The Journal of arthroplasty
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We systematically reviewed the English-language literature to assess the incidence, risk factors and prevention strategies for postoperative delirium following total joint arthroplasty (TJA). A total of 10 studies were included in the final review, of which 3 (30%) were Level I studies, 6 were Level II (60%) studies and 1 (10%) was a Level III study. ⋯ Pre-screening of patients was shown to reduce its incidence. Independent predictors include age, history of psychiatric illness, decreased functional status and decreased verbal memory.
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Review Meta Analysis Comparative Study
Comparison of Periarticular Multimodal Drug Injection and Femoral Nerve Block for Postoperative Pain Management in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
The analgesic efficacy and safety of periarticular multimodal drug injection (PMDI) compared with femoral nerve block (FNB) for postoperative pain management in total knee arthroplasty (TKA) still remains controversial. We therefore conducted a meta-analysis to quantitatively compare PMDI to FNB in TKA. 10 randomized controlled trials (RCTs) with 744 TKAs in 728 patients were included in this study. ⋯ No significant difference was seen in regard to the complications between the two groups. However, due to the variation of the included studies, no firm conclusions can be drawn.
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Review Meta Analysis
Releasing of tourniquet before wound closure or not in total knee arthroplasty: a meta-analysis of randomized controlled trials.
The purpose of this study is to examine our hypothesis that releasing tourniquet intraoperatively before wound closure is better than releasing postoperatively after wound closure and bandaging. We carried out a systematic review using meta-analysis of selected randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA. ⋯ However, it decreased the risk of both minor (P=0.0007) and major complications (P=0.05). The available evidence indicated that releasing tourniquet before wound closure for hemostasis increased perioperative blood loss, nevertheless, the risk of complications decreased significantly.
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The incidence of total knee arthroplasty (TKA) is increasing, as are periprosthetic supracondylar femoral fractures. Treatment is complex and may involve the use of a retrograde intramedullary femoral nail, and it is essential to know the nail will fit through the femoral prosthesis in line with the intramedullary canal. ⋯ A comprehensive data set lists manufacturer, model, size, minimal intercondylar notch distance and position. This will be of practical use when planning the operative management of periprosthetic supracondylar femoral fractures.
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Corrosion at the modular neck-stem taper junction has become an increasingly important topic as several reports have identified this couple as a possible source for early failure with findings similar to failed metal-on-metal hip arthroplasties. Recently, two different modular stem systems from a single manufacturer were voluntarily recalled due to concerns of failure of the modular taper junction. ⋯ We further reviewed the literature to evaluate whether this is a manufacturer-specific defect or indicative of a broader trend. Recent studies appear to implicate the basic design of the neck-stem taper junction, rather than a single manufacturer, which is at high risk for fretting and corrosion.