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.

Computer Assisted Knee Surgery Using Navigation System

Navigation systems are currently being widely used in orthopedic surgery, and especially for total knee arthroplasty (TKA) or UKA. The mechanical axis alignment and component insertion can be judged accurately via a navigation system and this also helps in ligament balancing. A navigation system can also be used in ACL reconstruction and High Tibial Osteotomy (HTO). In open-wedge HTO, accurate multiplane measurements of the lower limb alignment can be made intraoperatively in real time, and alignment adjustments can be made as the surgeon desires. Navigation more accurately improves the postoperative lower limb alignment than the conventional cable-method, and it significantly reduces the radiation exposure time. Navigation for ACL reconstruction allows exact placement of the tibial and femoral tunnels and it prevents impingement, and it also significantly improves the results of isometricity of the femoral tunnel and the stability of the reconstructed ACL ligament. Using a navigation system in knee surgery provided useful intraoperative information about the anatomical placement that's done intraoperatively in real time. It helps perform accurate surgery, it improves the radiologically assessed implantation and it allows precise correction of a mechanical axis, and so we can expect improved clinical results.

One-Staged Open-Wedge High Tibial Osteotomy and Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: We wanted to evaluate the clinical and radiological results of one-staged open-wedge high tibial osteotomy (HTO) and arthroscopic anterior cruciate ligament (ACL) reconstruction for patients with complete rupture of the ACL and concomitant varus malalignment of the lower limb. MATERIALS AND METHODS: Twenty-five patients were prospectively assessed before and 1 year after their simultaneous operation as a single procedure. The clinical assessment included the Lysholm score, the Tegner activity level scale and a physical examination. The radiological data was used to calculate the mechanical axis, the joint space, the tibial slope and the arthrometric stress test. The postoperative complications were also assessed. RESULTS: The Lysholm knee score and the Tegner activity level scale improved from a mean of 72.1 to 93.8 and from 1.45 to 4.65, respectively (p0.05). The severity and rate of the postoperative complications were both low. CONCLUSION: One-staged open-wedge HTO and ACL reconstruction produced satisfactory correction of the mechanical axis alignment and, it improved knee function. Further, the procedure had a low complication rate. It is also cost effective due to, reducing the frequency of operation and avoiding overlap of rehabilitation.

The Changes of Postural Balance in Patients with Total Hip Arthroplasty

PURPOSE: To investigate the changes in postural balance before and after total hip arthroplasty (THA) using computerized dynamic posturography MATERIALS AND METHODS: This was a prospective study of 18 patients undergoing total hip arthroplasty. We evaluated each patient's postural balance prior to, and at least 12 months after, total hip arthroplasty by using computerized dynamic posturography. We compared the preoperative equilibrium scores with the postoperative equilibrium scores. Clinical results were assessed for all patients preoperatively and postoperatively using the Harris hip scoring system. We investigated whether postural balance improves, and what factors were related to this parameter. RESULTS: Patients showed significant improvement in postural balance by means of proprioception after total hip arthroplasty (p<0.05). We found, during intercepting visual compensation, that an increase in the Harris hip score was correlated with an improvement in balance (p<0.01, r = 0.649). CONCLUSION: Patients with Total hip arthroplasty showed improvement in dynamic postural balance through proprioceptive recovery, and balance improved as the Harris hip score increased. This resulted in decreased pain, recovery of articular function, enhancement of physical activity, and ultimately improvement in postural balance by means of total hip arthroplasty.

Intramedullary Plate Fixation for the Comminuted Fracture of the Femoral Shaft: A Case Report

A case of the comminuted fracture of the femoral shaft with osteoporosis is presented. The patient lacked sufficient bony stability and cortical bone-contact which allows union by conventional reconstruction method. Therefore, the authors performed a technique utilizing an intramedullary plate in combination with the standard lateral plate in order to obtain bony stabilization, early range of motion of the knee, and partial weight bearing ambulation and the technique is introduced.

Intramedullary Plate Fixation for the Comminuted Fracture of the Femoral Shaft: A Case Report

A case of the comminuted fracture of the femoral shaft with osteoporosis is presented. The patient lacked sufficient bony stability and cortical bone-contact which allows union by conventional reconstruction method. Therefore, the authors performed a technique utilizing an intramedullary plate in combination with the standard lateral plate in order to obtain bony stabilization, early range of motion of the knee, and partial weight bearing ambulation and the technique is introduced.