The Knee
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Randomized Controlled Trial
Intra-articular local anaesthetic on the day after surgery improves pain and patient satisfaction after Unicompartmental Knee Replacement: a randomised controlled trial.
Intra-operative local anaesthetic infiltration provides good early pain relief after Unicompartmental Knee Replacement (UKR). However, appreciable pain may occur on the day after surgery. The purpose of this double-blinded, prospective randomised controlled trial was to evaluate the effectiveness of a bolus of local intra-articular anaesthetic given early on the day after surgery. ⋯ Patients injected with bupivacaine had significantly less (p<0.001) pain than control patients immediately (mean pain score 1.82 v 6.1) and 6 hours (2.5 v 5.7) after injection. Patient satisfaction was also significantly greater (p<0.001) in the local anaesthetic group. We conclude that a bolus dose of intra-articular bupivacaine early on the day after surgery dramatically improves pain control after UKR and improves patient satisfaction.
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Randomized Controlled Trial Comparative Study
Reducing blood loss in primary knee arthroplasty: a prospective randomised controlled trial of tranexamic acid and fibrin spray.
A prospective, randomised controlled trial compared the effects of two medications intended to reduce blood loss from total knee arthroplasty. Patients were randomised to one of the following three treatment groups: 10mg/kg tranexamic acid at given at induction of anaesthesia, 10 ml of fibrin spray administered topically during surgery, or to a control group receiving neither treatment. Sixty six patients underwent elective cemented total knee arthroplasty; computer navigation was used in all cases. ⋯ The fibrin spray led to a significant reduction in blood loss compared to control (p=0.007). The effect of tranexamic acid did not reach significance (p=0.173). We conclude that fibrin spray was effective in reducing blood loss but that with a study of this power, we were unable to detect an effect of tranexamic acid in cemented navigated total knee replacement at the dose used.
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Randomized Controlled Trial
Does periarticular injection have additional pain relieving effects during contemporary multimodal pain control protocols for TKA?: A randomised, controlled study.
Although the analgesic effects of periarticular multimodal drug injection (PMDI) after TKA have been well documented, there is little information about additional pain relieving effects of PMDI incorporated to contemporary multimodal pain control protocols which have been proved to provide excellent analgesia. We performed a parallel-group, randomised, controlled study to determine whether PMDI provides additional clinical benefits on contemporary multimodal analgesic protocols including preemptive analgesics, continuous femoral nerve block, and IV-PCA. Eighty-seven patients were randomized to a PMDI group (n=45) or to a No-PMDI group (n=42). ⋯ However, the PMDI group had a higher VAS pain score on the 1st postoperative day than during the operation night. No group differences in side-effects and complication incidences, functional recovery, and satisfaction were found. This study demonstrates that PMDI provides additional pain relief and reduces opioid consumption only during the early postoperative period in patients managed by the contemporary pain management protocol following TKA.
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A reduced range of motion post total knee replacement (TKR) is a recognised problem. Manipulation under anaesthesia (MUA) is commonly performed in the stiff post-operative TKR. Long-term results are variable in the literature. ⋯ However, one patient was eventually revised at 2 years secondary to low grade infection. Our findings show that MUA is a safe and effective method at improving the ROM in a stiff post-operative TKR. The improvement is maintained in the long term irrespective of time to MUA and range of motion pre TKR.
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Patellar resurfacing during total knee arthroplasty (TKA) remains controversial. The aim of this study was to evaluate the long-term outcomes of a mobile-bearing TKA without patellar resurfacing. ⋯ Non-resurfacing of the patella does not adversely affect the outcome of the LCS mobile bearing TKA at minimum 10 years follow-up.