Total knee arthroplasty is associated with substantial postoperative pain that may impair mobility, reduce the ability to participate in rehabilitation, lead to chronic pain, and reduce patient satisfaction. Traditional general anesthesia with postoperative epidural and patient-controlled opioid analgesia is associated with an undesirable adverse-effect profile, including postoperative nausea and vomiting, hypotension, urinary retention, respiratory depression, delirium, and an increased infection rate. Multimodal anesthesia--incorporating elements of preemptive analgesia, neuraxial perioperative anesthesia, peripheral nerve blockade, periarticular injections, and multimodal oral opioid and nonopioid medications during the perioperative and postoperative periods--can provide superior pain control while minimizing opioid-related adverse effects, improving patient satisfaction, and reducing the risk of postoperative complications.
and a Lower Extremity Reconstruction Fellowship at Johns Hopkins School of Medicine. He is certified by the American Board of Orthopedic Surgery. Throughout his career, Dr. Lavernia has developed hip and knee implants and conducted numerous studies in the field of orthopaedics. He has written many book chapters and has published over 300 abstracts and peer reviewed articles. These have been published in prestigious journals, including Clinical Orthopedics and Related Research, The Journal of Arthroplasty, Journal of Bone and Joint Surgery and International Orthopedics. Dr. Lavernia has received numerous awards and recognitions. In his spare time, Dr. Lavernia has performed numerous joint replacements and other orthopedic surgeries as part of Operation Walk, a private, non-profit, volunteer medical service organization which provides free surgical treatment for patients in developing countries and the United States of America, improving the lives of underprivileged patients in Latin America and the US. Trunnions were introduced to hip surgery in order to minimize inventories and optimize the mechanics of hip implants. Currently over 1 million hips are implanted every year. Trunnion corrosion has been the source of major problems. The etiology of clinically relevant trunnion corrosion remains to be fully understood, but appears to be multi-factorial with synergy among implant-based, surgeon-based, and patient-based factors. Trunnion corrosion causing an adverse local tissue reaction manifests as delayed onset of groin, buttock, or thigh pain. Trunnionosis is probably underreported since it often causes osteolysis and loosening. Measurement of serum cobalt and chromium ions and advanced cross-sectional imaging, including metal artifact reduction sequence magnetic resonance imaging, can aid in diagnosis. Revision for trunnion corrosion-induced ALTR can often be accomplished with a head and liner exchange, with retention of the acetabular and femoral components. Engineers and surgeons should be aware of implant recalls and be cognizant of ongoing litigation against implant manufacturers. Surgeons and engineers should strive to standardize angle and type of tapers in hip replacement surgery.
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