The American journal of orthopedics
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Uncontrolled pain associated with total knee arthroplasty can have significant untoward effects on patient outcomes, leading to delayed recovery, inability to participate in rehabilitation, prolonged hospitalization, and increased use of health care resources. In this article, I review the methodologies and outcomes of several studies and protocols involving preemptive, perioperative, and postoperative use of various anesthetic and analgesic agents. Used together with minimally invasive techniques, appropriate pain control should result in significant improvements in patient outcomes.
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Autogenous iliac crest bone graft (ICBG) is the gold standard of materials for spinal fusion. We conducted a prospective observational study of posterior autogenous ICBG harvesting and used process measures to establish a normative database of bone harvesting for future comparative studies and analyses of bone graft substitutes. Between August 2000 and March 2002, we obtained posterior autogenous ICBG from 36 consecutive patients (29 men, 7 women). ⋯ With the emergence of bone graft substitutes, costs and benefits of autogenous ICBG harvesting will be scrutinized. This database establishes a prospective benchmark for additional EBL, harvest time, harvest volume, and SI joint violation for ICBG harvesting. To our knowledge at the time of manuscript preparation, this is the first report of routine use of postoperative computed tomography to determine incidence of SI joint violation after ICBG harvesting.