Effectiveness of Accelerated Recovery Performance for Post-ACL Reconstruction Rehabilitation.

Atrophy and protracted recovery of normal function of the ipsilateral quadriceps femoris muscle following anterior cruciate ligament reconstruction surgery is well documented. The Accelerated Recovery Performance trainer is a type of electrical stimulation device that delivers a high-pulse frequency via a direct current, making it unique from many other devices on the market. The purpose of the present study was to investigate the effects of the direct current (via the Accelerated Recovery Performance trainer protocol) on gains in thigh circumference following anterior cruciate ligament reconstruction. Twenty-five patients were enrolled following isolated anterior cruciate ligament reconstruction and randomly assigned to either an isometric rehabilitation protocol augmented with the Accelerated Recovery Performance trainer protocol (experimental group) or the isometric rehabilitation protocol alone (control group). The two groups participated in sixteen sessions of directed rehabilitation over a two-month time period. Patients were followed with serial thigh circumference measurements at 5, 10, 15, and 20 centimeters above the superior patellar pole. Comparison of the overall mean circumferential gains in thigh circumference of the involved leg demonstrated approximately 3:1 gains in the ARP group over the control group, demonstrating it to be superior to isometric rehabilitation alone with regards to gains in thigh girth. The Accelerated Recovery Performance trainer protocol should be considered for post-anterior cruciate ligament reconstruction rehabilitation in order to reverse disuse atrophy of the ipsilateral quadriceps femoris.

Perioperative Dexamethasone Administration Does Not Increase the Incidence of Postoperative Infection in Total Hip and Knee Arthroplasty: A Retrospective Analysis.

BACKGROUND: Dexamethasone is frequently used for the treatment of postoperative nausea and vomiting and as an adjunct in multimodal postoperative analgesia after total joint arthroplasty; however, the incidence of periprosthetic joint infection (PJI) after the use of perioperative dexamethasone in total joint arthroplasty has yet to be fully elucidated. METHODS: A retrospective chart review was conducted of all patients who underwent total hip or knee arthroplasty (N = 6294) between January 1, 2002 and January 31, 2014. The primary outcome was PJI requiring surgical intervention. Patients were subdivided into 2 cohorts; patients who received perioperative dexamethasone, a single 4- to 10-mg intravenous dose, as prophylaxis against postoperative nausea and vomiting (Dex group; N = 557) and those that did not receive perioperative dexamethasone (No Dex group; N = 5737). Secondary measures included timing of infection, culture data, and the type and number of subsequent procedures. Statistical analysis was performed using a chi-square or Fisher's exact test where appropriate. RESULTS: Seventy-four joints of the 6294 joints included in this analysis ultimately developed a PJI for an overall incidence of infection of 1.2%. Seven of the 557 joints (1.3%) in the Dex group developed a PJI; 67 of the 5737 joints (1.2%) in the No Dex group developed an infection. This difference was not significant (P = .8022). No significant difference in the timing of infection or the number of subsequent procedures was seen. CONCLUSION: A single intravenous perioperative dose of dexamethasone had no statistically significant difference in the rate of PJI after total hip or knee arthroplasty.

Arthroscopic debridement: effective treatment for impingement after total ankle arthroplasty.

Total ankle arthroplasty has been gaining significant popularity for the treatment of ankle arthritis. Subsequent rates of revision surgery secondary to symptomatic bony impingement have been reported in 6-45 % of cases. Arthroscopic debridement of bony impingement following total ankle has been recently reported as an effective therapy. An arthroscopic technique has been recently published by one of the senior authors. In this paper, we expand this technique and retrospectively review our experience with arthroscopic debridement of twenty ankles in twenty patients with symptomatic bony impingement following total ankle arthroplasty.