The Journal of arthroplasty
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Cryotherapy is widely used as an emergency treatment of sports trauma and postoperatively especially after anterior cruciate ligament reconstruction. Studies in the literature on the effect of cryotherapy after total knee arthroplasty (TKA) have been limited and controversial. In this prospective study, 60 primary TKAs were done on 30 patients (all staged bilateral TKAs). ⋯ The other TKA in the same patient (control TKA) was done 6 weeks later and had no cooling device. The study compared the range of motion, the volume of hemovac output and blood loss, visual analog pain score, analgesic consumption, and wound healing in the 2 limbs of the same patient. This study showed that continuous-flow cold therapy is advantageous after TKA because it provides better results in all the areas compared.
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One-staged ipsilateral and contralateral total hip and total knee arthroplasties were compared. A total of 103 patients underwent a 1-staged total knee arthroplasty and total hip arthroplasty between January 1975 and July 1997 (67 contralateral and 36 ipsilateral patients). No prostheses were found to be loose or revised. ⋯ There was no significant difference in survival between the contralateral and ipsilateral groups. There was only 1 death within 3 months of the operation. The severity of these patients' deformity may necessitate these procedures be done at 1 operation with consideration of mortality and morbidity risks.
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Sleep apnea syndrome (SAS) is a condition of repeated episodes of apnea and hypopnea during sleep. It can cause life-threatening morbidities, including cardiac arrhythmia and ischemia, hypertension, and respiratory arrest, and even death. ⋯ There were 19 patients with a preoperative diagnosis of moderate or severe SAS; 15 patients received continuous positive airway pressure or bilevel positive airway pressure noninvasive ventilation, 1 patient experienced respiratory arrest secondary to intraoperative propafol, and 2 patients developed postoperative respiratory depression. Avoidance of opioids and sedative drugs, awareness of the possibility of acute airway obstruction, and close monitoring during and after surgery are vital in patients with SAS.
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The results of cemented total hip arthroplasty (THA) in patients with ankylosing spondylitis were studied to determine the utility of THA for these patients. A total of 103 patients with ankylosing spondylitis underwent 181 THAs; 72 patients (69.9%) had bilateral surgery. The mean follow-up was 10.3 years. ⋯ At final follow-up examination, 173 hips (96%) had an excellent (low) pain score, and 53 hips had a normal or near-normal function score (29.2%). The probability of survival of the implant was 71% at 27 years. THA provides long-term improvement in hip function for patients with ankylosing spondylitis.
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Randomized Controlled Trial Clinical Trial
Lumbar paravertebral nerve block in the management of pain after total hip and knee arthroplasty: a randomized controlled clinical trial.
The accepted mode of pain management after total hip or knee arthroplasty is patient-controlled analgesia. This study evaluates the efficacy of lumbar paravertebral nerve block in diminishing postoperative pain when used as an adjunct to patient-controlled analgesia. A total of 115 arthroplasty patients received postoperatively a lumbar paravertebral nerve block (block, n = 57) or a sham procedure (control, n = 58). ⋯ Visual analog scale pain score measurements at 4, 8, and 24 hours did not differ significantly between the groups. Paravertebral nerve block of the lumbar plexus is an invasive procedure with some risk. Considering the added risk and minimal benefits, routine use of this procedure is not supported.