RESUMO
Background: The use of a tourniquet has become widely accepted as standard practice during total knee arthroplasty (TKA). There are conflicting outcomes in using a tourniquet during TKA. This brings to question the role a tourniquet has in TKA. Therefore, we conducted a retrospective cohort study to examine the effects of TKA with and without the use of a tourniquet. Methods: A total of 120 patients (n = 60 underwent TKA with tourniquet and n = 60 underwent TKA without tourniquet) were included in this study. Patient medical records were retrospectively reviewed for preoperative and postoperative data. The Gross formula, a validated formula for calculating blood loss, was used to calculate each patient's total blood loss. Statistical analysis was performed using independent t-tests, Mann-Whitney U tests, and/or chi-square tests. Significance was determined using an alpha level of P < .05. Results: There was no statistically significant difference (P = .49) in the amount of total blood loss between patients undergoing TKA with a tourniquet and those without (199.6 ± 92.2 mL vs 211.1 ± 88.1 mL, respectively). However, there were statistically significant differences in the operating room time (P = .005), surgery time (P = .008), and functional return of postoperative straight leg raise (P < .001) between groups. Conclusions: This study supports existing evidence that tourniquet use during TKA does not significantly alter blood loss and presents evidence that using a tourniquet during TKA may add additional cost and increase surgical time without benefit.
RESUMO
We report a case series of 2 patients with screw/shell interface failure in the Stryker Trident II Acetabular System. Both failures consisted of screw penetration through the Trident II acetabular shell. One failure was observed postoperatively after a revision from a cephalomedullary nail to a total hip arthroplasty while the other was observed intraoperatively during a primary total hip arthroplasty. Both component failures were managed conservatively with weight-bearing as tolerated and radiographic monitoring. These are the first reported cup/screw failures of the Stryker Trident II system and should raise awareness of the potential complication and implant design flaw. When placing acetabular screws, we recommend obtaining intraoperative orthogonal screw radiographs that are tangential to the shell surface to assess for screw/shell failure.
