Acta Orthop Belg
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Randomized Controlled Trial
Local Infiltration Analgesia reduces pain and hospital stay after primary TKA : randomized controlled double blind trial.
Postoperative analgesia following Total Knee Arthroplasty (TKA) with the use of parenteral opioids or epidural analgesia can be associated with important side effects. Good perioperative analgesia facilitates faster rehabilitation, improves patient satisfaction, and may reduce the hospital stay. We investigated the analgesic effect of a locally injected mixture of drugs, in a double blinded RCT in 80 primary TKA. ⋯ In addition, they had lower VAS for pain during rest and activity and higher visual analog scores for patient satisfaction 72 hours postoperatively. No major complication related to the drugs was observed. Intraoperative periarticular injection with multimodal drugs following TKA can significantly reduce the postoperative pain and hence the requirements for PCA and hospital stay, with no apparent risks.
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Randomized Controlled Trial
The effect of local and systemic application of tranexamic acid on the amount of blood loss and allogeneic blood transfusion after total knee replacement.
The effect of local and systemic Tranexamic Acid on blood loss and need for transfusion after total knee replacement was compared prospectively. Between 2012-2013, 90 patients with unilateral TKR were included. They were randomly divided into 3 and 15 mg/kg TXA was infused before and 10 mg/kg 1 hour after surgery in Group 1, 2 gr TXA was used topically in 2 and no TXA was applied in 3. ⋯ No thromboembolic problem was seen in any patient. Since TXA decreased blood loss and lessen the need for transfusion significantly without increasing thromboembolic events in TKR, we suggest its usage in TKR either systemically or topically whenever possible. Level of evidence: Prospective Randomized Controlled Trial, Level II).
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The mechanism of neuropathic pain (NP) and osteoarthritic (OA) pain, although different, are both defined as chronic pain, and combinations are possible. In this study, the awareness of both types of chronic pain was investigated among patients and doctors. This prospective study was planned and coordinated by the orthopedic and internal medicine clinics and included 100 patients with a diagnosis of knee OA evaluated with the DN4 questionnaire. ⋯ It was observed that in these two knee OA patient groups, NP had a statistically significant enhancing effect on the WOMAC pain score and the VAS (p < 0.001). As underlying pathophysiological mechanism of pain caused by OA is complex, and OA is considered to have a component of NP, it has been proven to be useful to use drugs apart from conventional treatments for NP. We believe that, as a source of pain that is not relieved after arthroplasty, awareness level of NP among orthopedists should be increased and multidisciplinary studies are required on this topic.
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The purpose of this study is to analyze the clinical results of meniscal tears repaired with an all-inside suture with special attention to the results in stable versus anterior cruciate ligament (ACL)-deficient knees. ⋯ Our clinical results show that arthroscopic meniscal repair with all-inside devices provided a high rate of meniscus healing and seem to be safe and effective, for isolated meniscal tears as well as for ACL-deficient knees with meniscal tears. Final functional scores were similar for ACL-competent and ACL-deficient knees.