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Background and Objective: Total Knee Arthroplasty is a commonly performed procedure for arthritic knees. Preventing complications is of utmost importance for good functional outcomes and preventing morbidity. Wound closure after the procedure is as important as the replacement aspect of surgery.The objective of this study was to provide subjective and objective evidence of better closure technique and material; we conducted the study so that the outcome of TKA can be further improved Methods: We conducted a randomized trial at The Indus Hospital, Karachi, from December 2018 to June 2020. All patients from age 40 to 70 years who underwent total knee arthroplasty were included in the study. The wound of one knee was closed with Polypropylene (Prolene) sutures, and the other with staples. The wound was assessed independently by two assessors using Hollander’s score; lower score means a worse outcome. All data was entered and analyzed using STATA version 16. Results: Thirty patients who underwent bilateral total knee replacement were included in the analysis, among which 71.8% were female. The average age of participants was 57.3 (± 7.5) years. The mean incision length on the right knee was 17.6 ± 1.1 cm, while on the left the incision length was 18.3 ± 1.2 cm. Overall, the mean Hollander score was significantly different among participants in the sutures and staples group in both the right (p-value=0.001) and left knees (p-value=0.001). The score was significantly higher in knees closed with sutures as compared to staples. Also, the mean Hollander score is significantly higher in females than males in both the right knee (B=0.56, p-value=0.049) and the left knee (B=0.38, p-value=0.044). Conclusion: The study has shown that Hollander’s score was significantly higher in knees closed with sutures as compared to the patients in whom staples were used for wound closure. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) is a procedure performed for end stage knee osteoarthritis to reinstate leg function, pain control and improve quality of life. The surgery, however, is associated with a substantial risk of concealed blood loss for which tourniquets have been used to control bleeding. There has been a lot of debate over the relevance and benefits of using tourniquets during TKA. It has no effect on postoperative blood loss and has been claimed to be associated with post-operative pain, nerve damage, superficial wounds infections and deep vein thrombosis. Objective: The objective of the study was to compare the degree of blood loss and its clinical relevance in patients undergoing total knee arthroplasty with and without tourniquet. Study type settings and duration: A Randomized Controlled Trial conducted at The Indus Hospital, Karachi, Pakistan from January 2015 to September 2015. Methodology: In this randomized clinical trial, patients were recruited after local IRB approval. Sample size was calculated using OpenEpi and included all patients of age 40 to 80 years of either gender with chronic osteoarthritis, according to the Kellgren-Lawrence classification grade 4 of Osteoarthritis. The study included two groups, both consisting of 25 patients each. In group A (non-intervention, tourniquet), the tourniquet was inflated to 350 mmHg after the leg had been elevated and exsanguinated, and was deflated after closing the wound and application of compressive dressing. In group B (intervention, non-torniquet), the application of tourniquet took place but it was not inflated. Instead, electrical diathermy, and application of pressure with surgical swabs was performed intra-operatively to control bleeding. Blood loss was measured using the Mercuriali's formula. Results: There was an average blood loss of 807 ml during TKA. Group A had a mean blood loss of 604.6 (203.9) ml while a relatively higher statistically significant mean blood loss of 1010.7 (272.7) ml was noticed in the intervention group on whom tourniquets were not used (p <0.005). Conclusion: According to our study, calculated blood loss was relatively less in Group A, hereby showing that the use of tourniquet is superior to other forms of bleeding control during the surgery. We propose that the issue on the significance of the use of tourniquet during TKA verses no tourniquet use has to be decided on the basis of volume of blood loss. [ABSTRACT FROM AUTHOR]