Single-injection femoral nerve block. Effects on the independence level in functional activities in the early postoperative period in patients with total knee arthroplasty

To investigate the efficacy of single injection femoral nerve block [FNB] on the independence level in functional activities in the early postoperative period in patients with total knee arthroplasty [TKA]. We conducted this prospective, randomized, blinded trial in the Department of Orthopedics and Traumatology, Hacettepe University Hospital Ankara, Turkey, between June 2003 and April 2004. Twenty-three patients scheduled for elective TKA were randomly divided into 3 groups. Group I received preemptive single injection FNB, group II received postoperative single injection FNB, and group III served as a control group. Intravenous morphine patient controlled analgesia [PCA] was used following surgery in all groups. Morphine dose and pain score defined by the visual analog scale [VAS] were recorded postoperatively at the 15th minute, 30th minute, 1st, 4th, 6th, 12th, 24th, and 48th hours. A standard rehabilitation protocol was applied for all patients. The independence level in functional activities was assessed during the first 2 postoperative days and at discharge with the Iowa Level of Assistance Scale [ILAS] and the Iowa Ambulation Speed Scale [IASS]. Physical therapists that enrolled in the study were blinded to the groups. Pain scores were significantly different between the groups [p<0.05]. The preemptive and postoperative FNB group's VAS scores were both significantly lower than the control group [p<0.05]. However, there was no significant difference in VAS scores between preemptive and postoperative FNB groups [p>0.05]. There was no statistically significant difference between the groups in any of the functional scores in the first 2 postoperative days, and at discharge [p>0.05]. Single injection FNB provided effective analgesia in patients undergoing TKA. However, the independence level in functional activities in the early postoperative period was not influenced by the analgesia method

Immunohistochemical evaluation of periprosthetic membrane from loose cemented and uncemented total hip arthroplasty

Evaluate the cellular mechanisms responsible for the aseptic loosening of total hip replacements. Twenty periprosthetic membranes were collected during revision procedures at the Department of Orthopedics, Hacettepe University, Ankara, Turkey, during 1998 to 1999. Arthroplasties with polyethylene components and without polyethylene components were examined under light microscopy and immunohistochemically using the indirect immunoperoxidase technique into 2 different groups. Immunohistochemical analysis with monoclonal antibodies reactive to certain cell surface antigens [CD45, CD44, CD98, CD31, CD26, CD71] revealed different morphological characteristics regarding the adjacent fibrosis, leukocyte activation, and immunologic response. These findings suggested the role of different cellular mechanisms in each group

High independence level in functional activities reduced hospital stay after total hip arthroplasty regardless of pain intensity

The purpose of this study is to investigate the relationship between independence level in functional activities and pain, and length of hospital stay in the early postoperative period in patients with total hip arthroplasty [THA]. The study was performed over 26 end stage hip arthritis patients who were hospitalized in the Department of Orthopedics and Traumatology, Hacettepe University Hospital, Ankara, Turkey, between January 2000 and July 2003 for THA and operated with the same surgical technique by the same surgeon. All patients were mobilized in the first postoperative day and a standard rehabilitation protocol was applied to all patients. The independence level in functional activities of the cases was assessed with Iowa Level of Assistance Scale [ILAS]. Iowa Ambulation Speed Scale [IASS] was used to evaluate the speed of ambulation in the early postoperative period. Pain was assessed with visual analogue scale [VAS]. There was no statistically significant relation between pain intensity and independence level in functional activities on the second and sixth postoperative days [p>0,05], but independence level scores in functional activities on the second and sixth days were correlated with hospital stay length [p<0.05]. The results of this study indicate that in patients with THA, pain does not affect the independence level in functional activities in the early postoperative period. In the same period as the independence level improves, the hospital stay length decreases. This is an important factor that may reduce both the hospital costs and the possible complications due to prolonged hospital stay