Tourniquet use during primary total knee arthroplasty-a survey of Irish orthopaedic surgeons in 2022.

BACKGROUND: Tourniquet use during primary total knee arthroplasty is a debated topic in the literature with no consensus on its optimal use. AIM: To analyse current tourniquet practice amongst Irish orthopaedic surgeons performing primary total knee arthroplasty surgery. To evaluate if there has been a shift in practice in recent years and to explore potential reasons behind this. METHODS: An eleven-question online survey was developed using the online platform SurveyMonkey. This was distributed by email to Irish orthopaedic surgeons via the Irish Institute of Trauma and Orthopaedic Surgery. RESULTS: Fifty responses were included in the final analysis of this study. Eighteen (36%) respondents reported changing their tourniquet use in the past 5 years. Thirty-one (62%) respondents reported inflating the tourniquet for the entire case, with the remaining never applying a tourniquet (n = 6, 12%), applying a tourniquet but not routinely inflating it (n = 3, 6%), or inflating the tourniquet only during cementation (n = 5, 10%). The number of years of experience as a consultant appeared to impact tourniquet use in a bimodal pattern. CONCLUSION: While the majority of Irish orthopaedic surgeons in this survey inflate a tourniquet for the entire surgical procedure, there is a definite shift towards reduced tourniquet use compared to previous Irish, UK, and American surveys.

Open Versus Arthroscopic Latarjet Procedure for Anterior Shoulder Instability: A Systematic Review and Meta-analysis.

BACKGROUND: Anterior shoulder instability with significant glenoid bone loss is a challenging condition. The open Latarjet procedure is the established standard treatment method in this setting, but there is an increasing use of the arthroscopic technique. PURPOSE: To systematically review the current evidence in the literature to ascertain if the open or arthroscopic Latarjet procedure resulted in improved patient outcomes. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Cohort studies comparing the open and arthroscopic Latarjet procedures for anterior shoulder instability were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager (version 5.3). A P value of <.05 was considered statistically significant. RESULTS: Six clinical trials with 896 patients were included. The open and arthroscopic Latarjet procedures resulted in a similar number of total recurrent instability (2.0% vs 2.4%; P = .75), revision procedures (2.4% vs 5.4%; P = .06), and total complications (13.8% vs 11.9%; P = .50), but the open procedure had a lower rate of persistent apprehension (10.2% vs 35.7%; P < .05). In addition, after the learning curve, the operative time was similar between the 2 procedures. CONCLUSION: Both the open and arthroscopic Latarjet procedures result in significant improvements in patient function and outcome scores, with low rates of recurrent instability and similar complication rates. While technically challenging, the arthroscopic procedure has been shown to be a safe and viable alternative. However, there is a significant learning curve associated with the arthroscopic Latarjet procedure. The significant learning curve associated with this procedure suggests the arthroscopic procedure may be advisable to perform only in high-volume centers with experienced arthroscopists.

Quadriceps Tendon Autograft in Anterior Cruciate Ligament Reconstruction: A Systematic Review.

PURPOSE: To systematically review the current evidence to ascertain whether quadriceps tendon autograft (QT) is a viable option in anterior cruciate ligament reconstruction. METHODS: A literature review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Cohort studies comparing QT with bone-patellar tendon-bone autograft (BPTB) or hamstring tendon autograft (HT) were included. Clinical outcomes were compared, with all statistical analyses performed using IBM SPSS Statistics for Windows, version 22.0, with P < .05 being considered statistically significant. RESULTS: We identified 15 clinical trials with 1,910 patients. In all included studies, QT resulted in lower rates of anterior knee pain than BPTB. There was no difference in the rate of graft rupture between QT and BPTB or HT in any of the studies reporting this. One study found that QT resulted in greater knee stability than BPTB, and another study found increased stability compared with HT. One study found that QT resulted in improved functional outcomes compared with BPTB, and another found improved outcomes compared with HT, but one study found worse outcomes compared with BPTB. CONCLUSIONS: Current literature suggests QT is a viable option in anterior cruciate ligament reconstruction, with published literature showing comparable knee stability, functional outcomes, donor-site morbidity, and rerupture rates compared with BPTB and HT. LEVEL OF EVIDENCE: Level III, systematic review of Level I, II, and III studies.