There is currently an increased interest in the use of electro surgery in arthroscopy. Since the introduction of the bipolar arthroscopic radiofrequency (RF) wand, it has started to replace the classic Bovie monopolar probe on the assumption that the new technology provides multifunctional devices, combining both tissue removal and haemostasis into one instrument. The more efficient tissue ablation and precise haemostasis achieved with these instruments should result in a significant reduction in the operative time and cost. We ran a prospective comparative randomised study to test this hypothesis. Forty patients underwent arthroscopic subacromial decompression, randomised into two groups. The group treated with bipolar RF was associated with an average operative time saving of 8 min (P<0.0001) and an average cost saving of £83 (€111) per case (P<0.003), compared to monopolar RF. Bipolar RF is the instrument of choice in arthroscopic shoulder surgery, as it saves time and money.Résumé L'utilisation du bistouri électrique en arthroscopie est d'un intérêt croissant. Depuis l'introduction du bistouri bipolaire radio-fréquence RF, il est nécessaire de remplacer la classique sonde monopolaire Bovie en se basant sur l'hypothèse que les nouvelles technologies permettent, avec les nouveaux matériels multi fonctions de combiner résections tissulaires et l'hémostase avec la même sonde. Une bonne hémostase et une bonne résection par bistouri électrique permettent d'avoir des résultats significatifs notamment en ce qui concerne la diminution du temps opératoire et des côuts. Matériel et méthode: nous avons réalisé une étude randomisée prospective pour tester cette hypothèses 40 patients ont bénéficié d'une décompression sous acromiale arthroscopique et ont été randomisés en deux groupes. Résultat, le groupe traité avec bistouri bipolaire radio-fréquence est associé à un gain opératoire de 8 minutes (P<0,0001) et, à une diminution du coût de 83 £ (111 euros) par patient (P<0,003) comparé au bistouri monopolaire. En conclusion, le bistouri électrique bipolaire radio-fréquence RF est l'instrument de choix dans la chirurgie arthroscopique et permet à la fois de gagner du temps et de diminuer les coûts.
Purpose Venous thromboembolism (VTE) is a recognised post-operative complication of major lower limb joint arthroplasty. Current National Institute for Health and Clinical Excellence (NICE) guidelines suggest the use of both mechanical and pharmacological prophylaxis following hip and knee replacement. Since the introduction of enhanced recovery programmes following hip and knee arthroplasty the requirement for routine pharmacological VTE prophylaxis has been questioned. The purpose of this study was to assess the efficacy of pharmacological prophylaxis against symptomatic VTE in patients undergoing hip and knee arthroplasty under an enhanced recovery programme. Methods Symptomatic VTE incidence was audited in 1,100 patients undergoing primary or revision total hip or knee arthroplasty at the same hospital with only mechanical prophylaxis from 2007 to 2009. Following addition of chemical prophylaxis (enoxaparin) symptomatic VTE incidence in 522 patients undergoing primary or revision total hip or knee arthroplasty from 2011 to 2012 was re-audited. Results In the mechanical prophylaxis group incidence of DVT was 0.73 % [95 % confidence interval (CI) 0.37-1.43 %] and incidence of pulmonary embolism (PE) 0.91 % (95 % CI 0.49-1.67 %). Following addition of pharmacological prophylaxis incidence of DVT was 0.57 % (95 % CI 0.20-1.68 %) and incidence of PE 1.15 % (95 % CI 0.53-2.48 %). Conclusions We found no statistically significant difference in symptomatic VTE incidence following the addition of enoxaparin. We question whether routine pharmacological prophylaxis still has a role following total hip and knee arthroplasty. Peri-operative optimisation, including post-operative analgesia and mobility, with current enhanced recovery programmes may be sufficient. As anticoagulants carry increased risk of postoperative bleeding and wound ooze, in addition to significant cost implications, their role remains controversial.
Our results imply that staples are able to significantly restrict motion while not achieving motion reductions that one would achieve with fusion-promoting instrumentation. The choice between double- and single-prong staples remains a matter of preference. Neither staple variant provided a mechanical advantage. The single-prong staple did allow more control in the placement of the staple over the disc space. The addition of an anterior staple significantly reduced the overall flexion-extension ROM.
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