ABSTRACT
Abstract Introduction: Regional anesthesia is widely used for postopera tive analgesia in total knee arthroplasty (TKA). Although it is a safe and effective procedure, serious complications may still develop. In the event of an unusual or torpid evolution, the possibility of local anesthetic-induced myotoxicity should be suspected. Case presentation: A 54-year old patient, American Society of Anesthesiologists (ASA) II, underwent TKA due to primary gonarthrosis.. The analgesic technique used was a femoral nerve block associated with continuous perineural infusion. 24 hours later, the patient's medical condition deteriorated presenting pain, edema, and functional limitation of the thigh of the operated extremity. The symptoms were suggestive of myotoxicity, confirmed with diagnostic images leading to the removal of the catheter. The patient experienced then a significant improvement and was discharged 5 days after surgery. Conclusion: The diagnosis of myotoxicity from local anes thetics is rare, since its manifestations may be masked by the usual symptoms of the postoperative period. Early identification of the condition is fundamental to reduce its negative impact on the patient's recovery and satisfaction. Since the scope of the damage depends particularly on the concentration and duration of the exposure to the local anesthetic agent, there is a need to implement protocols that enable an effective block with the lowest concentration and volume of the medication.
Resumen Introducción: La anestesia regional es ampliamente usada para la analgesia posoperatoria en la Artroplastia de Reemplazo de Rodilla (ARR). Aunque son procedimientos seguros y efectivos, la posibilidad de complicaciones graves existe. Ante una evolución inusual o tórpida se debe sospechar la posibilidad de miotoxicidad inducida por anestésicos locales. Presentación del caso: En un paciente de 54 años, American Society of Anesthesiologists (ASA) II, se llevó a cabo ARR por gonartrosis primaria. Como técnica analgésica se usó el bloqueo de nervio femoral asociado a infusión continua perineural. 24 horas después el paciente presenta deterioro clínico dado por dolor, edema y limitación funcional en muslo de extremidad operada. Ante síntomas sugestivos de miotoxicidad confirmada por imágenes diagnósticas, el catéter fue retirado. Posteriormente, presentó una mejoría significa tiva y egresó del hospital al quinto día posoperatorio. Conclusiones: El diagnóstico de miotoxicidad por anestésicos locales es poco frecuente debido a que sus manifestaciones pueden estar enmascaradas por los síntomas habituales durante el periodo posoperatorio. Su identificación temprana es funda mental para disminuir el efecto negativo sobre la recuperación y la satisfacción del paciente. Dado que la magnitud del daño depende especialmente de la concentración y la duración de la exposición al anestésico local, es necesario implementar proto colos que permitan lograr un bloqueo efectivo con la menor concentración y volumen posible del medicamento.
Subject(s)
Humans , Male , Middle Aged , Arthroplasty , Bupivacaine , Myotoxicity , Analgesia , Surgical Procedures, Operative , ToxicityABSTRACT
Objective Uncemented prothesis has become the preference of first hip arthroplasty, but there is a little study on its application in cemented acetabular revision arthroplasty.This paper aimed to evaluate the clinical effects of uncemented acetabular cup in cemented acetabular prosthesis revision arthroplasty. Methods A retrospective analysis was made on the clinical data of 31 patients(31 hips) who underwent revision arthroplasty using uncemented acetabular prosthesis from January 2012 to March 2015.Har-ris hip score( HSS) was applied to measure the hip function and visual analogue score( VAS) was preformed to assess the pain degree of knee joint preoperatively and postoperatively(3 months, 6 months and 1 year).All the patients were followed up for a mean of 22 months ranging from 3 to 42 months. Result The mean HSS increased from preoperative points (53.19 ±9.12) to postoperative points([77.71 ±5.75]at 3 months,[80.61 ±5.74] at 6 months,[82.94 ±5.80] at 1 year ).The mean VAS score decreased from preoperativepoints (6.23 ±1.23) to postoperative points(0.26 ±0.27).No lossening, infection or deep vein thrombosis were found in the patients′prostheses. Conclusion For patients with PaproskyI-Ⅱ acetabular defects, uncemented acetabular prosthesis has satisfactory short-term clinical results in revision arthroplasty with cemented acetabular prosthesis, however, long-term clinical results remain to be further observed.
ABSTRACT
Osteoporosis due to the rheumatoid arthritis and the glucocorticoid therapy predisposes patients to insufficiency fractures. Insufficiency fractures or periprosthetic fractures of the lower extremity in the rheumatoid arthritis have been frequently reported. But those of the upper extremity were rarely reported. We report three cases of the insufficiency fracture of the olecranon after total elbow replacement arthroplasty in patients with the rheumatoid arthritis. All the cases were successfully treated by immobilization for 3 weeks. At the last follow-up, there were no functional impairments or residual symptoms caused by the fractures.