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AimsTotal knee arthroplasty is an established treatment for knee osteoarthritis with excellent long-term results, but there remains controversy about the role of uncemented prostheses. We present the long-term results of a randomized trial comparing an uncemented tantalum metal tibial component with a conventional cemented component of the same implant design.MethodsPatients under the age of 70 years with symptomatic osteoarthritis of the knee were randomized to receive either an uncemented tantalum metal tibial monoblock component or a standard cemented modular component. The mean age at time of recruitment to the study was 63 years (50 to 70), 46 (51.1%) knees were in male patients, and the mean body mass index was 30.4 kg/m2(21 to 36). The same cruciate retaining total knee system was used in both groups. All patients received an uncemented femoral component and no patients had their patella resurfaced. Patient outcomes were assessed preoperatively and postoperatively using the modified Oxford Knee Score, Knee Society Score, and 12-Item Short-Form Health Survey questionnaire (SF-12) score. Radiographs were analyzed using the American Knee Society Radiograph Evaluation score. Operative complications, reoperations, or revision surgery were recorded. A total of 90 knees were randomized and at last review 77 knees were assessed. In all, 11 patients had died and two were lost to follow-up.ResultsAt final review all patients were between 11 and 15 years following surgery. In total, 41 of the knees were cemented and 36 uncemented. There were no revisions in the cemented group and one revision in the uncemented group for fracture. The uncemented group reported better outcomes with both statistically and clinically significant (p = 0.001) improvements in knee-specific Oxford and Knee Society scores compared with the cemented group. The global SF-12 scores demonstrated no statistical difference (p = 0.812). Uncemented knees had better radiological analysis compared with the cemented group (p < 0.001)ConclusionUse of an uncemented trabecular metal tibial implant can afford better long-term clinical outcomes when compared to cemented tibial components of a matched design. However, both have excellent survivorship up to 15 years after implantation. Cite this article: Bone Joint J 2020;102-B(8):1025–1032.

The use of negative pressure wound therapy (NPWT) in civilian and military wounds is found effective in promoting granulation tissue, decreasing exudate and improving patient comfort. The Use of gauze-based NPWT is increasing in civilian trauma cases with availability of proprietary systems using gauze as filler material rather than the traditionally used reticulated open-cell foam. Military trauma wounds differ from civilian trauma wounds in energy of impact, degree and nature of contamination as well as the hostile environments. The Use of gauze as filler material for NPWT in military trauma wounds is less well studied. This study is a retrospective analysis of use of improvised gauze-based NPWT in military trauma wounds. The whole assembly was constructed from commonly available operation theatre supplies and no proprietary system was used. Results were very encouraging and the use of this improvised method can be useful and cheap alternative to costly proprietary systems.