Purpose The use of tourniquet in orthopedic surgery facilitates operation by establishing a bloodless surgical field. However, many complications following the use of tourniquets have been reported. Tourniquet pain is the most common complication. This study aimed to find the actual incidence of pain associated with tourniquet use in orthopedic surgery and the various factors. Methods It is a prospective observational study conducted on 132 consecutive cases. Patients aged 18-70 years with musculoskeletal problems of the forearm and leg requiring surgery were included in the study. Patients with open injuries or contraindications such as diabetes mellitus, compromised circulatory states, neurological deficit, compartment syndrome and unable to give informed consent were excluded. The parameters assessed included duration of tourniquet use, tourniquet pressure, type of anesthesia, any interval release of the tourniquet and reapplication after a reperfusion period, whether upper or lower limb surgery, severity of tourniquet pain, timing of tourniquet release and complications. Chi-square and non-parametric Mann-Whitney U test were used for data analysis. Results In upper limb surgeries, if duration of surgery was less than 60 min, 14 (51.8%) cases experienced tourniquet pain and 13 (48.1%) had no pain, and if duration of surgery was more than 60 min, 24 (60.0%) had pain and 16 (40.0%) experienced no pain. In lower limb surgeries if duration of surgery was less than 60 min, 2 (7.7%) experienced pain and 24 (92.3%) had no pain, and if duration of surgery was more than 60 min, 14 (35.8%) experienced pain and 25 (64.8%) had no pain. Degree of tourniquet pain increases with the duration of surgery. Statistically, there was significant association between tourniquet inflation time and tourniquet pain in both upper and lower limbs ( p = 0.034 and 0.024, respectively) Conclusion Incidence of tourniquet pain was in direct proportion to the duration of tourniquet use and was higher in cases with regional anesthesia. Other risk factors assessed including tourniquet pressure, upper or lower limb surgery, tourniquet release time and interval had no significant contribution to the incidence or severity of tourniquet pain.

Introduction: Short femoral stems were designed to bridge the gap between conventional straight design stems and hip resurfacing prostheses in total hip arthroplasty (THA). A number of clinical trials have been recently conducted to assess the clinical and safety profile of the cementless, colarless, tapered Metha short hip stem in young or active middle-aged individuals. Methods: A systematic scoping review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. 4 reviewers independently conducted the search using the MEDLINE/PubMed database and the Cochrane Database of Systematic Reviews. These databases were queried with the terms “short” AND “hip” AND “stem”. Results: From the initial 773 studies we finally chose 12 studies after applying our inclusion-exclusion criteria. The number of operated hips that were included in these studies was 5048 (mean BMI range: 22.7–35.2, mean age range: 44.4–60.4 years, mean follow-up range: 2–9 years). The mean modified Coleman methodology score was 52.3/100, while it ranged from 31/100 to 63/100. All mean clinical outcome scores that were used in the studies illustrated significant postoperative improvement when compared with the respective initial values. The revision rate of the Metha stem for component-related reasons was 2.5%, while the rate of major complications not requiring revision of the Metha stem was 2.8%. Conclusions: The Metha stem performs well in young or active middle-aged THA patients. Further studies are required for the assessment of the long-term results.

Objectives: To determine the healing rate of rotator cuff reconstruction with an acellular human dermal allograft compared with the current gold standard arthroscopic maximal rotator cuff repair of large, chronic tears of the rotator cuff. Methods: Thirty patients with a two-tendon chronic retracted rotator cuff tear were enrolled in the study and were randomly allocated (15) to each group. All the patients were evaluated for structural integrity of repair using a 1.5 T MRI at an average of 15 months after surgery. Rotator cuff arthropathy (RCA) and acromio-humeral distance (AHD) were graded using X-rays. WORC, DASH, MARX scores, range of motion (ROM) of shoulder were also analyzed. Results: The re-tear rate in reconstruction group was 13% (2 of 15 patients) compared to 67%(10/15) in repair group (p=0.008). Progression of RCA was seen in 7.14%(1/14) and 35.71%(4/14) of patients in reconstruction and repair group; respectively (p=0.006). The change in AHD (preop-postop) was significantly higher in repair (reduced by 2.27 mm) than the reconstruction group (increased by 0.1 mm) (P=0.006). Both groups had significant improvements in patient reported outcome scores. Reconstruction group had statistically significant better forward flexion (p= 0.01) and scapular plane abduction (p=0.03) compared to repair. Conclusion: Rotator cuff reconstruction with a dermal allograft demonstrated favourable structural healing rates and improved range of motion compared to maximal repair in the short term. Moreover, those in the maximal repair group were more likely to develop RCA compared to reconstruction.