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Background: High rates of loosening of cemented implants led to change in technique of fixation of the implant. Methods: Fifty-nine hips were operated in 42 patients with non­cemented acetabular and cemented femoral components between January 1999 and July 2003. The average age of the patient was 45.2 years in our study. Preoperative diagnosis was avascular necrosis (28), ankylosing spondylitis (18), fracture neck femur (9), rheumatoid arthritis (2) and osteoarthritis (2). Results: At an average follow up of 3.6 years (range 1.2-5.8 years) excellent to good results were obtained 92% according to Harris hip criteria. No radiological loosening was noted in any femoral or acetabular component on follow up. One poor result was seen in a case of bilateral ankylosing spondylitis operated on one side. Conclusion: Hybrid THA provides a viable and highly acceptable method of treatment of diseases of hip in young patients.

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Background: Success of arthroplasty is contingent on a clear understanding of the potential complications. Today with improved methods of sepsis control, incidence of joint sepsis has dropped to less than 2%. Despite this fever is still common in the early post-operative period. Methods: We reviewed 184 consecutive hip and knee replacement surgeries for incidence and clinical significance of post-operative fever. The cases were followed up for a period of over 3 to 5 years. Temperature charts up to 6 ^th postoperative day and all investigations were reviewed to determine the cause of fever. Results: Post operative fever was recorded after 82 procedures (44.6%). The average maximum temperature occurred on post­operative day 1 (98.9 ^o F). Only 2 TKR got infected. Incidence of fever was higher in TKR as compared to THR. Conclusion: Post-operative fever is common and probably inflammatory. It is not an important predictive factor of joint infection. Work up for joint infection is not indicated unless other corroborative features are present. Aspiration of painful joint is a highly accurate for identifying an infection.

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Background: Complex proximal femoral fractures are challenging problem. Methods: Forty-one patients had Russell- Taylor Delta reconstruction nailing done during the period from March 1992 to December 1996. 38 patients could be followed both clinically and radiologically either up to the fracture union or death. Clinical outcome was assessed by Kyle's criteria. Out of 13 patients with high-energy comminuted fractures, 12 were rated excellent or good. There was one death due to poly trauma. Results: Out of six elderly subtrochanteric fractures, 4 had excellent or good results. There was one poor result and one death. Out of 11 elderly interochanteric fractures with subtrochanteric extension, 8 had excellent or good results. There was 1 fair, 1 poor result and 1 death. In the elderly groups, the poor results were due to poor pre- existing medical conditions of the patients. In all the seven cases of pathological lesions, excellent or good results were achieved either till fracture union or death because of their malignant pathology. Conclusion: Russell- Taylor Delta reconstruction nail is a very useful device in high-energy comminuted proximal femoral fractures, in elderly low energy proximal femoral fractures and also in pathological lesions. The implant provides bio-mechanically stable fixation. The relatively high complication rate in elderly patients is because of their poor medical condition. In cases of pathological lesions, it is always preferable to fix the bone at the stage of impending fracture.

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Background: Ipsilateral fractures of shaft and neck of femur pose a problem of missed diagnosis and management. Method: Forty eight patients of ipsilateral femoral shaft and neck fractures were treated by closed reduction and fixation by Gamma nail. Patients were followed for average period of 48 months. Results: Six femoral shafts and two femoral necks had isolated non unions while one patient had nonunion at both sites. Varus malunion with resultant shortening was seen in six patients. Conclusion: Gamma nail is a good implant to treat ipsilateral fractures of shaft and neck of femur.

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Background: Management of tibial plateau fractures remains challenging because of their number, variety and associated soft tissue injuries that further augment their complexity. Comparison of operative results in recent reports has been difficult due to a lack of standard fracture classification scheme and uniform standardized objective criteria for evaluating results. Methods: Between August 1998 to December 2002, 27 closed tibial plateau fractures were treated operatively using methods and principles advocated by AO/ASIF and followed up for an average of 35.74 months (range 24-68 months). Fractures were classified according to Schatzker's staging system and results evaluated using Rasmussen's 30-point clinical grading system and Rasmussen's radiological evaluation of the knee at a minimum follow up of 2 years. Results: Type II was the most common fracture type (9 cases) followed by type I (6 cases). There were 37% excellent and 51.85% good functional results with only 3 patients having unacceptable results. The mean Rasmussen's functional score was 25.062 (range 15-30). Minimal fixation in comminuted or depressed fractures as compared to rigid fixation was the cause of unacceptable results. Loss of knee range of motion in a few cases was attributed to delayed knee mobilization in these cases. Using Rasmussen's radiological grading, 2 patients had excellent results and 81.48 % patients had good results. Only 3 patients had poor radiological results. The mean Rasmussen's radiological score was 15.33 (range 10-18). Moreover, clinical evaluation did not correlate with the follow up radiograph. Conclusion: Anatomic reduction and rigid internal fixation followed by early knee motion and partial weight bearing during bone healing are the cornerstones in the treatment of tibial plateau fractures. Standard fracture classification, uniform reporting and evaluating criteria, along with detailed analysis of uniform treatment methods, has helped us to enhance our understanding of these fractures.

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Background: Arthroscopy of the great toe MTP joint has been practiced with favourable outcomes. A range of indications have been described ranging from synovitis to osteochondral defects. The purpose of the present study was to describe our technique and to assess the functional outcome following arthroscopic management of Hallux MTP disorders using AOFAS scoring system. Methods: We describe the technique of Hallux MTP joint arthroscopy in twenty patients. Indications included hallux rigidus with osteophytes, chondromalacia, OCDs, loose bodies, arthrofibrosis, synovitis, tophaceous gout arthritis and intra­articular fractures of MTP joint. All patients had been evaluated clinically and radiologically with record of their AOFAS scores pre­operatively. At a minimum follow-up of two years the clinical assessment was carried out with AOFAS scores. Results: The mean pre-operative and post-operative AOFAS score were 47 (range 10-78) and 97 (87 -100) respectively. The patient with intra-articular fracture had an excellent outcome following arthroscopic reduction of the fracture. Conclusion: Arthroscopic management of painful hallucial MTP joint is a specialized technique, which if performed for the right indications, gives a favourable outcome with minimal complications.

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Background: Hyperuricaemia has been reported to be in normal healthy population. Method: Serum uric acid was estimated in 542 vegetarian healthy persons complaining of pain in the joint and in different musculoskeletal problems. Results: Four hundred cases (73.80 %) were having uric acid level above 5 mg %. The mean uric acid level was found to be 6.16% + 3.08 percent. Increased uric acid level was not found to be associated with the age. Conclusion: The rise in the uric acid does not merely indicate gout but derails the normal physiology in some musculoskeletal sites and produces symptoms. Its association with hypertriglyceridaemia and hypertension is also alarming .It is found also closely related to the high alcohol intake, diuretic drugs, hypothyroidism and obesity. Hyperuricaemia is more than what is as usually believed and needs investigation. The possible cause of the hyperuricaemia in normal healthy individuals is discussed.

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