The Knee
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Comparative Study
Continuous adductor canal blockade facilitates increased home discharge and decreased opioid consumption after total knee arthroplasty.
There is a growing interest in avoiding discharging patients to rehab to maximize outcome and minimize complications after total knee arthroplasty (TKA). In addition, use of postoperative pain pathways that minimize opioid use is critical amidst the current opioid epidemic. However, the ideal pain regimen after TKA has yet to be determined. ⋯ Level III.
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Comparative Study
Comparison of pharmacologic prophylaxis in prevention of venous thromboembolism following total knee arthroplasty.
Anticoagulants are used following total knee arthroplasty (TKA) to prevent venous thromboembolism (VTE). These drugs reduce VTE risk but may lead to bleeding-related complications. Recently, surgeons have advocated using antiplatelet agents including aspirin (ASA). However, there is no consensus regarding which medication has the optimal risk/benefit profile. The purpose of this study was to compare rates of VTE using different anticoagulants in anticoagulation-naïve patients being discharged home after TKA. ⋯ III.
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Total knee arthroplasty (TKA) remains the gold standard for end-stage knee osteoarthritis. The prevalence of stiffness after this procedure described in literature varies from 1.3% to 5.3%. The causes of arthrofibrosis after total knee arthroplasty are multifactorial. Revision TKA is a successful procedure when performed for loosening, instability, mechanical implant failure, or infection. The results of revision TKA for idiopathic arthrofibrosis and stiffening are however less favorable. ⋯ Our data show that revision arthroplasty of the stiff knee using a rotating hinged device can provide excellent results in selected cases. To date, this is the first study to describe the difference in outcome between revision total knee arthroplasty for idiopathic arthrofibrosis using a hinged or a constrained condylar knee device.
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A source of myofascial pain and myofascial trigger points (MTrPs) in muscles of the knee area could play a crucial role in the management of pain in osteoarthritis patients. The aim of this study was to describe and compare demographic, clinical and myofascial pain syndrome characteristics in older adults with knee osteoarthritis by sex and age distribution. ⋯ The demographic and clinical features of older adults with knee osteoarthritis may be influenced by sex and age distribution. Nevertheless, the myofascial pain syndrome associated with knee osteoarthritis did not seem to be related to sex or age distribution.
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Metal metaphyseal sleeves are an option for reconstruction as well as enhancing fixation in managing challenging bone defects in revision knee replacement. We report our results of revision knee replacement using metaphyseal sleeves with a minimum of seven years of follow-up. ⋯ At mid-term follow-up, metaphyseal sleeves demonstrate durable clinical results and radiographic fixation.