Postoperative analgesic efficacy of fascia iliaca block versus periarticular injection for total knee arthroplasty.

STUDY OBJECTIVE: This study evaluated the postoperative analgesic efficacies of fascia iliaca block and periarticular drug injection techniques after TKA (total knee arthroplasty) surgeries. DESIGN: Prospective, randomized clinical trial. SETTING: University Teaching and Research Center. PATIENTS: Seventy-one American Society of Anesthesiologists (ASA) I-III patients between 48 and 70 years of age who underwent total knee arthroplasty were randomized. INTERVENTIONS: Tenoxicam (20 mg) was administered intramuscularly to both groups of patients 30 minutes before surgery. Patients were randomized into two groups to receive fascia iliaca block before the induction of anesthesia (Group FI) or periarticular drug injection during the surgery (Group PI). All surgeries were performed under general anesthesia using standard techniques. Postoperative analgesia was provided with patient-controlled intravenous morphine. MEASUREMENTS: Total morphine consumption was the primary outcome measure and was recorded postoperatively at 1, 2, 6, 12 and 24 hours. Pain levels at rest and on movement (knee flexion) were evaluated using the Visual Analogue Scale (VAS) and recorded at the same time points. Patients' demographics, rescue analgesic demands, side effects, hemodynamics, and satisfaction scores were also recorded. MAIN RESULTS: The groups had similar VAS scores both at rest and on movement (P>.05). However, the amount of cumulative morphine and use at each follow-up period was higher in Group PI (P<.0001). The groups did not differ significantly in rescue analgesic use or side effects, such as nausea/vomiting, hemodynamic variables, and patient satisfaction scores (P>.05). CONCLUSIONS: Fascia iliaca block may be used as an alternative method to periarticular injection, and it effectively reduces the amount of morphine used to relieve post-TKA pain.

Knee joint synovial cyst following total knee arthroplasty with bone allograft.

Allograft has been shown to be highly successful for managing large osseous defects in total knee arthroplasty. We report a 68-year-old woman in whom a bone allograft had been used during total knee arthroplasty owing to a massive segmental medial tibia plateau defect 4 years earlier. Eighteen months after surgery, a 10x10 cm knee synovial cyst was detected by computed tomography scanning on the anteromedial side of the tibial plateau, and an en-bloc surgical excision was performed. At 36-month follow-up, a 16x12 cm cyst was found. Excision was again performed with removal of the allograft and application of an autologous iliac graft. After allograft removal, clinically and radiologically satisfactory results were achieved at the final follow-up.

The correlation of correction magnitude and tibial slope changes following open wedge high tibial osteotomy.

We investigated whether there is a correlation between coronal plane correction magnitude and tibial slope in patients treated with medial open wedge high tibial osteotomy (OWHTO) and also measured changes in patellar height. Thirty-four knees treated with for varus deformities were retrospectively reviewed and the follow-up period of the patients was averaged 24.1 months. Preoperative and postoperative measurements of the Hospital for Special Surgery (HSS) score, Insall-Salvati index, posterior tibial slope angle, mechanical axis deviation, proximal medial tibial angle (PMTA) was used to determine. All patients had a significant increase in their HSS score postoperatively (P < 0.0001). There was no significant correlation between the differences in patellar heights (P = 0.368). The mechanical axis deviation was altered by a mean of 25.5 +/- 10.9 mm and the difference was statistically significant (P < 0.05). The mean posterior tibial slope angle on preoperative radiographs was 9.0 +/- 5.1 degrees ; on postoperative radiographs it was 11.7 +/- 5.7 degrees and the difference was statistically significant (P < 0.007). Seventeen knees (50%) demonstrated postoperative posterior tibial slope angle increases; 7 knees (21%) had a decrease in this angle, while 10 knees (29%) showed no change. Statistical analyses revealed that the mechanical axis deviation was not correlated with change in tibial slope (P = 0.837). Although we could not find a correlation between tibial slope change and the amount of coronal correction, 50% of our patients demonstrated increased tibial slope.

Arthroscopic debridement and grafting of an intraosseous talar ganglion.

We report the case of a 41-year-old man with right ankle pain and swelling who had an intraosseous talar ganglion in the medial part of talar dome. A surgical procedure was performed using the 3-portal arthroscopic approach. The softened chondral surface was removed and the content of the cyst was discharged arthroscopically. The sclerotic rim was abraded until the bleeding spongious layer was seen. A grafting procedure was also performed arthroscopically. A trocar was introduced into the defect from the superomedial portal. Autografts were impacted using a cylindrical rod through the trocar into the defect. The clinical and radiologic results at the 1-year follow-up were satisfactory. We encountered no complications postoperatively. We conclude that arthroscopic debridement and grafting of an intraosseous ganglion adjacent to the articular surface may be a better option compared with open surgery.

Effects of methylprednisolone and betamethasone injections on the rotator cuff: an experimental study in rats.

Thirty-one female Sprague-Dawley rats were used to determine the effects of subacromial corticosteroid injections on the rotator cuff. The injection technique was tested in 6 animals, which were excluded from the study. The remaining 25 rats were randomly divided into three groups of 8 animals each; a single rat received no injections. Every other week for 8 weeks, one shoulder in each rat was injected with methylprednisolone, betamethasone, or saline in a dosage equivalent to that used in humans. The supraspinatus and infraspinatus tendons were removed 10 days after the last injection and evaluated. There were no pathologic changes in the tendons injected with saline. In 43% of the methylprednisolone-treated rats and 29% of the betamethasone-treated rats, the tendons were abnormally soft and light-colored. In 43% of the methylprednisolone group and 71% of the betamethasone group, fragmentation of collagen bundles and inflammatory cell infiltration were evident. Subacromial injections of methylprednisolone or betamethasone repeated frequently can cause deleterious changes in the normal structure of the rat rotator cuff. In light of these findings, therapy for subacromial impingement syndrome of the shoulder with frequent, repeated steroid injections is potentially harmful.