Eur J Orthop Surg Tr
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Eur J Orthop Surg Tr · Dec 2015
Randomized Controlled Trial Multicenter Study Comparative StudyLocal infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial.
Shoulder replacement involves significant post-operative pain, which is often managed by continuous interscalene brachial plexus block. Catheter displacement and complications limit the beneficial effect of the block. Local infiltration analgesia (LIA) has provided good results in knee replacement. We aimed to assess the effectiveness of LIA for pain after shoulder replacement. ⋯ The LIA technique cannot be recommended for shoulder replacement unless substantially modified. Occurrence of inadequate analgesia and complications following interscalene brachial plexus block prompt further studies into pain management after shoulder replacement.
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Cartilage damage or mechanical blocking from screw penetration into intra-articular cartilage can reduce the chances of successful outcomes during medial malleolus fixation. There have been diverging opinions among surgeons concerning the reliability of radiographic assessment of fracture fixation and malleolus screw positioning. Therefore, this radiographic study examines the location of medial malleolus lag screws relative to the ankle mortise articular surface. ⋯ At 20° internal rotation, a screw with a known extra-articular position appeared to be within the cartilage. Intra-operative fluoroscopy is necessary to ensure proper extra-articular placement of screws. If a screw is pictured extra-articular in any radiograph, then it can be assumed that the screw is indeed out of the joint.
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Eur J Orthop Surg Tr · Oct 2015
Comparative StudyValidation study of the Forgotten Joint Score-12 as a universal patient-reported outcome measure.
The Forgotten Joint Score-12 (FJS-12) is for patients to forget their artificial joint and is reportedly a useful patient-reported outcome tool for artificial joints. The purpose of this study was to determine whether the FJS-12 is as useful as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) or the Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) in Japan. ⋯ The FJS-12 was correlated with and showed reliability similar to that of the JHEQ and WOMAC. The FJS-12, which is not affected by culture or lifestyle, may be useful in Japan.
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Eur J Orthop Surg Tr · Oct 2015
Randomized Controlled TrialIntra-articular injection of tranexamic acid reduce blood loss in cemented total knee arthroplasty.
The purpose of this study was to compare the efficacy of intravenous and topical tranexamic acid (TXA) versus control group for reduction in blood loss following primary total knee arthroplasty (TKA). A total of 90 patients were prospectively allocated to each of three groups (control, intravenous IV and intra-articular) and underwent unilateral total knee arthroplasty. In the IV group, patients received one dose of TXA of 15 mg/kg before deflation of the tourniquet, while in the intra-articular group patients received 2 g TXA via the drain retrogradely after closure of the wound. ⋯ TXA reduced blood loss and transfusion requirement. Compared with one-dose intravenous administration, intra-articular administration of TXA seems to be more effective in terms of reducing drained blood loss and transfusion frequency. We recommend administration of topical TXA in primary TKA in healthy patients to decrease perioperative blood loss.
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Eur J Orthop Surg Tr · Oct 2015
Comparative StudyImplant-related complications following hip hemiarthroplasty: a comparison of modern cemented and uncemented prostheses.
Fractured neck of femurs is a very common presentation to hospital, especially in an elderly population and in almost all cases requires an operation, usually a cemented or uncemented hemiarthroplasty. Current evidence and multiple guidance issued in UK suggest the use of cemented hemiarthroplasty above uncemented prostheses. This retrospective case series performed in District General Hospital in Wales, UK. ⋯ In both groups, 24-h mortality rate was similar. Our study supports the use of modern cemented prosthesis as opposed to modern uncemented hemiarthroplasty. Post-operative complication rate after uncemented prosthesis is unacceptably high, especially periprosthetic fracture rate.