The Efficacy of Multimodal High-volume Wound Infiltration in Primary Total Hip Replacement

Full article available online at ORTHOSuperSite.com. Search: 20110714-11 The Efficacy of Multimodal High-volume Wound Infiltration in Primary Total Hip Replacement Purnajyoti Banerjee, MBBS, MrCSed; nikolaoS V. BardakoS, Md Messr Banerjee and Dr Bardakos are from the South West London Elective Orthopedic Centre, London, United Kingdom. Mr Banerjee and Dr Bardakos have no relevant financial relationships to disclose. The authors thank Mr P.J. Sing, FRCS(Orth), and Dr A. Hussain, FRCA, for their support of this study. Correspondence should be addressed to: Purnajyoti Banerjee, MBBS, MRCSEd, South West London Elective Orthopedic Centure, 28 Singleton Close, London, SW17 9JY, United Kingdom (banerjee_purnajyoti@yahoo.co.in). doi: 10.3928/01477447-20110714-11 Multimodal wound infiltration with local anesthetics, adrenaline, and nonsteroidal anti-inflammatory agents can lower the opiate intake, reduce the length of stay, and enhance early mobilization after total hip arthroplasty (THA). A retrospective review of 204 patients undergoing primary THA was undertaken. One hundred two patients had their wounds infiltrated with ropivacaine, adrenaline, and ketorolac by the operating surgeon intraoperatively. Subsequently, a 19-gauge wound catheter was inserted percutaneously into the hip joint. Patients received 2 further top-up doses of 20 mL of ropivacaine (7.5mg/mL) at 10 and 20 hours postoperatively. These patients were compared to a control group of 102 patients who received no local infiltration. Both groups were comparable in terms of body mass index and age. Opiate consumption in the first 48 hours after surgery and length of hospital stay were recorded. The mean consumption of morphine in the treatment group was 42.3 mg (standard deviation [SD], 31.2 mg) compared to 60.9 mg (SD, 33.8 mg) in the control group (P,.0001). The mean length of stay was significantly reduced from 5.2 days (SD, 1.6 days) in the control group to 4 days (SD, 1.3 days) in the treatment group (P,.0001). The time needed by the patients to walk for 3 meters after surgery was significantly reduced in the treatment group (median, 25 vs 46.1 hours; interquartile range, 20.745.1 vs 27.250.9; P,.0001). This is the largest series to demonstrate that a multimodal perioperative wound infiltration technique in primary THA surgery leads to early attainment of immediate postoperative rehabilitation milestones and reduced length of stay along with reduction in postoperative opiate consumption. erratuM This article has been amended to include a factual correction. An error was indentified subsequent to its original printing (2011; 34[9]:e522-e529), which was acknowledged in an erratum printed in 2012; 35(9):793. The online article and its erratum are considered the version of record. 698 Figure: Intraoperative photograph demonstrating the injection of the inferior capsule of the hip joint after implantation of the acetabular component (arrow in bottom right). A posterior surgical approach was used. Subsequent injections follow, until a total of 50 mL (first bolus dose) are injected circumferentially into the capsule (18-gauge needle used).