Acta orthopaedica Scandinavica
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Clinical Trial Controlled Clinical Trial
Increased flexion and reduced hospital stay with continuous intraarticular morphine and ropivacaine after primary total knee replacement: open intervention study of efficacy and safety in 154 patients.
A single injection of bupivacaine after wound closure reduces the need for analgesics and increases flexion after total knee replacement (TKR). We have therefore studied the effect of continuous injection of morphine and ropivacaine after TKR on range of movement and length of hospital stay. ⋯ Continuous intraarticular morphine and ropivacaine reduce pain and enhance rehabilitation after total knee replacement. Before advocating this as a standard procedure, further large-scale randomized studies will be needed to assess the safety of this regimen.
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A maximum surgical blood ordering schedule may lead to wastage of valuable resources due to over-ordering of blood and/or under-utilisation. We audited the results of a group-and-save (GS) policy for primary hip (THR) and knee (TKR) arthroplasty to evaluate its safety and practicality. ⋯ For routine primary THR/TKR, GS policy is a safe procedure. Reduction in non-utilisation of blood has economic and cost-saving implications for limited healthcare resources. Having subsequently introduced a group-and-save policy for all patients undergoing routine THR/TKR, considerable savings have been identified after only 2 months.
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Review
Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review.
Postoperative delirium is a frequent and serious complication in elderly patients following operation for hip fracture, leading to an increased risk of complications. The pathophysiological mechanisms are unresolved, but probably multifactorial. The purpose of this review is to summarize current knowledge about the pathogenesis of postoperative delirium with a view to finding strategies for prevention and management. ⋯ Postoperative delirium is a serious complication. The pathophysiology leading to delirium after hip fracture surgery still remains to be clarified and no single drug or surgical regimen has proven to be preventive. This calls for more detailed investigations of the differential role of different pathogenic mechanisms, as well as an aggressive multimodal approach to enhance recovery and reduce morbidity, as has proven to be successful in a variety of elective surgical procedures. Such multimodal interventional studies represent a major task for orthopedic departments in collaboration with anesthesiologists, geriatricians, physiotherapists and nursing staff.
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Many surgical procedures have been developed for the treatment of kyphoscoliosis. We present our experience of one technique for posterior total wedge resection osteotomy, with clinical and radiographic results. This is a one-stage solution which results in a shortened posterior column and reduced tension on the spinal cord in rigid angular kyphosis. ⋯ Posterior total wedge resection osteotomy eliminates the need for anterior procedure and does not cause tractional force on the spinal cord, since the posterior column is shortened. This is an effective one-stage procedure, especially for the treatment of sharp and rigid kyphosis.