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2.
Pain ; 164(5): 1138-1147, 2023 05 01.
Article in English | MEDLINE | ID: mdl-36448974

ABSTRACT

ABSTRACT: Recovery from surgery is quicker in the postpartum period, and this may reflect oxytocin action in the spinal cord. We hypothesized that intrathecal injection of oxytocin would speed recovery from pain and disability after major surgery. Ninety-eight individuals undergoing elective total hip arthroplasty were randomized to receive either intrathecal oxytocin (100 µg) or saline. Participants completed diaries assessing pain and opioid use daily and disability weekly, and they wore an accelerometer beginning 2 weeks before surgery until 8 weeks after. Groups were compared using modelled, adjusted trajectories of these measures. The study was stopped early due to the lack of funding. Ninety patients received intrathecal oxytocin (n = 44) or saline (n = 46) and were included in the analysis. There were no study drug-related adverse effects. Modelled pain trajectory, the primary analysis, did not differ between the groups, either in pain on day of hospital discharge (intercept: -0.1 [95% CI: -0.8 to 0.6], P = 0.746) or in reductions over time (slope: 0.1 pain units per log of time [95% CI: 0-0.2], P = 0.057). In planned secondary analyses, postoperative opioid use ended earlier in the oxytocin group and oxytocin-treated patients walked nearly 1000 more steps daily at 8 weeks ( P < 0.001) and exhibited a clinically meaningful reduction in disability for the first 21 postoperative days ( P = 0.007) compared with saline placebo. Intrathecal oxytocin before hip replacement surgery does not speed recovery from worst daily pain. Secondary analyses suggest that further study of intrathecal oxytocin to speed functional recovery without worsening pain after surgery is warranted.


Subject(s)
Analgesics, Opioid , Arthroplasty, Replacement, Hip , Female , Humans , Analgesics, Opioid/therapeutic use , Pain, Postoperative/drug therapy , Pain, Postoperative/etiology , Oxytocin/therapeutic use , Arthroplasty, Replacement, Hip/adverse effects , Treatment Outcome , Injections, Spinal , Double-Blind Method , Morphine/therapeutic use
3.
J Arthroplasty ; 38(4): 649-654, 2023 04.
Article in English | MEDLINE | ID: mdl-36328105

ABSTRACT

BACKGROUND: The COVID-19 virus is believed to increase the risk of diffusing intravascular coagulation. Total joint arthroplasty (TJA) is one of the most common elective surgeries and is also associated with a temporarily increased risk of venous thromboembolism (VTE). However, the influence of a history of COVID-19 infection on perioperative outcomes following TJA remains unknown. Therefore, this study sought to determine what effect a history of COVID-19 infection had on outcomes following primary TJA. METHODS: A retrospective case-control study using the national database was performed to identify all patients who had a history of COVID-19 and had undergone TJA, between 2019 and 2020. Patients who had a history of both were 1:1 matched to those who did not have a history of COVID-19, and 90-day outcomes were compared. A total of 661 TKA and 635 THA patients who had a history of COVID-19 were 1:1 matched to controls. There were no differences in demographics and comorbidities between the propensity-matched pairs in both TKAs and THAs studied. Previous COVID-19 diagnosis was noted in 28.3% of patients 5 days within TJA and in 78.6%, 90 days before TJA. RESULTS: Patients who had a previous diagnosis of COVID-19 had a higher risk of pneumonia during the postoperative period for both THA and TKA (6.9% versus 3.5%, P < .001 and 2.27% versus 1.21%, P = .04, respectively). Mean lengths of stay were also greater for those with a previous COVID-19 infection in both cohorts (TKA: 3.12 versus 2.57, P = .027, THA: 4.52 versus 3.62, P < .001). Other postoperative outcomes were similar between the 2 groups. CONCLUSION: COVID-19 infection history does not appear to increase the risk of VTE following primary TJA, but appears to increase the risk of pneumonia in addition to lengths of stay postoperatively. Individual risk factors should be discussed with patients, to set reasonable expectations regarding perioperative outcomes.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Arthroplasty, Replacement , COVID-19 , Pneumonia , Venous Thrombosis , Retrospective Studies , Case-Control Studies , Risk Factors , Venous Thrombosis/etiology , Pneumonia/complications , Postoperative Period , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Hip/adverse effects , Postoperative Complications
4.
Arthroplast Today ; 11: 146-150, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34541268

ABSTRACT

Improvements in materials, components, and surgical techniques in cementless total hip arthroplasty are resulting in improved femoral stem fixation through bony ongrowth or ingrowth. While improved femoral stem fixation is one reason for the current excellent total hip survivorship, indications for stem removal such as infection, implant fracture, or osteolysis remain. A commonly used technique for fully ingrown femoral stems is an extended trochanteric osteotomy which can result in comminuted fractures of the proximal femur during stem removal requiring additional fixation. Therefore, a novel hip stem removal was developed to facilitate removal of these well-ingrown stems without the need for an extended trochanteric osteotomy. This study describes the removal system and surgical technique and presents a case series of successfully removed ingrown stems.

5.
J Surg Orthop Adv ; 30(3): 166-169, 2021.
Article in English | MEDLINE | ID: mdl-34591006

ABSTRACT

The sterility of the gown-glove interface during total joint arthroplasty is a key factor in preventing contamination of the surgical field. To compare the potential of gown-glove interface contamination with a novel gloving technique versus standard gloving technique. We performed a study quantifying potential gown-glove interface contamination using two different gloving techniques. A 5 µm fluorescent powder simulated potential bacterial contamination. Each group gowned and gloved each hand using a modified technique versus traditional technique. Ultraviolet light was used to measure contamination at the gown-glove interface after performing a simulated surgery. The modified gloving technique did not statistically reduce the contamination at the gown-glove interface compared to the traditional gloving technique (p = 0.27). Despite using a gloving technique recently described as decreasing contamination, we noted contamination at the interface after performing a simulated surgery with a positive pressure exhaust suit. Further study is needed. (Journal of Surgical Orthopaedic Advances 30(3):166-169, 2021).


Subject(s)
Gloves, Surgical , Protective Clothing , Humans
6.
Clin Orthop Relat Res ; 452: 132-6, 2006 Nov.
Article in English | MEDLINE | ID: mdl-16906112

ABSTRACT

We studied whether computer-assisted surgery could properly align total knee arthroplasty when traditional instrumentation was not possible or appropriate. We identified 16 patients (18 knees) who we believed could not be treated using traditional instrumentation because of posttraumatic femoral deformity, retained femoral hardware, a history of osteomyelitis, or severe cardiopulmonary disease. Computer-assisted surgery was successfully used in 17 knees; we were unable to accurately register the hip in one morbidly obese patient. We judged the overall mechanical axis of the limb using computer-assisted surgery acceptable in 16 of 17 knees. One patient with a major posttraumatic biplane deformity had an overall mechanical axis in 4 degrees of varus. Computer-assisted navigation seemed helpful in difficult situations where accurate alignment remains crucial, yet traditional instrumentation is not applicable.


Subject(s)
Arthroplasty, Replacement, Knee/methods , Surgery, Computer-Assisted , Humans , Retrospective Studies
7.
J Bone Joint Surg Am ; 84(12): 2174-8, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12473705

ABSTRACT

BACKGROUND: We observed a complication of posterior stabilized total knee arthroplasty involving hypertrophy of tissue proximal to the patella associated with pain during active knee extension from 90 degrees of flexion. The purpose of this paper was to describe synovial entrapment and to determine if design features of the prosthesis predispose patients to the complication. METHODS: Between April 1990 and June 1999, we performed 459 consecutive posterior stabilized primary total knee arthroplasties using three prosthetic designs with different femoral intercondylar geometries. We identified twenty-six patients (twenty-seven knees) in whom arthroscopic débridement of the knee or open arthrotomy with débridement of the knee had been subsequently performed because of a diagnosis of synovial entrapment. We reviewed the records of these patients to identify the knee components that had been used and the symptoms and conditions that necessitated additional treatment. RESULTS: Symptoms (grating, crepitation, and pain with active knee extension from 90 degrees) necessitating subsequent débridement occurred in 13.5% (nineteen) of 141 knees treated with the Anatomic Modular Knee-Congruency implant, 3.8% (eight) of 212 treated with the Anatomic Modular Knee-Posterior Stabilized implant, and none of the 106 treated with the Press Fit Condylar Sigma-Posterior Stabilized implant. All patients had difficulty rising from a chair and climbing stairs; however, none had symptoms when standing or walking. No patient had a patellar clunk. The symptoms occurred at a mean of seven months after the arthroplasty in the patients with an Anatomic Modular Knee-Congruency implant and at a mean of twenty months after the arthroplasty in those with an Anatomic Modular Knee-Posterior Stabilized implant. Débridement of the frond-like hypertrophic synovial tissue at the distal aspect of the quadriceps tendon alleviated symptoms in all patients. No nodules were identified during the arthroscopy. CONCLUSIONS: Synovial entrapment is characterized by hypertrophic synovial tissue at the superior pole of the patella. Use of a posterior stabilized femoral component with a proximally positioned or wide femoral box is more likely to result in this complication.


Subject(s)
Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Synovial Membrane , Aged , Aged, 80 and over , Female , Humans , Joint Diseases/etiology , Joint Diseases/pathology , Joint Diseases/physiopathology , Male , Middle Aged , Range of Motion, Articular
8.
J Arthroplasty ; 17(6): 752-9, 2002 Sep.
Article in English | MEDLINE | ID: mdl-12216030

ABSTRACT

This study quantified the variability associated with diagnosing periprosthetic osteolysis from the radiographs of total hip arthroplasty patients. Four joint arthroplasty surgeons independently assessed radiographs of 60 patients for evidence of osteolysis in different zones. The surgeons agreed on the presence of lesions in at most 57% of the zones. kappa coefficients, used to quantify the extent of agreement among the surgeons, denoted poor interobserver reproducibility (kappa =.28 to.44). Intraobserver reliability-determined by comparing 2 reviews of the same radiographs done by 1 surgeon 2 weeks apart-was moderate to excellent (kappa =.48 to.84). We also compared the results from the most recent radiograph with those from a time series. Agreement improved when a series was reviewed. Reliable comparisons cannot be made with osteolysis rates reported by different observers. In the research setting, osteolysis rates are more reliable if they are determined by a single reviewer whose intraobserver variability has been reported. In assessing a patient for osteolysis, it is more accurate to analyze a series of radiographs than the most recent radiograph.


Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Osteolysis/diagnostic imaging , Humans , Observer Variation , Osteolysis/etiology , Prosthesis Failure , Radiography , Retrospective Studies
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