Primary total hip arthroplasty (THA) has been a very successful surgical intervention for the management of end-stage arthritis in geriatric patients (> age 65). The mid- to long-term results have been less satisfactory however, in younger patients primarily due to the wear of the acetabular liner and loosening of the femoral component. The primary study purpose was to compare pain, function and stiffness over the first five years in a population less than 60 years of age who received either an alumina liner/alumina femoral head (alumina group) or a crossfire UHMWPE liner/alumina head (Poly group) following primary THA. Secondarily, we compared re-operation rates over five years between these two groups. This was a randomized, controlled clinical trial of subjects with non-inflammatory OA who were booked for primary THA and consented to participate in the study. Subjects were evaluated pre-operatively and again at one and five years post-operatively by an evaluator who was blinded to group allocation. At each assessment, subjects completed the WOMAC Osteoarthritis Index (WOMAC); complications and re-operations were also recorded. All analyses were performed on an intention to treat basis.Purpose
Method
Femoral nerve block (FNB) following total knee arthroplasty (TKA) has had mixed results with some studies reporting improvement in pain and reduced narcotic exposure while others have not shown substantial differences. The effect of a FNB on rehabilitation indices (quadriceps strength, knee flexion) is also unclear. The study purpose was to compare the effect of FNB+ a multimodal analgesic protocol (MMA) to MMA only on the 1) development of a complete quadriceps motor block and 2) knee flexion during the first two postoperative days and 3) knee flexion out to 12 weeks after primary TKA. Secondarily, we compared hospital length of stay (LOS), postoperative pain, analgesic use and the incidence of nausea/vomiting. This was a controlled clinical trial undertaken at two tertiary hospitals that do high annual TJA volumes (>200 cases). Both hospitals followed the same regional clinical pathway for preoperative, perioperative and postoperative care. The pathway started mobilization on the day of surgery with a goal for discharge home on the third postoperative day. At one site, FNB was used for the first two postoperative days in addition to MMA as needed (FNB group [n=19]) while the other site used standardized MMA (MMA group [n=20]) only. The presence of a complete quadriceps block, knee flexion, pain, analgesic use, incidence of nausea and vomiting were recorded daily in hospital. Hospital LOS was also recorded and knee flexion and pain were assessed at two, six and 12 weeks post discharge.Purpose
Method
