Postoperative pain control modalities after total knee arthroplasty are highly variable among physicians. This variability has allowed researchers to review each modality and compare and contrast the benefits with the potential adverse effects of these medications on total knee replacement outcomes. The data in this study suggests that the use of Valium is correlated with increased pain medication consumption and decreased patient satisfaction. Data from this study also reveals that patients who underwent preoperative nerve blocks experienced decreased pain on postoperative day one and greater patient satisfaction. The most notable contribution of this study was the discovery of the adverse effects of the continuous pain pump, ON-Q. Patients treated with this modality had decreased ambulation on postoperative day one and on average remained in the hospital one extra day, a variable that significantly increases the cost of a total knee arthroplasty for the hospital, the surgeon and the patient. Even though this data is significant, further studies should be performed to enhance our knowledge of postoperative pain control for these patients.
Background: Multiple studies have described retrograde nailing as a treatment of periprosthetic supracondylar femoral fractures (OTA/ AO type 33A-C) above total knee replacements (TKRs). It is often difficult to discern which TKRs will be compatible with intramedullary nailing because the femoral component design and intercondylar distance is highly variable among total knee designs. The goal of our study is 3-fold: (1) Review and update previous work of intercondylar distances of all currently available prostheses in the United States. (2) Review retrograde nails currently on the market and associated driving end to nail shaft diameter mismatch and opening reamer sizing. (3) Review technical tricks for executing a retrograde femoral nail for the treatment of periprosthetic supracondylar femur fractures.Methods: Data for the intercondylar distance of the femoral components, diameter of retrograde nails and reamers, and notch compatibility were gathered.
Results:The results were compiled and recorded. A "technical tricks" section was included that highlights reduction and fixation techniques.Conclusions: This update further empowers surgeons to use all the tools available when treating periprosthetic femur fractures and allows efficient identification of the compatibility of different TKR designs with various intramedullary nails.
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