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https://www.readbyqxmd.com/read/29616915/refractory-hypoxemia-in-a-patient-with-submassive-pulmonary-embolism-and-an-intracardiac-shunt-a-case-report-and-review-of-the-literature
#1
REVIEW
Jean Liew, Janelle Stevens, Christopher Slatore
INTRODUCTION: Acute pulmonary embolism is the third leading cause of cardiovascular death. Management options include anticoagulation with or without thrombolysis. Concurrent persistent hypoxemia should be a clue to the existence of an intracardiac shunt. CASE PRESENTATION: A 46-year-old man experienced acute hypoxemic respiratory failure requiring mechanical ventilation after anesthesia induction for elective hip arthroplasty. He was found to have submassive bilateral pulmonary emboli with acute right ventricular dysfunction and a coexisting patent foramen ovale with right-to-left shunt...
March 2, 2018: Permanente Journal
https://www.readbyqxmd.com/read/29615378/intraoperative-psoas-compartment-block-vs-preoperative-fascia-iliaca-block-for-pain-control-after-direct-anterior-total-hip-arthroplasty-a-randomized-controlled-trial
#2
Clayton R Perry, Adam M Fahs, Michael D Kurdziel, Denise M Koueiter, Randy J Fayne, James J Verner
BACKGROUND: Modern joint arthroplasty protocols place an emphasis on minimizing patient-reported postoperative pain while minimizing opioid consumption. The use of multimodal pain management protocols has been reported to improve patient outcomes and satisfaction after total hip arthroplasty. METHODS: In a prospective, single-surgeon trial, 50 patients undergoing primary direct anterior approach total hip arthroplasty were randomized to receive a preoperative fascia iliaca compartment block (FICB) or an intraoperative surgeon-delivered psoas compartment block (PCB)...
January 31, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29607863/total-hip-replacement-in-sickle-cell-disorder-a-preliminary-report-of-challenges-and-early-outcome-of-21-consecutive-patients
#3
A U Katchy, U E Anyaehie, C U Nwadinigwe, G O Eyichukwu
Objective: The aim of this study is to describe the pattern of presentation osteoarthritic patients with sickle cell disorder (SCD) in our environment, determine the implant sizes taking the peculiar nature of the pathology and our operating environment into consideration, highlight the challenges and technical difficulties encountered during the procedure, measure the functional outcome and observe complications of treatment, recommend ways of improving outcome. Patients and Methods: Between November 2008 and November 2012, 29 consecutive primary total hip replacements (THRs) were performed on 21 patients with avascular necrosis of the head of femur secondary to SCD...
April 2018: Nigerian Journal of Clinical Practice
https://www.readbyqxmd.com/read/29555492/psoas-compartment-block-vs-periarticular-local-anesthetic-infiltration-for-pain-management-after-anterior-total-hip-arthroplasty-a-prospective-randomized-study
#4
Adam M Fahs, Denise M Koueiter, Michael D Kurdziel, Kristine A Huynh, Clayton R Perry, James J Verner
BACKGROUND: The psoas compartment block (PCB) or periarticular soft-tissue local anesthetic injection are forms of regional anesthesia often used as one of the components in multimodal anesthesia applied during total hip arthroplasty (THA). The most efficacious form of regional anesthesia for THA has yet to be determined. METHODS: In a single-surgeon, prospective, clinical trial, patients undergoing THA via direct anterior approach were randomized to receive an intraoperative periarticular local anesthetic infiltration (periarticular injection) or a PCB...
February 21, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29541272/is-head-and-neck-resection-of-the-femur-girdlestone-s-procedure-still-relevant-indications-and-results-about-24-cases
#5
Mamoudou Sawadogo, Hamado Kafando, Salam Ouedraogo, Alexandre Stanislas Korsaga, Souleymane Ouedraogo, Sayouba Tinto, Anatole Jean Innocent Ouedraogo, Mohamed Tall, Songahir Christophe DA
Introduction: Head and neck resection of the femur was described by Girdlestone in 1928 in the treatment of coxalgia. Very invasive at the beginning, this intervention is much less so today, but the term of "Girdlestone's operation" or "Girdlestone's procedure" has remained in use. The reported results are controversial. In resource-limited countries, Girdlestone's procedure is often indicated for lack of a better one. In this context, we report the results of a series of 24 patients operated in a regional hospital (Ouahigouya, Burkina Faso) with the aim of showing that this technique remains valid and can be benefit...
2018: Open Orthopaedics Journal
https://www.readbyqxmd.com/read/29523446/reasons-for-ninety-day-emergency-visits-and-readmissions-after-elective-total-joint-arthroplasty-results-from-a-us-integrated-healthcare-system
#6
Matthew P Kelly, Heather A Prentice, Wei Wang, Brian H Fasig, Dhiren S Sheth, Elizabeth W Paxton
BACKGROUND: Previous studies evaluating reasons for 30-day readmissions following total joint arthroplasty (TJA) may underestimate hospital-based utilization of healthcare resources during a patient's episode-of-care. We sought to identify common reasons for 90-day emergency department (ED) visits and hospital readmissions following primary elective unilateral TJA. METHODS: Patients from July 1, 2012 through June 30, 2015 having primary elective TJA and at least one 90-day postoperative ED-only visit and/or readmission for any reason were identified using the Kaiser Permanente Total Joint Replacement Registry...
February 12, 2018: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29493328/no-effect-of-double-nerve-block-of-the-lateral-cutaneous-nerve-and-subcostal-nerves-in-total-hip-arthroplasty
#7
Johannes L Bron, Jeanette Verhart, Inger N Sierevelt, Dirk De Vries, Hylke J Kingma, Maarten V Rademakers
Background and purpose - The use of local infiltration anesthesia (LIA) has become one of the cornerstones of rapid recovery protocols in total knee arthroplasty patients during the past decade. In total hip arthroplasty (THR), however, the study results are more variable and LIA has therefore not yet been generally accepted. There is no consensus on which structure should be infiltrated and the cutaneous nerves are generally neglected. Hence, we hypothesized a pain-reducing effect of specifically blocking these nerves...
March 1, 2018: Acta Orthopaedica
https://www.readbyqxmd.com/read/29468091/surgical-technical-evidence-review-for-elective-total-joint-replacement-conducted-for-the-ahrq-safety-program-for-improving-surgical-care-and-recovery
#8
REVIEW
Christopher P Childers, Anaar E Siletz, Emily S Singer, Claire Faltermeier, Q Lina Hu, Clifford Y Ko, Gregory J Golladay, Stephen L Kates, Elizabeth C Wick, Melinda Maggard-Gibbons
Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery-a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients...
2018: Geriatric Orthopaedic Surgery & Rehabilitation
https://www.readbyqxmd.com/read/29423252/extracapsular-local-infiltration-analgesia-in-hip-arthroscopy-a-retrospective-study
#9
Matthew T Philippi, Timothy L Kahn, Temitope F Adeyemi, Travis G Maak, Stephen K Aoki
Many hip arthroscopy patients experience significant pain in the immediate postoperative period. Although peripheral nerve blocks have demonstrated efficacy in alleviating some of this pain, they come with significant costs. Local infiltration analgesia (LIA) may be a significantly cheaper and efficacious treatment modality. Although LIA has been well studied in hip and knee arthroplasty, its efficacy in hip arthroscopy is unclear. The purpose of this retrospective study is to determine the efficacy of a single extracapsular injection of bupivacaine-epinephrine during hip arthroscopy in reducing the rate of elective postoperative femoral nerve blocks...
January 2018: Journal of Hip Preservation Surgery
https://www.readbyqxmd.com/read/29401106/csf-beta-amyloid-1-42-concentration-predicts-delirium-following-elective-arthroplasty-surgery-in-an-observational-cohort-study
#10
Emma L Cunningham, Bernadette McGuinness, Daniel F McAuley, Jamie Toombs, Tim Mawhinney, Seamus O'Brien, David Beverland, Jonathan M Schott, Michael P Lunn, Henrik Zetterberg, Anthony P Passmore
OBJECTIVE: To test the hypothesis that APOE ε4 status and cerebrospinal fluid (CSF) Aβ42, T-tau and P-tau would independently predict the risk of postoperative delirium. BACKGROUND: Delirium following surgery is common and associated with adverse outcomes. Age and cognitive impairment are consistent risk factors for postoperative delirium. METHODS: This observational cohort study recruited 282 participants aged 65 years or older, without a diagnosis of dementia, admitted for primary elective hip or knee arthroplasty...
February 2, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29280923/local-anesthetic-systemic-toxicity-in-total-joint-arthroplasty-incidence-and-risk-factors-in-the-united-states-from-the-national-inpatient-sample-1998-2013
#11
Daniel S Rubin, Monica M Matsumoto, Guy Weinberg, Steven Roth
BACKGROUND: Local anesthetic systemic toxicity (LAST) is a rare and potentially devastating complication of regional anesthesia. Single-institution registries have reported a decreasing incidence, but these results have limited broad applicability. A recent study using a US database found a relatively high incidence of LAST. We used the National Inpatient Sample, a US database of inpatient admissions, to identify the national incidence and associated risk factors for LAST in total joint arthroplasties...
February 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29195854/hypothermia-in-total-joint-arthroplasty-a-wake-up-call
#12
Jordan B Simpson, Vijai S Thomas, Sabir K Ismaily, Pavel I Muradov, Philip C Noble, Stephen J Incavo
BACKGROUND: Total joint patients are particularly vulnerable to perioperative hypothermia (PH) (combined effects of anesthesia, radiation, and convective heat loss from exposed skin surfaces and cool temperatures in the operating room). There are limited studies on PH in these patients. METHODS: In a retrospective review of 204 patients undergoing primary hip and 179 undergoing primary knee replacement surgeries, time and temperature parameters were collected from the electronic health records from preoperative and postoperative recovery room nursing assessments, intraoperative anesthesia records, and floor nursing notes...
November 8, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/29174424/hemi-arthroplasty-performed-in-a-109-year-old-patient-with-intertrochanteric-fracture-a-case-report
#13
Peng-Fei Yang, Hao Chen, Xiao-Jun Duan, Guang-Xing Chen, Lin Guo, Hua-Quan Fan, Liu Yang
The mortality of conservative treatment and the risk resulting from operation for elderly patients with femoral intertrochanteric fractures are high. Safety in the perioperative period and quicker recovery should be placed at the top priority for elderly patients with hip fractures. We reported a case of 109-year-old female patient with intertrochanteric fracture who has undergone the hemiarthroplasty in our center recently. With sciatic nerve and lateral cutaneous nerve block anesthesia, she was offered the artificial femoral head replacement in the lumbar plexus block after sufficient preoperative preparation...
December 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29145981/total-hip-arthroplasty-in-the-outpatient-setting-what-you-need-to-know-part-2
#14
REVIEW
Zain Sayeed, Leila Abaab, Mouhanad El-Othmani, Vinay Pallekonda, William Mihalko, Khaled J Saleh
The intra- and postoperative phases of outpatient total hip arthroplasty (THA) vary by institution and surgeon. An understanding of an evidence-based approach to enhancing the intra- and postoperative phases of the care continuum is warranted to offer high-value care to outpatient candidates. This article will discuss methods for implementing successful outpatient THA protocols. Specifically it reviews information regarding anesthesia and analgesia modalities, intraoperative considerations, and postoperative rehabilitation amenable to outpatient THA...
January 2018: Orthopedic Clinics of North America
https://www.readbyqxmd.com/read/29145334/concurrent-one-stage-total-knee-and-hip-arthroplasty-due-to-sequel-of-juvenile-rheumatoid-arthritis-a-case-report
#15
Afshin Taheriazam, Amin Saeidinia
RATIONALE: Rheumatoid arthritis is a chronic systemic connective tissue disease. Total hip and knee arthroplasties are common major orthopaedic procedures worldwide. PATIENT CONCERNS: To date, no studies have presented 1-stage concurrent total hip arthroplasty (THA) and total knee arthroplasty (TKA) in patients with rheumatoid arthritis (RA). We reported a case which is, to our knowledge, the first description of both THA and TKA in a patient with RA simultaneously...
November 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29133161/the-efficacy-of-high-volume-of-local-infiltration-analgesia-for-postoperative-pain-relief-after-total-hip-arthroplasty-under-general-anaesthesia-a-randomised-controlled-trial
#16
Saskia Titman, Ami Hommel, Igor Dobrydnjov, Anders Johansson
BACKGROUND AND AIM: Research regarding patients undergoing total hip arthroplasty (THA) has shown no significant difference in postoperative pain with or without the use of local infiltration analgesia (LIA). The aim was to evaluate whether intra-operative LIA with Ropivacaine in patients undergoing THA under general anaesthesia reduces postoperative pain. METHOD: A randomised, placebo-controlled trial. Forty patients undergoing elective primary THA under general anaesthesia were allocated to an intervention group (RG) who received 150 ml of LIA or a placebo group (CG) who received 150 ml of saline solution...
February 2018: International Journal of Orthopaedic and Trauma Nursing
https://www.readbyqxmd.com/read/29050162/-two-stage-total-hip-arthroplasty-using-an-antibiotic-loaded-cement-spacer-for-infected-internal-fixation-of-hip-fractures
#17
X Li, M Ni, H Li, J L Song, X G Song, J Fu, K Liu, B Z Yu, J Y Chen
Objective: To evaluate the application and clinical results of two-stage total hip arthroplasty in the treatment of the deep hip infection following the internal fixation of hip fractures. Methods: From May 2007 to November 2014, 21 patients with active hip infection secondary to internal fixation of hip fractures were treated with two-stage total hip arthroplasty using a temporary antibiotic-loaded cement spacers. Of 21 cases, 15 were males and 6 were females, aged from 27 to 64 years (mean, 45); there are 18 cases of femoral neck fractures and 3 cases of intertrochanteric fractures...
October 10, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29046771/a-comparison-of-palonosetron-and-dexamethasone-for-postoperative-nausea-and-vomiting-in-orthopedic-patients-receiving-patient-controlled-epidural-analgesia
#18
Byung-Gun Kim, Hyunzu Kim, Hyun-Kyoung Lim, Chunwoo Yang, Sora Oh, Byung-Wook Lee
BACKGROUND: Postoperative nausea and vomiting (PONV) is one of the major concerns after anesthesia and surgery, and it may be more frequent in orthopedic patients receiving patient-controlled epidural analgesia (PCEA). The purpose of this study was to compare the effect of palonosetron and dexamethasone on the prevention of PONV in patients undergoing total joint arthroplasty and receiving PCEA. METHODS: Patients scheduled for total hip or knee arthroplasty under spinal anesthesia/PCEA were randomly allocated to receive either intravenous palonosetron (0...
October 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28938977/efficacy-of-prewarming-with-a-self-warming-blanket-for-the-prevention-of-unintended-perioperative-hypothermia-in-patients-undergoing-hip-or-knee-arthroplasty
#19
Charlotte Rosenkilde, Marianne Vamosi, Jørgen T Lauridsen, Dorthe Hasfeldt
PURPOSE: Unintended perioperative hypothermia (UPH) is a common and serious complication for patients undergoing anesthesia. The purpose of this study was to identify the incidence of UPH and evaluate the efficacy of a self-warming blanket on the drop in core temperature and risk of UPH in patients undergoing hip or knee arthroplasty. DESIGN: A case-control study was used. METHODS: Sixty patients were included. Thirty patients received prewarming with a self-warming blanket and forced-air warming intraoperatively; thirty patients received only forced-air warming intraoperatively...
October 2017: Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia Nurses
https://www.readbyqxmd.com/read/28913395/simultaneous-bilateral-total-hip-arthroplasty-in-morquio-syndrome
#20
Imran Ilyas, Syed Kashif, Samar Rabbani, Husam A Alrumaih
A 16-year-old girl who had Morquio syndrome presented with severe bilateral hip pain and limited mobility because of bilateral hip osteoarthritis and fixed flexion deformities. She was wheelchair bound for the previous 6 months. Cervical spine flexion-extension views showed mild subluxation (<3 mm), and there was thoracolumbar spine kyphosis. Magnetic resonance imaging of the cervical and thoracolumbar spine showed hypoplasia of the odontoid and vertebral bodies, but no spinal cord compression. Bilateral cemented total hip arthroplasty was performed through a posterior approach under general anesthesia with fiberoptic intubation...
September 2017: Arthroplasty Today
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