Background:Patients undergoing total knee arthroplasty suffer from moderate-to-severe postoperative pain resulting in immobility-related complications and prolonged hospitalization. Femoral nerve block is associated with reduction in the quadriceps strength and increasing incidence of falls. Adductor canal block has been shown to be as effective as femoral nerve block without causing quadriceps weakness.Objectives:To compare outcomes of studies comparing adductor canal block and femoral nerve block in patients undergoing primary total knee arthroplasty.Data Sources:Original articles, published between July 2013 and April 2017, comparing the above interventions.Study Eligibility Criteria, Participants, and Interventions:Comparison of outcome measures of all original articles shortlisted by the PUBMED and Google Scholar databases search using key words, “adductor canal block; femoral nerve block; total knee arthroplasty; total knee replacement.”Study Appraisal and Synthesis Methods:The primary outcome measures reviewed were: pain scores; interventional failure; post-operative opioid consumption; patient fall or near fall during postoperative rehabilitation; and length of stay.Results:The opioid consumption was found to be comparable with both the interventions on the first and second postoperative day. Patients administered adductor canal block had better quadriceps power, longer ambulation distance, and shorter length of hospital stay.Limitations:Of the studies reviewed five were retrospective and thus data quality amongst the studies may have been compromised.Conclusions and Implications of Key Findings:Mobilization and ambulation, which are both important for recovery after total knee arthroplasty are both inhibited less by adductor canal block.

Background: The aim of this study is to assess the impact of Covid-19 crisis on hip and knee joint replacement surgeries at a high volume tertiary care hospital in the Indian National Capital Region and to evaluate the early experience of resumption of arthroplasty services. Methods: Institutional records of the arthroplasty cases, operated between 1st March to 31 August of 2019 (Group A, pre-Covid) and 2020 (Group B, pandemic year) were compared retrospectively over numerous parameters including the complications within six weeks of surgery. Results: There was a significant drop (by 82.53 %) in the total number of arthroplasty surgeries in Group B (62) as compared with Group A (355). Average number of arthroplasties per month were 59.17 ± 12.93 and 10.67 ± 13.29 in Group A and Group B respectively (p < 0.001). There was a significant increase in postoperative complication rate 7/355 (1.97 %) in Group A vs 7/62 (11.29 %) in Group B during pandemic (p < 0.002), along with a higher 30-days mortality rate 2/355 (3.22 %) vs 2/62 (0.56 %). Pandemic year also saw an increased readmission rate (4.83 %) vs (0.56 %) and postoperative ICU transfer rate (1.61 %) vs (0.56 %) in comparison with pre-Covid year. Conclusion: In the pandemic, arthroplasty services got severely affected at our center. With nearly six fold increase in complication rates, higher 30-days mortality and increased readmission rates, caution is advised in resuming arthroplasty surgeries without robust evaluation of cases. Whether undetected Covid-19 infection or poor pre-existing disease control due to lockdown can be linked to these results is a matter of further research with larger multicenter studies.

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Modularity in total hip arthroplasty (THA) not only allows adjustments of leg length and offset but also simplifies the revision. It allows limited revision of various components and decreases surgical morbidity of complete revision. Despite benefits, modularity is associated with risks like corrosion and component dissociation. Dissociation between head and neck taper is rare and the cause is attributed to taper corrosion, revision, stem subsidence, pumping phenomenon, injury and closed reduction of dislocated THA. We report a case of late-onset impending head-neck dissociation in a THA caused by a well-fixed anteverted cup with polyethylene liner wear by "reverse bottle opener effect." To our knowledge, this is the most late-onset reported case of head-neck dissociation, occurring after 13yrs of index surgery.

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