Minimum Two-year Results of Revision Total Knee Arthroplasty Following Infectious or Non-infectious Causes

PURPOSE: To compare clinical outcome of revision total knee arthroplasty (TKA) between the infected and non-infected groups. MATERIALS AND METHODS: This study compared the clinical and radiographic results of 21 infected and 15 non-infected revision TKAs at a minimum 2-years follow-up. Clinical evaluations were assessed using the range of motion (ROM), Hospital for Special Surgery (HSS) score, Knee Society Knee Score (KSKS), Knee Society Function Score (KSFS), and Western Ontario and McMaster Universities (WOMAC) score. Radiologic evaluations were assessed using the radiographic results of the American Knee Society and joint line change. RESULTS: Patients operated for non-infectious causes had significantly better postoperative ROM than the infected group (infected group, 101.7degrees; non-infected group, 117.8degrees). The infected group achieved significantly poor HSS (79.2 vs. 85.5), KSKS (75.5 vs. 86.6), KSFS (76.9 vs. 85.5), WOMAC (30.3 vs. 21.2) scores than the non-infected group. Postoperative joint line elevation was lower in the infected versus non-infected group (0.5 mm vs. 2.1 mm), but there was no significant difference. CONCLUSIONS: Revision TKA is an effective treatment that can provide successful results in the infected as well as non-infected patients. The overall results of non-infected revision were more satisfactory than infected revision.

Effectiveness of Pain Relief for Femoral Nerve Block in Multimodal Pain Control Protocols in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Authors evaluated the effectiveness of pain relief of the femoral nerve block in multimodal pain control protocols for patients with total knee arthroplasty in early postoperative period. MATERIALS AND METHODS: Seventy-six patients who underwent TKA under general anesthesia were enrolled in this study. Preemptive analgesic medication, periarticular multimodal drug injection, and IV-PCA were used for pain control in all patients. This single-blind, randomized controlled trial included 43 patients in the nerve block group and 33 patients in the control group. In the former group, the femoral nerve block was done by one author with a nerve stimulator set using 0.5% bupivacaine 20 ml and 1% lidocaine 10 ml. Pain scale was measured at 6, 12, 24, 48, 72 hours and 7 days postoperatively. In addition, amount of IV-PCA consumption, numbers of using acute pain rescuer, range of motion, straight leg raising, first ambulation time, and complications related with drugs were evaluated. RESULTS: Pain scale and the amount of IV-PCA consumption were significantly lower in nerve block group until 48 hours (p=0.04, 0.03), and the range of motion was better compared to the control group (p< or =0.02). The number of pain rescue medicines was significantly low in nerve block group within the first 3 days postoperatively (1.36 vs 2.58). The ability to raise a straightened leg was recovered more rapidly in the control group than in the nerve block group; this difference was statistically significant (12 vs 27.9 hours, p=0.02). There were no differences in first ambulation time and incidence of complications between the 2 groups. CONCLUSION: Femoral nerve block in the early period after TKA under multimodal pain control protocols showed significant improvement in pain relief and in range of motion, as well as a significant decrease in the requirement of IV PCA and acute pain rescuers.

Intraneural Ganglion of Ulnar Nerve in Proximal Forearm: Case Report

Cubital tunnel syndrome is a compressive neuropathy of the ulnar nerve posterior to the medial epicondyle of the elbow. The etiology is either idiopathic, or secondary to deformity, ectopic ossification, space occupying lesion, or osteophytes in elbow osteoarthritis. As a rare cause of cubital tunnel syndrome, we report an intraneural ganglion of ulnar nerve developed in proximal forearm with symptoms of ulnar neuropathy.