The Journal of arthroplasty
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Femoral component revision is the treatment of choice for Vancouver type B2/B3 periprosthetic femur fractures (PFFs). The purpose of this study was to report the clinical outcome of revision total hip arthroplasty with the use of a modified extended trochanteric osteotomy (ETO) in PFF treatment. ⋯ The modified ETO with a lateral approach to the hip for the treatment of PFF is compatible with fracture healing, a low dislocation rate, and good clinical results. However, component stability and apparent osseointegration are coincident with fracture healing only in the distal aspect of the inserted stem. Absence of proximal osseointegration might lead to poor osseous support resulting in inadequate fatigue strength at the junction of the dual modular revision stem.
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The United States is in the midst of an opioid epidemic. Little is known about perioperative opioid use for total knee arthroplasty (TKA). The purpose of this study was to identify rates of preoperative opioid use, evaluate postoperative trends and identify risk factors for prolonged use after TKA. ⋯ Approximately one-third of TKA patients use opioids within 3 months prior to surgery and this percentage has increased over 9% during the years included in this study. Preoperative opioid use was most predictive of increased refills of opioids following TKA. However, other intrinsic patient characteristics were also predictive of prolonged opioid use.
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The development of acute kidney disease (AKD) following total joint arthroplasty has not been well characterized in the literature. We sought to calculate the incidence and identify risk factors associated with postoperative AKD for patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). ⋯ A 6.8% incidence rate of postoperative AKD was noted in patients undergoing TKA or THA. Perioperative use of ARBs/ACEi, perioperative vancomycin use, and increased BMI were associated with increased odds of postoperative AKD.
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Randomized Controlled Trial Comparative Study
A Prospective, Randomized Trial Comparing Liposomal Bupivacaine vs Fascia Iliaca Compartment Block for Postoperative Pain Control in Total Hip Arthroplasty.
Increasing demand for total hip arthroplasty (THA) in a climate of increasing focus on clinical outcomes, patient satisfaction, and cost has created a need for better acute postoperative pain control for patients. An ideal pain control method would have few side effects, decreased opioid consumption, improved pain control, early ambulation, and decreased hospital length of stay (LOS). ⋯ Patients undergoing elective THA have decreased overall pain intensity and a shorter LOS with multimodal pain management regimen that includes either liposomal bupivacaine or FICB. Patients who received FICB required less overall total opioids than the control group.
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The aim of the present study was to investigate potential predictive factors of an unfavorable outcome in patients with prosthetic joint infection (PJI) undergoing 2-stage exchange. ⋯ A favorable outcome in patients with PJI undergoing 2-stage procedure was associated with an infection sustained by Gram-positive bacteria, absence of known comorbidities, and administration of oral therapy. Therefore, failure rate can be reduced with appropriate treatment choices.