Aims

This study aimed to investigate the role and mechanism of meniscal cell lysate (MCL) in fibroblast-like synoviocytes (FLSs) and osteoarthritis (OA).

Tourniquets have been used for many years during total knee arthroplasty (TKA). With a growing demand for TKA in recent years, tourniquet use has been surrounded by ongoing controversy due to many conflicting advantages and disadvantages of tourniquet use. Quantifying the case for or against tourniquet use in TKA, in terms of patient focused outcomes, is a priority. This meta-analysis analysed, the never before assessed, impact of tourniquet use during TKA on post-operative pain. We completed a systematic review and meta-analysis using PRISMA reporting guidelines to assess the impact of tourniquet use on patients post-TKA. Post-operative pain was the primary outcome. Secondary outcomes were post-operative range of motion (ROM) and length of stay (LOS). The initial search yielded 230 studies, of which 14 met the inclusion criteria. A post-operative increase in pain and reduction in ROM when using a tourniquet appeared significantly more likely when compared to no tourniquet use during TKA, yet with no overall difference in post-operative LOS. Subgroup meta-analysis demonstrated a trend that favoured the half-course tourniquet for reduced post-operative pain in patients when compared to full tourniquet use during TKA. This systematic review and meta-analysis concluded that the after-effects of tourniquet use in TKA patients and its impact on post-operative pain and ROM are indeed significant. We recommend further randomized controlled trials (RCTs) focusing on TKA patient outcomes of post-operative pain and ROM. Conflict of interest: The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

We performed a meta-analysis to evaluate the relative efficacy of regional and general anaesthesia in patients undergoing total hip or knee replacement. A comprehensive search for relevant studies was performed in PubMed (1966 to April 2008), EMBASE (1969 to April 2008) and the Cochrane Library. Only randomised studies comparing regional and general anaesthesia for total hip or knee replacement were included.

We identified 21 independent, randomised clinical trials. A random-effects model was used to calculate all effect sizes. Pooled results from these trials showed that regional anaesthesia reduces the operating time (odds ratio (OR) −0.19; 95% confidence interval (CI) −0.33 to −0.05), the need for transfusion (OR 0.45; 95% CI 0.22 to 0.94) and the incidence of thromboembolic disease (deep-vein thrombosis OR 0.45, 95% CI 0.24 to 0.84; pulmonary embolism OR 0.46, 95% CI 0.29 to 0.80).

Regional anaesthesia therefore seems to improve the outcome of patients undergoing total hip or knee replacement.

Purpose: To document clinical and radiographic outcome, and survivorship of long fusion constructs (> T12) stopping at L5.

Methods: Retrospective clinical and radiographic analysis of long fusions to L5 in an adult population, with follow-up greater than 5 years.

Results: We reviewed a consecutive series of patients with long fusion constructs ending at L5 from 1991–2000. 33 patients were identified with fusions from the thoracic spine to L5. 14 patients were excluded, including 7 deaths, 3 patients lost to follow-up, and 4 patients with incomplete radiographic and clinical data sets. There were 17 females and 2 males, with average age of 50 (range 25–73). 7 patients have since undergone extension of fusion to the sacrum, and comprised Group II; the remaining 13 patients comprised Group I. There was no association between preoperative radiographic characteristics of the deformity and outcome (coronal/ sagittal plane imbalance, curve magnitude). Specifically, the lumbosacral disk space appearance (disk height, lordosis) was similar in both groups preoperatively. Presence of postop degenerative changes at the lumbosacral disk did not correlate with outcome. Patients in group I and II had similar scores in SRS, ODI and SF-12 outcome measures. Some patients reported a change in functional status after revision to sacrum, including change in gait pattern, loss of twisting and bending ability, and more difficulty with perineal care. At least 4 patients in Group I are being considered for revision.

Conclusions: In conclusion, long fusions to L5 in an adult deformity population yields unpredictable results more than 5 years after surgery. Although of smaller magnitude than primary fusions to sacrum, stopping at L5 is associated with a significant revision rate. Some patients with long fusions to L5 have good function more than 5 years after surgery.