The Knee
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Femoral nerve block (FNB) is a well documented option for post-operative analgesia following major knee surgery. However, motor blockade may be prolonged preventing early mobilisation thereby increasing the length of stay. ⋯ The literature, which is largely in anaesthetic journals, reflects the high quality of analgesia of FNB but makes little or no mention of the delays or dangers in early mobilization. We believe that the potential risks to orthopaedic patients are underestimated.
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We measured the location of the popliteal artery (PA) in extension and 90 degree of knee flexion by magnetic resonance images (MRI) to provide practical information to avoid PA injury. The MRIs of 30 knees of Korean male subject whose mean age was 20.7 were acquired in knee extension and 90 degree flexion. The distance from the posterior aspect of knee joint to the PA was measured at three levels on the axial images and one sagittal image. ⋯ The PA was located around 3 mm lateral to the PCL, and within 5 mm in extension and 10 mm in 90 degree flexion of the knee behind knee joint. It moves farther posteriorly in 90 degree flexion than in extension of the knee. The conventional wisdom of flexing the knee to prevent the PA injury was supported by this study.
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Randomized Controlled Trial
Walking shoes and laterally wedged orthoses in the clinical management of medial tibiofemoral osteoarthritis: a one-year prospective controlled trial.
The purpose of the study was to examine the clinical efficacy of individually prescribed laterally wedged orthoses and walking shoes in the treatment of medial knee osteoarthritis using a prospective, single-blind, block-randomized controlled design. Sixty-six subjects (29 males, 37 females, mean age 62.4 years, mean BMI 33.0 kg/m(2)) were block-randomized to a lateral wedge (treatment) or neutral (control) orthotic group. Both groups were issued a standardized walking shoe for use with the orthoses. ⋯ Both groups also improved in 6-minute walk test distance (p<0.001), stair negotiation test time (p=0.004), and stair negotiation test pain change (p<0.001). The results suggest that both neutral and laterally wedged orthoses may be beneficial in the management of medial knee osteoarthritis when used with walking shoes. However, the addition of lateral wedging was associated with early improvements in 6-minute walk test pain change not seen in the control group.
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The purpose of the current study was to investigate inpatient recovery process during relaxed standing, and to clarify the question of when postoperative standing function would improve beyond preoperative level of function following total knee arthroplasty (TKA). Thirty patients with bilateral knee osteoarthritis, averaged 75 years old, participated. Subjects underwent unilateral TKA. ⋯ After TKA, knee flexion angle during standing became maximum (20.0) on postoperative day 4. Thereafter, subjects could gradually extend the knee, and on postoperative day 16, it (14.3 degrees ) was smaller. From our results, subjective pain was significantly reduced from postoperative day 8, and objective knee condition, including vertical knee force on TKA side and knee flexion angle on TKA side during standing, significantly became better from postoperative day 17 and 16, respectively.
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We compared the distance of patellar subluxation (lateral patellar displacement) during MIS TKA arthrotomy among sequential variations of tourniquet application and soft tissue release in a consecutive series of 40 knees. The distance of patellar subluxation from the Whiteside's line was measured for every knee under four consecutive conditions; A) the tourniquet inflated with knee in full extension, B) no tourniquet pressure applied, C) the tourniquet inflated with knee in deep flexion, and D) the tourniquet inflated with knee in deep flexion and lateral tibial release (a limited subperiosteal soft tissue dissection including limited patellar fat pad excision and limited capsular release from the upper lateral tibial plateau). There were 28 women and 12 men with the average age of 70 years and the average BMI of 25.5. ⋯ However, there was no statistical difference of measured distance between group with condition B and C (p=0.40). In conclusion, when MIS TKA is performed using the tourniquet, inflating the tourniquet with knee in deep flexion provided better arthrotomy exposure than the knee in full extension. Combined inflating tourniquet in deep knee flexion and lateral tibial release provided the greatest arthrotomy visualization.