The Journal of arthroplasty
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Postoperative pain after total knee arthroplasty (TKA) poses a major challenge. It delays mobilization, increases opioid consumption and side effects, and lengthens hospitalization. This challenge multiplies when treating an opioid-dependent population. We examined whether a novel suspended release local anesthetic, liposomal bupivacaine (LB) would improve pain control and decrease opioid consumption after TKA compared to a standard periarticular injection in opioid-dependent patients. ⋯ LB was not found to be superior to standard PAI in opioid-dependent patients undergoing TKA. This patient population continues to present a challenge even with modern multimodal pain protocols.
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Dexamethasone is frequently used for the treatment of postoperative nausea and vomiting and as an adjunct in multimodal postoperative analgesia after total joint arthroplasty; however, the incidence of periprosthetic joint infection (PJI) after the use of perioperative dexamethasone in total joint arthroplasty has yet to be fully elucidated. ⋯ A single intravenous perioperative dose of dexamethasone had no statistically significant difference in the rate of PJI after total hip or knee arthroplasty.
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Comparative Study
Effect of Patellar Resurfacing on Patellofemoral Crepitus in Posterior-Stabilized Total Knee Arthroplasty.
Patellofemoral crepitus (PC) is a complication of total knee arthroplasty (TKA). Although patellar resurfacing (PR) directly influences the kinematics of the patellofemoral joint, the influence of PR on PC is unclear. The purpose of this study was to investigate the influence of PR on the incidence of PC. ⋯ PR may decrease the incidence of PC by increasing the patellar tilt and medial shift and positioning the patella more closely parallel to the femur. PR is recommended during TKA with this prosthesis.
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Numerous series have documented short-term successes with cementless total hip arthroplasty (THA) and subtrochanteric shortening osteotomy for Crowe IV developmental dysplasia of the hip (DDH). However, data are lacking regarding long-term implant fixation and patient function. In this study, we aimed to evaluate the 10-year results of cementless THA with simultaneous subtrochanteric shortening osteotomy for Crowe IV DDH. ⋯ In the longest series to date, cementless THA combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to dysplasia was associated with high rates of successful implant fixation and stable clinical improvement.