The use of tourniquet in knee arthroplasty is common but in recent times, it has initiated a debate on its use. Complications from use of tourniquet are well documented in literature but there is less evidence on thigh pain, blood loss and length of stay post arthroplasty. We included 62 patients undergoing knee arthroplasty either Unicondylar knee arthroplasty or total knee arthroplasty. Patients were allocated randomly in tourniquet and without tourniquet groups. Half of the patients had UKA and other half TKA. Thigh pain was recorded using Visual analogue scale on day 1, 2 and on discharge. A drop in pre-operative and post operative haemoglobin level was recorded too. Independent sample t-test was done to compare the difference between the 2 groups mainly, drop in haemoglobin, thigh pain, knee pain and length of stay.Abstract
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Knee dislocations are a rare but serious cause of trauma. The aim of this study was to establish current demographics and injury patterns/associations in multi-ligament (MLI) knee injuries in the United Kingdom. A National survey was sent out to trauma & orthopaedic trainees using the British Orthopaedic Trainees Association sources in 2018. Contributors were asked to retrospectively collect a data for a minimum of 5 cases of knee dislocation, or multi-ligament knee injury, between January 2014 and December 2016. Data was collected regarding injury patterns and surgical reconstructions. 73 cases were available for analysis across 11 acute care NHS Trusts. 77% were male. Mean age was 31.9 (SD 12.4; range 16–69). Mean Body Mass Index (BMI) was 28.3 (SD 7.0; range 19–52). Early (<3 weeks) reconstruction was performed in 53% with 9 (23%) patients under-going procedures for arthrofibrosis. Late (>12 weeks) reconstruction took place in 37% with one (3.7%) patient under-going arthroscopic arthrolysis. 4% had delayed surgery (3–12 weeks) and 5% had early intervention with delayed ACL reconstruction. For injuries involving 3 or more ligament injuries graft choices were ipsilateral hamstring (38%), bone-patella tendon-bone (20%), allograft (20%), contralateral hamstring (17%) and synthetic grafts in 18%. Multi-ligament knee injuries are increasingly being managed early with definitive reconstructions. This is despite significant risk of arthrofibrosis with early surgery. Ipsilateral and contralateral hamstring grafts make up the bulk of graft choice however allograft (20%) and synthetic grafts (18%) remain popular.
Bowel management following joint replacement is often neglected leading lot of patient distress, with the advent of the enhanced orthopedic rehabilitation program, there is a need of a guideline to ensure prompt and quick recovery of bowel habits before discharge. Our aim was to identify the incidence of constipation in joint replacement patients, to evaluate the current practice of bowel management and formulate a protocol for management of constipation to improve the practice. We conducted a prospective study of 50 patients who underwent joint replacement procedures at our institute between September and October 2015. Following initial audit, we formulated a protocol for bowel management, and performed a re-audit by collecting a prospective data of 50 patients. The statistical analysis was done and calculating the mean and standard deviation for continuous variable and Fischer's exact test was used and significance level was set at 0.05. Incidence of constipation was 88% and laxatives were prescribed in 42%. More importantly, there was no correlation between constipation and pre operative fasting (p Value 0.33), post operative fasting (p Value 0.1822), type of surgery (p value 1.00) and type of anaesthesia (p Value 0.27). Following introduction of bowel protocol the laxative prescription increased to 98% (Prophylactic in 81%), consequently the incidence of constipation reduced to 18%. Implementing bowel protocol significantly will improve the patient care and reduce the rate of complications.
All Polyethylene Tibial components in Total Knee Arthroplasty have been in use for some years, studies showing equivalent results to Total Knee Arthroplasty (TKA) with metal-backed Tibial components at 10 years have shown no significant difference between the two on radiostereometric analysis and revision rates[1]. Post operative patient outcome data using standard metal-backed Tibial components is widely reported in the literature. This study is looking at patient outcomes following All-polyethylene tibial component TKA. We hypothesize that using standard patient outcome measures, an improvement comparable with that expected for metal-backed tibial component TKA will be shown with All-polyethylene tibial component TKA. Between August 2006 and August 2008, 229 all-polyethylene tibial component TKA were implanted at the elective orthopedic unit. The choice of implant was entirely dependent on surgeon's preference. Of the 229 patient's, 225 details were available for review, 27 did not wish to take part in the study and 1 patient died a year following surgery of an unrelated illness. The remaining 197 patients agreed to take part in the study. The patient's were contacted either in person or over the telephone and asked to completed questionnaires for standard knee scoring. These included: the Oxford Knee Score (OKS), the WOMAC Score and the SF-12 Score, both pre-operatively and post operatively.Objectives
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