The Journal of arthroplasty
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Randomized Controlled Trial
Sleep Quality Effects Recovery After Total Knee Arthroplasty (TKA) - A Randomized, Double-Blind, Controlled Study.
This study examined the effects of sleep quality on early recovery after total knee arthroplasty. A total of 148 patients were randomized 1:1 to receive either zolpidem or placebo for 2 weeks. VAS pain scores (rest, ambulation and night), range of motion (ROM), total amount of opioid analgesics and antiemetics taken, postoperative nausea and vomiting (PONV), sleep efficacy and satisfaction were recorded. ⋯ Patients in the intervention group had lower pain score and took less antiemetics. Moreover, a significant correlation between sleep quality and ROM was detected. These results demonstrated that improved sleep quality is beneficial to patients' post-TKA recovery.
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Consecutive patients undergoing knee arthroplasty completed questionnaires: FJS, Knee Injury and Osteoarthritis Outcome Score (KOOS) and WOMAC Score (mean 39 months after surgery), and were mailed a repeat questionnaire after 4 to 6 weeks. The test-retest reliability was almost perfect for the FJS (ICC = 0.97), and the FJS subdomains (ICC > 0.8). ⋯ The FJS demonstrates high test-retest reliability and construct validity compared to the Normalised WOMAC and KOOS Subscales. The FJS does not demonstrate the ceiling effect of the WOMAC or KOOS pain scores so may have greater discriminatory ability following TKR.
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Comparative Study
Reduced Blood Loss and Transfusion Rates: Additional Benefits of Local Infiltration Anaesthesia in Knee Arthroplasty Patients.
We hypothesised that local infiltration of anaesthesia (LIA) containing adrenaline may reduce peri-operative blood loss and transfusion requirements in primary total knee arthroplasty patients (TKA) when compared to simple patient control analgesia (PCA). In this retrospective cohort study there were 22 TKAs in the PCA group and 27 TKAs in the LIA group. ⋯ Patients receiving PCA were 4.3 times more likely to require blood transfusion. Using the LIA technique reduces blood loss and risk of blood transfusion.
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Randomized Controlled Trial
Multimodal Analgesia in Total Knee Arthroplasty: A Randomized, Double-Blind, Controlled Trial on Additional Efficacy of Periarticular Anesthesia.
Pain management is a main determinant of functional recovery after total knee arthroplasty (TKA). We performed a randomized, controlled, double blind study to evaluate additive efficacy of periarticular anesthesia in patients undergoing TKA in reducing post-operative pain, operated limb edema and improving post-operative mobility. ⋯ The results show no statistical differences in any of the variable evaluated. Our data suggest that additive periarticular anesthetic protocol with ropivacaine 1% 20 mL is not superior to oral and intravenous analgesia alone in patients undergoing TKA, regarding post-operative pain control, operated limb edema reduction and post-operative mobility improvement.
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Intra-articular steroid injections are widely used for symptomatic relief of knee osteoarthritis. This study used a national database to determine if there is an association between preoperative intra-articular knee injection at various time intervals prior to ipsilateral TKA and infection. ⋯ There was no significant difference in patients who underwent TKA more than 3 months after injection. Ipsilateral knee injection within three months prior to TKA is associated with a significant increase in infection.