The Knee
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Randomized Controlled Trial Clinical Trial
Intra-articular morphine and postoperative analgesia after knee arthroscopy.
The aim of this study was to evaluate the postoperative analgesic effect of intra-articular administration of a low- and a high-dose morphine solution after knee arthroscopy. Thirty patients who underwent diagnostic arthroscopy or arthroscopic meniscectomy were allocated in three groups. At the end of the arthroscopic procedure patients in Group A received intra-articularly 20 ml normal saline (N/S), Group B received 5 mg morphine in 20 ml N/S and Group C received 15 mg morphine in 20 ml N/S. ⋯ Side effects from the central action of opioids were not detected. Although the pain scores in the group of low-dose morphine were lower than in the control group, we failed to detect any significant differences in pain scores among the three groups. There was evidence that a high-dose can cause hyperalgesia.
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We investigated the physical characteristics and symptoms related to kneeling in a normal population. One hundred people were recruited at random. Of these, 27 subjects had knee pain and 73 were normal. ⋯ The 27 subjects with knee pain were able to kneel at 90 degrees with an average of 97% of their body weight and in full flexion with an average of 50% of their body weight. Weight transmitted through the knees at full flexion is significantly less than when at 90 degrees whether subjects had pain or not. Future development of knee arthroplasty, when catering for kneeling might need to concentrate on achieving a better range of movement.
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Femoral fracture may predispose the knee to the development of post-traumatic arthritis by either a direct intra-articular injury or residual limb malalignment. Malunion, intra-articular osseous defects, limb malalignment, retained internal fixation devices, and compromised surrounding soft tissues may in turn affect the outcome of total knee arthroplasty (TKA) in these patients. The aim of our study was to evaluate the result of TKA in patients with previous distal femoral fracture. ⋯ Significant improvement in function and relief of pain is seen in the vast majority of patients with previous distal femoral fractures undergoing subsequent TKA. However, these patients are at increased risk for restricted motion and perioperative complications following TKA. Special efforts to preserve the vascularity of the skin and subcutaneous tissues, restore limb alignment, ensure correct component positioning, and achieve soft tissue balance may help minimize the problems identified in this study.