Background Postoperative pain control is a challenge in patients undergoing TKA due to side effects and technical limitations of current analgesic approaches. Local anesthetic infiltration through continuous infusion pumps has been shown to reduce postoperative pain in previous studies. Questions/purposes We assessed the effectiveness of intraarticular ropivacaine infusions in reducing pain and postoperative opioid use after TKA and determined whether such infusions accelerate functional recovery of the patient and reduce length of hospital stay. Methods In a randomized, prospective, double-blind study, two groups were assigned: Group A (n = 25) underwent continuous intraarticular infusion with 300 mL ropivacaine 0.2% at a speed of 5 mL/hour through an elastomeric infusion pump and Group B (n = 25) had an elastomeric pump insertion with 300 mL saline solution at an infusion speed of 5 mL/hour. All patients had the same prosthesis model implanted. Parameters analyzed over the first 3 days, at discharge, and 1 month later included postoperative pain, joint function, opioid use, and length of hospital stay.
Summary. We report on a series of 92 surgical procedures (90 patients). It includes 35 orthopaedic procedures (33 patients) and 57 non-orthopaedic procedures (57 patients). The orthopaedic procedures include 27 radiosynovectomies (minor surgery) and eight major orthopaedic procedures. The non-orthopaedic procedures include 52 minor interventions and five major procedures. The average age of patients was 34 years (range: 8-56), and the average follow-up time was 3 years (range: 1-6). Of the 92 surgical procedures, 42 were performed with activated prothrombin complex concentrates [factor eight inhibitor bypassing agent (FEIBA)] and 47 with recombinant-activated factor VIIa (rFVIIa; NovoSeven, Novo Nordisk, Bagsvaerd, Denmark). Regarding FEIBA treatment in minor surgery, the initial dose was 100 IU kg )1 . After 6 h, we continued with 50 IU kg )1 every 12 h for at least 4 days (radiosynovectomies). In minor non-orthopaedic procedures, the dose was continued until day 14. In patients who underwent surgery with the haemostatic control achieved by means of rFVIIa, the initial dose of rFVIIa in minor procedures (both orthopaedic and nonorthopaedic) was 90-120 lg kg )1. In postoperative days 1-5, the dose was 2-4 · 90-120 lg kg )1 q3-6 h for 24 h. In major procedures (both orthopaedic and non-orthopaedic), the dose was 120 lg kg )1 preoperatively, 120 lg kg )1 q 3 h day 2/day 3-5, and then 90-120 lg kg )1 q 6 h until day 14. There were 87 good results, four fair results and one poor result. Our study has shown that haemophilic patients with inhibitors requiring surgery can undergo orthopaedic and non-orthopaedic procedures with a high expectation of success. In other words, surgery (orthopaedic and non-orthopaedic) is now possible in haemophilia patients with inhibitors, leading to an improved quality of life for these patients.
In the end-stage disease, chronic haemophilic synovitis of the knee results in changes that eventually lead to haemophilic arthropathy [1]. Incapacitating pain as a result of haemophilic arthropathy and a severely restricted range of motion are the usual indications for total knee arthroplasty (TKA) in haemophilic patients. Pain relief has been reported in persons with haemophilia who have undergone a TKA. Although the results of TKA in these patients have been described as satisfactory, some authors have reported a high rate of early and late complications, often related to infection and restricted range of motion.We have evaluated the relatively long-term results of primary TKA in a group of persons with haemophilia treated at a single institution, with special emphasis on the problem of deep infection. The results of many of the patients of this study have been previously published, but with a shorter follow-up [1]. Thus, this is an extended series with a longer follow-up, mainly focusing on the rate of infection.From
Total knee arthroplasty (TKA) is associated with blood loss, requiring blood transfusion in 44% of patients on average (range of 9-84%) [1]. Blood transfusion remains a standard treatment in case of postoperative anaemia after TKA, and in many institutions two packed red blood cell units are routinely prepared preoperatively for TKAs. However, the risks of blood transfusions are well established [2]. Many authors have reported the efficacy and safety of intravenous [3-7] and intra-articular [8,9] tranexamic acid (TXA) in preventing blood loss during TKA.The use of a multimodal blood loss prevention approach (MBLPA) that includes intra-articular TXA (MBLPA-TXA) has been shown to diminish the transfusion rate in TKA for persons without haemophilia [7][8][9]. However, the transfusion rates, haematological parameters that assess the prevention of blood loss, factor consumption and cost of surgery have not yet been defined in persons with haemophilia (PWH) when using the MBLPA-TXA. Our aim is to demonstrate that the MBLPA-TXA decreases the rate of postoperative blood transfusions by preventing blood loss, diminishing factor consumption in PWH.We conducted a retrospective case-control comparative study, including 10 PWH [severe haemophilia Aless than 1% factor VIII (FVIII) basal activity] with unilateral primary TKA at our institution. We included all PWH undergoing primary TKA in our institution since 1 January 2013 to 31 December 2013 (we currently perform around 10 TKAs per year in our centre). Patients were not selected to show a positive effect. The same surgeons did all the procedures and all patients were nursed in the same hospital on the same ward. Sex and preoperative haemoglobin (Hb) and haematocrit (Hct) were the same in both groups. The surgical technique was identical in both groups.
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