Periarticular infiltration used in total joint replacements: an update and review article.

Periarticular infiltration following total knee and hip arthroplasty has been demonstrated to be equivalent to peripheral nerve blocks for postoperative pain management. The ideal cocktail has not been established yet. We have conducted a literature search on PubMed and Embase. Our search criteria included randomized controlled trials (RCTs) and systematic reviews (SRs). We tried to only include the most recent studies to keep the information current. The included research focused at Dexmedetomidine, Liposomal Bupivacaine, Ropivacaine, Epinephrine, Ketorolac, Morphine, Ketamine and Glucocorticosteroids. Each medication's mode of action, duration, ideal dosage, contraindications, side effects and effectiveness have been summarized in the review article. This article will help the clinician to make an informed evidence-based decision about which medications to include in their ideal cocktail.

Pseudotumors in Total Joint Arthroplasty.

¼: The true incidence of pseudotumors in association with total joint arthroplasty is underestimated. ¼: Pseudotumors occur with metal-on-metal, metal-on-polyethylene, and metal-on-ceramic articulations. ¼: Metal ion levels should not be the only factor in decision-making regarding revision surgery. ¼: Revision surgery is only indicated in symptomatic patients with clinical and radiographic findings and elevated metal ion levels. ¼: Revision to a non-metal articulation is strongly suggested.

Metal Hypersensitivity in Joint Arthroplasty.

Metal hypersensitivity in joint arthroplasty is a very controversial topic with limited evidence. With increasing numbers of joint replacements being done annually, a clear understanding of the pathogenesis, clinical picture, preimplant screening, postimplant workup, and treatment plan is crucial. This review article looked at all the available evidence regarding metal hypersensitivity and summarized the key findings. An algorithm was also proposed for preimplant screening, postimplant workup, and management.

Controversial Topics in Total Knee Arthroplasty: A 5-Year Update (Part 1).

BACKGROUND: This review article examines updates to the literature during the past 5 years on numerous topics related to total knee arthroplasty which were felt to have ongoing controversy. These include the use of peripheral nerve blocks and local infiltrative analgesia, intrathecal morphine, patellar resurfacing, and bearing designs. METHODS: For each individual topic, a literature search was conducted on several databases with emphasis on studies that were published in the past 5 years. Preference was given to meta-analyses and randomized controlled trials. RESULTS: Multimodal periarticular injections may provide an equally effective analgesic effect to peripheral nerve blocks, but are also muscle sparing and less invasive. The use of intrathecal morphine in addition to periarticular injections is less desirable given the potential side effects, associated cost, and lack of clear benefit intrathecal morphine beyond the 6- to 12-hour postoperative period. Patellar resurfacing was associated with a lower rate of revision surgery, similar or potentially improved satisfaction and functional outcomes, and no increased risk of complications compared with nonresurfacing. There are no clear or notable differences between cruciate-retaining and posterior-stabilized total knee designs in terms of clinical outcomes and survivorship. Medial pivot designs theoretically recreate more normal knee kinematics compared with cruciate-retaining or posterior-stabilized designs, although superiority has not yet been clearly demonstrated and additional long-term data is necessary, particularly for survivorship. CONCLUSIONS: By analyzing the results of the aforementioned studies, surgeons can implement the most up-to-date evidence-based care when doing total knee arthroplasty surgery. However, many of these selected topics continue to have a component of ongoing controversy with no definitive conclusions developed in recent literature.

Controversial Topics in Total Knee Arthroplasty: A Five-Year Update (Part 2).

This review article examines updates to the literature during the past 5 years on numerous topics which were felt to have ongoing controversy. These topics include venous thromboprophylaxis, tranexamic acid usage, tourniquet usage, and wound closure techniques. Methods: For each individual topic, a literature search was conducted on several databases with emphasis on studies that were published in the past 5 years. Preference was given to meta-analyses and randomized controlled trials. Results: Tranexamic acid is a safe and effective treatment modality, and consideration should be given to use multiple doses and combine different modes of administration. Certain treatment modalities (skin sutures, limited or no tourniquet usage) can cause greater patient satisfaction at a cost of longer operating times. Postoperative anticoagulation is still a very controversial topic. There is however some evidence suggesting prolonging anticoagulation to 35 days postoperative. Conclusions: By analyzing the results of the aforementioned studies, surgeons can implement the most up-to-date evidence-based care when doing total knee arthroplasty surgery. However, many of these selected topics continue to have a component of ongoing controversy with no definitive conclusions developed in recent literature.

Comprehensive Review of Current Constraining Devices in Total Hip Arthroplasty.

Hip instability after total joint arthroplasty is a devastating complication. Appropriate management of instability is a challenge. Three components that are commonly used in these challenging scenarios are constrained liners, constrained tripolar components, and nonconstrained tripolar components. The biomaterials and biomechanics of these devices vary. Surgeons must take into account the risks associated with each of these components and some surgical pearls for their use. A thorough review of the recent literature allows comparison of results addressing the short-, medium-, and long-term survival of each component. Constraining devices are a good option when used in salvage procedures in elderly and/or low-demand patients with hip instability. However, constraining devices should not be used to correct deficiencies in surgical technique or implant placement.