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Bhenderu LS, Lyon KA, Soto JM, Richardson W, Desai R, Rahm M, Huang JH. Ropivacaine-Epinephrine-Clonidine-Ketorolac Cocktail as a Local Anesthetic for Lumbar Decompression Surgery: A Single Institutional Experience. World Neurosurg 2023; 176:e515-e520. [PMID: 37263493 DOI: 10.1016/j.wneu.2023.05.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The goal of this study is to discuss our initial experience with a multimodal opioid-sparing cocktail containing ropivacaine, epinephrine, clonidine, and ketorolac (RECK) in the postoperative management of lumbar decompression surgeries. METHODS Patients were either administered no local anesthetic at the incision site or were administered a weight-based amount of RECK into the paraspinal musculature and subdermal space surrounding the operative site once the fascia was closed. We performed a retrospective chart review of all patients 18 years of age or older undergoing lumbar laminectomy and lumbar diskectomy surgeries between December 2019 and April 2021. Outcomes including total opioid use, measured as morphine milligram equivalent, length of stay, and postoperative visual analog scores for pain, were collected. Relationships between variables were analyzed with Student's t-test, chi-square tests, and Fisher exact tests. RESULTS A total of 121 patients undergoing 52 lumbar laminectomy and 69 lumbar diskectomy surgeries were identified. For lumbar laminectomy, patients who were administered RECK had decreased opioid use in the postoperative period (11.47 ± 12.32 vs. 78.51 ± 106.10 morphine milligram equivalents, P = 0.019). For patients undergoing lumbar diskectomies, RECK administration led to a shorter length of stay (0.17 ± 0.51 vs. 0.79 ± 1.45 days, P = 0.019) and a lower 2-hour postoperative pain score (3.69 ± 2.56 vs. 5.41 ± 2.28, P = 0.006). CONCLUSIONS The RECK cocktail has potential to be an effective therapeutic option for the postoperative management of lumbar decompression surgeries.
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Affiliation(s)
- Lokeshwar S Bhenderu
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, Texas, USA.
| | - Kristopher A Lyon
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Jose M Soto
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - William Richardson
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Ronak Desai
- Department of Orthopedic Surgery, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Mark Rahm
- Department of Orthopedic Surgery, Baylor Scott & White Medical Center, Temple, Texas, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, Texas, USA
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Lisý P, Čabala J, Hrubina M, Melišík M, Nečas L. Comparison of short-time functional outcomes after TKA between Multigen Plus CR and Physica KR prostheses. Musculoskelet Surg 2023; 107:69-76. [PMID: 34665428 PMCID: PMC10020284 DOI: 10.1007/s12306-021-00730-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aim of this study was to compare functional results within 36 months following primary total knee arthroplasty (TKA) using a conventional prosthesis Multigen Plus CR and a new Physica KR implant. Our hypothesis was that the use of the Kinematics-Retaining design of an TKA implant leads to a significantly greater improvement in the active range of motion and better functional results (KSS 1, KSS 2 and WOMAC score) than the conventional CR implant at short-term follow-up. MATERIALS AND METHODS We retrospectively analysed data of 234 patients who underwent primary TKA at our hospital from April 2010 to August 2015 with the CR type of implant and from July 2014 to August 2015 with the KR implant due to advanced knee arthrosis of IIIrd and IVth grade of Kellgren-Lawrence classification, with no major ligamentous instability. Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, Knee Society Scores 1 (KSS 1) and 2 (KSS 2) and flexion (AROM) were recorded preoperatively and at 6, 12 and 36 months after surgery. RESULTS Our study showed a statistically significant difference in functional results at three years with better KSS 1 score, a tendency to higher values in the KSS 2 score, as well as a statistically significant overall improvement in AROM in favour of the new KR design over the conventional CR implant with a post-hoc power analysis of 83.8%. We found that there was no statistically significant difference between groups when comparing WOMAC score and complications at short-term follow-up. CONCLUSIONS Our study provided more favourable clinical results for using Kinematics-Retaining implant in primary TKA. Further studies should focus on radiological and functional outcomes from mid- to long-term follow-up.
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Affiliation(s)
- P Lisý
- Orthopaedic Clinic of University Hospital Martin, Kollárova 2, Martin, 036 59, Slovak Republic
| | - J Čabala
- Orthopaedic Clinic of University Hospital Martin, Kollárova 2, Martin, 036 59, Slovak Republic
| | - M Hrubina
- Orthopaedic Clinic of University Hospital Martin, Kollárova 2, Martin, 036 59, Slovak Republic
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Malá Hora 10701/4A, Martin, 036 01, Slovak Republic
| | - M Melišík
- Orthopaedic Clinic of University Hospital Martin, Kollárova 2, Martin, 036 59, Slovak Republic
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Malá Hora 10701/4A, Martin, 036 01, Slovak Republic
| | - L Nečas
- Orthopaedic Clinic of University Hospital Martin, Kollárova 2, Martin, 036 59, Slovak Republic.
- Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Malá Hora 10701/4A, Martin, 036 01, Slovak Republic.
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Ma Y, Fan Z, Gao W, Yu Z, Ren M, Ma Q, Song D, Zhang L, Mi L. Cognitive therapeutic exercise in early proprioception recovery after knee osteoarthritis surgery. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:915010. [PMID: 36188901 PMCID: PMC9397821 DOI: 10.3389/fresc.2022.915010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022]
Abstract
Objective This research aims to explore the therapeutic effect of cognitive therapeutic exercise (CTE) in proprioception recovery after knee osteoarthritis (KOA) surgery. Methods In total, thirty-seven patients recovering from KOA surgery (including 27 patients who had undergone high-tibial osteotomy (HTO) procedure and 10 patients who had received total knee arthroplasty (TKA) treatment were randomly assigned to two groups: 18 patients in the CTE group and 19 patients for the control group (non-CTE). Patients in the CTE group received proprioceptive training as cognitive therapy to facilitate proprioception recovery for up to 4 weeks: 5 days a week and two 10-min sessions a day. Except for cognitive therapeutic exercise, the NCTE group and CTE group had the same treatment protocols. All the interventions began with permission from the surgeon-in-charge. In this research, we applied the joint repositioning training or joint-matching tasks, which is part of the proprioceptive training as a measurement for a proprioceptive training result where patients moved their knee joint from 0° (completely straight knee joint) to produce a presented joint angle, such as 30, 60, and 90° of flexion. Joint-matching task results were recorded before the treatment, at 2 and 4 weeks, postoperatively. The absolute difference between the results of these exercises and the knee flexion angle targets will be measured at each test—pre-rehabilitation (Pre-Reha), 2 weeks post-rehabilitation (2 weeks post-Reha), and 4 weeks post-rehabilitation (4 weeks post-Reha). Results The absolute difference in the CTE group was significantly smaller than that of the control group after 4 weeks of treatment (P < 0.05). After 2 weeks of cognitive therapeutic exercise, the absolute difference between patients' exercises of joint repositioning and the target angle of 30° in the CTE group was smaller than that of the NCTE group (P < 0.01). After 4 weeks of therapy, the joint position sense (JPS) among patients who received cognitive therapeutic exercise when performing joint repositioning at angles of 30 and 60° were better improved than those without receiving proprioceptive training with the absolute difference smaller than those of the control group (P < 0.05). Conclusion The joint reposition training provided for the CTE group is a painless proprioceptive training practice. This method is simple and effective, making it easy for patients to understand the purpose of training and improve patient engagement. The research showed that after 4 weeks of rehabilitation and physical training, the proprioception sense of both the NCTE and CTE groups improved significantly, and the efficacy of proprioceptive training in the CTE group was better than that of the NCTE group, which provided a new approach to the early proprioception recovery of a patient with KOA after surgery.
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Affiliation(s)
- Yubao Ma
- Musculoskeletal Rehabilitation Center of Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Zhijiao Fan
- Rehabilitation Treatment Center of Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Weiguang Gao
- Department of Graduate, Shenyang Sport University, Shenyang, China
| | - Zihan Yu
- Department of Graduate, Shenyang Sport University, Shenyang, China
| | - Muchen Ren
- Nebraska Medical Center, University of Nebraska Medical Center, Omaha, NE, United States
| | - Quansheng Ma
- Musculoskeletal Rehabilitation Center of Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Dejun Song
- Musculoskeletal Rehabilitation Center of Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lihua Zhang
- Musculoskeletal Rehabilitation Center of Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lixin Mi
- Musculoskeletal Rehabilitation Center of Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
- *Correspondence: Lixin Mi
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Kim MS, Koh IJ, Sung YG, Park DC, Yoon EJ, In Y. Influence of increased pain sensitivity on patient-reported outcomes following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2022; 30:782-790. [PMID: 33486560 DOI: 10.1007/s00167-021-06455-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to discover whether increased pain sensitivity was associated with postoperative pain and patient-reported outcome measures (PROMs) after total knee arthroplasty (TKA). METHODS Pain sensitivity was evaluated preoperatively using a pain sensitivity questionnaire (PSQ). Resting, walking, nighttime, and average pain visual analog scale (VAS) were measured before surgery and 6 weeks, 3 months, 6 months, and 1 year after surgery. PROMs were also evaluated based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and patient satisfaction. The association between pain VAS average score, WOMAC total score, and PSQ score (minor, moderate, and total score) was assessed at each stage. RESULTS There were 59 patients with a high PSQ score (≥ 5.2) and 53 with a low PSQ score (< 5.2). Up to 1 year postoperatively, the group with high PSQ scores had higher resting, walking, nighttime, and average pain VAS scores than the group with low scores (all p < 0.05). Worse preoperative WOMAC pain, function, and total scores continued until 1 year after surgery in the high-scoring PSQ group (all p < 0.05). The group with low PSQ scores was more satisfied with surgery than the group with high scores (p = 0.027). There was a positive correlation between preoperative PSQ score and pain VAS average score at all time points (all p < 0.05). A relationship between PSQ score and WOMAC total score was also observed (all p < 0.05). CONCLUSION Increased pain sensitivity is a factor related to higher postoperative pain levels and inferior PROMs in patients undergoing primary TKA. LEVEL OF EVIDENCE Case-controlled study, III.
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Affiliation(s)
- Man Soo Kim
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil Ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Yong Gyu Sung
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Dong Chul Park
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Eun Ji Yoon
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Berkowitz RD, Steinfeld R, Sah AP, Mack RJ, McCallum SW, Du W, Black LK, Freyer A, Coyle E. Safety and Efficacy of Perioperative Intravenous Meloxicam for Moderate-to-Severe Pain Management in Total Knee Arthroplasty: A Randomized Clinical Trial. PAIN MEDICINE 2021; 22:1261-1271. [PMID: 33502533 PMCID: PMC8185557 DOI: 10.1093/pm/pnab016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To evaluate the effect of perioperative meloxicam IV 30 mg on opioid consumption in primary total knee arthroplasty (TKA). Design Multicenter, randomized, double-blind, placebo-controlled trial. Subjects In total, 181 adults undergoing elective primary TKA. Methods Subjects received meloxicam 30 mg or placebo via an IV bolus every 24 hours, the first dose administered prior to surgery as part of a multimodal pain management protocol. The primary efficacy parameter was total opioid use from end of surgery through 24 hours. Results Meloxicam IV was associated with less opioid use versus placebo during the 24 hours after surgery (18.9 ± 1.32 vs 27.7 ± 1.37 mg IV morphine equivalent dose; P < 0.001) and was superior to placebo on secondary endpoints, including summed pain intensity (first dose to 24 hours postdosing, first dose to first assisted ambulation, and first dose to discharge) and opioid use (48–72 hrs., 0–48 hrs., 0–72 hrs., hour 0 to end of treatment, and the first 24 hours after discharge). Adverse events (AEs) were reported for 69.9% and 92.0% of the meloxicam IV and placebo groups, respectively; the most common AEs were nausea (40% vs. 59%), vomiting (16% vs 22%), hypotension (14% vs 15%), pruritus (15% vs 11%), and constipation (11% vs 13%). Conclusions Perioperative meloxicam IV 30 mg as part of a multimodal analgesic regimen for elective primary TKA reduced opioid consumption in the 24-hour period after surgery versus placebo and was associated with a lower incidence of AEs typically associated with opioid use.
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Affiliation(s)
| | | | - Alexander P Sah
- Institute for Joint Restoration & Research, Fremont, California, USA
| | | | | | - Wei Du
- Clinical Statistics Consulting, Blue Bell, Pennsylvania, USA
| | | | | | - Erin Coyle
- Baudax Bio Inc., Malvern, Pennsylvania, USA
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Duensing I, Peters CL, Monteiro P, Anderson MB, Pelt CE. Higher incidence of manipulation under anesthesia following TKA associated with the periarticular infiltration of a liposomal bupivacaine cocktail compared to a modified Ranawat cocktail. J Orthop Surg (Hong Kong) 2020; 28:2309499020910816. [PMID: 32216578 DOI: 10.1177/2309499020910816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the frequency of postoperative stiffness requiring manipulation under anesthesia (MUA) before and after switching from the intraoperative use of liposomal bupivacaine (LB). METHODS This was an institutional review board (IRB)-exempt retrospective cohort study (IRB#71733) on all patients who underwent primary total knee arthroplasty (TKA) by a single surgeon between April 2016 and December 2017. We compared 169 knees that received LB group to 167 knees that received a modified Ranawat cocktail (MR group). Perioperative care pathways remained consistent during the study period, as were requirements for MUA which included flexion range of motion below approximately 90 at 6-12 weeks. To compare the incidence of MUA between the groups, a population-averaged Poisson regression analysis was used. RESULTS The two groups were similar, with mean age of 63 (range 31-91) in the LB group and 64 (range 42-84) in the MR group, a preponderance of females in both groups (p = 0.866), similar preoperative knee flexion between groups (p = 0.162), and similar Patient-Reported Outcomes Measurement Information System scores. The frequency of MUA, however, was significantly lower in the MR group (LB: 7.7% [95% CI 3.7-12%] vs. MR: 2.4% [95% CI <1-4.7%] [IRR 3.2, 95% CI 1.08-9.76, p . 0.037]). CONCLUSIONS In summary, this is a novel report of a potentially previously unrecognized increased incidence of MUA associated with the use of LB compared with a MR cocktail. Given no other notable changes to the perioperative care or MUA thresholds following TKA, the reasons for these findings are unclear but deserve additional investigation.
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Affiliation(s)
- Ian Duensing
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | | | - Priscila Monteiro
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Mike B Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
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Zhuang Q, Tao L, Lin J, Jin J, Qian W, Bian Y, Li Y, Dong Y, Peng H, Li Y, Fan Y, Wang W, Feng B, Gao N, Sun T, Lin J, Zhang M, Yan S, Shen B, Pei F, Weng X. Postoperative intravenous parecoxib sodium followed by oral celecoxib post total knee arthroplasty in osteoarthritis patients (PIPFORCE): a multicentre, double-blind, randomised, placebo-controlled trial. BMJ Open 2020; 10:e030501. [PMID: 31924632 PMCID: PMC6955469 DOI: 10.1136/bmjopen-2019-030501] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate the morphine-sparing effects of the sequential treatment versus placebo in subjects undergoing total knee arthroplasty (TKA), the effects on pain relief, inflammation control and functional rehabilitation after TKA and safety. DESIGN Double-blind, pragmatic, randomised, placebo-controlled trial. SETTING Four tertiary hospitals in China. PARTICIPANTS 246 consecutive patients who underwent elective unilateral TKA because of osteoarthritis (OA). INTERVENTIONS Patients were randomised 1:1 to the parecoxib/celecoxib group or the control group. The patients in the parecoxib/celecoxib group were supplied sequential treatment with intravenous parecoxib 40 mg (every 12 hours) for the first 3 days after surgery, followed by oral celecoxib 200 mg (every 12 hours) for up to 6 weeks. The patients in the control group were supplied with the corresponding placebo under the same instructions. PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was the cumulative opioid consumption at 2 weeks post operation (intention-to-treat analysis). Secondary endpoints included the Knee Society Score, patient-reported outcomes and the cumulative opioid consumption. RESULTS The cumulative opioid consumption at 2 weeks was significantly smaller in the parecoxib/celecoxib group than in the control group (median difference, 57.31 (95% CI 34.66 to 110.33)). The parecoxib/celecoxib group achieving superior Knee Society Scores and EQ-5D scores and greater Visual Analogue Scale score reduction during 6 weeks. Interleukin 6, erythrocyte sedation rate and C-reactive protein levels were reduced at 72 hours, 2 weeks and 4 weeks and prostaglandin E2 levels were reduced at 48 hours and 72 hours in the parecoxib/celecoxib group compared with the placebo group. The occurrence of adverse events (AEs) was significantly lower in the parecoxib/celecoxib group. CONCLUSIONS The sequential intravenous parecoxib followed by oral celecoxib regimen reduces morphine consumption, achieves better pain control and functional recovery and leads to less AEs than placebo after TKA for OA. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (ID: NCT02198924).
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Affiliation(s)
- Qianyu Zhuang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University 3rd Hospital, Beijing, China
| | - Jin Lin
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Jin Jin
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Wenwei Qian
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Yanyan Bian
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Yulong Li
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Yulei Dong
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Huiming Peng
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Ye Li
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Yu Fan
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Bin Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Na Gao
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Tiezheng Sun
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Jianhao Lin
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
| | - Miaofeng Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Shigui Yan
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Bin Shen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Fuxing Pei
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China
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Social determinants associated to chronic pain after total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2019; 43:2767-2771. [DOI: 10.1007/s00264-019-04370-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/19/2019] [Indexed: 12/18/2022]
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Nishitani K, Kuriyama S, Nakamura S, Ito H, Matsuda S. A Multivariate Analysis on the Effect of No Closed Suction Drain on the Length of Hospital Stay in Total Knee Arthroplasty. Knee Surg Relat Res 2019; 31:25-30. [PMID: 30871289 PMCID: PMC6425893 DOI: 10.5792/ksrr.18.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022] Open
Abstract
Purpose Despite the long history of drain use in total knee arthroplasty (TKA), no drain has been gaining popularity. The purpose of this study was to investigate whether drainage is related to the length of hospital stay. Materials and Methods A total of 166 consecutive unilateral TKAs performed on 135 patients with osteoarthritis were retrospectively reviewed. Closed suction drainage was used in 111 cases (67%). Length of hospital stay after surgery was recorded, and a multivariate linear regression analysis was performed to evaluate various variables (patient factors, surgical factors, and post-surgical factors) and to investigate whether drainage was an independent variable. Results Hospital stay was shorter in no drain cases (21.7±4.8 days) than in drain cases (24.2±3.7 days, p<0.001). The multivariate analysis showed that older age (β=0.12, p=0.02), drain use (β=2.81, p=0.03), and occurrence of comorbidity (β=1.46, p=0.04) were the independent variables associated with the extended hospital stay. There was no difference in comorbidity between drain cases (39.6%) and no drain cases (27.2%, p=0.13). Conclusions The drain use, age, and occurrence of comorbidity were related to the length of hospital stay. TKA without drain is an effective procedure both medically and economically.
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Affiliation(s)
- Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuicih Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Zhao XY, Zhang EF, Bai XL, Cheng ZJ, Jia PY, Li YN, Guo Z, Yang JX. Ultrasound-Guided Continuous Femoral Nerve Block with Dexmedetomidine Combined with Low Concentrations of Ropivacaine for Postoperative Analgesia in Elderly Knee Arthroplasty. Med Princ Pract 2019; 28:457-462. [PMID: 30995645 PMCID: PMC6771060 DOI: 10.1159/000500261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 04/09/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This study aims to investigate the clinical effect of dexmedetomidine (DEX) combined with low concentrations of ropivacaine in ultrasound-guided continuous fem-oral nerve block for postoperative analgesia in elderly patients with total knee arthroplasty (TKA). MATERIALS AND METHODS Patients were divided into three groups: group C, group D1, and group D2. For postoperative analgesia, patients in group C were given 0.15% ropivacaine, patients in group D1 were given 0.15% ropivacaine + 0.02 μg × kg-1 × h-1 DEX, and patients in group D2 were given 0.15% ropivacaine + 0.05 μg × kg-1 × h-1 DEX. The visual analogue scores in the resting state, active state (AVAS), and passive functional exercise state (PVAS), degree of joint bending, and Ramsay scores were recorded. RESULTS The Ramsay scores were significantly higher, AVAS scores were significantly lower, PVAS scores were significantly decreased, the degree of joint bending was significantly higher, and the time to the first postoperative ambulation was shorter in groups D1 and D2 than group C. Furthermore, the time to the first postoperative ambulation was shorter in group D2 than in group D1, patients in groups D1 and D2 were more satisfied than patients in group C, and patients in group D2 were more satisfied than patients in group D1. CONCLUSION The protocol of 0.05 μg × kg-1 × h-1 of DEX combined with 0.15% ro-pivacaine in ultrasound-guided continuous femoral nerve block for postoperative analgesia in elderly patients with TKA provides a better analgesic effect than without DEX performance. UNLABELLED X.-Y.Z. and E.-F.Z. have contributed equally to this research.
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Affiliation(s)
- Xiao-Ying Zhao
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Er-Fei Zhang
- Department of Anesthesiology, The Affiliated Hospital of Yan'an University, Yan'an, China
| | - Xiao-Li Bai
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zi-Jian Cheng
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Peng-Yun Jia
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan-Nan Li
- Shanxi Medical University, Taiyuan, China
| | - Zheng Guo
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jian-Xin Yang
- Department of Anesthesiology, The Second Hospital of Shanxi Medical University, Taiyuan, China,
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Cho WJ, Bin SI, Kim JM, Lee BS, Sohn DW, Kwon YH. Total Knee Arthroplasty With Patellar Retention: The Severity of Patellofemoral Osteoarthritis Did Not Affect the Clinical and Radiographic Outcomes. J Arthroplasty 2018; 33:2136-2140. [PMID: 29576487 DOI: 10.1016/j.arth.2018.02.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/11/2018] [Accepted: 02/19/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to compare the clinical and radiographic outcomes of total knee arthroplasty (TKA) with patellar retention in accordance with the severity of patellofemoral arthritis. METHODS We retrospectively reviewed patients who underwent TKA with patellar retention using the NexGen LPS or LPS-flex system between September 2010 and May 2015. The radiographic severity of patellofemoral arthritis was categorized according to the Iwano classification system, and subjects were divided into mild (stage 0-I) and moderate to severe (stage II-IV) groups. Clinical outcomes were evaluated using the Hospital for Special Surgery score, Knee Society Score, function score, Western Ontario and McMaster Universities Osteoarthritis Index, and Feller score. Radiographic outcomes were assessed using the congruence angle, patellar tilt angle, and lateral patellar displacement. The minimum follow-up for clinical and radiographic evaluation was 2 years. Clinical and radiographic outcomes were compared between the 2 groups preoperatively and at the time of the last follow-up. RESULTS Four hundred seventy-four knees were enrolled and assigned to mild (n = 208) or moderate to severe (n = 266) groups. The preoperative Feller score was significantly lower in the moderate to severe group (P = .030), whereas the postoperative clinical and radiographic results did not differ significantly between the 2 groups. CONCLUSION Clinical and radiographic outcomes did not differ in accordance with the severity of patellofemoral arthritis after a minimum 2 years of follow-up of patients treated with TKA with patellar retention. Good outcomes were obtained with patellar retention in TKA, even in patients with advanced patellofemoral osteoarthritis.
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Affiliation(s)
- Won-Joon Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | - Dong-Wook Sohn
- Department of Orthopedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea
| | - Young-Hee Kwon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
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Comparing the efficacy of intravenous or intra-articular tranexamic acid in reducing blood loss in simultaneous bilateral knee replacement surgery without the use of tourniquet. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1417-1420. [PMID: 29594528 DOI: 10.1007/s00590-018-2194-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare the effect of intravenous or intra-articular route of administration of tranexamic acid in reducing the blood loss in simultaneous bilateral total knee replacement surgeries performed without the use of tourniquets. METHODS Prospective cohort study of 30 consecutive patients grouped into two groups; Group 1: intravenous group and group 2: intra-articular group. Two outcome measures were studied; mean drop in post-operative haemoglobin and need for blood transfusion in both groups. RESULTS No significant difference in mean drop of haemoglobin and need for blood transfusion in both groups. CONCLUSION Route of administration of tranexamic acid does not influence on the mean drop of haemoglobin and need for blood transfusion in simultaneous bilateral total knee replacement surgeries performed without the use of tourniquet.
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The Bicruciate Substituting Knee Design and Initial Experience. Tech Orthop 2018. [DOI: 10.1097/bto.0000000000000280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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