The Journal of arthroplasty
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Cerebral emboli identified as high-intensity transient signals (HITS) occur during total knee arthroplasty (TKA). Their effects on cognitive outcome remain speculative. Intraoperative HITS and postoperative complications were correlated with the cognitive function of TKA patients. ⋯ At 1 week, 58% of patients with cognitive deficits had at least 1 postoperative complication (6% in nondeficit patients). All cognitively impaired patients at 3 months had complications (17% in the nondeficit group). This raises the possibility that postoperative complications might be associated with cognitive dysfunction in TKA patients.
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Iatrogenic injuries to the vascular system are a rare but serious complication of primary and revision hip arthroplasty. These injuries usually occur during screw or retractor placement at the acetabulum or proximal femur. ⋯ This case report describes an unusual injury to the femoral artery and vein by a cerclage wire passed around the femoral midshaft during revision total-hip arthroplasty. It underscores the need for diligent comparison of preoperative and postoperative vascular examinations and emergent vascular surgery consultation when needed to avoid disastrous complications.
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Blood management in the perioperative period of the total joint arthroplasty procedure has evolved over the last 3 decades. Strategies have changed and are changing based on a better understanding of blood loss and blood replacement options in this patient population. Patient-specific options based on preoperative hemoglobin levels and patient comorbidities as well as anticipated blood loss have been developed and studied. Patient-specific blood management programs have provided cost-efficient care with low morbidity.
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Venous thromboembolism is a recognized complication of total hip arthroplasty, knee arthroplasty, and hip fracture surgery. Various pharmacological agents have been introduced in orthopedic surgery in an attempt to reduce the mortality as well as the short-term and long-term morbidity associated with the development of deep vein thrombosis and pulmonary embolism. ⋯ The most current guidelines of the American College of Chest Physicians regarding thromboprophylaxis after total hip arthroplasty, total knee arthroplasty, and hip fracture surgery give the highest recommendations in support of the use of low-molecular-weight heparin, warfarin, or fondaparinux. Their highest recommendation is also given against the use of aspirin due to its lack of demonstrated efficacy.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cryo/Cuff compared to epidural anesthesia after knee unicompartmental arthroplasty: a prospective, randomized and controlled study of 60 patients with a 6-week follow-up.
The aim of this prospective, randomized, and controlled study was to evaluate the efficacy of cold compressive dressings (Cryo/Cuff) and epidural anesthesia (EDA) in the postoperative management of primary unicondylar knee arthroplasty. Sixty patients (61 knees) were randomized into 3 groups. ⋯ There was no significant difference in morphine consumption between the 2 treatment groups. Based on the results of this study, Cryo/Cuff seems to be a rational, effective, risk-free, and well-tolerated alternative to EDA to reduce pain and morphine after unicondylar knee arthroplasty.