A pilot study evaluating presurgery neuroanatomical biomarkers for postoperative cognitive decline after total knee arthroplasty in older adults.

Background: Total knee arthroplasty improves quality of life but is associated with postoperative cognitive dysfunction in older adults. This prospective longitudinal pilot study with a parallel control group tested the hypotheses that (1) nondemented adults would exhibit primary memory and executive difficulties after total knee arthroplasty, and (2) reduced preoperative hippocampus/entorhinal volume would predict postoperative memory change, whereas preoperative leukoaraiosis and lacunae volumes would predict postoperative executive dysfunction.

Methods: Surgery (n = 40) and age-education-matched controls with osteoarthritis (n = 15) completed pre- and postoperative (3 weeks, 3 months, and 1 yr) memory and cognitive testing.

Obesity and long term functional outcomes following elective total hip replacement.

Introduction: Obesity rates continue to rise and more total hip arthroplasty procedures are being performed in progressively younger, obese patients. Hence, maintenance of long term physical function will become very important for quality of life, functional independence and hip prosthesis survival. Presently, there are no reviews of the long term efficacy of total hip arthroplasty on physical function.

Health-related quality of life after hip arthroplasty with and without an extended-duration continuous posterior lumbar plexus nerve block: a prospective, 1-year follow-up of a randomized, triple-masked, placebo-controlled study.

Background: We previously reported that extending an overnight continuous posterior lumbar plexus nerve block to 4 days after hip arthroplasty provides clear benefits during the perineural infusion in the immediate postoperative period. However, it remains unknown whether the extended infusion improves subsequent health-related quality of life.

Methods: Patients undergoing hip arthroplasty received a posterior lumbar plexus perineural infusion of ropivacaine 0.

Health-related quality of life after tricompartment knee arthroplasty with and without an extended-duration continuous femoral nerve block: a prospective, 1-year follow-up of a randomized, triple-masked, placebo-controlled study.

Background: We previously provided evidence that extending an overnight continuous femoral nerve block to 4 days after tricompartment knee arthroplasty (TKA) provides clear benefits during the perineural infusion in the immediate postoperative period. However, it remains unknown if the extended infusion improves subsequent health-related quality of life between 7 days and 12 mo.

Methods: Patients undergoing TKA received a femoral perineural infusion of ropivacaine 0.

Ambulatory continuous posterior lumbar plexus nerve blocks after hip arthroplasty: a dual-center, randomized, triple-masked, placebo-controlled trial.

Background: The authors tested the hypotheses that after hip arthroplasty, ambulation distance is increased and the time required to reach three specific readiness-for-discharge criteria is shorter with a 4-day ambulatory continuous lumbar plexus block (cLPB) than with an overnight cLPB.

Methods: A cLPB consisting of 0.2% ropivacaine was provided from surgery until the following morning.

Ambulatory continuous femoral nerve blocks decrease time to discharge readiness after tricompartment total knee arthroplasty: a randomized, triple-masked, placebo-controlled study.

Background: The authors tested the hypotheses that, compared with an overnight continuous femoral nerve block (cFNB), a 4-day ambulatory cFNB increases ambulation distance and decreases the time until three specific readiness-for-discharge criteria are met after tricompartment total knee arthroplasty.

Methods: Preoperatively, all patients received a cFNB (n = 50) and perineural ropivacaine 0.2% from surgery until the following morning, at which time they were randomly assigned to either continue perineural ropivacaine or switch to perineural normal saline.

Total hip arthroplasty as an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block: a prospective feasibility study.

Objective: Total hip arthroplasty (THA) results in severe postoperative pain requiring hospitalization to provide potent analgesia. Consequently, the average duration of hospitalization after THA in the United States is 4 to 5 days. This prospective study investigated the feasibility of converting THA into an overnight-stay procedure using a continuous psoas compartment nerve block provided at home with a portable infusion pump.

Total knee arthroplasty as an overnight-stay procedure using continuous femoral nerve blocks at home: a prospective feasibility study.

The average duration of hospitalization after total knee arthroplasty (TKA) in the United States is 4-5 days. In this two-phase study we investigated the feasibility of converting TKA into an overnight-stay procedure using a continuous femoral nerve block provided at home through postoperative day 4. Nine of 10 patients met discharge criteria and were discharged home the day after surgery.

Shoulder arthroplasty in the young patient.

We reviewed the performance of 22 shoulder implant arthroplasties in 19 patients age 50 or younger at surgery. Patients were evaluated by telephone interview, written questionnaire, and radiographic examination. The average age at surgery was 38.

Cerebral microembolism diagnosed by transcranial Doppler during total knee arthroplasty: correlation with transesophageal echocardiography.

Background: Tourniquet deflation following total knee arthroplasty (TKA) frequently results in release of emboli into the pulmonary circulation. Small emboli may gain access to the systemic circulation via a transpulmonary route or through a patent foramen ovale. This study examined the incidence of cerebral microembolism after tourniquet release by transcranial Doppler (TCD) ultrasonography and its correlation with echogenic material detected in the left atrium.

Knee arthrodesis in the treatment of failed total knee replacement.

Twenty-six primary arthrodeses and 6 repeat arthrodeses were done for a total of 32 arthrodesis procedures in 26 patients, with followup from 2 to 10 years (mean, 4 years). The indications for arthrodesis were septic failure in 18 patients and aseptic loosening in 8 patients. Thirteen arthrodeses were done using external fixators, and 12 arthrodeses were done using a closed fluted intramedullary nail for fixation (1 arthrodesis was done with a custom proximal and distal interlocked nail).

Long-term outcome of 42 knees with chronic infection after total knee arthroplasty.

The outcome of treatment in 40 patients (42 knees) with chronic infections after total knee arthroplasty was reviewed. Eighteen knees were treated with a 2-stage reimplantation. Sixteen of these 18 knees were treated with antibiotic-containing beads between debridement and reimplantation, and 7 of these were also treated with antibiotics in the cement at reimplantation.

Structural bone-grafting for early atraumatic avascular necrosis of the femoral head.

Between 1970 and 1987, nineteen patients, thirty-one to fifty-five years old, had twenty core-decompression procedures with corticocancellous bone-grafting for Stage-I or II atraumatic avascular necrosis of the femoral head. A tibial autogenous graft was used in three hips; a fibular autogenous graft, in seven hips; and a fibular allograft, in ten hips. Treatment was considered to have failed when there was clinical or roentgenographic evidence of progression of the necrosis.

Infected total knee arthroplasty. A protocol for management.

All cases of deep wound infection following total knee arthroplasty presented to the senior author between April 1977 and February 1984 were reviewed in an attempt to develop a protocol for salvaging a functional, painless knee. Two of 23 knees were eliminated because of extensive soft tissue loss. The remaining 21 infected total knee arthroplasties were analyzed.

Fibrous dysplasia of the femoral neck. Treatment by cortical bone-grafting.

Fibrous dysplasia of the femoral neck is difficult to treat. In a series of fifteen young patients, ten had a monostotic lesion and five, the polyostotic form of the disease. Twelve patients were first seen with a fatigue fracture.