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Background The benefit of suction drains (SD) for the first 24-48 hours following joint replacement surgery is controversial. We aimed to determine if there is any difference in the early outcome of revision TKA when performed with, or without SD. Methods 83 cases indicated for revision knee arthroplasty were randomized to receive (42) or not receive (41) a deep intra-articlular drain. First-stage revisions for treating periprosthetic infection were excluded. Patients were statistically compared for demographic parameters, early complications and early knee functional outcome. The assessed outcomes included total blood loss, number of transfusions, fever and wound complication rate at 24 months follow-up. In addition, the change in knee society score at 12 weeks postoperatively was compared between the groups. Results There were no significant difference in demographic factors, wound complications, knee scores at 12 weeks and infection rate 24 months after surgery in either group. Average blood loss was 1856ml and 1533ml for the drain and no drain groups, respectively (P value=0.0470). The need for transfusion was significantly less in the no-drain group with an average of 0.15 unit/patient as compared to an average 0.37 unit/patient for the drain group (P value=0.0432). Conclusion We were unable to find a point of superiority for using a drain for revision knee arthroplasty. Future studies with longer follow-up and larger population of patients are needed to make a valid conclusion.

The use of distal femoral replacement (DFR) prosthesis is an option for treating distal femoral periprosthetic fracture (PPF). It is particularly helpful when the distal femoral bone is small and not amenable to rigid fixation. We report the results of 13 distal femoral PPFs at an average age of 77.5 years that were treated by this technique. At a mean follow-up of 30.5 months, the average Knee Society Score and functional score were 82 and 20, respectively. All patients who were ambulatory before fracture, regained their ability to walk after the surgery. There was a revision surgery for treating patellar instability. DFR is a reliable treatment for distal femoral PPFs with poor bone stock that allows for early ambulation in an elderly and low-demand group of patients.

Patients who have hip dysplasia are often young and active. Hence, total hip replacement in this group needs meticulous planning to obtain satisfactory fixation with good long-term outcome. Acetabular reconstruction is often complex because of acetabular bone deficiency. Various techniques to deal with the deficiency of acetabular bone stock have been described, including cemented and cementless cups with or without bone graft, impaction bone grafting, perforating the medial acetabular wall (the cotyloplasty technique), and a small-diameter cup at elevated hip center. Multiple studies have reported long-term results of various techniques for acetabular reconstruction.

The cup-cage reconstruction is indicated in massive acetabular bone loss with or without pelvic discontinuity during revision hip arthroplasty. We report the results of 26 pelvic discontinuities treated by this technique at a mean follow up of 46.6 months. The average Harris hip score was 76.6. Three constructs failed all within the first postoperative year. Complications included one deep infection, two dislocations and one peroneal neuropathy. Cup-cage construct is a reliable technique for treating pelvic discontinuity in mid-term follow-up.