Purpose

Primary total hip arthroplasty (THA) has been a very successful surgical intervention for the management of end-stage arthritis in geriatric patients (> age 65). The mid- to long-term results have been less satisfactory however, in younger patients primarily due to the wear of the acetabular liner and loosening of the femoral component.

The primary study purpose was to compare pain, function and stiffness over the first five years in a population less than 60 years of age who received either an alumina liner/alumina femoral head (alumina group) or a crossfire UHMWPE liner/alumina head (Poly group) following primary THA. Secondarily, we compared re-operation rates over five years between these two groups.

Purpose

Femoral nerve block (FNB) following total knee arthroplasty (TKA) has had mixed results with some studies reporting improvement in pain and reduced narcotic exposure while others have not shown substantial differences. The effect of a FNB on rehabilitation indices (quadriceps strength, knee flexion) is also unclear.

The study purpose was to compare the effect of FNB+ a multimodal analgesic protocol (MMA) to MMA only on the 1) development of a complete quadriceps motor block and 2) knee flexion during the first two postoperative days and 3) knee flexion out to 12 weeks after primary TKA. Secondarily, we compared hospital length of stay (LOS), postoperative pain, analgesic use and the incidence of nausea/vomiting.

Purpose: Despite the excellent results of total knee arthroplasty (TKA), controversy over whether or not to resurface the patella persists. Anterior knee pain, which occurs with variable frequency, continues to be a problem in a subset of the TKA patient population. Some clinicians advocate resurfacing all patellae while others cite the complications attributed to patellar resurfacing as reasons to avoid this aspect of the procedure. Still others favour selective resurfacing based on subjective criteria. To address this clinical controversy, we prospectively randomized patients receiving TKA into two groups, those receiving patellar resurfacing and those left without resurfacing to determine clinical outcomes and revisions at five and 10 years postoperatively. Our primary objective was to compare the revision rate following TKA between the two study groups. Secondarily, we compared pain and function at five and 10 years and knee range of motion (ROM) over the first year.

Method: Patients receiving TKA were prospectively enrolled in the study and randomized intraoperatively to either receive patellar resurfacing or have no patellar intervention. All surgeries were performed through the standard medial parapatellar approach. The Smith and Nephew Profix TKA system was implanted in all cases and all subjects followed a standardized post-operative regimen. Subjects were assessed pre-operatively and at 6 months, 1, 3, 5 and 10 years postoperatively for knee ROM, function, and pain using the WOMAC and SF-36 questionnaires. Re-operations and revisions were also documented.

Results: Thirty-nine patients were enrolled in the study. There was 83% patient retention at five years and 74% at 10 years. Study groups were similar in baseline characteristics. At five years, three (18%) revisions had been performed in the retained patella group and one (5%) in the resurfaced group (p=0.31). There were no further revisions between five and 10 years. ROM was similar between the groups at all evaluations (p> 0.05). SF-36 and WOMAC scores demonstrated that both groups improved their pain and function significantly following surgery (p< 0.04).

Conclusion: The decision whether or not to resurface the patella during TKA remains controversial. This study demonstrated that initial results with either technique are comparable, but it appears that there may be clinically significant differences by five years postoperatively. These trends continued throughout the study and were statistically significant at the 10 year mark. Revision surgery was required in 18% of the retained group compared to 5% in the re-surfaced group.

The administration of heparin during operation has been reported to enhance the efficacy of thromboprophylaxis in patients undergoing total hip replacement. We have performed a small pilot study in which intraoperative doses of heparin were given in addition to the usual postoperative thromboprophylaxis with enoxaparin in 32 patients undergoing total knee replacement. The primary endpoint was deep-vein thrombosis (DVT) as demonstrated by bilateral venography on 6 ± 2 days after operation.

Sixteen patients developed DVT; in two the thrombosis was proximal as well as distal and in one the occurrence was bilateral. There was one major haemorrhage. These results are similar to those obtained with the use of postoperative thromboprophylaxis with enoxaparin alone. They do not provide support for the initiation of a larger randomised trial of this approach to management.