The Journal of arthroplasty
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The American Association of Hip and Knee Surgeons (AAHKS) distributed a survey to its members exploring practice patterns implemented to prevent venous thromboembolic disease (VTED) in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Of 720 (33%) members, 236 responded. Prophylaxis was prescribed for 100% of patients during the course of hospitalization for THA and TKA. ⋯ The most commonly employed mechanical modality was pneumatic devices in THA (51%) and TKA (50%). Universal acceptance of the need for prophylaxis administration for patients undergoing THA and TKA is shown. The method and duration remain highly variable; although the survey illustrates such variation, it suggests there is no one best method of prophylaxis.
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A 68-year-old patient developed Parsonage-Turner syndrome after total hip arthroplasty. There was an acute onset of intense pain in the shoulder 48 hours after surgery followed by complete paralysis of the shoulder and almost complete loss of strength in the arm. ⋯ For medicolegal reasons, it should be distinguished from a traction injury of the brachial plexus or compression of the radial or ulnar nerve resulting from positioning of the patient. Parsonage-Turner syndrome should be considered in the differential diagnosis when a patient describes pain or weakness in the shoulder after joint arthroplasty.
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In the current medical environment of increased awareness about latex sensitivity, more patients are presenting with known latex allergy. One such patient presented to us for total knee arthroplasty. During this procedure, we noticed holes in our latex-free surgical gloves when polymethyl methacrylate (PMMA) was being handled. ⋯ Biogel Neotech and Duraprene latex-free gloves show no such destruction. These results indicate that Allergard gloves should not be used in procedures in which bone-cement is employed. Biogel Neotech and Duraprene latex-free gloves are an acceptable alternative.
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Comparative Study
Continuous femoral blocks improve recovery and outcome of patients undergoing total knee arthroplasty.
This study was designed to determine the effects of continuous femoral infusion (CFI) on total knee arthroplasty recovery. A total of 92 patients were distributed in 3 groups: Patients in group 1 received general anesthesia followed by patient-controlled analgesia (PCA) with morphine (n = 33), patients in group 2 received 3-in-1 and sciatic blocks followed by CFI (n = 29), and patients in group 3 received epidural analgesia (n = 30). Blocks reduced postoperative morphine requirement by 74% (vs group 1; P<.05) and 35% (vs group 3; P<.05). ⋯ The use of CFI was associated with a reduction of postoperative bleeding by 72% (vs group 1; P<.05) and allowed better performance on continuous passive motion. CFI was associated with a 90% decrease in serious complications and a 20% decrease in the length of hospitalization. CFI represents a better alternative than PCA or epidural analgesia for postoperative pain management and immediate rehabilitation after total knee arthroplasty.
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Comparative Study
The efficacy of intra-articular analgesia after total knee arthroplasty in patients with rheumatoid arthritis and in patients with osteoarthritis.
The pain relief provided by intra-articular injection of morphine plus bupivacaine after total knee arthroplasty (TKA) plus partial synovectomy in patients with rheumatoid arthritis was compared with pain relief after TKA alone in patients with osteoarthritis. There were lower pain scores, a much smaller requirement for systemic analgesics, longer duration until the first requirement of systemic analgesics, and improvement in the range of motion of the knee joint in the patients who received intra-articular injection of analgesics. There was more pronounced postoperative analgesia in the patients with rheumatoid arthritis than in the patients with osteoarthritis in the study groups that received intra-articular injection of analgesics.