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| Name | Class |
|---|---|
| Western Galilee Hospital-Nahariya | OTHER_GOV |
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The goal of this interventional study is to compare pain management techniques (femoral nerve block, intra-articular block, none) in TKA patients. The main questions it aims to answer are:
Total knee arthroplasty (TKA) is a frequently undertaken elective orthopedic intervention for severe knee osteoarthritis, frequently yielding postoperative discomfort and complications. Peripheral nerve blocks, notably femoral nerve blocks, are commonly utilized for analgesia but may transiently impede motor nerve function, weakening the quadriceps muscle. Intra-articular blocks offer a potential alternative to mitigate motor impairment. However, there exists a dearth of information regarding the comparative effectiveness of these methods with respect to short-term functional outcomes in the immediate postoperative phase following TKA.
Objectives: This study assesses functional outcomes, pain, quadriceps strength after TKA with femoral nerve block, intra-articular block, and a control group. It identifies predictors of postoperative functional ability.
Methods: 54 patients undergoing TKA were evaluated, measuring pre-op quadriceps strength, and utilizing the Oxford Knee Score for functionality. Post-op, we evaluated mobility using the Timed Up & Go, Elderly Mobility Scale, and Five Times Sit-to-Stand tests on POD 1 & 3/4. Pain levels, hospitalization, surgical duration, complications, and falls were also recorded.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Femoral nerve block | Experimental | Patients undergoing total knee arthroplasty received a single-shot femoral nerve block during the surgical procedure. |
|
| Intra-articular block | Experimental | Patients undergoing total knee arthroplasty received a intra-articular block during the surgical procedure. |
|
| Control group | No Intervention | Patients undergoing total knee arthroplasty and didn't receive pain block. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Femoral nerve block | Procedure | Patients who receive a femoral nerve block during surgery, fill out a questionnaire and undergo a muscle strength test before surgery, undergo functional tests, a muscle strength test and are asked about pain intensity after surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Change in Timed up & go test | Total time to arise from chair, walk 3 m, turn around, return to chair and sit down. Two trials performed and the faster of the two is recorded to the nearest 10th of a second. | first and fifth day after the surgery |
| Change in Elderly mobility scale | The EMS is a 20 point validated assessment tool for the assessment of frail elderly subjects. The EMS is measured on an ordinal scale of 0-20, when Scores under 10 - generally these patients are dependent in mobility manoeuvres; require help with basic ADL, such as transfers, toileting and dressing. Scores between 10 - 13 - generally these patients are borderline in terms of safe mobility and independence in ADL i.e. they require some help with some mobility manoeuvres. Scores over 14 - Generally these patients are able to perform mobility manoeuvres alone and safely and are independent in basic ADL. | first and fifth day after the surgery |
| Change in 5 times sit to stand test | The score is the amount of time (to the nearest decimal in seconds) it takes a patient to transfer from a seated to a standing position and back to sitting five times. | first and fifth day after the surgery |
| Change in Numeric pain rating scale | An 11-point scale scored from 0 to 10: 0 = no pain, 10= the most intense pain imaginable | up to five days |
| Chane in Quadriceps muscle strength | muscle strength measure by dynamometer (Nâ‹…m) | A 1 day before the surgery, first and fifth day after the surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Hospitalization duration | Number of days of hospitalization after the surgery- taken from the patient's file | At discharge (assessed up to day 10) |
| Surgery duration | minutes- taken from the patient's file |
| Measure | Description | Time Frame |
|---|---|---|
| Oxford knee score questionnaire | The OKS is a patient self-completion PRO containing 12 questions on activities of daily living. It provides a single summed score which reflects the severity of problems that the respondent has with their knee. The OKS is scored 0-48 when Score 0-19 May indicate severe knee arthritis. Score 20-29 May indicate moderate to severe knee arthritis. Score 30-39 May indicate mild to moderate knee arthritis. Score 40-48 May indicate satisfactory joint function. |
Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Haim Shtarker, Dr | Head of the orthopedic department, Galilee medical center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Galilee medical center | Nahariya | Israel |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 40388473 | Derived | Kliger-Tendler M, Elboim-Gabyzon M, Bathish E, Shtarker H. Assessing Functional Outcomes and Pain Intensity Variations After Total Knee Arthroplasty: A Comparative Analysis of Pain Block Techniques. J Am Acad Orthop Surg Glob Res Rev. 2025 May 13;9(5):e24.00323. doi: 10.5435/JAAOSGlobal-D-24-00323. eCollection 2025 May 1. |
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| Type | Date | Date Unknown |
|---|---|---|
| Release | Dec 18, 2023 | |
| Reset | Jun 7, 2024 |
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| Release Date | Unrelease Date | Unrelease Date Unknown | Reset Date | MCP Release Number |
|---|---|---|---|---|
| Dec 18, 2023 | Jun 7, 2024 |
| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D010146 | Pain |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D009461 | Neurologic Manifestations |
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| ID | Term |
|---|---|
| D003766 | Dental Occlusion |
| ID | Term |
|---|---|
| D003813 | Dentistry |
| D009063 | Dental Physiological Phenomena |
| D055688 | Digestive System and Oral Physiological Phenomena |
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The outcome assessor who was blinded to the treatment group allocation and who was not involved in the interventions.
| Intra-articular block | Procedure | Patients who receive an intra-articular block at the time of surgery, fill out a questionnaire and undergo a muscle strength test before surgery, undergo functional tests, a muscle strength test and are asked about pain intensity after surgery. |
|
| During the surgery |
| consumption of analgesics | taken from the patient's file | At discharge (assessed up to day 10) |
| occurrence of falls | throughout the hospitalization- taken from the patient's file | At discharge (assessed up to day 10) |
| A 1 day before the surgery |
| D012816 | Signs and Symptoms |