independent adjustment of femoral anteversion. Despite the potential advantages of hip systems using increased modularity, these component designs also offer a greater number of junctions through which problems may occur. This case demonstrates the potential for dissociation of a Morse taper between a modular femoral neck and stem.
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Comparative Study
Bilateral vs unilateral total knee arthroplasty: a patient-based comparison of pain levels and recovery of ambulatory skills.
Two important questions remain in simultaneous bilateral total knee arthroplasty (TKA). Is bilateral TKA significantly more painful and is physical recovery significantly more difficult compared with unilateral TKA? A retrospective matched-pair analysis compared 59 bilateral and 59 unilateral TKA patients based on age, sex, diagnosis, surgeon, and surgery date. Analog pain scores, narcotic use, ambulatory distances, and rehabilitative milestones were recorded. ⋯ Narcotic use was 20% higher for the first 48 hours but equalized after that period. Ambulatory milestones lagged behind by 36 hours. Patients wishing to pursue bilateral TKA can proceed without pain, use of narcotics, and walking distance significantly different than unilateral TKA.
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Randomized Controlled Trial
Preoperative epoetin alfa vs autologous blood donation in primary total knee arthroplasty.
This prospective randomized trial compared preoperative autologous blood donation (PAD) with epoetin alfa in patients undergoing primary total knee reconstruction. Fifty adult patients with pretreatment hemoglobin level of 100 to 130 g/L were randomized to either epoetin alfa 40,000 U at preoperative days 14 and 7 or to a standard PAD protocol. Patient characteristics and operative blood loss were similar between groups. ⋯ There was no significant difference in the incidence of allogeneic transfusions between groups (28% for epoetin alfa vs 8% for PAD; P = .1383). Both treatments were generally well tolerated. Epoetin alfa appears to be a safe alternative to PAD in patients who are at risk for transfusion in the perioperative period following total knee arthroplasty.
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A highly effective comprehensive multimodal pain protocol has evolved at our institution for both primary and revision hip and knee arthroplasty. At the center of this protocol are peripheral nerve blocks to deliver postoperative pain relief. Total hip arthroplasty patients receive a lumbar plexus block with an indwelling catheter. ⋯ Before surgery, patients are given a long-acting oral narcotic medication and a nonsteroidal anti-inflammatory. After surgery, oral medications are given on a set schedule and include acetaminophen, a nonsteroidal anti-inflammatory, and a long-acting oral narcotic. Outstanding pain control is achieved without parenteral narcotics and allows early physical therapy, early return to self-care, and improved patient satisfaction.
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Gender, preoperative function, and other variables were explored as predictors of recovery after total hip and knee arthroplasty. One hundred fifty-two subjects (63.8 +/- 10.2 years) were repeatedly assessed in the first 4 postoperative months. Average recovery curves for the Western Ontario and McMaster Universities Osteoarthritis Index, 6-minute walk test, and timed up and go test were characterized using hierarchical linear modeling. ⋯ Thereafter, men and women had similar rates of improvement. Preoperative score was a significant predictor (P < or= .001) in all models. Patients' and surgeons' expectations of outcome need to take preoperative function into account.