Grimesharrington0551

0% of preoperative narcotic-free patients, 35.2% opioid users (relative risk [RR] 5.83 [5.63-6.03]), 9.2% tramadol users (RR 1.52 [1.40-1.63]), and 29.5% opioid or tramadol users (RR 4.88 [4.72-5.05]). Opioid or tramadol prescriptions were filled by 7.7% of preoperative narcotic-free patients, 37.3% opioid users (RR 4.84 [4.70-4.99]), 26.2% tramadol users (RR 3.40 [3.26-3.57]), and 35.7% opioid or tramadol users (RR 4.64 [4.50-4.78]) at 12 months. CONCLUSION Patients taking tramadol preoperatively were found to be at lower risk for prolonged postoperative opioid use following TKA. Patients taking either narcotics preoperatively continued use of these medications at a higher rate than those who were not. BACKGROUND Antimicrobial-impregnated incise drapes are often used despite any literature that demonstrates a reduction in the rate of periprosthetic joint infection (PJI). The aim of this study is to compare the efficacy of antimicrobial-impregnated incise drapes with nonantimicrobial-impregnated incise drapes for the prevention of PJI in patients undergoing total joint arthroplasty (TJA). METHODS A retrospective study of 9774 primary TJAs from 2000 to 2012 was performed. Patients who received an antimicrobial-impregnated incise drape (n = 5241) were compared with patients who received a nonantimicrobial-impregnated incise drape (n = 4533). The decision to use an antimicrobial drape was based on the surgeon's discretion. Patients who developed PJI within 1 year after index surgery were identified. Multivariate logistic regression analysis and sensitivity analysis using propensity score matching were performed to control for potential confounders. RESULTS The overall PJI rate was 1.14% (60 of 5241) for patients who received an antimicrobial-impregnated incise drape compared with 1.26% (57 of 4533) for those with a nonantimicrobial-impregnated incise drape. There was no difference in the PJI rate between patients with an antimicrobial-impregnated incise drape and those who received nonantimicrobial-impregnated incise drape in the univariate (odds ratio [OR] = 0.91; 95% confidence interval [CI] = 0.63-1.30), multivariate (adjusted OR = 0.92; 95% CI, 0.63-1.34), or propensity score matching analysis (OR = 0.84; 95% CI = 0.52-1.35). CONCLUSION Despite the increasing adoption of the use of antimicrobial-impregnated incise drapes in our institute, this study suggests that antimicrobial-impregnated incise drapes do not reduce PJI in patients undergoing primary TJAs. BACKGROUND The use of the femoral component position to balance the flexion space and its relationship to the transepicondylar axis (TEA) and posterior condylar angle (PCA) has not been thoroughly evaluated. METHODS A total of 233 patients undergoing robotic arm-assisted total knee arthroplasty were evaluated. Native TEA and PCA were established on preoperative computed tomography scans. Femoral component rotation was set in the axial plane to match the native trochlea and native medial femoral condyle to set the flexion gap. Knee flexion space gaps and component position were recorded. The relationship of the femoral component to the native TEA, PCA, and preoperative radiographic landmarks was evaluated. RESULTS The intraoperative measured medial flexion space gap did not significantly correlate with the relationship of the femoral component to the PCA or TEA in varus or valgus knees. In varus knees, the preoperative mechanical axis alignment had a positive relationship to femoral component position when compared to the PCA (P = .04) and TEA (P = .002). In valgus knees, there was a positive correlation between the preoperative lateral distal femoral angle and component position when compared to the PCA (P = .04) only. CONCLUSION Intraoperative measured flexion space balance through femoral component positioning did not correlate with its relationship to the native TEA or PCA. In varus knees, the preoperative mechanical axis alignment correlated with an increase in femoral component external rotation to the TEA and PCA. In valgus knees, the severity of preoperative lateral distal femoral angle correlated with the rotational relationship of the femoral component to the PCA only. BACKGROUND Periarticular injection or anesthesiologist-performed adductor canal block are commonly used for pain management after total knee arthroplasty. A surgeon-performed, intra-articular saphenous nerve block has been recently described. There is insufficient data comparing the efficacy and safety of these methods. METHODS This is a retrospective two-surgeon cohort study comparing short-term perioperative outcomes after primary total knee arthroplasty, in 50 consecutive patients with surgeon-performed high-dose periarticular injection and intra-articular saphenous nerve block (60 mL 0.5% bupivacaine, 30 mL saline, 30mg ketorolac) and 50 consecutive patients with anesthesiologist-performed adductor canal catheter (0.25% bupivacaine 6 mL/h infusion pump placed postoperatively with ultrasound guidance). CAPE Chart review assessed pain scores through POD #1, opioid use, length of stay, and short-term complications, including local anesthetic systemic toxicity. Statistical analysis was performed with two-tailed Student's T-test. RESULTS The high-dose periarticular injection cohort had significantly lower pain scores in the postanesthesia care unit (mean difference 1.4, P = .035), on arrival to the inpatient ward (mean difference 1.7, P = .013), and required less IV narcotics on the day of surgery (mean difference 6.5 MME, P = .0004). There was no significant difference in pain scores on POD #1, total opioid use, day of discharge, or short-term complications. There were no adverse events related to the high dose of bupivacaine. CONCLUSION Compared with postoperative adductor canal block catheter, an intraoperative high-dose periarticular block demonstrated lower pain scores and less IV narcotic use on the day of surgery. No difference was noted in pain scores on POD #1, time to discharge, or complications. There were no cardiovascular complications (local anesthetic systemic toxicity) despite the high dose of bupivacaine injected. LEVEL OF EVIDENCE III.