The Journal of arthroplasty
-
Total joint arthroplasty (TJA) patients are at increased risk of post-operative delirium (POD) given their demographics and functional impairment. Certain pharmacologic agents are known to cause delirium, but those that cause delirium following TJA are unknown. Our aim was to explore if specific anesthetic agents, opiate pain medications, or benzodiazepines are associated with POD following TJA. ⋯ The model was adjusted for gender, pre-operative alcohol use, and pre-operative depression. Our data suggest that isoflurane and benzodiazepines are associated with an increased risk of delirium in TJA patients and should be used with caution. Hydromorphone and morphine did not increase the risk of delirium in TJA patients and may be considered for post-operative pain control.
-
Meta Analysis
Postoperative cognitive dysfunction after total joint arthroplasty in the elderly: a meta-analysis.
This meta-analysis consolidated the research on postoperative cognitive dysfunction (POCD) following total joint arthroplasty (TJA). Data from 17 studies that assessed cognition pre- and post-surgery in TJA patients alone (15 studies) or matched TJA and control groups (2 studies) were analysed. ⋯ Very limited TJA and Control data indicated no group differences in the changes to performance over time; however, the TJA group was cognitively compromised pre- and post-surgery compared to Controls. Further appropriately controlled research is required to clarify whether POCD commonly occurs after TJA.
-
Randomized Controlled Trial Comparative Study
Multimodal pain management in total knee arthroplasty: a prospective randomized controlled trial.
We analyze the effects of a multimodal analgesic regimen on postoperative pain, function, adverse effects and satisfaction compared to patient-controlled analgesia (PCA). Thirty-six patients undergoing TKA were randomized to receive either (1) periarticular injection before wound closure (30cc 0.5% bupivacaine, 10mg MSO4, 15 mg ketorolac) and multimodal analgesics (oxycodone, tramadol, ketorolac; narcotics as needed) or (2) hydromorphone PCA. ⋯ The multimodal group had lower VAS scores, fewer adverse effects, lower narcotic usage, higher satisfaction scores and earlier times to physical therapy milestones. Multimodal pain management protocol decreases narcotic usage, improves pain scores, increases satisfaction and enhances early recovery.
-
FDA's Unique Device Identification (UDI) Rule will mandate manufacturers to assign unique identifiers to their marketed devices. UDI use is expected to improve implant documentation and identification. ⋯ UDI in TJA registry and UDI in EMR were indicated practices to best support implant identification and save time. FDA's UDI rule sets the foundation for UDI use in patient care settings as standard practice for implant documentation.
-
Total hip arthroplasty (THA) may produce blood loss requiring allogenic blood transfusion. Recently several authors have reported success decreasing their transfusion rate with tranexamic acid (TXA). ⋯ Infusion of TXA acid produced a statistically significant difference in transfusion rate (p<0.001) while topical TXA failed to reach statistical significance (P=0.15). The transfusion rate without TXA was 19.86%, 4.39% with TXA infusion (odds ratio=5.36), and 12.86% (odds ratio=1.67) with topical TXA.