Background: This study compares postoperative pain scores and functional outcomes between liposomal bupivacaine peri-articular injection (LB-PAI) vs a single-shot adductor canal block (ACB) using bupivacaine HCl in patients undergoing primary total knee arthroplasty (TKA). Methods: This is a randomized controlled trial of 56 patients who were treated with TKA for arthritis. Patients were randomized to receive an intraoperative LB-PAI (n ¼ 27) or preoperative ACB using bupivacaine HCl (n ¼ 29). Both groups were otherwise given our institutional standard multimodal pain protocol. Data on Visual Analog Scale (VAS) pain scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, knee range of motion, postoperative ambulation distance, hospital length of stay, and opioid use were collected. The total cost of each intervention was compared at the conclusion of the study. Results: Age, gender, or body mass index was similar between groups. Compared to the ACB group, the LB-PAI group trended to lower average VAS pain scores on postoperative days 0, 1, and 2 (average difference [95% confidence interval] ¼ À0.5 [À0.7, 1.7], À1.0 [À0.1, 2.0], À0.2 [À0.8, 1.3]), and identical average VAS pain scores on postoperative days 4 and 7. These differences and all postoperative outcome measures were not statistically significant at any time point. A single 266-milligram vial of liposomal bupivacaine costs $351, and a single-shot ACB costs $893 at our institution. Conclusions: This randomized controlled trial shows similar postoperative pain control, functional outcomes, and opioid use between LB-PAI and a single-shot ACB in patients undergoing primary TKA.

Osteoid osteomas are one of the most common bone tumors. Although benign in nature, they can cause significant pain and distress to the afflicted patient. The main goal of treatment is to relieve pain. Historically, these tumors were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) or surgery. Percutaneous ablative techniques have since gained popularity because of their efficacy and low risk profiles. Radiofrequency ablation was the first of these technologies used in the treatment of these tumors. More recently, microwave ablation has gained popularity. However, the literature is sparse regarding the safety and efficacy of this treatment. Here, we discuss our experience with microwave ablation in the treatment of osteoid osteomas in two patients and review the current literature on this technique. Microwave ablation in the treatment of osteoid osteoma seems to be a safe and effective treatment for this tumor.

BackgroundThere is ample literature describing surgical outcomes after oncologic musculoskeletal tumor surgery, however, there is limited understanding of the time to optimization of functional outcome scores after resection. The purpose of this study was to identify the time to functional outcome optimization of Musculoskeletal Tumor Society (MSTS) scores after surgery for bone and soft tissue tumors and to identify factors correlated with recovery. MethodsWe retrospectively reviewed 187 patients from April 2016 to May 2021 that had undergone surgical treatment for musculoskeletal tumors. We assessed MSTS scores to determine the time to optimization and evaluated patient-specific and surgical factors for any influence on post-operative recovery. ResultsThe majority of patients (92%) achieved their optimized score in one year or less. Eighty-two percent achieved the maximum MSTS score of 30. Osseous tumors, malignancy, adjuvant treatment with radiation and/or chemotherapy, deep location for soft tissue tumors, and bony work required for soft tissue tumors all significantly impacted time to MSTS score optimization. ConclusionThe majority of patients with musculoskeletal tumors undergoing surgery can be expected to improve up to one year postoperatively. Those with bone tumors, malignant tumors, treatment with radiation and/or chemotherapy, deep soft tissue tumors, and bony work for soft tissue tumors can expect to have a longer recovery time and are at higher risk for not achieving premorbid functionality.

INTRODUCTION. The knee is a weight bearing synovial joint, which is frequently injured. May lead to significant time off work and loss of fitness activity resulting in a sedentary lifestyle. Contemporary methodology of knee anatomy teaching applies a systems approach (SA). SA to the knee does not intuitively integrate the mechanism of injury (MoI), symptoms and examination with common pathologies. Musculoskeletal training during family practice residency is approximately 10% of the curriculum. Objective of this study was to apply a 3‐column approach of teaching knee anatomy. METHODS. Knee was divided into 3 columns and taught as a tutorial to first year medical students during lab versus a systems lecture approach. Likert scale and random interviews were conducted. RESULTS. A 3‐column approach was successfully taught and well received regarding Likert scores and interview analysis. DISCUSSION. SA to knee anatomy teaching often leaves a void between classroom and clinic. Musculoskeletal specialists focus on the posteromedial and posterolateral regions of the knee. This pilot work successfully applied a 3‐column approach integrating structures, MoI, examination and symptoms with common pathologies. CONCLUSSION. This study suggests a 3‐column teaching approach may provide a successful platform enabling students to apply knee anatomy in the clinical arena resulting in critical thinking aiding diagnosis.