Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 1987
Patient-controlled analgesia in the total joint arthroplasty patient.
In a prospective study of 30 total hip or knee joint arthroplasty patients, the use of the patient-controlled analgesia (PCA) pump was evaluated for patient acceptance and relief of pain. In 30 patients, (average age, 72.5 years) excellent analgesia was obtained with the PCA machine without the side effects of conventional intramuscular dosing. PCA was enthusiastically received by nurses, physicians, and patients, and it has become the method of choice in the author's hospital.
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Eighty-five patients with a total of 103 foci of chronic hematogenous osteomyelitis were treated in the period from 1965-1982. Only patients who had been followed for two or more years of treatment were included in the series for evaluation. All foci were treated surgically with thorough debridement. ⋯ Closed intermittent irrigation and suction drainage with high concentrations of antibiotic solutions gave the best results. In instances of failure, the causes may be due to inadequate removal of infected sclerotic bone and sequestra, obstruction of drainage tubes, resistance to antibiotics, or inadequate systemic antibiotic treatment. The use of myocutaneous flap transference to close the postoperative wound of chronic osteomyelitis was introduced, and preliminary results are encouraging.