The journal of knee surgery
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Comparative Study Clinical Trial Controlled Clinical Trial
The role of drains and tourniquets in primary total knee replacement: a comparative study of TKR performed with drains and tourniquet versus no drains and adrenaline and saline infiltration.
One hundred fifteen consecutive patients undergoing TKR were divided into two groups to determine whether blood loss and transfusion in total knee replacement (TKR) using adrenaline with saline infiltration would be less than TKR with tourniquet and drain. Group 1, composed of 60 patients, received 2.5 mg of 1:1000 adrenaline diluted in 500 mL of normal saline, which was infiltrated into the skin, subcutaneous tissues, and capsule before surgical incision. No tourniquets or postoperative drains were used. ⋯ The average volume transfused was 1.2 U. Adrenaline and saline infiltration is safe and helps reduce intraoperative blood loss. Suction drain use for surgical wounds after primary, uncomplicated TKR is questionable.
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Recent developments in patellar instability have focused on the passive restraints against mediolateral patellar motion. Viewed from this perspective, muscle alignment is considered secondary because, although muscle forces are important, their ability to cause or prevent patellar dislocation depends on passive stability or the lack thereof. In the normal knee, the patella seats quickly in the trochlea in early flexion, so that the ligamentous restraints are important only near full extension. ⋯ Lateral release has no role in the treatment of a hyperlax patellofemoral joint, as it adds additional laxity to a system that is already unstable. If surgery is performed, current evidence suggests techniques aimed at repair or reconstruction of the passive retinacular restraints are as effective as more extensive procedures at preventing subsequent dislocations. Among the latter procedures, realignment procedures use active muscle forces to help seat the patella in the femoral groove; however, biomechanical costs are associated with this approach and superior results have not been demonstrated with distal and combined realignments compared with more limited proximal procedures.