Clinics in geriatric medicine
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Clin. Geriatr. Med. · Aug 2012
Pharmacologic pain management before and after total joint replacement of the hip and knee.
There are many effective treatment measures for OA of the hip or knee, with varying degrees of effectiveness. Nonoperative measures include patient education, physical therapy, activity modification, weight loss, and medications. Pharmacologic strategies include acetaminophen, NSAIDs, injections of cortisone or viscosupplementation, and, less commonly, tramadol or other pain relievers. ⋯ Over the past 20 years, multimodal pain management has been beneficial to the patient undergoing TJR surgery. Studies have shown this form of pain management decreases postoperative opioid consumption and the related adverse effects. Research is warranted in the areas of postoperative pain scores and patient satisfaction as institutional multimodal protocols continue to evolve.
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The number of primary and revision total joint arthroplasty procedures is increasing exponentially with time. It is anticipated that there will be a huge expected demand for revision knee surgery over the next 2 decades. ⋯ Unless the surgeon accurately identifies the mode of failure, successful treatment becomes very unlikely; an increasing physical burden on the patient and financial burden on hospital trusts ensues. In comparison with primary joint arthroplasty, complication rates after revision surgery are significantly increased, and outcome is less assured.