The Journal of arthroplasty
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Hemiarthroplasty of the hip for displaced fracture of the femoral neck (including Austin-Moore and Thompson arthroplasties) frequently is performed by orthopaedic surgeons. The posterior approach is used despite the slight increase in risk of postoperative dislocation. The outcome after dislocation can be disastrous. ⋯ From January 1998 to April 1999, 205 hips were operated on and followed up for >3 months; no dislocation was found. Using the past records as the comparative group, 28 posterior dislocations (1.9%) were found in 1,483 hip hemiarthroplasties using the posterior approach (P <.05 using exact probability test). Enhanced soft tissue repair with locking loop stitch is an effective way to reduce the incidence of dislocation after hip hemiarthroplasty using the posterior approach.
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The purpose of this study was to evaluate the efficacy of combined lumbar plexus block techniques for total knee arthroplasty. Long-acting local anesthetics were used to ensure adequate intraoperative and postoperative anesthesia and analgesia. All patients undergoing total knee arthroplasty at our institution were offered lumbar plexus block after obtaining informed consent. ⋯ There was a 92% overall satisfaction rate with the anesthesia provided by the lumbar plexus block. Lumbar plexus block can be used successfully for total knee arthroplasty. Lumbar plexus block appears to have advantages for early postoperative analgesia, leading to increased patient comfort and satisfaction.
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Randomized Controlled Trial Clinical Trial
Aprotinin (Trasylol) does not reduce bleeding in primary total hip arthroplasty.
This is a randomized, double-blind, controlled study of the effects of aprotinin (Trasylol) during primary total hip arthroplasty. Sixty patients were randomized to receive either 1.5 x 10(6) KIU of aprotinin or a similar volume of normal saline as a bolus preoperatively. Blood loss was measured from the femoral canal at the time of surgery. ⋯ There was no significant difference between the groups in terms of total blood loss, postoperative hemoglobin, or transfusion requirement. In the group that received aprotinin, there was a trend toward reduced blood loss from the femoral canal, but this was not statistically significant. The results of this study do not support the routine use of aprotinin in primary total hip arthroplasty.
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Complications after spinal or epidural anesthesia are rare. We report 2 cases of postoperative, complete paraplegia after regional anesthesia in orthopaedic patients not on anticoagulants. ⋯ A review of the literature regarding complications of regional anesthesia is presented. Regional anesthesia should be administered with caution and in selected patients.
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The Swedish National Total Hip Arthroplasty (THA) Register was initiated in 1979, and it is one of the oldest quality registers in the world. The register covers all hospitals in Sweden, and today it contains > 205,000 hip arthroplasties. The failure endpoint definition in the register is revision. ⋯ The risk for death compared with an age-matched and sex-matched population was lower for patients with osteoarthrosis treated with hip arthroplasty. The results with revision as failure endpoint showed that the Swedish THA register is reliable. The register includes >95% of the primary and revision THAs performed in Sweden between 1986 and 1995.