Purpose: Concerning the ongoing debate on the effects of continuing aspirin therapy on blood loss in knee arthroplasty, we conducted a retrospective investigation to test the hypothesis that continuation of aspirin prior total knee arthroplasty (TKA) will not cause more blood loss. Methods: From a database of patients who underwent unilateral TKA between 2011 and 2016, we identified two groups: the aspirin group (patients continued aspirin during perioperative period) and the nonaspirin group (patients had no current or recent history of aspirin usage). We extracted and compared patient demographic information, comorbidity index, baseline serum hemoglobin (Hb), and creatinine level between the two groups. We also compared our primary outcomes, including the total blood loss, transfusion requirement, and length of hospitalization between the two groups. A multivariate logistic regression for analyzing the risk factors of requiring transfusion was performed. Results: We found that apart from preoperative serum creatinine level, there was no difference in the baseline Hb level, perioperative change in Hb, total blood loss, or length of hospitalization between the two groups. The percentage of transfusion utilization was also comparable between the two groups. Our regression analysis shows that the risk of requiring transfusion after TKA is not significantly associated with patients taking aspirin therapy before operation. Conclusion: Patients who underwent TKA with continuation of low-dose aspirin did not result in more blood loss. Current blood loss management has provided sufficient reduction of blood loss to accommodate aspirin therapy perioperatively. We suggest that it is safe to continue aspirin prior to TKA.

Purpose The aim of this study was to (1) develop suture techniques in repairing radial meniscal tear; (2) to compare the biomechanical properties of the proposed repair techniques with the conventional double horizontal technique. Methods Thirty-six fresh-frozen porcine medial menisci were randomly assigned into four groups and a complete tear was made at the midline of each meniscus. The menisci were subsequently repaired using four different repair techniques: double vertical (DV), double vertical cross (DVX), hybrid composing one vertical and one horizontal stitch, and conventional double horizontal (DH) suture technique with suturing parallel to the tibia plateau. The conventional double horizontal group was the control. The repaired menisci were subjected to cyclic loading followed by the load to failure testing. Gap formation and strength were measured, stiffness was calculated, and mode of failure was recorded. Results Group differences in gap formation were not statistically significant at 100 cycles (p = .42), 300 cycles (p = .68), and 500 cycles (p = .70). A trend was found toward higher load to failure in DVX (276.8 N, p < .001), DV (241.5 N, p < .001), and Hybrid (237.6 N, p < .001) compared with DH (148.5 N). Stiffness was also higher in DVX (60.7 N/mm, p < .001), DV (55.3 N/mm, p < .01), and Hybrid (52.1 N/mm, p < .01), than DH group (30.5 N/mm). Tissue failure was the only failure mode observed in all specimens. Conclusion Our two proposed vertical suture techniques, as well as the double vertical technique, had superior biomechanical properties than the conventional technique as demonstrated by higher stiffness and higher strength.

Background and Aims TPDI is the treatment of choice for patients with severe hyperparathyroidism who have failed medical therapy in our centre. The auto-transplantation of parathyroid tissue in the deltoid reduces the risk of permanent hypoparathyroidism. However, there is a risk of recurrent hyperparathyroidism from the implanted parathyroid tissue. Traditionally, these autografts are removed surgically in the event of recurrent hyperparathyroidism exposing the patients to the risk of permanent hypoparathyroidism. We attempted radiologically guided ablation of the implanted tissue to allow near but not complete ablation of the tissue. We aim to report our experience in using this technique to treat patients with recurrent hyperparathyroidism following TPDI. Method This is a single centre retrospective study of 9 patients who are on regular dialysis and underwent ablation of their deltoid parathyroid implants at Singapore General Hospital between May 2020 to July 2022. Baseline demographic data, as well as biochemistry results including intact parathyroid hormone (iPTH), serum calcium, phosphorus and alkaline phosphatase (ALP) levels were retrieved from electronic medical records and analysed. We define successful procedure as achieving 2 out of the following 3 criteria: i. &gt;50% drop in iPTH level at 3 months, ii. correction of hypercalcemia at 3 months, iii. off calcimimetic at 3 months Results A total of 9 patients underwent ablation of their parathyroid deltoid implants, of which 8 (89%) had thermal ablation and 1 (11%) had cryoablation. 1 patient required a repeat procedure within 3 month as only 50% of the implanted tissue were targeted instead of the intended 80% and another patient had a repeat procedure &gt;3 month after initial unsuccessful procedure. The median age of patients undergoing this procedure was 60 years (IQR 60, 66) and majority were female (5/9, 55.5%). 8 out of 9 patients were on haemodialysis. 7 out of 9 patients (78%) had a successful procedure based on our definition. 6 patients (67%) had a &gt;50% reduction of iPTH at 3 month, 6 patients (67%) were off calcimimetic at 3 months and out of the 5 patients who were hypercalcemic pre procedure, 4(80%) patients had normalisation of hypercalcemia at 3 months. 3 patients (33%) had iPTH &lt; 2x upper limit of normal with only 1 out of the 3 patient requiring high dose oral calcium replacement at 3 months. Pre ablation levels of PTH decreased from 191.87 ± 93.52 pmol/L to 99.77 ± 111.007 pmol/L (P = 0.773) 1 day after ablation and 92.450 ± 70.235 pmol/L (P = .0450) at 1 month and 91.25 ± 81.25 (P = .024) pmol/L at 3 months. Serum calcium levels decreased from 2.48 mmol/L ± 0.286 pre ablation to 2.11 mmol/L ± 0.322 1 day post ablation (P = 0.007) and remained 2.28 mmol/L ± 0.403 (P = .122) at 3 months post ablation. Serum ALP levels decreased from 478 ± 292.00 pre ablation to 238 ± 157 at 3 months post ablation. There were no re-admissions and no immediate post procedure complications in all patients. 4 out of 9 patients (44%) required intravenous calcium replacement post- procedure during the same admission. Limitations of this study are the relatively short follow-up duration and the small number of patients. 2 out of the 9 patients were lost to follow up at 3 months. Conclusion Ablation of deltoid parathyroid autografts may be a safe and effective minimally invasive procedure to manage recurrent hyperparathyroidism and minimising the risk of permanent hypoparathyroidism. However, further studies with larger sample sizes and longer follow up duration would be prudent to confirm our findings

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