Abstract：
BACKGROUND:Despite the overall success of total joint arthroplasty, patients undergoing this procedure remain susceptible to cognitive decline and/or delirium, collectively termed postoperative cognitive dysfunction. However, no consensus exists as to whether general or regional anesthesia results in a lower likelihood that a patient may experience this complication, and controversy surrounds the role of pain management strategies to minimize the incidence of postoperative cognitive dysfunction. QUESTIONS/PURPOSES:We systematically reviewed the English-language literature to assess the influence of the following anesthetic and/or pain management strategies on the risk for postoperative cognitive dysfunction in patients undergoing elective joint arthroplasty: (1) general versus regional anesthesia, (2) different parenteral, neuraxial, or inhaled agents within a given type of anesthetic (general or regional), (3) multimodal anesthetic techniques, and (4) different postoperative pain management regimens. METHODS:A systematic search was performed of the MEDLINE(®) and EMBASE™ databases to identify all studies that assessed the influence of anesthetic and/or pain management strategies on the risk for postoperative cognitive dysfunction after elective joint arthroplasty. Twenty-eight studies were included in the final review, of which 21 (75%) were randomized controlled (Level I) trials, two (7%) were prospective comparative (Level II) studies, two (7%) used a case-control (Level III) design, and three (11%) used retrospective comparative (Level III) methodology. RESULTS:The evidence published to date suggests that general anesthesia may be associated with increased risk of early postoperative cognitive dysfunction in the early postoperative period as compared to regional anesthesia, although this effect was not seen beyond 7 days. Optimization of depth of general anesthesia with comprehensive intraoperative cerebral monitoring may be beneficial, although evidence is equivocal. Multimodal anesthesia protocols have not been definitively demonstrated to reduce the incidence of postoperative cognitive dysfunction. Nonopioid postoperative pain management techniques, limiting narcotics to oral formulations and avoiding morphine, appear to reduce the risk of postoperative cognitive dysfunction. CONCLUSIONS:Both anesthetic and pain management strategies appear to influence the risk of early cognitive dysfunction after elective joint arthroplasty, although only one study identified differences that persisted beyond 1 week after surgery. Investigators should strive to use accepted, validated tools for the assessment of postoperative cognitive dysfunction and to carefully report details of the anesthetic and analgesic techniques used in future studies.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Zywiel MG,Prabhu A,Perruccio AV,Gandhi Rdoi
10.1007/s11999-013-3363-2subject
Has Abstractpub_date
2014-05-01 00:00:00pages
1453-66issue
5eissn
0009-921Xissn
1528-1132journal_volume
472pub_type
杂志文章,评审abstract：BACKGROUND:Child abuse and neglect (CAN) is a serious problem that has major implications for the welfare of the child involved. Unexplained fractures are of particular concern to the orthopaedic surgeon, who must often consider alternative diagnoses to CAN. QUESTIONS/PURPOSES:We therefore (1) determined which bone di...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1007/s11999-010-1578-z
更新日期：2011-03-01 00:00:00
abstract：BACKGROUND:Grip strength reflects functional status of the upper extremity and has been used in many of the clinical studies regarding upper extremity disease or fracture. However, the smallest difference in grip strength that a patient would notice as an improvement resulting from treatment (defined as the minimum cli...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-014-3666-y
更新日期：2014-08-01 00:00:00
abstract：:The results of revision total hip arthroplasty, with or without sepsis, are compared in a review of the recent literature. In 661 total hip revisions without sepsis, there is an overall 54% excellent/good/satisfactory rate and a 12% infection rate. Of 1063 total hip revisions in the presence of or after sepsis, there ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-10-01 00:00:00
abstract：:In situ hybridization was employed to study cellular phenotypes in the ossification groove of Ranvier in young rabbits. The expression of Type II collagen mRNA was seen in chondrocytes in all layers of the growth plate. Messenger RNA for the cartilage-specific Type II collagen was also detected in cells of the inner l...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1993-12-01 00:00:00
abstract：:Bone remodeling after cementless total hip arthroplasty was evaluated by dual energy x-ray absorptiometry in a longitudinal study of 32 hips. After insertion of a fully porous surface anatomic stem made of cobalt chromium, bone mineral density was analyzed until at least 2 years postoperatively. Bone remodeling was ev...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199706000-00017
更新日期：1997-06-01 00:00:00
abstract：UNLABELLED:New prostheses should be evaluated for stability and clinical performance. In a prospective randomized clinical trial, we implanted 22 titanium (Ti) and 20 hydroxyapatite-coated (HA) ProxiLock femoral hip prostheses during total hip arthroplasty in 42 patients. The patients were followed for 24 months with c...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,随机对照试验
doi：10.1097/01.blo.0000224011.12175.83
更新日期：2006-07-01 00:00:00
abstract：:The objective of lower extremity amputation surgery is to create a viable, functional residual limb to maximize patient mobility and independence. When part or all of the forefoot is lost to trauma, infection or gangrene, and the hindfoot is viable, every attempt should be made to preserve as much foot function as pos...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199904000-00012
更新日期：1999-04-01 00:00:00
abstract：:The Wilmington brace is a custom-molded thoracolumbosacral orthosis for decompensated adolescent idiopathic curves. Using the roentgenographic measurement of Rudicel and Renshaw, 71 patients with pretreatment curves that were decompensated greater than 1.0 cm were investigated in detail. The average follow-up period w...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1987-10-01 00:00:00
abstract：:Painless inferior subluxation of the shoulder is a common finding following stroke and is a manifestation of the adynamic nature of the disorder. The weight of the limb is not counterbalanced by shoulder musculature. This is a preliminary report of a simple tenodesis procedure performed in six patients with uniformly ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1986-05-01 00:00:00
abstract：:A prospective study of 236 patients with neglected femoral neck fractures was done to determine the usefulness of a preoperative classification based on the radiologic changes that occur at the site of the fracture. Thirty-four patients were observed in Group I, 125 patients were observed in Group II, and nine patient...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：2005-02-01 00:00:00
abstract：:Shoulder arthrodesis, while providing a useful and predictable solution to many problems associated with glenohumeral degeneration, has been less than desirable for many patients due to the frequent need for postoperative spica cast or airplane splint immobilization. A new technique of external fixation of shoulder fu...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1986-10-01 00:00:00
abstract：:Analysis of bilateral EMG and operative findings reveal that there is a definite correlation between bilateral positive EMG in particular and multiradicular EMG's and the findings of stenosis or spondylosis of the lumbar canal. Electromyography is helpful in identifying the atypical patient or the patient with unilate...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1976-03-01 00:00:00
abstract：BACKGROUND:Although aortic balloon occlusion has been shown to reduce blood loss during sacral tumor resections, it has not been validated in larger sacral tumors involving the lower lumbar spine. If such an approach were shown to be associated with less blood loss, it might aid the tumor surgeon in resecting these dif...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999.0000000000000053
更新日期：2018-03-01 00:00:00
abstract：UNLABELLED:Osteoporotic spinal deformities with global sagittal imbalance have devastating effects on patients. However, treatment is difficult and there is a high risk of perioperative medical and mechanical complications. Patients with osteoporotic spinal deformities are not ideal candidates for posterior pedicle sub...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000200237.22308.93
更新日期：2006-02-01 00:00:00
abstract：BACKGROUND:Scores derived from comorbidities can help with risk adjustment of quality and safety data. The Charlson and Elixhauser comorbidity measures are well-known risk adjustment models, yet the optimal score for orthopaedic patients remains unclear. QUESTIONS/PURPOSES:We determined whether there was a difference ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,多中心研究
doi：10.1007/s11999-014-3686-7
更新日期：2014-09-01 00:00:00
abstract：:Transforming growth factor-beta1 is known for its effect on the production of extracellular matrix in tendons. Elevated levels of transforming growth factor-beta1 have been reported in tendon adhesion and tendinosis, which suggests that transforming growth factor-beta1 plays an important role in matrix disturbances. T...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000145887.48534.6f
更新日期：2005-02-01 00:00:00
abstract：:Stress deprivation alters the morphologic, biochemical, and biomechanical characteristics of various components of synovial joints. Prominent among the protean changes that result are proliferation of fibrofatty connective tissue within the joint space, adhesions between synovial folds, adherence of fibrofatty connect...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1987-06-01 00:00:00
abstract：:This biographical sketch of Marshall R. Urist corresponds to the historic texts, The Classic: Bone Morphogenetic Protein, available at DOI 10.1007/s11999-009-1068-3; The Classic: A Morphogenetic Matrix for Differentiation of Cartilage in Tissue Culture, available at DOI 10.1007/s11999-009-1069-2; and The Classic: A Mo...
journal_title：Clinical orthopaedics and related research
pub_type： 传,历史文章,杂志文章
doi：10.1007/s11999-009-1067-4
更新日期：2009-12-01 00:00:00
abstract：:Accurate diagnosis of the degree of malignancy of individual chondrosarcomas is a difficult problem for the orthopedist. To determine whether certain biochemical and metabolic parameters might provide a useful supplement to roentgenologic and histologic evaluations, 19 human chondrosarcomas were analyzed for DNA and c...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-08-01 00:00:00
abstract：:This is a report of replantation of a completely severed forefoot which was divided through the distal tarsus by a samurai sword cut. Primary reconstruction of bone, vessels, nerve and skin was carried out 2 hours following amputation. Neither the long extensor nor the long flexor tendons were repaired. Three years fo...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1979-03-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-014-3636-4
更新日期：2014-08-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-008-0341-1
更新日期：2009-03-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-197509000-00032
更新日期：1975-09-01 00:00:00
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journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200108000-00018
更新日期：2001-08-01 00:00:00
abstract：BACKGROUND:Early adverse tissue reactions around metal-on-metal (MoM) hip replacements, especially pseudotumors, are a major concern. Because the causes and pathomechanisms of these pseudotumors remain largely unknown, clinical monitoring of patients with MoM bearings is challenging. QUESTIONS/PURPOSES:The purpose of ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-015-4466-8
更新日期：2015-12-01 00:00:00
abstract：:Many situations in revision THA require the exchange of a PE liner in the setting of a well-fixed cementless acetabular shell. Unfortunately, a replacement liner is not always available, the locking mechanism of the metal shell may be damaged or incompatible with the desired liner, or the shell is malpositioned. Revis...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/01.blo.0000096805.78689.8b
更新日期：2003-12-01 00:00:00
abstract：:The variability in alignment of the natural patellar groove was determined about various anatomic axes of the femur, using 3 plane radiographs and electronic digitization. After the patellar groove was identified and marked on 15 anatomic specimen femurs, radiographs were taken in the coronal, sagittal, and transverse...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199610000-00009
更新日期：1996-10-01 00:00:00
abstract：:The mechanism by which a malignant tumor cell establishes a metastatic foci is a complex process requiring the successful completion of a series of steps. If any step cannot be completed, the entire process fails. The tumor cell must separate from the primary tumor, gain access to an efferent channel (lymphatic or vas...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1982-09-01 00:00:00
abstract：:Gout, although relatively rare in joint replacements, can present as an acute or chronic painful knee or hip arthroplasty. Gout and acute infection of a joint replacement can be difficult to differentiate, with the physical examination and laboratory study results frequently being similar. Both conditions can present ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200111000-00049
更新日期：2001-11-01 00:00:00
abstract：:Rigid body mechanics with computer data acquisition and analysis techniques were used to determine the three-dimensional motions of any point on the tibial component of a total knee arthroplasty. Three stem configurations were compared: (1) no stem; (2) short stem (40 mm); and (3) long stem (75 mm). In addition, three...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1997-12-01 00:00:00
