Orthopedics
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Multicenter Study Comparative Study Controlled Clinical Trial
Pain control after total knee arthroplasty: a prospective study comparing local infiltration anesthesia and epidural anesthesia.
Postoperative pain control after total knee arthroplasty (TKA) is a well-known clinical problem. Efforts to treat it with the use of local anesthesia have been made, but the results have been contradictive. In the late 1990s, an infiltrated solution of ropivacaine/ketorolac/adrenaline was shown to be effective for this purpose, and this technique has since spread over the world. ⋯ The local infiltration anesthesia technique is better for postoperative pain relief in TKA than epidural anesthesia. It offers equal pain relief, faster mobilization, and more satisfied patients. No negative side effects were seen during the study.
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Randomized Controlled Trial
The effect of tranexamic acid on reducing blood loss in cementless total hip arthroplasty under epidural anesthesia.
Total hip arthroplasty (THA) is associated with high intraoperative and postoperative blood loss. Antifibrinolytic drugs have been used to minimize the potential risks of bleeding and blood transfusion. Studies on the effect of tranexamic acid on decreasing blood loss in THA have revealed interesting results, but most have focused on cemented THA. ⋯ Our results also revealed a higher mean of 6- and 24-hour hematocrit level and shorter hospital stay in the tranexamic acid group compared to the control group, which were not statistically meaningful. In our study no thromboembolic event was seen; except 1 patient in the control group. Our study showed that administering tranexamic acid before the start of cementless THA under epidural anesthesia can reduce intraoperative and postoperative bleeding as well as need for blood transfusion.
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Clinical Trial
Balloon kyphoplasty in the treatment of osteoporotic vertebral compression fracture nonunion.
Patients with nonunion of osteoporotic vertebral compression fractures that are refractory to conservative treatments have persistent back pain, progressive vertebral body collapse and kyphosis, and mobility of the fracture. Although many previous reports have reported vertebral compression fractures treated by balloon kyphoplasty, few data is available on using this method to treat nonunion of vertebral compression fractures. This study evaluated the therapeutic potential of balloon kyphoplasty in the treatment of nonunion of osteoporotic vertebral compression fractures. ⋯ There was also statistically significant improvement in the mean values for Cobb's angle, pain (visual analog scale), and the Oswestry Disability Index at the postoperative assessment compared with the preoperative assessment. No statistically significant differences were noted between the postoperative and final follow-up assessment in any of the evaluated efficacy measures. The study suggests that balloon kyphoplasty is an effective technique to treat nonunion of osteoporotic vertebral compression fractures.
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Heterotopic ossification represents one of the most frequent complications following any type of hip arthroplasty. However, disagreement exists regarding the clinical significance of heterotopic ossification after total hip arthroplasty (THA). This study evaluated the effect of different grades of heterotopic ossification on range of hip motion, pain, and the clinical outcome in patients after THA. ⋯ The incidence of heterotopic ossification was 47% and the incidence of severe ossification was 11%. The severe heterotopic ossification significantly reduced clinical outcome, overall range of hip motion and certain components such as flexion, abduction and external rotation, but had no significant effect on pain, while the lower degree of ossification did not significantly influence the clinical outcome, hip motion and pain. This study has shown that only severe heterotopic ossification is of clinical significance.
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Anteroinferior plating has been described for internal fixation of clavicular fractures, citing improved bicortical fixation, less hardware prominence, and safer drill trajectories compared with other plate configurations. This anatomic study defined structures at risk during anteroinferior clavicular plating. Four paired cadaveric specimens (8 clavicles) from ages 75 to 93 years were systematically dissected. ⋯ At the lateral three-fifths point of the clavicle (point C), the brachial plexus is 12.76 mm from the posterior clavicle and is more at risk than the subclavian artery. Lateral to the three-fifth point of the clavicle, there were no vital structures that could be injured by overdrilling. Our results suggest that more care should be observed with placement of screws in the medial half of the clavicle where subclavian artery damage is more likely.