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Chronic Postacute Pain
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
For example, in one study, 58% of patients after total knee arthroplasty reported CPSP at three months—all had higher pain scores on mobilization for each of the first eight days after surgery compared with those patients who were pain-free at three months (Lavand’homme et al, 2014). Of the patients with CPSP, rising pain trajectories over the first postoperative week predicted development of CPSNP.
Monographs of Topical Drugs that Have Caused Contact Allergy/Allergic Contact Dermatitis
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
Three months after a 79-year-old male patient had received a right cemented total knee arthroplasty, pain, swelling and a reduced range of motion were noted after an extended walk. Physical examination by the orthopedic surgeon showed joint effusion. Subsequent computed tomography showed a correct implant position without any signs of loosening. Diagnostic joint aspiration and microbiological analysis showed no signs of infection. Scintigraphy was suggestive of local synovitis. Thus, synovitis caused by ‘excessive walking’ was diagnosed, and oral diclofenac was prescribed. However, the patient complained of increasing pain, and presented with local eczema of the right knee a few weeks later. Patch tests were positive to gentamicin and neomycin, but an antibiotic-free bone cement had been used for the operation. However, it was found that, while performing the diagnostic joint aspiration, the orthopedic surgeon had injected gentamicin solution to prevent infection. Taking this detail into account, the authors diagnosed ‘synovitis and allergic contact dermatitis’ resulting from intra-articular gentamicin application. In the course of the next 10 months, the patient’s symptoms, including his eczema, completely resolved (50).
Management of vascular complications during nonvascular operations
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Kush Sharma, M. Ashraf Mansour
Total knee arthroplasty is a commonly performed operation. Iatrogenic arterial injury is reported to be less than 1%.43 Delayed diagnosis and improper management can result in significant morbidity with the risk for limb loss.43 Most commonly, popliteal artery injury is possible and would require prompt response by a vascular surgeon to avoid hemodynamic collapse and complications of acute limb ischemia.
Physical activity, pain interference and comorbidities relate to PROMIS physical function in younger adults following total knee arthroplasty
Published in Disability and Rehabilitation, 2021
Jesse Christensen, Christopher Peters, Jeremy Gililland, Gregory Stoddard, Christopher Pelt
Total knee arthroplasty is a highly successful elective procedure for knee pain reduction and improved functional performance [20–22]. However, as high as 34% of younger adults continue to report residual symptoms limiting functional performance [5] compared to 25% of older counterparts post-total knee arthroplasty [20,23]. Limited investigation has studied why some relatively younger adults report poorer clinical outcomes following total knee arthroplasty. Younger, more medically complex, adults with TKA are increasing at an alarming rate, despite being commonly excluded from research participation due to preoperative health concerns [5,24–26]. Studies have shown preoperative health risk factors to be predictive of perceived functional performance in older adults post-total knee arthroplasty [27]. However, it remains unknown if preoperative health risk factors are influential in relatively younger adults post-total knee arthroplasty. Detecting preoperative health risk factors that influence clinical outcomes could allow for improved presurgical decision making and improved health care delivery in this growing patient population.
Reliability, responsiveness, and validity of handheld dynamometry for assessing quadriceps strength in total knee arthroplasty
Published in Disability and Rehabilitation, 2021
Andrew J. Kittelson, Jesse C. Christensen, Brian J. Loyd, Kristine L. Burrows, Johna Iannitto, Jennifer E. Stevens-Lapsley
Over 700,000 total knee arthroplasties are performed annually in the USA [1]. This number is expected to rise dramatically in the coming decades as surgical indications expand to include younger and less healthy patients, and as the average age of the population increases [2,3]. Although total knee arthroplasty is widely regarded as effective at reducing knee pain [4], the surgery results in immediate and persistent deficits in lower extremity strength [5]. Quadriceps weakness is a hallmark of total knee arthroplasty, with an average strength loss of approximately 50–60% by 1 month following surgery [6–9]. On average, it takes the better part of the first postoperative year to recover quadriceps strength to preoperative levels [5]. Even then, quadriceps strength remains diminished 6–13 years following surgery relative to healthy peers [9]. Moreover, impairments in quadriceps strength are associated with decreased walking speed, diminished household mobility, and impaired balance leading to increased fall risk [8,10–12]. As such, quadriceps strength is an important indicator of overall physical health for patients with total knee arthroplasty [13,14].
Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials
Published in Journal of Investigative Surgery, 2021
Baoyuan Meng, Juan Ma, Zhou Liu, Changhong Du, Guoqiu Zhang
TKA results in massive blood loss and a higher transfusion rate due to greater surgical trauma [14,15]. Excessive intraoperative blood loss will affect the recovery of postoperative knee function so that the prolonged postoperative recovery time will be prolonged and the incidence of postoperative complications will increase [16,17]. Total knee arthroplasty patients are mostly middle-aged and elderly with relatively poor physical function and poor tolerance to blood loss. Therefore, allogeneic blood transfusion is often used in clinical practice to correct anemia in the perioperative period [18–20]. It is a truth that allogeneic blood transfusion is an effective way to correct anemia. However, it also brings about blood transfusion diseases and potential risks, such as allergic reactions, fever reactions, bacteremia, etc. [21]. In recent years, the increasing incidence of such knee diseases as osteoarthritis and rheumatoid arthritis in elderly patients has promoted the clinical application rate of total knee arthroplasty [22–24]. Therefore, joint surgeons should think about how to address the problem of perioperative blood loss during operation.