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Fast track arthroplasty is a holistic approach to patients who undergo total hip and knee arthroplasty, a journey or care that begins with setting patient’s expectation, optimising medical status, using intraoperative local anaesthetic infiltra-tion, decreasing narcotics usage either in spinal or post-operative medication, discouraging usage of patient controlled analgesia or urinary catheters, encouraging day of operation mobilisation and optimising post-operative physiotherapy protocols. The use of local infiltration analgesia (LIA) is a good alternative compared to other traditional pain management techniques. The purpose of adoption of LIA technique is to provide comfort from the trauma associated with hip and knee arthroplasty particularly for the first 36 h post-operatively, during the time of high post-operative pain, to facilitate increased post-operative mobilisation and function. LIA is safe and effective to achieve good outcomes, early mobilisation and decreasing length of stay without jeopardising clinical outcomes. This chapter discusses LIA and its multimodal approach to analgesia, regional anaesthesia and early mobilisation that improves overall patient experience and satisfaction. The chapter discusses LIA techniques, wound catheter placement, and postoperative protocol to achieve fast track hip and knee arthroplasty.

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Animal models are frequently used to elucidate pathomechanism and pathophysiology of various disorders of the human intervertebral disc (IVD) and also to develop therapeutic approaches. Here we report morphological characteristics of the kangaroo lumbar IVDs and compare them with other animal models used in spine research. Methods: Twenty-five fresh-frozen cadaveric lumbar spines (T12–S1) derived from kangaroo carcases (Macropus giganteus) of undetermined age were first scanned in a C-Arm X-ray machine. A photograph of the axial section of the disc including a calibrated metric scale was also acquired. The digital radiographs and photographs were processed in ImageJ to determine the axial and sagittal plane dimensions for the whole disc (WD) and the nucleus pulposus (NP) and the mid-sagittal disc height for all the lumbar levels. Results: Our results suggest that the L6–S1 IVD in kangaroos is distinctly large compared with the upper lumbar IVDs. Based on previously published data, human lumbar IVDs are the largest of all the animal IVDs used in spine research, with camelid cervical IVDs being the closest relative in absolute dimensions (llamas: 78% in disc height, 40% in WD volume, and 38% in NP volume). Kangaroo L6–S1 IVD was approximately 51% in height, 20% in WD volume, and 20% in NP volume of the human lumbar IVD. Conclusions: We conclude that morphological similarities exist between a kangaroo and human lumbar IVD, especially with the lima bean shape in the axial plane, wedge shape in the sagittal plane, convexity at the cephalad endplates, and percentage volume occupied by the NP in the IVD. Graphic abstract: These slides can be retrieved under Electronic Supplementary Material. [Figure not available: see fulltext.]

Study Design: Translational review encompassing basic science and clinical evidence. Objectives: Multiple components of the lumbar spine interact during its normal and pathological function. Bony stress in the lumbar spine is recognized as a factor in the development of pars interarticularis defect and stress fractures, but its relationship with intervertebral disc (IVD) degeneration is not well understood. Therefore, we conducted a systematic review to examine the relationship between bony stress and IVD degeneration. Methods: Online databases Scopus, PubMed and MEDLINE via OVID were searched for relevant studies published between January 1980-February 2020, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two authors independently analyzed the data, noting characteristics and biases in various studies. Results: Thirty-two articles were included in the review: 8 clinical studies, 9 finite element modeling studies, 3 in-vivo biomechanical testing studies, and 12 in-vitro biomechanical testing studies. Of the 32 articles, 19 supported, 4 rejected and 9 made no conclusion on the hypothesis that there is a positive associative relationship between IVD degeneration and bony stress. However, sufficient evidence was not available to confirm or reject a causal relationship. Conclusions: Most studies suggest that the prevalence of IVD degeneration increases in the presence of bony stress; whether a causal relationship exists is unclear. The literature recommends early diagnosis and clinical suspicion of IVD degeneration and bony stress. Longitudinal studies are required to explore causal relationships between IVD degeneration and bony stress.

BackgroundMultiple components of the lumbar spine interact during the normal and pathological function. Bony stress in the lumbar spine is recognised as a factor in the development of pars defects and stress fractures, but its relationship with intervertebral disc (IVD) degeneration is not well understood. Therefore, a translational review encompassing basic science and clinical evidence was conducted to examine the relationship between bony stress in the lumbar spine and IVD degeneration.MethodsOnline databases Scopus, PubMed and MEDLINE via OVID were searched for relevant studies published between January 1980 – February 2020, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Two authors independently analysed the data, noting study characteristics and bias.ResultsThirty-two articles were included in the review: eight human studies, nine finite element analysis studies, three in-vivo biomechanical testing studies, and twelve in-vitro biomechanical testing studies. Of the 32 articles, 19 supported, four rejected and nine made no conclusion on the hypothesis that there is a positive associative relationship between IVD degeneration and bony stress. However, not enough evidence was available to confirm or reject a causal relationship.ConclusionMost studies suggest that the prevalence of IVD degeneration increases with the presence of bony stress, but whether a causal relationship exists is unclear. The literature recommends early diagnosis and clinical suspicion of IVD degeneration and bony stress. Longitudinal studies are required to explore causal relationships between IVD degeneration bony stress.