Short duration and low suction pressure drain versus no drain following total knee replacement.

PURPOSE: To compare the short-term outcome in patients with or without a drain (short duration and low suction pressure) following total knee replacement (TKR). METHODS: A consecutive series of 106 women and 48 men (mean age, 69 years) underwent unilateral TKR. The first 77 patients used a low suction pressure (200 mm Hg) drain following TKR for 24 hours, and the next 77 patients used no drain. RESULTS: The 2 groups were comparable in terms of preoperative characteristics, the proportion of patients with pharmacological prophylaxis for deep vein thrombosis, the tourniquet time, and mode of anaesthesia. The mean drain output in the drain group was 221 ml. The time to achieve straight-leg-raising was earlier in the drain group (3.1 vs. 4.2 days, p<0.001). CONCLUSION: The use of a short duration, low suction pressure drain following TKR enabled an earlier return of quadriceps power, without increasing haemoglobin drop and transfusion rate.

Blood management protocol for total knee arthroplasty to reduce blood wastage and unnecessary transfusion.

PURPOSE: To compare outcomes of 2 cohorts of patients who underwent total knee arthroplasty (TKA) before and after the introduction of a blood management protocol. METHODS: Records of 97 and 96 consecutive patients who underwent unilateral TKA before and after introduction of the blood management protocol, respectively, were reviewed. Before introduction of the protocol, patients were cross-matched for blood before surgery. Transfusion after surgery was at the discretion of the surgeons or the on-call doctors. After introduction of the protocol, only patients with a preoperative haemoglobin level of <110 g/l underwent 'type and screening' of blood group. 2 units of blood were cross-matched preoperatively when multiple red-cell antibodies were identified or postoperatively when blood transfusion was required. Only patients with a postoperative haemoglobin level of <80 g/l or being symptomatic received blood transfusion until the haemoglobin level reached >100 g/l. Those with a postoperative haemoglobin level of 80 to 100 g/l were given iron sulphate 300 mg twice daily for a month. RESULTS: The 2 groups did not differ significantly in age, sex ratio, pre- and post-operative haemoglobin levels, and drain output. Comparing outcome before and after introduction of the protocol, the transfusion rate (10.3% vs. 3.1%, p=0.046), crossmatch rate (100% vs. 3.1%, p<0.001), and crossmatch to transfusion ratio (9.7:1 vs. 1:1, p<0.001) decreased. Among transfused patients, the decreased postoperative haemoglobin level indicated a lower transfusion trigger point (100 g/l vs. 75 g/l, p<0.006) No patient developed infection, cardiovascular or cerebrovascular complications within 30 days. CONCLUSION: The blood management protocol for TKA is effective in reducing unnecessary allogeneic blood transfusions and wastage of unused blood, without an increase in postoperative complications.

Effect of patellar thickness on early results of total knee replacement with patellar resurfacing.

PURPOSE: Patellar thickness is a concern in total knee replacement with patellar resurfacing because of the risk of patellar fracture or implant loosening. The aim of this study was to evaluate if patellar thickness is related to clinical outcome in the absence of patellar fracture or implant loosening. METHODS: Early results of 169 patients who underwent total knee replacement with patellar resurfacing were reviewed to assess the effect of patellar thickness on clinical outcome. The mean follow-up was 13 months. The range of motion, Knee Society Score, Function Score and WOMAC Score were assessed preoperatively, at day 0, 6 months and 1 year. Radiographs were assessed for patellar fracture or implant loosening. RESULTS: Thirty-one percent of all patients had preoperative thickness <21 mm. Seven percent had <12 mm residual thickness after patellar cut, all were female. Twenty-three percent had ≥1 mm increase of thickness after surgery. Radiographs did not show any patellar fracture or implant loosening. However, preoperative patellar thickness <21 mm had poorer gain in range of motion at 1 year. Preoperative range of motion had greater influence on postoperative range of motion than preoperative patellar thickness. Residual thickness <12 mm had lower gain in WOMAC score at 1 year and an increase in thickness ≥1 mm postoperatively was associated with lower gain in WOMAC score at 6 months. CONCLUSIONS: Early results of patellar resurfacing with preoperative thickness <21 mm or residual thickness <12 mm were found to be inferior even in the absence of patellar fracture or implant loosening. Conservative cutting resulting in 1 mm increase in thickness was also found to have inferior clinical results. LEVEL OF EVIDENCE: II.

Non-union of the triquetrum with pseudoarthrosis: a case report.

We report a case of symptomatic non-union of the triquetrum with pseudoarthrosis in a 34-year-old man. Motion of the pseudoarthrosis was noted from radial to ulnar deviation. The patient was treated with bone grafting and screw fixation. The non-union healed and the symptoms subsided. The Mayo wrist score had improved from 65 (fair) to 90 (excellent).

Intraoperative frozen section for detecting active infection in failed hip and knee arthroplasties.

The authors reported the result of 40 sessions of intraoperative frozen section on polymorph count in 33 patients undergoing exploration or revision hip and knee surgery to detect active infection. The correlation rate between frozen section and permanent section was 0.95 to 1.00. If the polymorph count more than 5 per high-power field (40 X) was chosen as positive, the sensitivity, specificity, positive predictive value, and negative predictive value would be 0.93, 0.77, 0.68, and 0.95, respectively. Taking polymorph count of more than 10 as positive, the sensitivity, specificity, positive predictive value, and negative predictive value would then be 0.86, 0.85, 0.75, and 0.92, respectively. The authors concluded that intraoperative frozen section is an inexpensive, rapid, and helpful adjunct to detect active infection. A polymorph count of lower than 5 highly suggests the absence of active infection.