Background and Objectives: Adequate pain management during early rehabilitation is mandatory for improving the outcomes of patients undergoing total knee arthroplasty (TKA). Conventional pain management, mainly comprising opioids and epidural analgesia, may result in certain adverse effects such as dizziness, nausea, and motor blockade. We proposed a multimodal analgesic (MA) strategy involving the use of peripheral nerve block (NB), periarticular injection (PAI), and intravenous patient-controlled analgesia (IVPCA). This study compared the clinical efficacy and adverse effects of the proposed MA strategy and patient-controlled epidural analgesia (PCEA). Materials and Methods: We enrolled 118 patients who underwent TKA under spinal anesthesia. The patients followed either the MA protocol or received PCEA after surgery. The analgesic effect was examined using a numerical rating scale (NRS). The adverse effects experienced by the patients were recorded. Results: A lower proportion of patients in the MA group experienced motor blockade (6.45% vs. 22.98%) compared to those in the PCEA group on the first postoperative day. Furthermore, a lower proportion of patients in the MA group experienced numbness (18.52% vs. 43.33%) than those in the PCEA group on the first postoperative day. Conclusions: The MA strategy can be recommended for reducing the occurrence of motor blockade and numbness in patients following TKA. Therefore, the MA strategy ensures early rehabilitation while maintaining adequate pain relief.

Accurate hip-knee-ankle (HKA) alignment plays a crucial role in the success of total knee replacement (TKR). Kinematic alignment (KA) aims to restore the patient's natural joint anatomy to improve postoperative function and satisfaction. Ultrasound, a noninvasive and real-time imaging technique, can identify the center of the femoral head (COFH) and enhance surgical alignment accuracy. This study aimed to evaluate whether ultrasound-guided COFH identification improves postoperative HKA alignment accuracy in KA-based TKR. A retrospective analysis of 217 patients who underwent primary TKR at Show Chwan Memorial Hospital (2020-2022) was performed. Patients were divided into a calipered group (without ultrasound) and an ultrasound-guided group. Postoperative alignment and HKA angles were compared between the groups using radiographic measurements and statistical analysis. The ultrasound-guided group demonstrated significantly improved alignment, with 91.6% of patients achieving postoperative HKA within the safe range (-4° valgus to +5° varus) compared to 81.1% in the calipered group (p=0.029). Moreover, the ultrasound-guided technique reduced the risk of postoperative varus cross-over to valgus by 59%. Ultrasound-guided COFH identification significantly enhances the accuracy of KA-based TKR, particularly in neutral-type osteoarthritis knees. This noninvasive and real-time approach serves as a valuable adjunct for improving alignment precision and clinical outcomes.

(1) Background: deep venous thrombosis (DVT) has long been recognized as the most devastating complication after total knee replacement (TKR). To prevent DVT, intermittent pneumatic compression to improve venous return in the lower leg has been advocated by surgeons. Physical activities such as active ankle pumping and early mobilization have been recommended as auxiliary measures to increase venous return in the lower leg and help in ambulation after TKR. In this study, in order to remind patients to exercise their ankle actively and efficiently after TKR, a foot band with motion sensor and reminder alarm was used. (2) Methods: The patients were randomly allocated into three groups according to the therapeutic protocols. The patients in group 1 conducted active ankle pumping without any reminders, those in group 2 underwent intermittent pneumatic compression, and those in group 3 conducted active ankle pumping with ankle motion sensor/reminder. The parameters of blood flow, namely, peak flow velocity and flow volume, in the bilateral common femoral vein and popliteal vein on the 1st, 3rd, and 14th days after surgery were measured using the echo technique, an index to evaluate the effect on promotion of venous return, among the three groups. (3) Results: The peak flow velocity and flow volume of the operative limb in group 3 (with motion sensor/reminder) were significantly higher than those in other groups. The peak flow velocity and flow volume in the popliteal vein in group 3 increased by 112% and 93.8%, respectively, compared to group 1 on the 14th day. No significant difference in peak flow velocity or flow volume was found in the nonoperative limb between the groups. (4) Conclusions: According to the results, a motion sensor/reminder with vibration alarms can improve the performance of active ankle pumping exercises in improving lower leg circulation, and hence may reduce the risk of DVT.