Traditional use of tourniquets and reinfusion drains in total knee replacement (TKR) has recently been challenged. Many studies have challenged the benefits of their use. Our aim was to compare the outcomes of three different blood management techniques in primary TKR.

We conducted a prospective randomised study of 87 patients with a mean age of 71 years. All patients were randomised into three groups: Group A (29 patients without tourniquet and drain), Group B (27 patients without tourniquet or drain but cell salvage system) and Group C (31 patients with the use of tourniquet and drain).

The results showed no difference between the postoperative haemoglobin drop and blood transfusion rate between the groups. At day two, range of knee movements (Group A: 80.2 degree; Group B: 79.6 degree; Group C: 77.9 degree) showed no significant difference. Two Group C patients (6.4%) had postoperative thromboembolic events (one DVT, one TIA). Knee stiffness leading to readmission (Group A: 6.8%; Group B: 7.4%; Group C: 3.2%) and superficial wound problems did not reveal any significant difference. The average operative time and hospital stay were the same in all groups and there was no wound haematoma or deep infection in any groups.

There was no statistical difference between the groups for any outcome measure assessed thus the use of tourniquets and drains in total knee arthroplasty are controversial and questionable. We can conclude that all techniques are safe and it is the surgeon's choice as to which they apply routinely in their clinical practice.

Purpose

The traditional use of pneumatic tourniquets and reinfusion drains in total knee replacement (TKR) has recently been challenged and the aim of our study was to compare the outcomes of three different blood management techniques in primary TKR.

Introduction: We describe our experience with the Exeter femoral component in a District General Hospital. We implanted 230 Exeter Universal stems in 215 patients between 1994 and 1996, which were reviewed at a mean of 11.2 years. Unlike previous studies we have used one acetabular implant, the Elite Ogee Cup in the majority of patients (218/230 patients).

Methods: 76 patients (79 hips) had died, and 121 patients were alive and well enough to attend for radiographic analysis at a minimum of 10 years. One patient was lost to follow up.

Results: No stems were revised for aseptic loosening. Three hips were revised for deep infection. Six acetabular components were revised: 4 for loosening, and 2 for recurrent dislocations. Taking the worst-case scenario including the one patient lost to follow up, the overall survival rate was 94.2%.

Discussion: Our results confirm excellent medium term results of the Exeter Universal femoral component, implanted outside of a specialist centre (either originating centre or teaching hospital). The excellent survival of the Exeter stem, in mix and match combination with the Ogee cup would indicate that this is a successful pairing.

This paper presents the first report of a prospective study to assess the outcome of using coregistration localisation and selective arthrodesis in chronic midfoot degenerative arthritis.

In a previous report from Cambridge (J Bone Jt Surg [Br]1998; 80B:777), a new coregistration imaging technique in the foot was described, using superimposed X-rays and technetium scintigram and showing significantly higher anatomical localisation of active joint disease than either alone.

Nineteen consecutive patients over a three-year period (1996–9) with severe midfoot joint pain and disability of over six months’ duration underwent coregistration imaging followed by selective arthrodesis. The procedures involved 17 patients with one-level single or multiple fusions of the metatarsocuneiform, metatarsocuboid or naviculocuneiform joints, and two patients with two-level multiple fusions.

Pain and functional assessments were recorded pre-operatively and at one and at two to four years postoperatively using the American Orthopaedic Foot and Ankle Society Midfoot Scoring System. Bone union was determined clinically and with X-rays.

Results showed fusions in all 19 patients between 10 and 15 weeks. Three K-wires and one screw required removal for later prominence and there was one delayed wound healing. Pian and functional scores showed significant differences between the pre- and post-operative and one year measurements, and less between the one year and two to four year scores.

This preliminary study concludes that there is a high correlation between the coregistration localisation of the midfoot degenerative arthropathies and the successful results of selective fusion of these joints for the one to four year follow-up period.