Background: We implemented local infiltration analgesia (LIA) as a technique of providing post‐operative pain management and early mobilization after arthroplasty surgery and have progressively found patients able to go home earlier. This study compares the national data on hip and knee arthroplasty provided by the Royal Australasian College of Surgeons and Medibank Private with our outcomes using LIA and rapid recovery.Methods: Prospective study of one surgeon including 200 knees, and 165 hips in the two years till June 2016. Variables included in comparison to the two groups were: length of stay, percentage of patients transferred to rehabilitation or intensive care unit (ICU), readmitted within 30 days and average separation cost.Results: Hip replacement median length of stay in our series was two nights versus five nights, inpatient rehabilitation 7% versus 36%, ICU admission zero versus 4%, and readmissions 3.9% versus 6.0%, the average hospital separation cost in our series was $17 813 versus $26 734. Knee replacement median length of stay in our study was one night versus five nights, ICU 0.5% versus 3%, rehabilitation 4.5% versus 43%, and readmission 6% versus 7%, the average hospital separation cost in our group was $16 437 versus $27 505.Conclusion: The comprehensive approach of LIA and rapid recovery enables patients to have shorter hospitalization, lower rehabilitation incidence and a resultant reduction in health expenditure.

(1) Background: Bone healing is influenced by various mechanical factors, such as stability, interfragmentary motion, strain rate, and direction of loading. Far cortical locking (FCL) is a novel screw design that promotes bone healing through controlled fracture motion. (2) Methods: This study compared the outcome of distal femur fractures treated with FCL or SL (standard locking) screws and an NCB plate in a randomised controlled prospective multicentre trial. The radiographic union scale (RUST) and healing time was used to quantify bone healing on follow-up imaging. (3) Results: The study included 21 patients with distal femur fractures, 7 treated with SL and 14 treated with FCL screws. The mean working length for patients with SL screws was 6.1, whereas for FCL screws, it was 3.9. The mean RUST score at 6 months post fracture was 8.0 for patients with SL plates and 7.3 for patients with FCL plates (p value > 0.05). The mean healing time was 6.5 months for patients with SL plates and 9.9 months for patients with FCL plates (p value < 0.05). (4) Conclusions: Fractures fixed with SL plates had longer working lengths and faster healing times when compared to FCL constructs, suggesting that an adequate working length is important for fracture healing regardless of screw choice.

Background: Non‐steroidal anti‐inflammatory drugs (NSAIDs) are fundamental for multimodal analgesic therapy, but are traditionally avoided in renally impaired patients. We aim to show NSAIDs can be safely administered to arthroplasty patients with a pre‐operative estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m² without causing a permanent reduction in post‐operative eGFR and, in doing so, minimise opioid use.Methods: We prospectively collected data from patients with a pre‐operative eGFR less than 60 mL/min/1.73 m² undergoing arthroplasty between January 2018 and June 2023 at St John of God Ballarat Hospital, Australia. Baseline eGFR was obtained pre‐operatively, and on at least 1 of days 1, 2, 10, or a follow‐up review appointment of at least 4 weeks. Patients received tailored dosing of perioperative NSAIDs corresponding to pre‐operative eGFR. Acute kidney injury (AKI) was defined using the RIFLE criteria.Results: We identified 221 patients. Median baseline eGFR was 50 mL/min/1.73 m² and median eGFR recovery at latest follow‐up was 109% of baseline eGFR. 28% of the cohort had a clinically significant reduction in eGFR on day 1 post‐operatively, and by latest follow‐up, this subgroup had a median recovery of 106% of baseline eGFR. At the 2‐week follow‐up, there were no cases of AKI, and by latest follow‐up, no patients had a clinically significant reduction of baseline eGFR.Conclusion: Perioperative NSAIDs in renally impaired patients undergoing arthroplasty surgery can be safely given using an adjusted dose protocol based on pre‐operative renal function. Future studies investigating the circumspect use of NSAIDs for pain management during arthroplasty are warranted.