The Knee
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Patellar tendon rupture after total knee arthroplasty is a rare, but often catastrophic complication. Many different reconstruction techniques of patellar tendon rupture have been described with variable and often discouraging results. A case report with patellar tendon rupture after a total knee arthroplasty is presented. Also, an alternative surgical technique of reconstruction of the patellar tendon using a semitendinosus-gracilis (STG) graft with an interference screw and a staple fixation enabling an immediate mobilization is described.
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A systematic review of the literature will fail to provide information needed for evidence-based medicine (EBM) if the design, execution and reporting of individual trials do not adhere to strict guidelines. Experience gained while conducting systematic literature reviews have revealed serious shortcomings in current literature. These limitations pertain to randomisation, blinding, outcome assessments and data reporting. The principles related to these issues are discussed with solutions and improvements provided.
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A 63-year-old gentleman presented with a history of worsening left knee pain almost 5 years following bilateral uni-compartmental knee replacements. X-Rays revealed a fracture of the medial tibial plateau and revision surgery was undertaken. ⋯ Cyst progression in association with wear debris is a rare problem following unicompartmental knee replacement. The findings at the time of revision in this case demonstrate that the complications of unicompartmental arthroplasty may affect all compartments of the knee.
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Randomized Controlled Trial Clinical Trial
The role of timing of tourniquet release and cementing on perioperative blood loss in total knee replacement.
The purpose of our study is to estimate the effect of tourniquet release and cementing in perioperative blood loss associated with total knee arthroplasty. Eighty patients were randomly allocated into two equal groups concerning the timing of tourniquet release. Group A: patients with tourniquet release and haemostasis before wound closure and group B: patients with tourniquet release after skin closure and compressive bandaging. ⋯ Cementing of total knee replacements has a better haemostatic role compared to non-cemented prosthesis (P<0.05). Even though complications were more in postoperative tourniquet release group, no statistically significant difference was found between group A and B. Postoperative tourniquet release seems to offer better conditions of haemostasis probably due to the better controlled fibrolytic activity.
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The clinical survival of joint arthroplasties is related to the quality of the surrounding bone environment. Bone mineral density (BMD) is an important measure of bone strength and quality. The aim of this prospective study was to measure the quantitative changes in BMD in the distal femur after cemented total knee arthroplasty (TKA) in osteoarthrotic knee joints. ⋯ The clinical status and function parameters of the knee joint, evaluated by the American Knee Society (AKS) score, had improved significantly on the preoperative values at the three- and 12-month follow-ups (P<0.0005). However, improvement in the AKS score was not associated with periprosthetic BMD change (P=0.204), whereas age (P=0.067) and body mass index (P=0.019) correlated with BMD loss for the total metaphyseal region of interest (ROI), by repeated measures ANOVA. We suggest that the observed periprosthetic bone loss was mainly the result of prosthesis-related stress-shielding.