Symposium: Advanced Techniques for Rehabilitation after Total Hip and Knee Arthroplasty

Clinical Orthopaedics and Related Research®

, Volume 467, Issue 6, pp 1458-1462

First online:

Functional Outcome of Femoral versus Obturator Nerve Block after Total Knee Arthroplasty

  • Stephane G. BergeronAffiliated withDivision of Orthopaedic Surgery, Montreal General Hospital, McGill University Health Centre
  • , Kenneth J. KardashAffiliated withDepartment of Anesthesia, SMBD-Jewish General Hospital
  • , Olga L. HukAffiliated withDepartment of Orthopaedics, SMBD-Jewish General Hospital
  • , David J. ZukorAffiliated withDepartment of Orthopaedics, SMBD-Jewish General Hospital
  • , John AntoniouAffiliated withDepartment of Orthopaedics, SMBD-Jewish General Hospital Email author 

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Patients undergoing total knee arthroplasty often experience substantial postoperative pain, which may delay functional recovery and hospital discharge. We recently reported the short-term analgesic efficacy of a single-injection femoral nerve block after spinal anesthesia in total knee arthroplasty. We have now followed 30 patients a minimum of 1 year to determine the functional outcome and pain relief after femoral and obturator nerve block after total knee arthroplasty. Patients undergoing primary unilateral total knee arthroplasty were randomized to one of three treatment groups: (1) femoral nerve block; (2) obturator nerve block; or (3) placebo (sham block). At 6 weeks and 1 year, all three groups had similar total Hospital for Special Surgery knee scores and similar subscores such as range of motion, daily function, and resting and dynamic pain. The data support the usefulness of a peripheral nerve blockade in the context of a multimodal analgesic regimen and a tailored rehabilitation program to individual patients and institutions.

Level of Evidence: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.