We are currently conducting a research study to determine the best method of pain control after Total Hip Replacement (THR) or Total Knee Replacement (TKR).

An estimated 46 million adults in the United States reported doctor-diagnosed arthritis, according to annual estimates from combined 2003–2005 data. As the U.S. population ages, these numbers are likely to increase dramatically. Nearly 19 million adults reported activity limitations because of arthritis each year during 2003–2005.

Many of these disabled elect to have Total Joint Replacement (TJR) surgery, when more conservative treatment fails. In 2003, approximately 652,000 total TJR surgeries were performed in the United States, according to data from the American Academy of Orthopaedic Surgeons, using figures from the National Center for Health Statistics.

Here at St. Vincent's Medical Center, 423 TJR surgeries were preformed between June 1, 2006 and May 31, 2007.

Perioperative pain management in major surgery such as Total Joint Replacement, has traditionally been difficult. The lay press, and direct to consumer marketing have raised public awareness of recent advances in total joint replacement of the hip and knee. However it has been the recent concomitant implementation of multimodal, perioperative pain management techniques which has improved patient satisfaction and significantly decreased their pain. Much of the perceived "benefit " of these new arthroplasty technologies can be attributed to the multimodal pain management.

The purpose of this study is to investigate the efficacy of intraarticular injection of a "Ropivacaine cocktail" (Ropivacaine and Methylprednisolone) intraoperatively with the use of a commercially available pump in the post operative period.

To do this we will compare pain control between subjects using a commercially prepared Bupivacaine Hydrochloride (Marcaine) pump post operatively in conjunction with the intraarticular injection of a "Ropivacaine cocktail" to a control group using a saline pump post operatively in conjunction with the intraarticular injection.

All patients will be have additional methods of pain control available in the post operative period. Pain levels will be measured on the day of surgery and on post operative days 1, 2 and 3. In addition, other outcomes will be measured and compared.