Short versus standard duration tourniquet use during Total Knee Replacement: A pilot study.

We performed a prospective, randomized, controlled trial to know whether a short duration of tourniquet application affects surgical time, post-operative swelling, pain, early rehabilitation and complications compared to standard use of tourniquet throughout the procedure. Sixty knees were randomized. There were no differences in terms of surgical time and pain experienced between the two groups. Patients in the short duration tourniquet group had significantly less thigh swelling (3.7±1.6 versus 4.8±2.35 p<0.01). There were no differences in the early rehabilitation between the groups. Soft tissue complications were higher in standard duration group. The use of tourniquet only during cementation of the implants reduces the thigh swelling and soft tissue complications associated with tourniquet use throughout the procedure.

Tibial-stem dissociation in a modular revision total knee arthroplasty system: a comparative clinical outcome study.

Stem dissociation in modular revision knee arthroplasty, due to failure of the frictional lock of the Morse taper, has previously been reported in the literature. The medium-term to long-term implications of stem dissociation are however unknown because the clinical outcomes have not been reported. We report a series of 10 cases of tibial-stem dissociation in the Coordinate revision knee system (DePuy, Warsaw, Ind). At an average follow-up of 8.1 years (range, 6-11 years), there was no detriment to the clinical outcome in 9 cases in which there was a contained bony defect. In one case in which there was a significant medial-tibial uncontained bony defect, there was a failure of the prosthesis, which necessitated re-revision arthroplasty surgery at 4 years. We therefore question whether long canal-filling tibial stems are necessary in all revision knee arthroplasties, particularly when there is a contained bone defect together with optimal alignment and adequate support of the prosthesis, and a non-constrained-polyethylene insert is used.