The Journal of arthroplasty
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Randomized Controlled Trial
Single-injection femoral and sciatic nerve blocks for pain control after total knee arthroplasty.
This study was designed to evaluate the addition of a single-injection sciatic nerve block to a femoral nerve block for analgesia after total knee arthroplasty. Fifty-seven patients undergoing primary total knee arthroplasty were randomized to receive femoral nerve blockade or a sham block. A subsequent 31 patients received both femoral and sciatic nerve blocks (FSNBs) before general anesthesia. ⋯ Lower visual analog pain scale scores were noted in both femoral nerve blockade and FSNB groups compared to shams through 48 hours. Morphine use was significantly lower in the FSNB group. Femoral and sciatic nerve block can be placed quickly and consistently in the operating room with improved postoperative pain relief and reduced narcotic consumption.
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Randomized Controlled Trial
Continuous femoral nerve block in total knee arthroplasty: immediate and two-year outcomes.
We conducted a prospective study to investigate the immediate and 2-year outcomes of total knee arthroplasty patients who received continuous femoral nerve block (FNB) for analgesia. Sixty patients undergoing unilateral total knee arthroplasty were randomized into 3 groups and received high-dose continuous FNB, low-dose continuous FNB, or no FNB. ⋯ Immediately after surgery, there was less pain, higher satisfaction, and lower morphine use among patients on continuous FNB regardless of ropivacaine dosage used. At 2 years, there were no significant differences in functional outcomes.
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Randomized Controlled Trial
Heterotopic ossification after surface replacement arthroplasty and total hip arthroplasty: a randomized study.
With a randomized clinical trial, we compared the incidence and severity of heterotopic ossification in cohorts of patients who have undergone either surface replacement arthroplasty or total hip arthroplasty at a minimum follow-up of 1 year. Surface replacement arthroplasty group had a significantly higher rate of severe heterotopic ossification (Brooker grades 3-4) than the total hip arthroplasty group, 12.6% (13/103) vs 2.1% (2/97) respectively (P = .02). ⋯ Patients with severe heterotopic ossification had significantly inferior functional outcome scores. Surgeons offering surface replacement must be aware of this risk and use meticulous surgical technique and consider routine prophylaxis against heterotopic ossification.
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Randomized Controlled Trial Multicenter Study Comparative Study
Prospective randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty in the treatment of displaced femoral neck fractures: winner of the Dorr Award.
The Displaced Femoral (neck fracture) Arthroplasty Consortium for Treatment and Outcomes study is a prospective, multicenter randomized clinical trial comparing hemiarthroplasty to total hip arthroplasty (THA) in the treatment of displaced femoral neck fractures in previously independent patients. Primary outcomes were measured at 6, 12, and 24 months with the Short Form-36 (SF-36), Western Ontario and McMaster Osteoarthritis Index (WOMAC), and the Harris Hip Score and the Timed "Up & Go" Test. ⋯ Total hip arthroplasty patients also had superior WOMAC function scores (81.8 +/- 10.2 vs 65.1 +/- 18.1, P = .03). Significant differences in outcomes, without a significantly greater incidence of complications, suggest THA is a valuable treatment option for the active elderly hip fracture population.
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Randomized Controlled Trial
Multimodal analgesia without parenteral narcotics for total knee arthroplasty.
Use of parenteral narcotics after total knee arthroplasty is considered by most orthopedic surgeons to be the standard of care. This study tested the hypothesis that a multimodal oral pain medication protocol could control pain and minimize complications of parenteral narcotics. ⋯ The average daily pain score was less than 4 out of 10, nausea occurred in 15 patients (21%), emesis in 1 patient (1.4%), and there were no severe complications. This study proved the hypothesis that pain after total knee arthroplasty could be effectively managed without routine use of parenteral opioids.