Pain management remains a challenge in the optimization of outcomes after total knee arthroplasty. Multimodal analgesia is commonplace for modern elective joint replacement, combining various medications and anesthetics along the pain pathway. Local analgesics have the advantage of avoiding systemic effects and offering concentrated local delivery of medications. Long-acting local anesthetics provide the added advantage of providing sustained pain relief when other treatment options may no longer be effective. It is important to provide an update on current local analgesic strategies available with a review of the current literature, outlining the potential benefits and unique considerations of each treatment. Novel medications in development targeting pain management following total knee arthroplasty are possible options in the future.
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BMC Musculoskelet Disord
January 2025
Division of Orthopedic Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Background: Despite advancements in prosthetic designs and surgical techniques, patellar dislocation remains a rare but significant complication following total knee arthroplasty, with an incidence ranging between 0.15% and 0.5%.
View Article and Find Full Text PDFBr J Anaesth
January 2025
Department of Theatres, Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK.
Total knee arthroplasty is a life-changing surgical procedure that is associated with a high incidence of severe postoperative pain. Key to enhancing recovery after surgery is effective analgesia and early mobilisation. Innovations in motor-sparing regional anaesthesia techniques that have improved recovery include targeted surgical local infiltration analgesia, adductor canal blockade, genicular nerve blocks, and the infiltration between the popliteal artery and posterior capsule of the knee (iPACK) block.
View Article and Find Full Text PDFJ Knee Surg
January 2025
Lenox Hill Hospital Department of Orthopedic Surgery, Northwell Health, New York, United States.
Patellar instability following total knee arthroplasty (TKA) is a rare, yet serious complication, potentially requiring revision surgery or resulting in chronic dysfunction. When encountered, it is paramount to understand the etiologies, diagnostic approaches, treatment options, and outcomes of the selected treatment. The most common cause of patella instability is improper positioning of components, leading to lateral maltracking of the patella.
View Article and Find Full Text PDFJ Knee Surg
January 2025
Department of Orthopedic Surgery, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Dongjak-gu, Korea (the Republic of).
Purpose The purpose of this study was to evaluate whether IV dexamethasone, within the current multimodal pain management protocol, (1) could maintain postoperative pain at a comparable level without IV PCA, (2) could reduce opioids-related side effects, and (3) whether an additional dose of dexamethasone on POD 2 would offer further pain-relieving effect without increasing the risk of complications. Methods A total of 178 patients (182 knees) who underwent total knee arthroplasty (TKA) for osteoarthritis were included in the study. The patients were divided into Dexa 2 & PCA and Dexa 3 & NoPCA group.
View Article and Find Full Text PDFJ Knee Surg
January 2025
Orthopaedic Surgery, Cleveland Clinic, Cleveland, United States.
Patellar tendon rupture (PTR) is a rare and severe postoperative complication of total knee arthroplasty (TKA). Even rarer is the intraoperative occurrence of PTR during TKA. PTR is a major complication as it can lead to chronic disability, functional limitations, and postoperative morbidity.
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