Pain management after total knee arthroplasty: A prospective randomized study

INTRODUCTION

Total knee arthroplasty (TKA) is a common procedure for improving mobility and quality of life in patients with osteoarthritis. Postoperative pain control management after TKA is still a concern as it relates to patients satisfaction and functional recovery.Many anesthetic regimens and techniques have been explored to decrease postoperative pain and enhance the fast recovery after TKA. The aim of this study was to evaluate the best anesthetic treatment in pain control after TKA.

METHODS

51 patients were included in a randomized prospective study and distributed in three groups. The first group (CG) in which no analgesic protocol was implemented (control group). The second group (LIA group) received an intraoperative local infiltration anesthesia (LIA) (60 ml mixture of two ropivacaine 75mg/10 mL + adrenaline 100μg/10 mL + physiological solution). The third group (FNB group) had only a femoral nerve block (FNB). Continuous outcomes including visual analogue scale (VAS) at 5,24,48 h and at 1 week, morphine consumption and range of motion (ROM) at 1,2,7 days.

RESULTS

There was significant difference between all groups (p < 0,001) in terms of the VAS score: at 5h after surgery (4.55,2.15,1.82); at 24h (4.15,2.65,3.36); at 48h (3.85,2.45,2.73); at 1 week (2.95,1.80, 1.64), respectively for groups CG, LIA, FNB.ROM was better in LIA and FNB groups than CG: at 1 die after surgery (44°,50°,54°); at 3 dies (69°,70°,71°); at 7 dies (91°,98°,98°), respectively for groups CG, LIA, FNB (p < 0,001).

DISCUSSION

LIA and FNB groups both showed a significant reduction at VAS score, better range of motion and less morphine consumption than CG (control group). LIA group has obtained a constant pain control in the postoperative days; FNB group had a good pain control in the hours after surgery, with a decrease in efficacy in the following days.

CONCLUSION

Further studies are still needed in order to define LIA as the reference pain management in TKA.

Comparative evaluation of meniscal pathology: MRI vs arthroscopy

The meniscal pathology of the knee is one of the clinical realities the orthopedic surgeon must daily confront with. The diagnosis is generally both clinical and instrumental; among the different diagnostic imaging techniques, Magnetic Resonance Imaging (MRI) appears to be the most accurate method regarding sensitivity and specificity for the study of meniscal fibrocartilages and articular cartilage. In an attempt to clarify the roles of MRI and diagnostic knee arthroscopy, we performed a retrospective comparative study of the two methods to assess their sensitivity and specificity in the diagnosis of meniscal pathology. We evaluated 105 consecutive patients with a clinical diagnosis of intra-articular knee pathology who were subjected to MRI examination and subsequently to surgical arthroscopy, recording on a graphic card the surgical and radiographic findings expressed by a blinded expert radiologist. Comparison of MRI and arthroscopy data showed, for the internal meniscus, values of 98.5% sensitivity, 94.7% specificity and 93.8% "K" index for MRI compared to arthroscopy, and of 90%, 98.6% and 90.5% for the external meniscus. These results allow us to state that the diagnostic capacity of MRI appears to be very high and therefore crucial in the planning of the correct surgical treatment of individual patients, thanks to its ability to highlight even small changes affecting intra-articular structures.

Arthroscopic anatomic repair of Bankart lesion in rugby players

Recent studies have reported equivalent outcomes of arthroscopic and open shoulder stabilization. However, surgical strategy for shoulder instability is a challenging and controversial problem for surgeons that have to treat collision sport athletes. In fact, only few studies support the arthroscopic surgery for this group of patients. The aim of this study is to evaluate the outcome of arthroscopic stabilization in a homogenous population of professional young athletes practicing in high-level collision sport. We treated 22 consecutive professional rugby players, with a mean age of 23.6 years, affected by traumatic anterior shoulder instability. All patients underwent arthroscopic Bankart repair with bone suture-anchors. Exclusion criteria were: failed previous shoulder surgery, atraumatic, multidirectional or posterior instability, bone defects greater than 20% of the anterior-inferior glenoid, engaging Hill-Sachs, rotator cuff tears, capsular-ligament avulsion on the humeral side (HAGL). Patients were evaluated according to Constant score, Rowe score and Visual Analogue Scale (VAS) for discomfort and handicap. The mean follow-up was 40.7 months (range, 6 to 87 months). All patients except one were able to return at the same previous sports level at 5 to 6 months postoperatively. Re-dislocation occurred in 3 players for high impact trauma during competition or training. Our results confirm that, also in the collision sport patients, anatomic arthroscopic Bankart repair is a good option for the treatment of traumatic anterior instability without associated lesions. .

Arthroscopy in osteochondral pathology of the elbow: indications, treatment and complications

The arthroscopic technique has revolutionized orthopaedic surgery in the last forty years, due to the improvement in surgical technique and innovations in technologies. Actually, knee and shoulder arthroscopy are commonly used to treat the most frequent pathologies with mini-invasive approaches demonstrate recovery of function and outcomes. Not the same thing can be said for other joints such as ankle, elbow and hip, where the narrowness of the space makes the technique more challenging. In this study, a brief review of the literature and the history of elbow arthroscopy are described. Indications, surgical technique, risks and complication, tip and tricks, advices and notes to avoid complications are reported. Elbow arthroscopic surgery is a difficult technique that requires a long learning curve, but in an experienced surgeon's hands, it is a safe and successful methodology when applied with correct indications and cautions.