Narrow Results

The purpose of the present study was to test the responsiveness of the Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder and Hand questionnaire (DASH-JSSH) by evaluating effect size (ES) and standardised response mean (SRM) in patients undergoing carpal tunnel release. Subjects comprised 25 patients with carpal tunnel syndrome. All subjects completed the DASH-JSSH, medical outcomes 36-item short-form health survey (SF-36) and visual analogue scale (VAS) for pain and underwent objective assessment of grip strength, pinch strength and static two-point discrimination before and three months after surgery. DASH-JSSH displayed the highest sensitivity to changes at three months, followed by VAS. All subscales of SF-36 were much less sensitive and both grip and pinch strength were unchanged over the three-month period. DASH-JSSH demonstrated more responsiveness to changes after carpal tunnel release than SF-36, VAS and physical measurements, and displayed correlations with subscales of SF-36.

Background: Tourniquets are used during total knee arthroplasty for better surgical fields and improved cementation. The functional benefits of tourniquet application for limited periods compared with total duration applications during total knee joint arthroplasty (TKA) surgery have not been well explored.

Aim of the study: To evaluate and compare the outcomes of limited use of a tourniquet (LT) for a shorter duration (just before cement application) with total use of a tourniquet (TT) for a longer duration (from skin incision to the completion of surgery).

Patients and method: A sum of 100 patients who undertook primary total knee arthroplasty were involved in this study, they were allocated randomly into two groups according to whether a limited or total tourniquet was used during the surgery. Both groups underwent the same surgical procedures with a digital tourniquet applied to all patients using the same technique. Intraoperative and postoperative assessment of blood loss, knee functional society score (KSS), visual analogue score (VAS) for thigh pain and knee pain evaluation, surgical complications like deep vein thrombosis (DVT), wound infections and nerve injuries are the main factors evaluated in the study.

Results: Patients with LT required more intraoperative blood transfusion compared with those with TT who required more blood transfusion postoperatively. There were no significant differences in KSS, VAS for thigh pain and knee pain evaluation, and surgical complications like DVT, wound infections and nerve injuries.

Conclusion: Limited tourniquet application from starting of cementing is associated with a higher need for intraoperative blood transfusion, but the use of a TT throughout surgery is associated with a higher need for postoperative blood transfusion.