Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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To determine 1) causes of failure of primary total hip replacement (THR) in Thai patients and 2) whether patient characteristics, underlying diagnosis, and type of primary THR were associated with the causes of revision THR. ⋯ Most THRs failed after 5 years. Periprosthetic joint infection was the most common cause of failure in the early period. Aseptic loosening was a major cause of failure in the late period and overall in both periods. Hybrid fixation is an independent risk factor for revision surgery after primary THR. Younger patients at the time of primary THR were associated with a reduced risk for failure.
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Low urine output (LUO) for six hours is defined as the stage that is at risk of acute renal failure. Major surgeries with a bloodless field, such as total knee arthroplasty (TKA), may be associated with LUO; however; there has been no study addressing this point. The present study evaluated the incidence of LUO and the effect of fluid balance on LUO in TKA patients during the first 24 hours after surgery. ⋯ Urine output is one of the common monitoring parameters of fluid balance in the perioperative period; it should be ≥ 0.5 mL/kg/h. Prolonged low urine output for six hours and for 12 hours are categorized as causing risk and injury to the kidney, respectively. The incidence of LUO at our institution during the first 24 hours after TKA is not uncommon and is significantly related to intra-operative fluid replacement. Fortunately, all LUO patients had further fluid replacement, resulting in no renal complications at discharge. As eighty percent of patients had less than ideal fluid replacement, and patients having LUO during the first 24 hours had a significantly lower volume of intra-operative fluid replacement, the authors propose reconsidering perioperative fluid replacement in TKA patients, especially intra-operative IV fluid to avoid LUO.
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Randomized Controlled Trial
Post-op pain and blood loss in total knee arthroplasty: an RCT using periarticular injection with diclofenac-based multimodal drugs.
To study post-operative pain and blood loss after intraoperative periarticular injection with the multimodal drugs diclofenac, adrenaline, marcaine (bupivacaine) and morphine in total knee arthroplasty. ⋯ Multimodal drugs, periarticular injections consisting of diclofenac, adrenaline, Marcaine plus a patient controled anesthetic machine (PCA) with morphine can significantly reduce post-operative pain and blood loss in total knee arthroplasty without significant adverse effects.
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Knee osteoarthritis (OA) with pain, stiffness and functional limitations is associated with risk of falls. Total knee arthroplasty (TKA) is an effective treatment for OA knee and affords significant improvements in pain, function and proprioception. Many studies have shown proprioceptive/balance deficits and decreases in knee extension strength following TKA, which could increase risk of falls. ⋯ The prevalence rate offalls for this group of TKA patients was about 42%. Limited motion and pain of the knee joint were associated with falls in this study group.
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Acute kidney injury (AKI) is a common complication in patients undergoing open cardiac surgery. Urinary neutrophil gelatinase-associated lipocalin (UNGAL) is an early marker of AKI, however its predictive value in adult patients undergoing open cardiac surgery has never been investigated in Thailand. ⋯ UNGAL level may be a useful marker for predicting AKI in Thai adult patients undergoing open cardiac surgery. Lower ejection fraction and longer CPB time were two major risk factors for AKI development.