We report an unusual case of knee disease where calcific tendonitis occurring in both quadriceps and patellar tendon simultaneously in the same knee. A 47 year old female presented to orthopaedics outpatient clinic with acute onset of swelling and knee pain with no history of trauma. She was found to have a moderate effusion of the knee joint with mild tenderness over the mid quadriceps tendon. Active flexion of the knee joint was painful with a range of motion between 0-90 degrees. She is otherwise healthy with no past medical history. Plain radiographs and Magnetic Resonance Imaging (MRI) Scan revealed calcification of both tendons.

Calcific tendonitis is classically found in the supraspinatus tendon of the shoulder. In addition, it has been described in other areas of the body such as the wrist, thigh, hip, knee and ankle. This condition usually occurs in the quadriceps or patellar tendons separately and rarely affecting both tendons in the same knee simultaneously. The patients condition improved significantly with physiotherapy, anti-inflammatory medications and ultrasound therapy.

Calcific tendinitis of both quadriceps and patellar tendon is a very rare cause of knee pain. Most of the time it is treated conservatively with non-steroidal anti-inflammatory drugs and ultrasound therapy and some times steroid injection. However; patient may require surgical intervention especially in refractory cases to resolve the condition.

Background: There remains no clear guidance from the British Orthopaedic Association regarding the use of closed suction drains after primary total knee replacement (TKR). Previous studies suggest no benefit in their use and no significant difference between the type of drain used.

Aims: To assess whether allogenic transfusion requirements are altered by the use of closed suction drainage and to establish if drains reduce post-operative complications and length of stay in hospital.

Materials and Methods: 60 patients undergoing TKR in Eastbourne between December 2008 and June 2009 were evaluated pre- and post-operatively. The population was divided into those with no drain, a Redivac drain (fluid discarded) and a re-transfusion drain (fluid filtered and transfused into the patient).

Results: 23 patients had Redivac drains and 5 (22%) required an allogenic blood transfusion. 37 patients had no drain and 2 (5%) required allogenic blood. For the 14 re-transfusion drain patients none received allogenic blood. There was no significant difference in the length of stay across all 3 groups (p=> 0.25). There was a significantly higher incidence of wound ooze and cellulitis in patients with no drain (50%; p=< 0.01). This is in comparison to the other two groups where only 30% of patients with a Redivac drain and 7% of patients with a re-transfusion drain experienced these complications. There was no significant difference in the average haemoglobin drop between the 3 groups (p=> 0.1).

Conclusions: The results suggest a benefit in using drains to reduce the risk of post-operative wound ooze and cellulitis after TKR. Re-transfusion drains also appear to reduce the requirement for allogenic blood transfusion in the post-operative period.

Aim: The aim of this study is to assess whether closure of wound in ßexion or extension during total knee replacement has any inßuence on the postoperative range of motion of the knee. Methods: We carried out a prospective randomised study of 58 total knee replacements in 53 osteoarthritic patients. Two senior surgeons performed all the procedures using a cemented IB II posterior stabilised prosthesis. The wound was closed with knee in 60 Ð 70 degrees of ßexion in group A patients and in full extension in group B after deßating the tourniquet. Five Patients underwent bilateral total knee replacements with one closed in ßexion and the other in extension. The incidence of complications, amount of blood loss, length of hospital stay and postoperative range of knee motion were recorded. Results: The mean range of preoperative ßexion was 110 degrees and 104 degrees in the ßexion and extension group respectively. The range of ßexion at the end of one year was 114 degrees in the ßexion group and 106 degrees in extension group. There was no signiþcant statistical difference between the two groups including those with bilateral knee replacements (p> 0.05). Conclusions: Closure of the knee wound in ßexion or extension during total knee replacement has no inßuence on the postoperative range of ßexion at 6 weeks, 6 months and 1 year follow-up. However, the operating surgeons felt that closure in ßexion had an advantage of being haemostatic during closure, but carries a risk of scratching the femoral component while suturing.

We assessed the influence of the use of a tourniquet in total knee arthroplasty in a prospective, randomised study. After satisfying exclusion criteria, we divided 77 patients into two groups, one to undergo surgery with a tourniquet and one without. Both groups were well matched. The mean change in knee flexion in the group that had surgery without a tourniquet was significantly better at one week (p = 0.03) than in the other group, but movement was similar at six weeks and at four months. There was no significant difference in the surgical time, postoperative pain, need for analgesia, the volume collected in the drains, postoperative swelling, and the incidence of wound complications or of deep-venous thrombosis.

We conclude that the use of a tourniquet is safe and that current practice can be continued.