Long-term results of per-operative knee arthroscopy in confirming suitability for unicompartmental arthroplasty.

BACKGROUND: Patient selection is key to the success of medial unicondylar knee arthroplasty (UKA). Progression of arthritis is the most common indication for revision surgery. Per-operative arthroscopy is a means of directly assessing the integrity of the lateral compartment. The aim of the study is to assess the long-term survivorship of UKA performed when per-operative arthroscopy is used as a final means of deciding whether to proceed with UKA. METHODS: We used per-operative arthroscopy as a means to confirm suitability for UKA in a consecutive series of 279 Oxford medial UKA. Our series of UKA with per-operative arthroscopy (Group 1) was compared to all Oxford UKA (Group 2) and all UKA in the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (Group 3). RESULTS: The 14-year cumulative percentage revision (CPR) was 18.5% (95% CI 12.7, 26.4) for group 1, 19.7% (95% CI 18.8, 20.6) for group 2, and 19.2% (95% CI 18.5, 19.8) for group 3. There was no statistically significant difference in the (CPR) for the entire period when group 1 was compared to groups 2 or 3. Progression of arthritis was least in Group 1 compared to groups 2 and 3; 3.6 versus 4.4 and 4.1% respectively. Following per-operative arthroscopy 21.6% (77/356) of knees underwent a change of surgical plan from UKA to TKA. CONCLUSION: In our practice, which includes per-operative arthroscopy, we have identified a reduced risk of revision due to progression of arthritis but no difference in overall long-term implant survivorship.

Femoral nerve block vs fascia iliaca block for total knee arthroplasty postoperative pain control: a prospective, randomized controlled trial.

Femoral nerve block (FNB) is an accepted mode of analgesia for lower limb procedures but has a documented complication rate. This study compared femoral nerve and fascia iliaca regional anesthesia for total knee arthroplasty (TKA), using fentanyl consumption as the primary outcome measure. Ninety-eight primary unilateral TKA patients were blinded and randomized into fascia iliaca block (FIB) (n = 51) or FNB (n = 47) groups. No significant differences were found in analgesia use (fentanyl and tramadol) at 12 and 36 hours in pain, nausea and range of motion between the groups. There was one case of paresthesia in the femoral nerve in the FNB group. Fascia iliaca block is as effective as FNB as part of a multimodal anesthetic regimen for TKA.

Early prosthetic complications after unipolar hemiarthroplasty.

BACKGROUND: In Australia, the most frequently used hemiarthroplasty prosthesis for the management of displaced intracapsular femoral neck fractures is the Uncemented Austin Moore (UAM). Despite concerns regarding poor functional outcomes and increased early revision rates associated with the UAM prosthesis, apprehension regarding the systemic side-effects of polymethylmethacrylate cement implantation in the elderly patient continues to influence prosthesis selection. This study examines the incidence of early prosthesis related complications after UAM and Cemented Thompson (CT) hemiarthroplasty procedures for the management of femoral neck fractures. METHODS: A multicentre retrospective review of charts and radiographs was conducted in 1118 unipolar hemiarthroplasty implantations to determine early complications associated with the CT and UAM prostheses over a 6-year period in five Queensland public hospitals. RESULTS: Intraoperative periprosthetic fractures were sustained in 11.8% of UAM and 1.8% of CT implantations (P < 0.0001). Intraoperative periprosthetic fractures were associated with an increased requirement for reoperation within 1 month of the index procedure (P = 0.05). No statistical difference in the incidence of intraoperative periprosthetic fractures could be observed between the hospitals participating, regardless of the proportional use of each prosthesis. Early dislocation rates were similar for the UAM and CT prostheses. The intraoperative mortality rate attributable to the use of polymethylmethacrylate cement during hip hemiarthroplasty was 1/738 (0.14%). CONCLUSIONS: The results of this study support the use of the CT prosthesis for the management of femoral neck fractures to reduce the high incidence of intraoperative periprosthetic fractures and associated requirements for early reoperation experienced with the UAM.