The Journal of arthroplasty
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We investigated the frequency of undiagnosed sleep apnea in patients scheduled for elective total joint arthroplasty. Two hundred fifty-four patients were assessed between September 1999 and May 2001. ⋯ The identification of undiagnosed OSA is an issue for orthopedic practice because many patients referred to an arthroplasty service for hip and/or knee surgeries are obese. A few screening questions, readily incorporated into the preoperative assessment, may prevent perioperative complications such as postextubation airway obstruction, negative pressure pulmonary edema, or opioid-induced airway obstruction.
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Comparative Study
Comparing the effects of femoral nerve block versus femoral and sciatic nerve block on pain and opiate consumption after total knee arthroplasty.
The goal of this study was to compare femoral and femoral plus sciatic nerve blocks in the postoperative pain management of patients undergoing total knee arthroplasty (TKA). A total of 97 patients participated in a convenience sample, comparative study. Patients who received femoral nerve block only (n = 30) reported statistically higher pain scores (P <.05) and showed 61% higher opiate consumption than those who received femoral and sciatic nerve blocks (n = 67) in the first 24 hours after surgery. The results suggest that the combined femoral and sciatic nerve block provides superior pain management in the early postoperative period after TKA.
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Periprosthetic fractures around hip prostheses are difficult problems. We reviewed the results of treatment with Wagner revision stems in geriatric patients (> or = 65 years old) with Vancouver type B2 periprosthetic fractures. Over a 5-year period, 14 patients with Vancouver's type B2 periprosthetic fractures in the proximal femur were revised. ⋯ Twelve patients were available for assessment; all 12 reconstructions showed a stable prosthesis and solid fracture union. Seven patients had excellent outcome, 3 had a good outcome, and 2 had a poor outcome. Our series shows that the Wagner revision stem is a satisfactory prosthesis in revision of Vancouver type B2 periprosthetic fractures in geriatric patients.
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Sixty-three cementless Mallory-Head HA-coated femoral prostheses (Biomet, Warsaw, IN) were used in primary total hip arthroplasty in 50 patients with osteoarthritic hips because of congenital hip dysplasia. The implanted cup was also cementless (41 Harris Galante and 22 Ringlock). The patients were followed up for a mean period of 75.1 months (range, 44-110). ⋯ No correlations were found between the radiologic phenomena and the clinical outcome, but the tightness of the prosthesis fit had a definitive influence on the radiographic bone remodeling pattern. The cementless Mallory-Head HA-coated femoral prosthesis shows excellent clinical and radiological mid-term results in osteoarthritic hip dysplasia patients. There was no need for the use of a specially designed dysplasia femoral prosthesis.
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Multicenter Study
Knee range of motion after total knee arthroplasty: how important is this as an outcome measure?
We investigated the relationship of knee range of motion (ROM) and function in a prospective, observational study of primary total knee arthroplasty (TKA). Preoperative and 12-month data were collected on 684 patients, including knee ROM, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function questionnaire scores, patient satisfaction, and perceived improvement in quality of life (QOL). ⋯ In linear regression models, WOMAC pain and function scores at 12 months were both correlates of patient satisfaction and perceived improvement in QOL (standardized beta>3.5; P<.0001), but knee flexion was not. For assessment of these outcomes, WOMAC function appears to be more important than knee flexion.