Perioperative Pain Management in Patients Undergoing Total Hip Arthroplasty: Where Do We Currently Stand?

Total Hip replacement (THR) is a well-discussed topic, and it offers excellent results in patients suffering from end-stage osteoarthritis (OA). However, despite the fact that patients can fully bear weight immediately after the surgery, THR is often associated with a great amount of postoperative pain affecting recovery and rehabilitation. Therefore, the efficient management of pain is of paramount importance. The aim of this review is to examine all the currently available strategies of pain management such as preemptive analgesia (PA), patient-controlled analgesia (PCA), and the various types of anesthesia that are used during the operation. With that objective in mind, we conducted our research by searching through the PubMed database for articles published in 2015 and after. For purely clinical reasons, we have attempted to classify all the best available evidence into three major categories: prior to surgery, during the surgery, and after the surgery. Multimodal analgesia seems to play a major role in the perioperative care of patients undergoing total hip arthroplasty (THA). Therefore, a considerable number of studies have been conducted analyzing all the current strategies that aim to minimize perioperative pain and consequent complications.

Grade 3 AC joint injury: A survey of current practice in the United Kingdom.

Acromio-clavicular (AC) joint injuries are a common injury seen in athletes and represent 9% to 12% of all shoulder injuries. There is no clear consensus on treatment of grade 3 injuries. We conducted a survey among upper limb surgeons in the United Kingdom to review commonly accepted practise. We found that majority of surgeons never did stress view. Most surgeons favoured surgery only if needed but not first choice. There is no consensus on timing of surgery. There are many fixation options available for AC joint dislocation and we found that surgeon's preferences were quiet wide for choosing fixation method. That is also evident from this questionnaire as there is no consensus in orthopaedic surgeons for ideal treatment of type 3 AC joint dislocations. Authors recommend randomized controlled trial to formulate definite treatment plan.

Technique for gentle accurate reproducible closed reduction of intracapsular fracture of neck of femur.

Non-anatomic reduction with either inferior offset or varus angulation was the strongest predictor of re-displacement of the fracture and poor outcome after fixation of intracapsular fracture of neck of femur. There are many techniques for closed reduction and can be broadly divided into non-invasive and invasive techniques. We describe a minimally invasive technique, which we believe is easy, reproducible and successful in achieving good anatomical reduction.

Modified incision for Brostrom lateral ligament reconstruction of the ankle.

PURPOSE: To describe a modified incision for the Brostrom procedure to correct lateral ankle instability. METHODS: 14 men and 12 women aged 23 to 38 (mean, 27) years with lateral ankle instability underwent the Brostrom procedure with a modified incision to repair both the anterior talofibular and calcaneofibular ligaments, without endangering the sural or superficial peroneal nerves. The incision ran longitudinally over the distal fibula extending 2.5 cm distal to the tip of the lateral malleolus. RESULTS: There were no instances of wound healing problems, neurological damage, and repair failure. Surgical exposure of all patients was graded as excellent. CONCLUSION: The modified incision enables easy repair without endangering the sural and superficial peroneal nerves. Access to the peroneal tendons is allowed if necessary.

Flexor hallucis longus tendon transfer for reconstruction of chronically ruptured Achilles tendons.

PURPOSE: To report the mid-term results of flexor hallucis longus (FHL) tendon transfer for reconstruction of chronically ruptured Achilles tendons. METHODS: 24 men and 12 women aged 56 to 78 (mean, 70) years underwent FHL tendon transfer for reconstruction of chronically ruptured Achilles tendons by a single surgeon. Ruptures were secondary to trauma (n=20), long-term steroid intake (n=12), or chronic renal failure (n=6). Two patients had bilateral ruptures. The mean interval from rupture to surgery was 15 (range, 12-24) weeks. Pre- and post-operative American Orthopaedic Foot and Ankle Society (AOFAS) hind foot scores were compared. Wound healing, push-off, and patient satisfaction were evaluated. RESULTS: The mean follow-up period was one year. The mean AOFAS scores were 69 (range, 58-76) preoperatively and 88 (range, 79-94) postoperatively; the mean improvement was 19 (p<0.001). 28 patients had excellent and 8 had fair results. 33 patients graded their outcome as 'very satisfactory' and 3 as 'satisfactory'. Five patients developed wound healing complications but only one needed debridement. There was no fixation-related complication or sural nerve injury. CONCLUSIONS: Transfer of the FHL for reconstruction of chronically ruptured Achilles tendons is effective, safe and easily performed in patients with low-to-moderate demands.

Arthroscopic repair of the triangular fibrocartilage complex using a hypodermic needle: a technical note.

Tears of the triangular fibrocartilage complex (TFCC) often lead to chronic wrist pain. The commonly used 2-needle outside-in and inside-out suturing techniques require an extra incision to tie the sutures subcutaneously. We use a practical and cost-effective arthroscopic technique for treatment of peripheral Palmer type 1B TFCC tears using a hypodermic needle. This obviates the need for an additional skin incision, thus lowering the risk of neurovascular damage, reducing postoperative pain, and enabling faster rehabilitation and better cosmesis.

Single transverse, dorsal incision for lesser metatarsophalangeal exposure.

BACKGROUND: The exposure of the lesser metatarsophalangeal joints is often difficult and inadequate in the presence of rheumatoid arthritis and associated deformities. We describe our results following the use of a single curved transverse, dorsal incision for the Mann-Thompson type of forefoot arthroplasty,(5, 9) multiple Weil osteotomies,(1, 2, 7, 11) and other forefoot procedures. MATERIALS AND METHODS: One hundred thirty-nine consecutive patients (163 feet) were included in the study. Wound healing, and patient and surgeon satisfaction were assessed. RESULTS: Ease of exposure and visualization of the target area was good-to-excellent in all patients. There were eight minor wound complications. There were no neurovascular complications. CONCLUSION: A single transverse incision offers adequate exposure of lesser metatarsophalangeal joints and good cosmesis.

Secondary chondrosarcoma in an enchondroma in a proximal phalanx of toe. A diagnostic problem. A case report.

The authors present a case of secondary chondrosarcomatous transformation in enchondroma in toe. The authors have discussed the available literature to throw light on differentiation of benign and malignant form.

Deformity correction with external fixator in pseudoachondroplasia.

Patients with pseudoachondroplasia have complex, difficult to correct deformities including angular deformity, rotational deformity, and ligament laxity. We retrospectively reviewed seven patients (two children, five adults) with 26 segmental deformities (12 femora, 14 tibiae). We performed bilateral femoral and tibial osteotomies in six patients and bilateral tibial osteotomies in one patient. Distraction osteogenesis was used in 20 segments and acute deformity correction was done in six segments. External fixation was applied to all segments. Of 26 segments, there were five good, 12 fair, and nine poor radiographic results with nine major and 12 minor complications. Recurrent deformity in children and refracture in adults were related to poor results. Of 14 limbs, there were four good, five fair, and five poor clinical results with five major and 14 minor complications. Knee stiffness was the most common complication related to poor results in our series, and occurred particularly in patients with simultaneous correction of the ipsilateral tibial and femoral deformities. Therefore, two-stage surgery including bilateral tibial osteotomies first and then bilateral femoral osteotomies is recommended instead of simultaneous correction of the ipsilateral tibial and femoral deformities to avoid knee stiffness.