The relationship of lateral release and tourniquet deflation in total knee arthroplasty.

A total of 242 knees in 198 patients undergoing total knee arthroplasty were reviewed to evaluate the effect of tourniquet deflation on lateral release rates, possible variables associated with the need for lateral release, and adequacy of intraoperative evaluation on final radiographs. The need for lateral release was determined using the "no-thumbs" and "full contact" rules and visual evaluation. Lateral release was performed after tourniquet deflation. A total of 171 (71%) knees needed a lateral release before tourniquet deflation. After tourniquet deflation, only 53 (22%) required lateral release, representing a 69% reduction. Obesity was the only other significant factor in lateral release requirement. Based on the observations of this study, it is recommended that the need for lateral release be evaluated after tourniquet deflation. A 69% reduction in lateral release supports the hypothesis that tourniquet pressure has an effect on patellar tracking. Lateral release appears to be effective in restoring normal patellar tilt, and obesity increases its need.

Cementless double-tapered total hip arthroplasty in patients 75 years of age and older.

Concerns exist with cementless total hip arthroplasty (THA) femoral fixation in the elderly patient population. This study reviews the outcomes of a tapered cementless femoral component in elderly patients 75 years of age and older. Forty-seven patients (49 hips) older than 74 years of age (average age, 79 years) underwent primary cementless THA with a double-tapered stem between 1996 and 2000. Radiographs and clinical data were reviewed. At a mean follow-up of 5 years, the mean postoperative Harris Hip Score was 84, with 87% having no or minimal pain; none had severe thigh pain. Two cases of stem subsidence and no progressive radiolucencies were seen. One well-fixed stem was revised for unexplained pain (2%). Survival with aseptic loosening as an end-point was 100%. Overall implant survival was 98% at an average of 5 years. No perioperative deaths or significant orthopedic complications were identified. Advanced age is not a contraindication for tapered cementless THA.