The Journal of arthroplasty
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Meta Analysis Comparative Study
The Efficacy of Liposomal Bupivacaine Over Traditional Local Anesthetics in Periarticular Infiltration and Regional Anesthesia During Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
Since its Food and Drug Administration approval in 2011 as a local anesthetic for postsurgical analgesia, liposomal bupivacaine (LB) has been incorporated into the periarticular injection (PAI) of many knee surgeons. The slow release of this medication from vesicles should significantly extend the duration of its analgesic effect, but current evidence has not clearly demonstrated this benefit. ⋯ While LB may offer a statistically significant benefit over a traditional PAI, the increase in pain control may not be clinically significant and it does not appear to offer a benefit in reducing opioid consumption. However, there is no standardization among current studies, as they vary greatly in design, infiltration technique, and outcome measurement, which precludes any reliable summarization of their results. Future independent studies using a standardized protocol are needed to provide clear unbiased evidence.
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Comparative Study
Comparing the Safety and Outcome of Simultaneous and Staged Bilateral Total Knee Arthroplasty in Contemporary Practice: A Systematic Review of the Literature.
Although a variety of studies have assessed the outcomes of simultaneous bilateral total knee arthroplasty (BTKA) and staged BTKA, there remains no definitive conclusion regarding the superiority of one technique in terms of safety. ⋯ In contemporary studies involving comparable baseline demographics (including comorbidity index, American Society of Anesthesiologists grade), there was moderate evidence to show that simultaneous BTKA is as safe as the staged BTKA.
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Patellar or quadriceps tendon ruptures after total knee arthroplasty constitute a devastating complication with historically poor outcomes. With advances in soft tissue reconstruction and repair techniques, treatment has become more nuanced. Numerous graft options for reconstruction and suture techniques for repair have been described but there is no consensus regarding optimal treatment. ⋯ Extensor mechanism disruption after total knee arthroplasty is a complication with high morbidity. Reconstruction of patellar tendon rupture has a much lower complication rate than repair. Our findings support the recommendation of patellar tendon reconstruction in both the early and late presentation stages. Quadriceps rupture can be treated with repair in early ruptures or with reconstruction in the late rupture or in the case of revision surgery.
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Meta Analysis Comparative Study
Factor Xa Inhibitors and Direct Thrombin Inhibitors Versus Low-Molecular-Weight Heparin for Thromboprophylaxis After Total Hip or Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.
The purpose of this study is to perform a meta-analysis to compare outcomes of venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin (LMWH) vs other anticoagulants in patients who received total knee (TKA) or total hip arthroplasty (THA). ⋯ LMWH is associated with a higher rate of VTE than factor Xa inhibitors in TKA and THA patients. Direct thrombin inhibitors are associated with a lower rate of VTE in THA patients, but their effectiveness with respect to DVT and pulmonary embolism prophylaxis is similar to that of LMWH in TKA and THA patients.
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Total knee arthroplasty is a treatment option for debilitating arthritis. In the postoperative period, patients experience moderate to severe pain affecting the rehabilitation, hospital stay, and patient satisfaction. This study aims at utilizing current best evidence to determine whether adductor canal block (ACB) or periarticular injection (PAI) is a better modality for managing short-term postoperative pain and opioid consumption. ⋯ PAI could significantly improve postoperative pain and opioid consumption when compared with ACB. Additional, high-quality studies are required to further address this topic.