Shannonsimmons2914

To determine whether local infiltration analgesia by catheter infusion was superior to conventional analgesia in terms of postoperative pain control after THR. A randomized double-blind clinical trial was performed. There were four groups based on catheter placement and the infusion constituents 1) Intraarticular catheter + anesthetics ; 2) Intraarticular catheter +placebo ; 3) Subfascial catheter + anesthetics ; 4) Subfascial catheter + placebo. The anesthetic infusion contained bupivacaine (bolus + continuous perfusion up to 36 hours). The placebo solution was physiological serum. The same conventional analgesic schedule was prescribed to all patients. Pain was evaluated by means of PCA shots and the VAS. Side effects, time to start rehabilitation and time to discharge were also analyzed. 100 patients (25 for group). Mean age was 67 years old (SD 12 y/o) and 53% were male. Mean PCA shots was 27 [range 2-87] and mean VAS was 1 [range 0-7]. No differences were found (p>0.05) when these variables were compared between the groups. The use of LIA with bupivacaine using a catheter infusion does not provide better pain control after THR.Treatment of subtrochanteric fractures is challenging because of their typical displacement pattern. Use of circumferential cerclage wires can be added to intramedullary nailing to facilitate better anatomical reduction. Concerns exist regarding additional soft tissue damage and ischemia of the periosteum. The aim of this study was to assess the effect of cerclage on union and infection rates. The postoperative results of 115 patients over 11 years were retrospectively viewed. Twenty-three patients were treated with cerclage. The primary outcome measure was 'return to theatre for fixation failure'. There was no difference in reoperation rate or in infection rate. Average displacement of the lateral wall was larger (9mm vs 1,3mm) in the no-cerclage group (p=0,003). The mean duration of surgery in the cerclage group was 28 minutes longer (p=0.003). Cerclage wiring does not lead to higher re-operation, nor higher infection rates. The use of cerclage wire in open reduction is advocated when closed reduction is not satisfactory.Developmental dysplasia of the hip with a high dislocation may lead to severe hip pain and a marked shortening. Nerve palsy rates following THA in dysplastic hips have been reported as being higher by ten times or more compared to the general population. We report a new technique to perform THA in high congenital dislocations. Between 2013 and 2015, 3 consecutive patients (4 hips) with severe hip pain and Crowe III hip dysplasia were treated. Surgeries were performed on a standard table using the DAA and intraoperative neurophysiological monitoring. At final follow-up (mean 24 months, range 15-43), all 3 patients reported excellent pain relief and significant improvement in activities of daily living. Radiographs showed the components to be solidly fixed in satisfactory position. Average postoperative leg lengthening was 24 mm (range 20-36). None of the patients experienced an acute or delayed neurologic deficit. Total hip arthroplasty for high congenital dislocations can be safely performed using the direct anterior approach and neuromonitoring. learn more Significant lengthening could be obtained without neurological complications.The aim of this study was to evaluate the inter- and intraobserver reliability of a CT-based femoral anteversion measurement. 17 CT scans showing an abnormal anteversion on one side were presented to 6. Three measurements of all scans were obtained two bilateral measurements and a third measurement with a flipped CT scan. Interobserver correlation results using the spearman test for left, right and anteversion difference had a mean of respectively 0.918, 0.760 and 0.757. Intraobserver correlation had a maximum of respectively 0,99, 0,89 and 0,94. Correlation coefficients were consistently higher for the second measurement. The lower correlation boarder of 0,8 was often exceeded. Intraobserver correlation was higher than interobserver correlation. As we evaluated a high variance in interobserver reliability, we recommend an accurate and objective measurement of the anteversion angle. A personal measurement and comparison to the radiological protocol is necessary.Long-term evaluation of prosthetic joint infection treated with two-stage revision. Retrospective analysis of 102 periprosthetic infections treated with two-stage revision from 2010 to 2012 in Albenga hospital, Italy. During the second stage, samples for microbiological tests were collected. Failure was defined as a persistence of infection during the second stage or as a relapse during follow-up. 102 cases (55 hip, 47 knee) were analyzed. Patients were evaluated for a median of 44 months. 8/102 (8%) had positive cultures at replacement. These patients were treated with long-term antibiotic treatment and in 3/8 (38%) infection was cured. 9 patients were loss to follow-up or died, 6 patients (6%) had a relapse a median of 16,3 months from replanting. Risk factors significantly related to failures were diabetes and infection due to methicillin-resistant staphylococci. Two stage revision requires continued follow up. Screening for infection at replacement suggests prolonged antibiotic treatment.The purpose of this narrative review was to highlight the research on the influence of weather conditions on patients with osteoarthritis, the pathophysiological mechanisms and the therapeutic consequences. A search was conducted using the Pubmed, Medline and Web of Science databases. Barometric pressure, temperature and humidity are the weather conditions that are found to be correlated most to the worsening of pain complaints. But, due to the difficulty of measuring the impact of these variables and the great diversity in study protocols, an analysis of studies regarding this topic shows conflicting results. Central sensitization mechanisms and the function of a Transient Receptor Potential channel might explain the pain hypersensitivity to cold weather. Joint pain, caused by central sensitization mechanisms, cannot always be treated with joint arthroplasty. When pain remains present after joint arthroplasty, centrally mediated pain constitutes an important role.