Adequate pain control is important in allowing early participation in physical therapy after total joint replacement. Opioidanalgesics often cause side effects that limit physical therapy. Therefore, adequate pain relief with reduced narcotics opioids should speed recovery.

Purpose: To determine whether postoperative acupuncture would reduce narcotic usage and improve physical therapy after total joint replacement.

Total knee (TKR) and total hip replacement (THR)patients who received acupuncture on POD 1–3 or did not receive acupuncture were prospectively followed. Postoperative usage of patient controlled analgesia (PCA, normalized to intravenous morphine) and oral and parenteral opioids (normalized to oral immediate release morphine) were measured. Verbal analog pain scores, performance in physical therapy, length of stay(LOS) and location of discharge were recorded.

After TKR, there was no difference in pain scores in either group (acupuncture n=23, non-acupuncture n=25). PCA usage was 58% less in the acupuncture group for the entire hospital stay (p< 0.05). 74% of acupuncture patients and 36% of non-acupuncture patients did not require PCA after POD 2 (p< 0.05). The amount of additional narcotics was 58% less(p< 0.05) for the acupuncture group. Walking distance was greater in the acupuncture group by greater than 40% (p< 0.05) on any day after surgery.43% of the acupuncture patients and 24% of the non-acupuncture patients went home. There was no significant difference in knee flexion or LOS. After THA, the acupuncture group (n=7) used 54% less PCA (p< 0.05), used 96% less additional narcotic, and had 36–83% greater walking distance on any POD than-non-acupuncture group (n=7). Location of discharge and LOS was the same in both groups. There were no complications related to acupuncture in any patient.

Acupuncture is a safe and effective adjunct to traditional methods of postoperative pain management after total hip and total knee replacement.

Introduction: Tapered proximally porous-coated stems have many advantages, including no diaphyseal reaming, proximal fixation, and less thigh pain. Conventional rehabilitation suggests that touch-down weight-bearing (TDWB) is required for bone ingrowth and soft-tissue healing to occur. Immediate weight-bearing as tolerated (WBAT) could provide rapid mobilization and quicker recovery and faster return to functionality. This study examines early results with WBAT after implantation of a tapered stem.

Materials and methods: During 1999 and 2000, all THAs were performed with a fiber-metal taper (FMT) component and WBAT was allowed immediately. No cemented or hybrid THAs were performed during this time-period. Radiographs were obtained in the recovery room, and then at 6, 12 and 52 weeks postoperatively. Patients with a minimum 12-week follow-up were included to answer five study questions: Does immediate WBAT affect ingrowth of the stem? Does immediate WBAT lead to more subsidence and/or instability? Does immediate WBAT affect the acetabular component? Does immediate WBAT affect Harris Hip Score? Is there an age limitation? Forty-one cases performed had a minimum 12-week follow-up. Four intraoperative fractures occurred (4.8%), and these patients were excluded as they were made TDWB for 6 weeks. Thus, 37 cases remained and comprised the study group.

Results: Of the 37 patients, 21 were perfomed for OA, 14 for AVN and two for post-acetabular fracture DJD. The average age was 57 (range, 16–78). The average follow-up was 6 months (range, 3–20 months). Radiographically, all 37 stems were ingrown by the 12-week radiograph. Seven patients (17%) had subsidence of the stem, with an average of 0.9 mm (range, 0–7 mm). There were no dislocations. Thirty-six acetabular components (97%) achieved bony ingrowth by the 12-week radiograph. No cups had measurable migration and 9 had nonprogressive radiolucent lines present in one zone. The average HHS was 88 (range, 64–100). Among patients older than age 70, 5/5 stems were ingrown with one stem showing subsidence prior to ingrowth. Two patients (5.4%) had minimal thigh pain.

Discussion and conclusions: This study demonstrates that immediate WBAT does not preclude bony fixation of the stem or acetabulum after Cementless THA. Clearly, longer follow-up will determine whether issues regarding fixation arise at later dates. However, it would be expected that since bony ingrowth occurs, reliably, fixation should remain stable for long periods of time. One immediate advantage of WBAT is that rehabilitation can be facilitated.