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Femoral pain after arthroplasty

Akihiko Toda, Katsumasa Tei, Tomoyuki Matsumoto, Kazunari Ishida, Hiroshi Sasaki, Kazuki Kodato, Yuichiro Nishizawa, Shinsuke Kirizuki, Nao Shibanuma, Hiroomi Tateishi, Ryosuke Kuroda, Masahiro Kurosaka
Soft tissue impingements are well-known complications of total knee arthroplasty. The impingements usually occur between the medial or lateral femoral component and tibial insert, and between the patella and femoral components. We report a rare case of impingement of the soft tissue between the femoral intercondylar fossa and post of the polyethylene insert, which caused pain and walking disability. After the surgery for the arthroscopic removal of the soft tissue, the symptoms disappeared. However, prosthetic loosening of the femur occurred several months after the arthroscopic surgery, requiring revision surgery...
January 2018: Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology
Matthew T Houdek, Cody C Wyles, Mark S Collins, Benjamin M Howe, Andre Terzic, Atta Behfar, Rafael J Sierra
BACKGROUND: Randomized trials have shown the benefits of injecting bone marrow-derived mesenchymal stem cells (BmMSCs) after standard hip decompression in patients with osteonecrosis of the femoral head. However, the combination of BmMSCs and platelet-rich plasma (PRP) injected into the femoral head after decompression has not been reported previously. This study reports the results in a preliminary series of patients with osteonecrosis of the femoral head treated with BmMSCs plus PRP...
February 2018: Clinical Orthopaedics and related Research
Stephen Yu, John Dundon, Olga Solovyova, Joseph Bosco, Richard Iorio
BACKGROUND: TKA pain management protocols vary widely with no current consensus on a standardized pain management regimen. Multimodal TKA pain management protocols aim to address pain control, facilitate functional recovery, and maintain patient satisfaction. QUESTIONS/PURPOSES: (1) Did changes to our pain management protocol, specifically adding liposomal bupivacaine, eliminating patient-controlled analgesia (PCA), and discontinuing femoral nerve blocks (FNBs), affect narcotic consumption after TKA? (2) Did these changes to our pain management protocols affect patient-reported pain scores? (3) Does the use of an immediate postoperative PCA affect rapid rehabilitation and functional recovery? (4) How did changes to our pain management regimen affect discharge disposition and pain-related Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores? METHODS: We retrospectively analyzed an institutional arthroplasty database between September 2013 and September 2015 containing 1808 patients who underwent primary TKA...
January 2018: Clinical Orthopaedics and related Research
Simon W Young, Mustafa Saffi, Mark J Spangehl, Henry D Clarke
BACKGROUND: Malrotation of tibial and femoral components is a potential source of pain following total knee arthroplasty (TKA). This study aimed to 1) compare component rotation in TKA patients with unexplained pain versus a control group with well-functioning TKAs and 2) investigate the relationship between TKA component rotation and pain. METHODS: Seventy one patients with unexplained pain after primary TKA were compared to a control cohort of 41 well functioning TKA patients...
March 8, 2018: Knee
Andres Zorrilla-Vaca, Jinlei Li
INTRODUCTION: Femoral nerve block (FNB) appears to have higher postoperative analgesic benefits compared with the patient-controlled analgesia (PCA) in total knee arthroplasty (TKA). However, the role of sciatic nerve block (SNB) as a complement to FNB remains controversial. We performed a meta-analysis assessing the benefits of the SNB as a complement to FNB, as well as comparing the efficacy of single-injection versus continuous SNB in TKA. METHODS: Our group conducted a systematic literature search in PubMed, EMBASE and Google Scholar...
March 8, 2018: Journal of Anesthesia
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
Peter Cnudde, Ola Rolfson, A John Timperley, Anne Garland, Johan Kärrholm, Göran Garellick, Szilard Nemes
BACKGROUND: Hip replacements are successful in restoring mobility, reducing pain, and improving quality of life. However, the association between THA and the potential for increased life expectancy (as expressed by mortality rate) is less clear, and any such association could well be influenced by diagnosis and patient-related, socioeconomic, and surgical factors, which have not been well studied. QUESTIONS/PURPOSES: (1) After controlling for birth year and sex, are Swedish patients who underwent THA likely to survive longer than individuals in the general population? (2) After controlling for relevant patient-related, socioeconomic/demographic factors and surgical factors, does relative survival differ across the various diagnoses for which THAs were performed in Sweden? METHODS: Data from the Swedish Hip Arthroplasty Register, linked to administrative health databases, were used for this study...
February 28, 2018: Clinical Orthopaedics and related Research
M Nersesjan, D Hägi-Pedersen, J H Andersen, O Mathiesen, J B Dahl, L Broeng, K H Thybo
BACKGROUND: The lateral femoral cutaneous nerve (LFCN) block may be used for post-operative pain management in patients undergoing total hip arthroplasty. The aim of this trial was to investigate the sensory coverage of the posterior and the lateral incision lines and the involvement of the femoral nerve after an LFCN block. METHODS: The study was a randomised, blinded trial in 20 healthy volunteers. All subjects received a bilateral LFCN block randomised to 8 ml ropivacaine on the right side and 8 ml isotonic saline on the left side, or vice versa...
February 21, 2018: Acta Anaesthesiologica Scandinavica
Qi-Cai Sun, Xuan-Liang Ru, Zhi-Gang Qian, Li-Dong Wu, Shi-Gui Yan, Xiang-Hua Wang
OBJECTIVE: To retrospective analysis the mid-term follow-up effect of hip joint replacement in elderly patients with failure of intertrochanteric fractures of the hip joint internal fixation. METHODS: From December 2008 to December 2011, 32 elderly patients underwent arthroplasty after intertrochanteric fracture fixation failure, of which, 4 death cases were excluded from the study, and the remaining 28 cases were in the study group. The age of patients ranged from 69 to 83 years old with a mean of 75 years old...
July 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
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
Konstantinos I Alexiou, Andreas Roushias, Sokratis E Varitimidis, Konstantinos N Malizos
Fractures due to fragility of the bone around the hip joint have become a major public health issue, presenting with an increasing incidence due to the growth of the elderly population. The purpose of this review was to evaluate the impact of hip fractures on the quality of life (QoL), health status (HS), functioning, and psychological parameters, and factors influencing the outcome and the appropriate interventions for improvement of elderly patients. A systematic electronic search of the relevant literature was carried out using the CINAHL, Cochrane, EMBASE, Medline (OvidSP), and PubMed databases spanning the time period from their establishment up to January 2017...
2018: Clinical Interventions in Aging
Joel Wells, Perry Schoenecker, Stephen Duncan, Charles W Goss, Kayla Thomason, John C Clohisy
BACKGROUND: The Bernese periacetabular osteotomy (PAO) is an alternative to arthroplasty for treating symptomatic acetabular dysplasia, but there have been few studies on the intermediate-term outcomes of this procedure. In the present study, we assessed intermediate-term hip survival and patient-reported outcomes of PAO used to treat symptomatic acetabular dysplasia. METHODS: From July 1994 to August 2008, 238 hips (206 patients) were treated with PAO. Sixty-two had a diagnosis other than classic acetabular dysplasia, and 22 were lost to follow-up...
February 7, 2018: Journal of Bone and Joint Surgery. American Volume
Kai Xie, Yuanqing Mao, Xinhua Qu, Kerong Dai, Qingwei Jia, Zhenan Zhu, Mengning Yan
BACKGROUND: Nontraumatic osteonecrosis of the femoral head (ONFH) is treated with a series of methods. High-energy extracorporeal shock wave therapy (ESWT) is an option with promising mid-term outcomes. The objective of this study was to determine the long-term outcomes of ESWT for ONFH. METHODS: Fifty-three hips in 39 consecutive patients were treated with ESWT in our hospital between January 2005 and July 2006. Forty-four hips in 31 patients with stage I-III nontraumatic ONFH, according to the Association Research Circulation Osseous (ARCO) system, were reviewed in the current retrospective study...
February 2, 2018: Journal of Orthopaedic Surgery and Research
Donghai Li, Zhouyuan Yang, Zhun Wei, Pengde Kang
This study aimed to determine whether bisphosphonates exert an effect on preventing femoral head collapse after osteonecrosis of the femoral head (ONFH) in an animal model and in clinical trials. A systematic literature search was performed for studies published up to January 2017. Twenty-three articles (16 animal studies, seven clinical trials) were included in the meta-analysis. We found that the bisphosphonate group obtained significant improvement in epiphyseal quotients (MD = 15.32; 95% CI, 9.25-21...
January 23, 2018: Scientific Reports
Luis E P Tírico, Julie C McCauley, Pamela A Pulido, William D Bugbee
BACKGROUND: Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. PURPOSE: To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions...
January 1, 2018: American Journal of Sports Medicine
Jason Ch Fan, K B Kwok, Y W Hung
By analyzing a case of total knee arthroplasty (TKA) in a knee with complex deformity and secondary osteoarthritis, we demonstrated the rationale of preoperative planning and the detail of intraoperative execution. The lady had right TKA with combined medial closing wedge femoral osteotomy, neutral wedge valgus derotational tibial osteotomy, fibular osteotomy, and quadriceplasty. Four months later, she had left TKA. Osteotomies healed well and she was pain-free at 18 months after right TKA. Combination of intra-articular and extra-articular correction of deformity was the key to achieve a well-aligned TKA with good soft tissue balancing in both coronal and sagittal planes...
January 2018: Journal of Orthopaedic Surgery
Honglue Tan, You Wang, Teng Long, Binen Nie, Zhenyang Mao, Bing Yue
PURPOSE: Distal femoral resection in total knee arthroplasty (TKA) is commonly performed using intramedullary jigs with a pre-operatively planned valgus cut angle (VCA). For valgus knees with lateral femoral condyle hypoplasia, the method of determining the accurate VCA has not been clarified. The aim of the present study is to introduce a method that can accurately determine the distal femoral VCA in the valgus knee arthroplasty. METHODS: Twenty patients with valgus deformity caused by lateral femoral condylar hypoplasia underwent primary TKA with individually measured VCA...
January 22, 2018: International Orthopaedics
Hua-Li Gao, Lian-Bo Xiao, Wei-Tao Zhai, Yong He, Fei Zhu, Lin Zheng, Xiu-Wei Han
OBJECTIVE: To compare the analgesic effect between multimodal and patient-controlled intravenous analgesia(PCIA) in patients with rheumatoid arthritis(RA) in the perioperative period of knee joint replacement. METHODS: From June 2015 to June 2016, 40 RA patients undergoing total knee arthroplasty were randomly divided into two groups. There were 20 patients in PCIA group, including 3 males and 17 females, with an average age of(59.6±2.3) years old, who received controlled instillation of sufentanil analgesia controlled by an intravenous analgesia pump...
April 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Shang Piao, Yong-Gang Zhou, Yin-Qiao Du, Hai-Yang Ma, Jing-Yang Sun, Zhi-Sen Gao, Ya-Wen Peng, Wen-Ming Wu
OBJECTIVE: To investigate and the clinical effect of S-ROM modular stem in femur reconstruction in hip revision arthroplasty. METHODS: From January 2008 to January 2016, 21 patients received revision hip arthroplasties using S-ROM stems. There were 5 males and 16 females with an average of 48.33 years old(range, 29 to 73 years old). There were 13 cases caused by aseptic loosening, 4 cases by infection, 2 cases by nonunion of sub-tuberosity osteotomy, 1 case for repeated dislocation, 1 case for traumatic great trochanter fracture...
April 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Xian-Wu Chen, Ru-Qing Ye, Hai-Ping Xu
OBJECTIVE: To retrospectively study the clinical results of total hip arthroplasty(THA) using Wagner SL revision stem for patients with femoral intertrochanteric fracture. METHODS: From 2006 January to 2009 December, 29 consecutive patients with femoral intertrochanteric fractures were performed THA using Wagner SL revision stem and intertrochanteric reconstruction, including 18 males and 11 females with an average age of 49 years old ranging from 43 to 58. Among them, 8 cases were oboslete femoral intertrochanteric fractures and 21 cases were the intertrochanteric fractures with painful arthritis before injuries...
March 25, 2017: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
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