The Knee
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Review Meta Analysis
Is a tourniquet beneficial in total knee replacement surgery? A meta-analysis and systematic review.
Proponents of tourniquets postulate that they optimise intra-operative visibility and reduce blood loss. This study compared the outcomes of tourniquet assisted to non-tourniquet assisted total knee replacement (TKR). A systematic review was undertaken of the electronic databases Medline, CINAHL, AMED and EMBASE, in addition to a review of unpublished material and a hand search of pertinent orthopaedic journals. ⋯ There was a trend for greater complications in tourniquet compared to non-tourniquet patients. There was no difference between the groups for any other outcome measure assessed. In conclusion, this systematic review has found that there is no advantage to using a tourniquet in knee replacement surgery for reduction of transfusion requirements.
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Comparative Study
Postoperative morbidity and mortality following total knee arthroplasty with computer navigation.
The incidence of postoperative complications following computer navigated total knee arthroplasty is unknown. There is no published evidence to support decreased morbidity compared to standard conventional technique. The Nationwide Inpatient Sample database was used to identify 101,596 patients who underwent total knee arthroplasty in 2005. ⋯ We found no differences in postoperative mortality or complications for the majority of our measured outcomes. Under multivariate regression analysis, computer navigation was associated with a lower rate of postoperative cardiac complications (odds ratio 0.40, p=0.042), a shorter length of stay, and a trend towards fewer hematomas. Further clinical study is required to examine the possible association of computer navigation with postoperative morbidity following knee arthroplasty.