Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Nov 2004
Soft tissue and intra-articular injection of bupivacaine, epinephrine, and morphine has a beneficial effect after total knee arthroplasty.
The purpose of this study was to determine if an intraoperative intraarticular and soft-tissue injection of local anaesthetic, epinephrine, and morphine has a beneficial effect for total knee arthroplasty. A control group of 138 patients (181 knees) received no intraoperative injection. The study group of 171 patients (197 knees) received intraoperative injection of 0.25% bupivacaine with epinephrine and morphine with 2/3 injected into the soft tissues and 1/3 injected into the joint. ⋯ Considerably more control patients required rescue doses of narcotics. Preemptive analgesia with soft tissue and intra-articular injection of long-acting local anesthetic with epinephrine and morphine provides better pain control in the immediate postoperative period, decreases blood loss, and decreases the need for rescue narcotics and reversal agents. This simple, inexpensive method provides an effective adjunct to a multimodal approach in improving the postoperative course of primary total knee arthroplasty.
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Clin. Orthop. Relat. Res. · Nov 2004
Randomized Controlled Trial Comparative Study Clinical TrialPatella resurfacing versus nonresurfacing in total knee arthroplasty: results of a randomized controlled clinical trial at a minimum of 10 years' followup.
Patellar resurfacing in total knee arthroplasty remains controversial. This study evaluates the results of resurfacing and nonresurfacing the patella in a randomized controlled, clinical trial at a minimum of 10 years followup. One hundred knees (90 patients) with osteoarthritis were enrolled in a prospective randomized clinical trial using a posterior-cruciate-retaining total knee arthroplasty. ⋯ Intraoperative cartilage quality was not a predictor of outcome. This study currently is the longest followup of a randomized controlled, clinical trial that examines patellar resurfacing in total knee arthroplasty. The results showed no significant difference between the groups for all outcome measures at a minimum of 10 years of followup.
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Clin. Orthop. Relat. Res. · Nov 2004
Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty.
Nine patients with chronic extensor mechanism disruption were treated with an extended medial gastrocnemius rotational flap reconstruction of the extensor mechanism. Seven patients previously had total knee arthroplasty and two patients had chronic infection of nonreplaced, native knees. Four patients previously had failed Achilles' tendon allograft reconstruction after total knee arthroplasty and two were complicated by infection. ⋯ Two patients were able to ascend stairs foot over foot without support. In addition to the patient who had amputation, the other complication involved a wound breakdown that required a free flap at 13 months in a patient who had a failed Achilles' tendon allograft reconstruction after takedown of a knee fusion. Medial gastrocnemius flap reconstruction can provide successful salvage of a failed extensor mechanism allograft or an alternative to allograft reconstruction in patients with poor soft tissue coverage, previous infection, or a compromised immune system.
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Clin. Orthop. Relat. Res. · Oct 2004
ReviewLocal antibiotic therapy in the treatment of open fractures and osteomyelitis.
Local antibiotic therapy is part of the treatment protocol of open fractures and osteomyelitis. However, there are limitations in the literature evaluating the efficacy of the technique and controversies remain. Polymethylmethacrylate cement commonly is used as a delivery vehicle, but bioabsorbable vehicles are being investigated. ⋯ Local antibiotics effectively have controlled infection in animal models and, despite limitations of the existing literature, seem to be useful in the clinical setting. The length of implantation and the need for removal of the delivery vehicle remain controversial. Nonabsorbable vehicles may eliminate the need for reoperation and removal.
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Clin. Orthop. Relat. Res. · Oct 2004
ReviewPractical applications of antibiotic-loaded bone cement for treatment of infected joint replacements.
The use of antibiotic-loaded bone cement is an accepted treatment method for infected joint arthroplasties. It is helpful to separate the use of antibiotic-loaded bone cement as a method of prophylaxis as compared with the treatment of an established infection. A low dose of antibiotic-loaded bone cement (< or = 1 g of antibiotic per batch of cement) should be used for prophylaxis, and high-dose antibiotic-loaded bone cement (> 1 g antibiotic per batch of cement) is indicated for treatment. ⋯ High-dose antibiotic-loaded bone cement requires hand mixing by the surgeon to facilitate the use of high dosages and choices of multiple antibiotics. Treatment of infected hip and knee arthroplasties with high-dose antibiotic-loaded bone cement is aided by the use of spacers of various shapes and sizes. These spacers, whether they are static or articulating (mobile), are meant to provide local delivery of antibiotics, stabilization of soft tissues, facilitation of an easier reimplantation, and improved clinical outcomes.