Archives of Orthopaedic and Trauma Surgery最新文献

{"title":"What does the patients' perception of alignment tell us about alignment targets in total knee arthroplasty?","authors":"Tim Ludwig Tuengler, Christian Manuel Sterneder, Lyubomir Haralambiev, Friedrich Boettner","doi":"10.1007/s00402-025-05765-4","DOIUrl":"https://doi.org/10.1007/s00402-025-05765-4","url":null,"abstract":"<p><strong>Introduction: </strong>Knee alignment significantly impacts the outcome of total knee arthroplasty (TKA). Understanding patient perceptions of their knee alignment in relation to objective measurements is essential to ensure optimal surgical outcomes and to meet patients' expectations. This study reports patients' perception of pre- and postoperative knee alignment in relation to radiographic alignment measurements.</p><p><strong>Materials and methods: </strong>The study included 141 patients with primary osteoarthritis of the knee (mean age: 65.4 years, BMI: 30.8). Patients categorized their knee alignment before and after surgery using a picture-based rating scale: very bow-legged (> 10° varus), bow-legged (2.1-10° varus), straight (2° varus to 2° valgus), knock-kneed (2.1-10° valgus), and very knock-kneed (> 10° valgus). Hip-to-ankle films were performed to compared actual knee alignment with patients' assessments retrospectively.</p><p><strong>Results: </strong>Preoperatively, 15.1% of patients with severe varus, 55.6% with varus, and 86.7% with neutral alignment perceived their knees as straight. None of the patients with valgus or severe valgus alignment considered their knees as straight. Overall, 40.2% of patients with radiographic varus alignment classified their knees as straight, while nobody with valgus alignment did. Postoperatively patients with preoperative varus considered their knees as straight with an average of 1.8 ± 1.7 deg. mechanical varus alignment, while patients with preoperative valgus alignment considered their knees straight with an average of 0.4 ± 0.9 deg. mechanical valgus alignment.</p><p><strong>Conclusion: </strong>Patients predominantly desire a straight knee postoperatively, however, most patients tend to perceive some varus alignment as straight. This is most common in patients with up to 5 degrees of varus deformity and suggests that a restricted or inverse kinematic alignment with up to 5 degrees of varus can meet the expectations of most patients. In contrast, patients with valgus deformity are sensitive to any remaining valgus deformity and leaving the knees in more than 2 deg. of valgus will unlikely satisfy the patients' overall desire for a straight knee after surgery.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"145"},"PeriodicalIF":2.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of functional recovery following surgical repair of quadriceps tendon rupture: insights from a German multicentre study.","authors":"Ronny Langenhan, Niklas Reimers, Petr Kohut, Axel Probst, Stefan Bushuven, Ludwig Schütz, Milena Trifunovic-Koenig","doi":"10.1007/s00402-024-05750-3","DOIUrl":"https://doi.org/10.1007/s00402-024-05750-3","url":null,"abstract":"<p><strong>Introduction: </strong>More extensive and cohesive studies on quadriceps tendon rupture (QTR) repair surgery are required to guide effective treatment strategies. Therefore, in this study, we aimed to identify predictors of subjective functional recovery following QTR repair surgery.</p><p><strong>Materials and methods: </strong>This multicentre retrospective cohort study enrolled 191 adults (age ≥ 18 years) who underwent surgical unilateral QTR repair (2010-2022) and had ≥ 1-year postoperative follow-up at three trauma centres in Germany. Multiple linear regression and moderation analyses evaluated seven patient-centred factors and eight treatment-related predictors of the International Knee Documentation Committee (IKDC) and Tegner-Lysholm Knee scores.</p><p><strong>Results: </strong>The participants ( mean age = 62.3 years) had mean (standard deviation) IKDC and Tegner-Lysholm Knee scores of 67.4 (19.4) and 74.8 (22.5), respectively. Male sex, lower body mass index (BMI), shorter time to surgery, and early rehabilitation adoption predicted higher functional scores (p < 0.05). Smoking and suturing techniques showed no significant main effects. Age was negatively correlated with IKDC scores when transosseous sutures were applied but not when suture anchors were used. Notably, 6% of the cohort were affected by complications such as re-rupture or deep vein thrombosis.</p><p><strong>Conclusions: </strong>Patient-centred factors (sex and BMI) and treatment-related factors (timing of surgery and rehabilitation protocols) significantly influence postoperative functional outcomes in patients with QTR. Early surgical intervention and dynamic rehabilitation protocols are important for optimising recovery, and suture anchor techniques may be advantageous in older patients. Further research is essential to improve QTR management strategies and enhance patient outcomes.</p><p><strong>Evidence level: </strong>IV-Retrospective cohort study without a comparison group.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"147"},"PeriodicalIF":2.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autologous minced cartilage implantation in osteochondral lesions of the talus-does fibrin make the difference?","authors":"Jan Kühle, Ferdinand C Wagner, Samuel Beck, Lukas Klein, Lisa Bode, Kaywan Izadpanah, Hagen Schmal, Nils Mühlenfeld","doi":"10.1007/s00402-025-05762-7","DOIUrl":"10.1007/s00402-025-05762-7","url":null,"abstract":"<p><strong>Introduction: </strong>Implantation of minced cartilage is a one-step-procedure that leads to satisfactory results in osteochondral defects.</p><p><strong>Material and methods: </strong>A retrospective review was performed on a consecutive cohort of patients that received minced cartilage with fibrin (MCF), minced cartilage with membrane and fibrin (MCMF) and minced cartilage with the \"AutoCart\"-procedure (MCAC) between January 2019 and December 2023. Radiological outcome parameters were evaluated via Magnet-Resonance-Tomography (MRI) within one year using Ankle-Osteoarthritis-Scoring-System (AOSS).</p><p><strong>Results: </strong>Final data included 25 patients: 13 women and 12 men with a mean age of 28.2 years ± 10.9(range:18-51). Mean defect size was 103.6mm² ± 59.0(95% CI = 79.2-128.0), mean depth 5.2 mm ± 3.6(3.7-6.6). Differences between groups in defect sizes were not significant (p = 0.999). MCF was carried out in 9(36.0%), MCMF in 7(28.0%) and MCAC in 9(36.0%) patients. Mean postoperative AOSS values were 2.6 ± 1.9(95%CI:1.1-4.1) for MCF-patients, 3.3 ± 2.9(0.6-5.9) for MCMF patients and 3.9 ± 2.8(1.7-6.1) for MCAC-patients, respectively. Differences were not significant (p = 0.639). Revision surgery because of symptomatic non-integration of the graft or ventral impingement occurred in 5(20%) of cases - all part of MCAC-patients that did not receive additional fibrin fixation as the top layer of transplant (p < 0.05).</p><p><strong>Conclusions: </strong>Autologous minced cartilage implantation seems to be sufficient as a viable, one-step treatment for osteochondral lesions of the talus. It leads to low complication rates and excellent AOSS values within a 12-month period whereas the application of fibrin as the last fixation layer seems to be advisory, which demands further investigation.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"144"},"PeriodicalIF":2.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient total hip arthroplasty: robotic assistance reduces 90-Day postoperative events and optimizes outpatient care.","authors":"Pascal Kouyoumdjian, Malek Brichni, Philippe Marchand, Rémy Coulomb","doi":"10.1007/s00402-025-05767-2","DOIUrl":"https://doi.org/10.1007/s00402-025-05767-2","url":null,"abstract":"<p><strong>Purpose: </strong>The adoption of robotic-assisted total hip arthroplasty (THA) is increasingly widespread, yet its influence on outcomes in outpatient surgery remains uncertain. This study aimed to evaluate whether robotic assistance reduces the rate of 90-day postoperative events in patients undergoing outpatient THA, compared to those in inpatient procedures.</p><p><strong>Methods: </strong>This historical-prospective cohort study analyzed 706 primary THA cases performed between January 2017 and January 2023 by three senior surgeons. Patients were grouped into outpatient (n = 132) and inpatient (n = 576) cohorts. From December 2019, robotic-assisted THA using the MAKO™ system was implemented. Propensity score matching was used to minimize baseline differences between groups. The primary outcome was the occurrence of any event within 90 days post-surgery, including readmissions, reoperations, and other complications. Secondary outcomes included functional scores, length of hospital stay, and intraoperative factors such as blood loss and Operative Room (OR) time.</p><p><strong>Results: </strong>No significant differences were found between inpatient and outpatient groups in terms of gender, age, BMI, ASA score, or surgeon. The 90-day event rates were similar between the two groups (8.59% vs. 9.38%, p > 0.999). However, outpatient THA was associated with lower blood loss (p = 0.02) and shorter hospital stays (p < 0.001). Multivariate analysis identified prolonged OR time (> 2 h), BMI ≥ 25, and manual surgical techniques as significant risk factors for 90-day events. Robotic-assisted surgery, although not statistically significant (p = 0.105), showed a trend towards reducing complications in outpatient THA.</p><p><strong>Conclusion: </strong>Outpatient THA is a safe alternative to inpatient surgery, with no significant difference in 90-day postoperative events. Robotic-assisted surgery appears to reduce complications, particularly in the outpatient setting, and may optimize outpatient care pathways. Further research is needed to confirm these findings and explore long-term outcomes.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"146"},"PeriodicalIF":2.0,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143036245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood management protocol for baseline anemic patients undergoing hip arthroplasty.","authors":"Hervé Hourlier, Guillaume Fricault, Peter Fennema","doi":"10.1007/s00402-025-05764-5","DOIUrl":"https://doi.org/10.1007/s00402-025-05764-5","url":null,"abstract":"<p><strong>Introduction: </strong>Patients undergoing total hip arthroplasty (THA) with preoperative anemia are at higher risk for transfusion. Blood-conserving interventions can reduce perioperative transfusions. This retrospective study evaluates the efficacy and safety of a patient blood management (PBM) protocol in elective primary THA patients with preoperative anemia.</p><p><strong>Materials and methods: </strong>We analyzed data from a prospectively collected database of THAs performed consecutively from January 2013 to October 2023. The patients were grouped based on baseline hemoglobin (Hb) levels, as follows: <12 g/dL (group 1) and ≥ 12 g/dL (group 2). The PBM protocol included optimized preoperative epoetin (EPO) for Hb < 11 g/dL, bleeding reduction measures, and restrictive transfusion thresholds. Blood loss was measured using a bleeding index (BI-7), accounting for Hb decrease from admission to the 7th postoperative day and total transfused units. Multiple linear regression was used to assess the differences in BI-7.</p><p><strong>Results: </strong>Of the 1,442 patients, 104 (7%) had Hb < 12 g/dL (group 1). Among these, 46 (45%) received EPO, with none requiring transfusion in the first week. The mean adjusted BI-7 was 2.3 g/dL (95% CI, 2.1 to 2.6) in group 1 and 2.7 g/dL (95% CI, 2.6 to 2.7) in group 2, showing a significant difference (-0.4 g/dL; 95% CI, -0.6 to -0.1; p < 0.001).</p><p><strong>Conclusions: </strong>THA patients with baseline Hb < 12 g/dL had a zero-transfusion rate and significantly lower blood loss than those with Hb ≥ 12 g/dL. Optimizing preoperative Hb levels above 12 g/dL is not necessary for patients undergoing standard THA. Optimizing preoperative Hb may not be necessary for patients with baseline anemia due to their low blood loss. The PBM protocol was effective in conserving blood, time, and resources, offering a viable alternative for blood conservation in elective hip arthroplasty.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"143"},"PeriodicalIF":2.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased stiffness with medial column screw supplementation of lateral locking plate for distal femur fractures: a biomechanical study.","authors":"Joseph Henningsen, Kyle Mobley, Scott Huff, Joshua Perrin, William Naylor, Andrew Froehle, Jennifer Jerele, Michael Prayson","doi":"10.1007/s00402-024-05659-x","DOIUrl":"https://doi.org/10.1007/s00402-024-05659-x","url":null,"abstract":"<p><strong>Introduction: </strong>We propose and assess the biomechanical stability of medial column screw supplementation in a synthetic distal femur fracture model.</p><p><strong>Materials and methods: </strong>Twenty-four low density synthetic femora modeling osteoporotic, intraarticular distal femur fractures with medial metaphyseal comminution were split into two fixation groups: (1) lateral locking distal femur plate (PA- plate alone) and (2) lateral locking distal femur plate with a 6.5 mm fully threaded medial cannulated screw (PWS- plate with screw). Cyclic biomechanical testing included 5 steps of 10,000 cycles with each step increasing axial loads starting at 0.5xBW (BW = 80 kg) up to 2.5xBW. Discrete stiffness was calculated for each step and cumulative stiffness was calculated across the entire protocol. Outcomes of interest included cumulative stiffness, discrete stiffness, and instrumentation failure.</p><p><strong>Results: </strong>Seven of the PA models had failure during testing. No failures were seen in the PWS group. PWS had 19.8% higher cumulative stiffness compared to PA (676.3 N/mm vs 809.8 N/mm; P = 0.014). Discrete stiffness showed < 1% differences at lower loads, but increasing loads found the PWS group with 12% greater discrete stiffness than the PA group (879.1 N/mm vs 983.8 N/mm; P = 0.028).</p><p><strong>Conclusion: </strong>This is the first study to evaluate the contribution of a medial column screw in a distal femur fracture model. PWS had superior stiffness and few failures compared to PA. Applied clinically, a medial column screw can increase construct stability in the setting of complex distal femur fractures with minimal increase in operative time, patient morbidity and cost.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"142"},"PeriodicalIF":2.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors predicting manipulation under anaesthesia after total knee replacement.","authors":"Aruni Areti, Terrul Ratcliff, Vinayak Perake, Senthil N Sambandam","doi":"10.1007/s00402-025-05758-3","DOIUrl":"https://doi.org/10.1007/s00402-025-05758-3","url":null,"abstract":"<p><strong>Introduction: </strong>Manipulation under anesthesia (MUA) is a standard and effective treatment to correct stiffness and improve range of motion (ROM) following total knee arthroplasty (TKA). Delayed MUA has been associated with increased rates of revision surgeries and infections. Early MUA has been shown to double the mean gain in flexion compared to delayed interventions. To identify candidates early and effectively, this study aimed to evaluate various risk factors influencing the likelihood of undergoing MUA after TKA using statistical analysis.</p><p><strong>Methods: </strong>Data from 1973 to 2023 were collected from TriNetX, reviewing 245,567 unique patients. Current Procedural Terminology (CPT) codes identified those who had undergone TKA and MUA. ICD-9 and ICD-10 codes identified preoperative comorbidities and complications. Univariate and multivariate analyses assessed the association between preoperative risk factors and MUA likelihood. Independent sample t-tests, Levene's test, and effect size analyses examined age differences between MUA and non-MUA cohorts. The study included 6,867 patients (2.8%) in the MUA cohort and 238,700 patients (97.2%) in the non-MUA cohort.</p><p><strong>Results: </strong>Among 245,567 TKA patients, 6,867 (2.8%) required MUA. Univariate analysis showed significant associations with age < 65 (OR = 2.49 [CI: 2.37-2.61], p < 0.001), Black race (OR = 2.04 [CI: 1.91-2.18], p < 0.001), SCD (OR = 2.96 [CI: 2.01-4.35], p < 0.001), and cannabis-related disorders (OR = 2.38 [CI: 1.29-4.38], p = 0.004). Multivariate analysis confirmed significant predictors: age < 65 (OR = 2.39 [CI: 2.26-2.53], p < 0.001), Black race (OR = 1.65 [CI: 1.51-1.81], p < 0.001), SCD (OR = 1.51 [CI: 1.00-2.26], p = 0.048), and female sex (OR = 1.13 [CI: 1.07-1.18], p < 0.001). The average age was 61.94 years in the MUA cohort and 67.09 years in the non-MUA cohort, with a significant mean difference of 5.14 years (p < 0.001).</p><p><strong>Conclusion: </strong>Our study demonstrates that younger age, female sex, and Black race are significant predictors of MUA after TKA. Additionally, novel risk factors such as peripheral artery disease (PAD), chronic kidney disease (CKD), and sickle cell disease (SCD) were identified, with SCD notably increasing the likelihood of MUA. This study uniquely highlights reduced likelihoods of MUA in PAD and CKD patients, contrasting with prior literature. The significant association of SCD with MUA, alongside these novel findings, emphasizes the value of demographic and comorbidity-specific predictors in refining postoperative risk stratification.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"138"},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment of both bone forearm fractures with 2.7 mm plates: a non-inferiority study.","authors":"Michael C Harrington, Blake Nourie, Dana Perim, Amit Ratanpal, Gokul Kalyanasundaram, Patrick Marinello","doi":"10.1007/s00402-024-05692-w","DOIUrl":"https://doi.org/10.1007/s00402-024-05692-w","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the effectiveness of 2.7 mm plates in treating both bone forearm fractures (BBFFs) compared to the current gold standard of 3.5 mm fixation. More specifically, to determine if 2.7 mm plates are non-inferior to the current standard of 3.5 mm plates.</p><p><strong>Design: </strong>Retrospective including patients from 2016-2021.</p><p><strong>Setting: </strong>Single institution, level-1 trauma academic medical center.</p><p><strong>Patients/participants: </strong>77 patients met inclusion criteria, 58 patients underwent fixation with 3.5 mm plates and 19 underwent fixation with 2.7 mm plates.</p><p><strong>Intervention: </strong>Plate osteosynthesis with either 2.7 mm or 3.5 mm plate instrumentation.</p><p><strong>Main outcome measure: </strong>Maintenance of reduction and achievement of fracture union.</p><p><strong>Results: </strong>Among 77 total patients, 19 received 2.7 mm plates and 58 received 3.5 mm plates. There was no difference in age and BMI between groups, but the 2.7 mm group had fewer males (47% vs 79%, p = 0.02). Primary end points of achievement of union (89.5% vs. 79.3%, p = 0.39) and maintenance of reduction (100% vs. 94.8%, p = 0.99), and secondary end points of implant removal (15.8% vs. 13.8%, p = 0.79), return to the operating room (OR) (5.3% vs. 5.2%, p = 0.63), and minor complications (0% vs. 6.9%, p = 0.99) were similar between the 2.7 mm and 3.5 mm groups.</p><p><strong>Conclusion: </strong>This study challenges the current standard of ORIF using 3.5 mm plates for diaphyseal forearm fractures. 2.7 mm plating resulted in at least equivocal achievement of fracture union and thus may be more efficacious given previous studies showing lower refracture risks after implant removal.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"134"},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating the complexities of hallux valgus surgery.","authors":"Sarah Ettinger, Fabian T Spindler, Sebastian F Baumbach","doi":"10.1007/s00402-024-05607-9","DOIUrl":"10.1007/s00402-024-05607-9","url":null,"abstract":"","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"139"},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143027914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous local infiltration analgesia is equal to femoral and sciatic nerve block for total knee arthroplasty.","authors":"Christoph Simon, Matthias Schwab, Hanns Ackermann, Lukas Krüerke, Dirk Meininger","doi":"10.1007/s00402-024-05641-7","DOIUrl":"10.1007/s00402-024-05641-7","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is associated with moderate to severe postoperative pain. Pain control is crucial for rapid mobilisation and reduces side effects as well as the length of hospital stay. In this context, a variety of multimodal pain control regimes show good pain relief, including several nerve blocks, iPACK and local infiltration analgesia (LIA). To compare the analgesic potency of LIA and the combination of continuous femoral nerve block + sciatic single-shot nerve block under general anaesthesia, we conducted a prospective, randomized, controlled, non-blinded single-centre study.</p><p><strong>Method: </strong> 139 ASA I-III Patients were enrolled in the study, randomised into two groups. The LIA group received an intra- and periarticular infiltration containing a mix of ropivacaine 0,2%, adrenaline and ketorolac, followed by an infusion of the same mixture for 48 h via an intraarticular catheter. The patients in the FEM group received a combination of continuous femoral nerve block with a catheter using 30 ml prilocaine 1% and ropivacaine 0,2% plus a single-shot sciatic nerve block via an antero-medial approach (landmark-based technique) with 20 ml ropivacaine 0,75%. Postoperative pain scores were analysed during the first two postoperative days, as well as opioid consumption, the degree of knee movement and the occurrence of infections in both groups applying the Wilcoxon-Mann-Whitney test, Friedman chi-square test and the Log-rank-test.</p><p><strong>Results: </strong>No significant difference in pain scores, opioid consumption, time to first rescue analgesia, knee range of motion, age, height, weight and ASA could be detected. No severe side effects, such as secondary bleeding or infections, were reported.</p><p><strong>Conclusion: </strong>Both techniques are well established, provide equal pain relief for TKA and support early postoperative mobilisation.</p><p><strong>Trial registration: </strong>DRKS 00027145 08/12/2021. \"retrospectively registered\".</p>","PeriodicalId":8326,"journal":{"name":"Archives of Orthopaedic and Trauma Surgery","volume":"145 1","pages":"136"},"PeriodicalIF":2.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11759472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}