Orthopedics
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Continuous peripheral nerve block has been shown to be superior to traditional opioid-based analgesia in terms of improved analgesia with reduced sedation, nausea, pruritis, and hospital stay. Because of its safety and efficacy, continuous peripheral nerve block has broad application in ambulatory and pediatric patients. ⋯ Continuous peripheral nerve block is associated with some limitations, including infection, neurologic injury, local anesthetic toxicity, and patient falls. The benefits of continuous peripheral nerve block are becoming increasingly relevant in the ambulatory surgery setting where more complex procedures are being performed on an outpatient basis.
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Patients undergoing total hip and knee arthroplasty experience substantial and sustained postoperative pain. Inadequate analgesia may impede recovery and delay hospital discharge. ⋯ An increasing number of studies have reported multimodal analgesia featuring unilateral peripheral block provide pain relief and functional outcomes similar to that of continuous epidural and superior to systemic analgesia but with fewer side effects. This review discusses the indications, benefits, and side effects associated with conventional and innovative analgesic approaches to facilitate rehabilitation and improve outcome following total joint arthroplasty.
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Arthroscopy of the osteoarthritic knee is a common and costly practice with limited and specific indications. The extent of osteoarthritis (OA) is determined by joint space narrowing, which is best measured on a weight-bearing radiograph of the knee in 30° or 45° of flexion. The patient older than 40 years with a normal joint space should have a magnetic resonance image taken to rule out focal cartilage wear and avascular necrosis before recommending arthroscopy. ⋯ There is no evidence that removal of loose debris, cartilage flaps, torn meniscal fragments, and inflammatory enzymes have any pain relief or functional benefit in patients that have joint space narrowing on standing radiographs. Many patients with joint space narrowing are older with multiple medical comorbidities. Consider the complications and consequences when recommending arthroscopy to treat the painful osteoarthritic knee without mechanical symptoms, as there is no proven clinical benefit.
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A 39-year-old man presented with weakness and a nonmobile mass in the buttock of 5 months' duration. Hip flexion was limited to 70 degrees. Strength was diminished for both ankle/foot plantar and dorsiflexion. ⋯ The importance of protecting the medial femoral circumflex artery during approaches to the hip is paramount. In this case, the tumor arose from the central aspect of the quadratus femoris, with the superior muscle protecting the medial femoral circumflex artery from harm. Although osteochondromas are a rare cause of mass effect, they should be considered in the differential diagnosis of sciatic nerve compression in this anatomical location.
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Comparative Study
Comparison of MRI and arthroscopy after autologous chondrocyte implantation in patients with osteochondral lesion of the talus.
No reported postoperative evaluation method is accurately correlated with the clinical outcome of repaired cartilage after autologous chondrocyte implantation. This study investigated the correlation of follow-up magnetic resonance imaging (MRI) evaluation and arthroscopic findings to the clinical outcome of surgically repaired osteochondral lesion of the talus with autologous chondrocyte implantation using the modified magnetic resonance observation of cartilage repair tissue (MOCART) scoring system. The study group comprised 21 consecutive patients with an osteochondral lesion of the talus who underwent autologous chondrocyte implantation. ⋯ Although the arthroscopic findings of the repaired osteochondral lesion of the talus showed better correlation with the clinical outcome when used with the modified MOCART scoring system, the higher correlation occurred only within a statistical error range, thus making the correlation not significantly different from the one determined on MRI. Therefore, a second-look arthroscopy is not necessary to evaluate the repaired talar cartilage after an autologous chondrocyte implantation. Magnetic resonance imaging is a useful method for long-term follow-up of patients with osteochondral lesions of the talus.