The Knee
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Randomized Controlled Trial Comparative Study
Pain control after primary total knee replacement. A prospective randomised controlled trial of local infiltration versus single shot femoral nerve block.
We report a prospective blinded randomised trial of local infiltration versus femoral nerve block in patients undergoing primary total knee replacement (TKR), in accordance with the CONSORT statement 2010. ⋯ Intraoperative local infiltration gives superior pain relief compared to single shot femoral nerve block over the first 24h following primary TKR and minimises post-operative opiate use.
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To compare the patient-reported outcomes and arthroscopic findings between drilling and autologous osteochondral grafting (AOG) for the treatment of articular cartilage defects combined with anterior cruciate ligament (ACL) injuries. ⋯ Case-control study (LEVEL III).
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Local infiltration analgesia (LIA) is a relatively novel technique developed for effective pain control following total knee arthroplasty (TKA), reducing requirements for epidural or parenteral postoperative analgesia. This study investigated the anatomical spread of an LIA used in TKA to identify the nerve structures reached by the injected fluid. ⋯ These results support the positive clinical outcomes with this LIA technique. However, the lack of infiltration into the lower popliteal fossa suggests more fluid or a different injection point could be used. The solution reaching the extensor muscles of the lower leg is likely to have no beneficial analgesic effect for a TKA patient. The LIA technique is already used in clinical practice following total knee arthroplasty. Results from this study show there may be scope to optimise the injection sites in LIA technique.
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Fast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee arthroplasty. ⋯ Optimisation of pre-, per- and postoperative pathway for knee arthroplasty reduces morbidity after this type of surgery and results in shorter length of stay.
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In this review the evidence for the management of patients with patellofemoral disorders is presented confined to anterior knee pain and patellar dislocation (excluding patellofemoral arthritis). Patients present along a spectrum of these two problems and are best managed with both problems considered. ⋯ Operations should be reserved for those with correctable anatomical abnormalities that have failed conservative therapy. The current dominant operation is a medial patellofemoral ligament reconstruction.