Comparison of 2 Analgesia Modalities in Total Knee Replacement Surgery: Is There an Effect on Knee Function Rehabilitation?

BACKGROUND We compared the effects of continuous femoral nerve block (CFNB) and continuous intraarticular block (CIAB) on pain, functional recovery and adverse effects after total knee arthroplasty (TKA). MATERIAL AND METHODS We prospectively randomized 54 patients undergoing TKA into 2 groups: CFNB (Group F) and CIAB (Group I). Surgery was performed under spinal anesthesia. All patients received patient-controlled analgesia (PCA) with morphine, diclofenac, and acetaminophen for the first 72 h postoperatively. Pain was assessed with a visual analog scale (VAS), 48-h morphine consumption and 72-h local anesthetic dosage were recorded, motor blockade was assessed, maximum range of motion (ROM) was measured, and adverse effect profiles were recorded. RESULTS There was no significant difference in postoperative pain at rest, in passive motion, active motion, or active movement (2-min walk test (2MWT)) between study groups. Group I had less opioid usage in the first 24 h postoperatively (p<0.05). No significant difference was found between the groups in the postoperative local anesthetic dosage (p>0.05). Significantly lower scores of Bromage scale in Group I in 72 h after surgery (p<0.05) were found. Group I had superior passive maximum ROM in 1 month after surgery and superior active maximum ROM on day 7 and at 1 month after surgery (p<0.05). CONCLUSIONS Both CFNB and CIAB are effective postoperative analgesia methods after TKA. CIAB leads to lower postoperative opioid usage in the first 24 h, lower motor blockade in the first 72 h, and better knee function on day 7 and at 1 month after surgery.

Delayed hospitalization increases mortality in displaced femoral neck fracture patients.

BACKGROUND AND PURPOSE: Reports regarding the relationship between delayed surgery and mortality in femoral neck fracture patients are contradictory. We could not find any study in the literature investigating delayed arrival to hospital and delayed surgery as separate factors affecting mortality in femoral neck fracture patients, which was the purpose of our study. PATIENTS AND METHODS: We analyzed 265 consecutive patients with displaced femoral neck fractures. We recorded the time period from trauma to admission, and to surgery, and correlated it to mortality during the first postoperative year. RESULTS: We found that arrival within 6 hours had 0.4 times (CI 0.2-0.8) reduction of the risk of death within 1 year compared to those who arrived later, whereas delayed surgery after admission did not have a statistically significant effect on mortality. INTERPRETATION: Femoral neck fracture patients who arrived at hospital 6 hours or later after the trauma had increased mortality.

Trial femoral head loss in to the soft tissues of pelvis during primary total hip replacement: a case report.

The loss of trial femoral head in the soft tissues is a rare per operative complication in total hips replacement. We report the loss of the femoral head in surrounding hip joint soft tissues and unsuccessful attempts to locate and remove it. Surgeons should be aware of such complication as trial femoral heads usually are made from non radiolucent material and cannot be detected by regular x-ray examination during surgery. The industry should consider manufacturing trial femoral heads from x-ray visible material.

[Treatment outcome in femoral neck fractures]. / Slaunikaulio kaklo luziu gydymo rezultatai.

Retrospective study of 372 patients with Garden III-IV type intracapsular femoral neck fractures performed in Clinic of Orthopedics and Traumatology, Kaunas University of Medicine, Kaunas Red Cross hospital. Ninety eight percent of them were operated: osteosynthesis for 302 patients, and arthroplasty for 63 patients. Evaluating results of treatment we paid attention on walking ability, pain in hip joint. Mean follow-up time was 1.5 years. Satisfactory results we received for 41.8%. The best results we received after total hip replacement and after osteosynthesis with modern fixation devices. Delayed surgery worsens results. Type of anesthesia did not influence results of osteosynthesis.