Subject(s)
Health Services Accessibility/standards , Medically Underserved Area , Orthopedics/statistics & numerical data , Orthopedics/standards , Patient Care/standards , Quality of Health Care/standards , Australia/epidemiology , British Columbia/epidemiology , Health Services Accessibility/organization & administration , Health Services Accessibility/statistics & numerical data , Humans , Maine/epidemiology , Patient Care/statistics & numerical data , Quality of Health Care/statistics & numerical data , Rural Population/statistics & numerical data , United States/epidemiology , Vulnerable Populations/statistics & numerical dataABSTRACT
BACKGROUND: The primary objective of the study was to determine if local infiltration anaesthetic (LIA) reduced total length of hospital stay in total knee arthroplasty (TKA) patients. The study also examined whether LIA improves early pain management, patient satisfaction and range of motion in TKA patients. METHODS: We conducted a randomized controlled double-blinded study. Fifty patients undergoing TKA were randomized to receive either placebo or LIA at the time of surgery and on the first day post-operatively. Pain scores, level of satisfaction and range of motion were recorded preoperatively and post-operatively. RESULTS: There was no statistical difference between the groups for length of stay, post-operative pain scores, satisfaction scores or range of motion 6 weeks post-operatively. CONCLUSION: This randomized double-blinded trial did not demonstrate a decrease in pain or reduction of length of stay due to local infiltration analgesia.
Subject(s)
Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Arthroplasty, Replacement, Knee/methods , Pain, Postoperative/drug therapy , Arthroplasty, Replacement, Knee/adverse effects , Double-Blind Method , Female , Humans , Length of Stay , Male , Pain Management/methods , Pain Measurement/methods , Patient Satisfaction , Range of Motion, Articular/drug effects , Treatment OutcomeABSTRACT
STUDY DESIGN: Randomized investigation of multiaxial pedicle screw mechanical properties. OBJECTIVES: Measure static yield and ultimate strengths, yield stiffness, and fatigue resistance according to an established model. Compare these measured properties with expected loads in vivo. SUMMARY OF BACKGROUND DATA: Multiaxial pedicle screws provide surgical versatility, but the complexity of their design may reduce their strength and fatigue resistance. There is no published data on the mechanical properties of such screws. MATERIALS AND METHOD: Screws were assembled according to a vertebrectomy model for destructive mechanical testing. Groups of five assemblies were tested in static tension and compression and subject to three cyclical loads. Modes of failure, yield, and ultimate strength, yield stiffness, and cycles to failure were determined for six designs of screw. RESULTS: Static compression yield loads ranged from 217.1 to 388.0 N and yield stiffness from 23.7 to 38.0 N/mm. Cycles to failure ranged from 42 x 10(3) to 4,719 x 10(3) at 75% of static ultimate load. There were significant differences between designs in all modes of testing. Failure occurred at the multiaxial link in static and cyclical compression. CONCLUSIONS: Bending yield strengths just exceeded loads expected in vivo. Multiaxial designs had lower static bending yield strength than fixed screw designs. Five out of six multiaxial screw designs achieved one million cycles at 200 N in compression bending. "Ball-in-cup" multiaxial locking mechanisms were vulnerable to fatigue failure. Smooth surfaces and thicker material appeared to be protective against fatigue failure.
Subject(s)
Bone Screws/statistics & numerical data , Bone Screws/standards , Materials Testing/methods , Materials Testing/statistics & numerical data , Spinal Fusion/instrumentation , Equipment Failure Analysis/methods , Equipment Failure Analysis/statistics & numerical data , Stress, Mechanical , TorqueABSTRACT
Augmenting healing through a single application of an exogenous growth factor or bone morphogenetic protein is not a new concept. The use of autologous growth factors through platelet isolation and concentration provides multiple endogenous growth factors to the healing site. A posterolateral fusion model in aged sheep (5- to 6-year-old ewes) was used to examine the effects of the addition of growth factors through autologous platelet isolation on the biomechanic and histologic properties of the fusion using a resorbable coral bone graft substitute. At 6 months the combination of autologous growth factors to the Pro Osteon 500R plus aspirated bone marrow resulted in the greatest bending stiffness but not ultimate load. Autologous growth factors can be isolated from platelets and concentrated to provide multiple growth factors to the fusion site to aid in spinal fusion.