OKOJ, Volume 12, No. 2

New Techniques in Continuous Regional Anesthesia

Postoperative pain is an important concern for patients having orthopaedic surgery. Continuous perineural catheters play a key role in the multimodal analgesic plan for these patients. With appropriate patient selection, both inpatients and outpatients may benefit from a continuous nerve block delivered through a perineural catheter. Numerous procedures on both the upper and lower extremities can be done with anesthesia in the form of a targeted block. Such targeted blocks include but are not limited to interscalene, supraclavicular, and infraclavicular blocks of the brachial plexus and blockade of the femoral and sciatic nerves of the lower extremities. Numerous studies have outlined safe dosing regimens for such anesthesia, although no ideal drug, dose, or schedule has been found for all blocks, and many changes in the technology and equipment for continuous nerve blockade have occurred in the past several decades, with a trend toward ultrasound guidance and the use of simple, reliable infusion pumps. Postoperative management of the patient undergoing nerve blockade through a continuous catheter infusion is influenced by the type of catheter, type of surgery, inpatient status, and patient requirements for physical therapy and ambulation. Common issues and concerns relating to catheter optimization are managed by the team that provides regional anesthesia or treatment for acute pain.

    • Keywords:
    • continuous regional anesthesia

    • nerve blocks

    • perineural catheter

    • postoperative pain

    • orthopaedic surgery

    • Subspecialty:
    • Pain Management

Arthroscopic Transosseous Rotator Cuff Repair

Traditional open repair using transosseous sutures remains the preferred technique for tears of the rotator cuff. It has been shown to provide biomechanically secure fixation and avoids complications related to the use of suture anchors, such as anchor pullout and osteolysis of the greater tuberosity. Recently, however, newer arthroscopic techniques and technology that combine the benefits of a transosseous construct with the deltoid-sparing nature of shoulder arthroscopy have been developed, and have shown promising results. This article presents our detailed surgical technique for arthroscopic transosseous rotator cuff repair, which we use for virtually all repairs of rotator cuff tears, with the same indications, preoperative workup, and postoperative care as an anchor-based repair.

    • Keywords:
    • shoulder arthroscopy

    • transosseous

    • rotator cuff repair

    • anchor-based repair

    • bursoscopy

    • subacromial decompression

    • rip-stop suture

    • ArthroTunneler

    • Force Fiber

    • FiberWire

    • Orthocord

    • nitinol loop

    • Subspecialty:
    • Shoulder and Elbow

Periprosthetic Fractures After Total Knee Arthroplasty

Periprosthetic fractures following total knee arthroplasty (TKA) are an uncommon problem. However, as the population of the United States continues to age and joint replacements become more prevalent, these fractures will be encountered more frequently. The treatment of periprosthetic fractures following TKA can present a significant challenge to the treating surgeon for a variety of reasons, particularly the limited bone stock and often poor quality of the bone involved. Various potential treatment options exist for such fractures, from nonsurgical treatment to fixation with a plate and screws or an intramedullary nail to revision arthroplasty. Proper indications for the surgical treatment of such fractures, appropriate implant selection, effective surgical technique, and a sound postoperative rehabilitation protocol facilitate the treatment of these difficult fractures, with the goals of their stable fixation and early patient mobilization, while minimizing complications.

      • Subspecialty:
      • Trauma

      • Adult Reconstruction