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   2013| January-February  | Volume 47 | Issue 1  
    Online since February 4, 2013

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Periprosthetic joint infection: Current concept
Vinay K Aggarwal, Mohammad R Rasouli, Javad Parvizi
January-February 2013, 47(1):10-17
DOI:10.4103/0019-5413.106884  PMID:23531512
Periprosthetic joint infection (PJI) is one of the most devastating and costly complications following total joint arthroplasty (TJA). Diagnosis and management of PJI is challenging for surgeons. There is no "gold standard" for diagnosis of PJI, making distinction between septic and aseptic failures difficult. Additionally, some of the greatest difficulties and controversies involve choosing the optimal method to treat the infected joint. Currently, there is significant debate as to the ideal treatment strategy for PJI, and this has led to considerable international variation in both surgical and nonsurgical management of PJI. In this review, we will discuss diagnosis and management of PJI following TJA and highlight some recent advances in this field.
  5,331 486 6
Computed tomographic evaluation of femoral component rotation in total knee arthroplasty
Shrinand V Vaidya, Rajesh M Gadhiya, Vaibhav Bagaria, Amar S Ranawat, Chitranjan S Ranawat
January-February 2013, 47(1):40-44
DOI:10.4103/0019-5413.106898  PMID:23532377
Background: Optimal femoral component rotational alignment in total knee arthroplasty (TKA) is crucial to establish a balanced knee reconstruction. Unbalanced knees can lead to instability, patellofemoral problems, persistent pain, stiffness, and generally poorer outcomes including early failure. Intraoperative techniques to achieve this optimal femoral component rotation include the use of the transepicondylar axis (TEA), the posterior-condylar-cut-parallel-to-the-tibial-cut (PCCPTC) technique and the anteroposterior axis technique (Whiteside's line). The purpose of this study was to compare the PCCPTC technique to the TEA technique using computed tomography (CT) scans to assess femoral component rotational alignment. Materials and Methods: This study used postoperative CT scans to compare the degree of femoral component rotation obtained with the use of PCCPTC technique and the TEA. The femoral component rotation of 30 TKA was measured on postoperative CT scans the angle of deviation between the two lines radiographic trans-epicondylar axis (rTEA) and femoral prosthesis posterior condylar line (FPPCL) was determined. This angle represented the rotation of the femoral component relative to the true rTEA. Results: The degree of rotation measured 2.67 ± 1.11 degrees in the PCCPTC group and 5.60 ± 1.64 degrees in the TEA group. Conclusion: The use of the TEA technique for determining rotational alignment in TKR results in excessive external rotation of the femoral component compared to the PCCPTC technique.
  5,433 205 3
Total knee arthroplasty in extra articular deformities: A series of 36 knees
Ashok Rajgopal, Attique Vasdev, Vivek Dahiya, Vipin C Tyagi, Himanshu Gupta
January-February 2013, 47(1):35-39
DOI:10.4103/0019-5413.106893  PMID:23532339
Background: The presence of extra articular deformities either in the femur or the tibia with arthritis of the knee makes total knee arthroplasty (TKA) technically demanding. The purpose of this study is to report outcomes with Total Knee Arthroplasty in patients with arthritis of the knee associated with extra articular deformity by intraarticular resection and soft tissue balancing. Materials and Methods: Thirty six knees (32 patients) who had arthritis of the knee associated with extra articular deformity, underwent total knee arthroplasty between 1999 and 2006 were included in this retrospective analysis. All patients had intraarticular resection with soft tissue balancing to correct the deformity. Full length weight bearing anteroposterior X-rays, Knee society scores, and Knee range of motion was recorded pre- and postoperatively. Results: The mean period of followup was 85 months (range 42-120 months). The deformities amenable to correction by intraarticular resection in our series were Femur- Coronal plane 11°-18° (mean 16.2°) Saggital plane 0°-15° (mean 10.1°) Tibia - Coronal plane 12°-24° (mean 21°). There was an improvement in the range of motion from mean of 54° preoperatively to 114° postoperatively (P value < 0.05). The Knee Society- Knee Score improved from 37 points to 85 points postoperatively (P value < 0.05). The functional score improved from a mean value of 19 to a mean of 69.5 at followup ( P < 0.01). The preoperative hip knee ankle angle in the coronal plane improved from a mean of 14° ± 2° varus (26° varus to 4° valgus) to a mean of 2° ± 0.6° varus (6° varus to 2° valgus). Conclusion: With a good preoperative planning and templating, intraarticular bone resection and good soft tissue balancing both in flexion and extension, correction would be possible in majority of extraarticular deformities.
  4,552 244 6
Basic research: Issues with animal experimentations
Shyam K Saraf, Vinay Kumaraswamy
January-February 2013, 47(1):6-9
DOI:10.4103/0019-5413.106882  PMID:23532705
In vivo studies using the animals are helpful in developing the treatment strategies as they are important link between the successful in vitro testing and safe human use. Various research projects in the field of fixation of fractures, development of newer biomaterials, chemotherapeutic drugs, use of stem cells in nonunion of fractures and cartilage defects etc., have hugely depended on animal experimentation. The employment of animals in experiments is both scientific and ethical issue. There must be reasonable reasons to show that it will significantly advance the present knowledge and lead to improvement in care. The regulatory bodies exist for humane use and care of animals used for experiments e.g., International Council for Laboratory Animal Science, Council for International Organizations of Medical Sciences, International Union of Biological Sciences, International Committee on Laboratory Animals. In India, Indian National Science Academy, Indian Council of Medical Research, National Centre for Laboratory Animal Sciences promote high standards of laboratory animal quality, care and health. The Committee for the Purpose of Control and Supervision on Experiments on Animals guidelines are well defined and is a must read document for any one interested to carry out research with animal facilities.
  4,303 209 1
Component alignment and functional outcome following computer assisted and jig based total knee arthroplasty
Dnyanesh G Lad, Jai Thilak, Mohan Thadi
January-February 2013, 47(1):77-82
DOI:10.4103/0019-5413.106915  PMID:23533002
Background: Incorrect positioning of the implant and improper alignment of the limb following total knee arthroplasty (TKA) can lead to rapid implant wear, loosening, and suboptimal function. Studies suggest that alignment errors of > 3° are associated with rapid failure and less satisfactory function. Computer navigated systems have been developed to enhance precision in instrumentation during surgery. The aim of the study was to compare component alignment following computer assisted surgery (CAS) and jig based TKA as well as functional outcome. Materials and Methods: This is a prospective study of 100 knees to compare computer-assisted TKA and jig-based surgery in relation to femoral and tibial component alignment and functional outcome. The postoperative x-rays (anteroposterior and lateral) of the knee and CT scanogram from hip to foot were obtained. The coronal alignment of the femoral and tibial components and rotational alignment of femoral component was calculated. Knee society score at 24 months was used to assess the function. Results: Results of our study show that mean placement of the tibial component in coronal plane (91.3037°) and sagittal planes (3.6058°) was significantly better with CAS. The difference was statistically insignificant in case of mean coronal alignment of the femoral components (90.34210° in navigation group and 90.5444° in jig group) and in case of the mean femoral condylar twist angle (external rotation 2.3406° in navigation group versus 2.3593° in jig group). Conclusions: A significantly improved placement of the component was found in the coronal and sagittal planes of the tibial component by CAS. The placement of the components in the other planes was comparable with the values recorded in the jig-based surgery group. Functional outcome was not significantly different.
  3,232 159 6
Iatrogenic giant cell tumor at bone graft harvesting site
Zile S Kundu, Vinay Gupta, Sukhbir S Sangwan, Shobit Goel, Parveen Rana
January-February 2013, 47(1):107-110
DOI:10.4103/0019-5413.106936  PMID:23531784
30 year old female patient with giant cell tumor of the distal tibia initially treated at a peripheral nononcological center by curettage and autologous bone grafting from the ipsilateral iliac crest reported to us with local recurrence and an implantation giant cell tumor at the graft harvesting site which required extensive surgeries at both sites. The risk of iatrogenic direct implantation of tumor, often attributable to inadequate surgical planning or poor surgical techniques, and the steps to prevent such complication is reported here.
  2,971 215 -
Outcome of total hip arthroplasty as a salvage procedure for failed infected internal fixation of hip fractures
Shubhranshu S Mohanty, Mandar V Agashe, Binoti A Sheth, Kumar K Dash
January-February 2013, 47(1):87-92
DOI:10.4103/0019-5413.106921  PMID:23533069
Background: Failed infected internal fixation produces significant pain and functional disability. In infected internal fixation of hip fractures with partial or complete head destruction, total hip arthroplasty (THA) can be technically challenging; however, it restores hip biomechanics. The present study is to evaluate the results and assess the complications of THA following failed infected internal fixation of these fractures. Materials and Methods: A retrospective review of prospectively collected data in a tertiary healthcare center was performed of 20 consecutive patients of THA following failed infected internal fixation operated between September 2001 and November 2007. There were 11 dynamic hip screw failures for intertrochanteric fractures, 6 failed osteotomies following transcervical fractures, and 3 failed screw fixations for transcervical fractures. Results: The average age of the patients was 48.5 years (range 28-70 years) and the average followup period was 6.5 years (range 3.5-10.5 years). An indigenously designed cement spacer was used in a majority of patients ( n = 15). The custom-made antibiotic impregnated cement spacer was prepared on-table, with the help of a K-nail bent at 130°, long stem Austin Moore's prosthesis (n=1), Charnley's prosthesis (n=1), or bent Rush nail (n=1). The antibiotic mixed cement was coated over the hardware in its doughy phase and appropriately shaped using an asepto syringe or an indigenously prepared spacer template. Nineteen of the 20 patients underwent two-stage revision surgeries. The average Harris hip score improved from 35.3 preoperatively to 82.85 postoperatively at the last followup. A significant difference was found ( P < 0.0001). None of the patients had recurrence of infection. Conclusions: The results were comparable to primary arthroplasty in femoral neck fractures. Thus, THA is a useful salvage procedure for failed infected internal fixation of hip fractures.
  2,842 169 6
Factors affecting range of motion in total knee arthroplasty using high flexion prosthesis: A prospective study
Kantilal H Sancheti, Parag K Sancheti, Ashok K Shyam, Rajeev Joshi, Kailash Patil, Anubhav Jain
January-February 2013, 47(1):50-56
DOI:10.4103/0019-5413.106901  PMID:23532488
Background: High flexion implants have been reported to provide better range of motion (ROM). The few studies analyzing the factors affecting the ROM are scarce. This study aims to find the factors that affect ROM when using a high flex knee design (INDUS knee). Materials and Methods: Two hundred and fifty three consecutive patients of total knee arthroplasty (TKA) done by using INDUS knee prosthesis between Sept 2008 and Sept 2009 were included in the study. The cases with osteoarthritis (OA) and Rheumatoid arthritis (RA) were included in study. 5 patients were lost to followup and 248 patients (267 knees, 19 bilateral, 221 OA, and 46 RA) were analyzed for the following factors - sex, age, body mass index (BMI), preoperative ROM, flexion deformity, preoperative total knee score and functional score, time of tourniquet release and patella resurfacing. Subgroup classification using above factors was performed and statistical analysis of effect of all the above factors on final knee ROM was done. Assessment was done preoperatively and at 3 months, 6 months and 1 year postoperatively. The final outcome evaluation was done at one year followup. Results: The mean age was 68.2 years (range 40-89 years) with 79 males and 189 females. The mean knee range improved from 97.62 ± 11° to 132 ± 8°. Factors that positively affect ROM of INDUS knee prosthesis at the end of 1 year were preoperative ROM, total knee score and functional score, and diagnosis of osteoarthritis, whereas BMI, preoperative flexion deformity has a negative influence on final flexion at the end of 1 year. Age and gender of the patients, patella resurfacing, and use of two different tourniquet protocols did not affect the final outcome. Conclusion: Preoperative ROM and preoperative functional status are the most important factors affecting final range. Patients should be counseled accordingly and made to understand these factors.
  2,830 166 8
Correlation of posterior tibial slope with metaphysio-diaphyseal angle in total knee arthroplasty: A radiological study
Shubhranshu S Mohanty, Nandan N Rao, Kumar K Dash, Sunil K Bhosale
January-February 2013, 47(1):67-71
DOI:10.4103/0019-5413.106910  PMID:23532803
Background: Posterior tibial slope (PTS) is an important factor affecting postoperative range of motion (ROM) following total knee arthroplasty (TKA). Metaphysio-diaphyseal angle (MDA) is a new entity defined as angle between proximal anatomical axis and metaphyseal axis of tibia. This study was undertaken to determine PTS in Indian patients and find its correlation with MDA of tibia. Accuracy of extramedullary jigs and the influence of MDA on the accuracy was also evaluated. This study is a retrospective analysis of prospectively collected data in a tertiary healthcare center. Materials and Methods: Data of 100 consecutive patients undergoing TKA in a single center by a single surgeon was analyzed. Posterior cruciate ligament (PCL) substituting TKA was done with same jig to achieve different PTS in different patients. MDA, preoperative PTS and postoperative PTS were calculated. The data was analyzed using appropriate statistical analysis. Results: Mean preoperative PTS was 11.64° and mean MDA was 23.76° with a strong correlation between them (Pearson's coefficient 0.72). Extramedullary jigs were accurate in 53% cases. In remaining 47%, postoperative PTS was less than planned PTS in 30%, and more in 17%. Mean postoperative PTS was 2.54°. In patients with MDA < 20°, postoperative PTS was significantly less ( P = 0.0176) compared with those with MDA > 20°. Conclusions: The study establishes the positive correlation between MDA and PTS in Indians; and that MDA is an independent factor affecting accuracy of extramedullary jigs in TKA.
  2,671 196 2
Results of infected total knee arthroplasty treated with arthroscopic debridement and continuous antibiotic irrigation system
Che-Wei Liu, Chun-Lin Kuo, Shih-Youeng Chuang, Jen-Huei Chang, Chia-Chun Wu, Tsung-Ying Tsai, Leou-Chyr Lin
January-February 2013, 47(1):93-97
DOI:10.4103/0019-5413.106925  PMID:23533105
Background: Arthroscopic debridement with continuous irrigation system was used with success in treating infective arthritis. We evaluated the effectiveness of arthroscopic debridement coupled with antibiotic continuous irrigation system in acute presentation of late infected total knee arthroplasty. Materials and Methods: We performed a retrospective review of medical record of patients with acute presentation of late infected total knee arthroplasty who were treated by arthroscopic debridement coupled with continuous postoperative antibiotic irrigation system. Results: Seventeen patients were included in our study. 15 (88%) patients preserved their total knee prosthesis at mean of followup of 27.5 months (range, 14-28 months). Two (12%) patients failed arthroscopic protocol and finally needed two stages revision. Our study showed an 88% prosthesis retention rate in patients with acute presentation of late prosthetic knee infection. No complication was associated with use of antibiotic irrigation system. Conclusion: Arthroscopic debridement combined with continuous antibiotic irrigation and suction is an effective treatment for patients with acute presentation of late infected total knee arthroplasty.
  2,674 92 2
Mid term results of LCS knee: The Indian experience
Rajesh N Maniar, Tushar Singhi, Bharat Gangaraju, Aniket Patil, Parul R Maniar
January-February 2013, 47(1):57-62
DOI:10.4103/0019-5413.106903  PMID:23532673
Background: The low contact stress rotating platform (LCS RP) knee (DePuy Orthopedics, Inc, Warsaw, Indiana), in use for last four decades in Western population, is reported to have a survival of more than 95% at 15 to 20 years. The reported Indian experience of this knee is limited to 5 years. Our aim was to report the clinical and radiological results of the LCS RP TKA design in the Indian population with a minimum followup of 10 years. Materials and Methods: Fifty-five LCS knees (45 patients) operated between February 1997 and October 2001 were evaluated retrospectively. LCS design was generally selected if the patient was young (≤65 years of age), active and had no severe deformity. There were 40 female (88.9%) and 5 male (11.1%) patients; 47 knees had osteoarthritis (85.5%) and 8 knees had rheumatoid arthritis (14.5%). Knee Society Scores (KSS) and outcome questionnaire were filled at followup and radiographs were analyzed using Knee Society radiographic evaluation and scoring system. Results: Of 45 patients (55 knees) enrolled, 37 patients (44 knees; 80%) were available for followup at 10 years. Average age was 59.6 years (range 40 to 77). Minimum followup was 10 years (average 12.3 years; range 10 to 15.3 years.). Three knees (6.8%) had been revised, one each for aseptic loosening, bearing dislocation and infection. Mean preoperative KSS of 33 improved to 91 postoperatively. Mean preoperative functional score of 45 improved to 76 postoperatively. Mean preoperative flexion of 113° (90°-140°) reduced to 102° (80°-135°) postoperatively. Erratic femoral rollback and tighter flexion gap to prevent spin out are the probable factors for decreased postoperative range of motion. Five (12%) patients could sit cross-legged and sit on the floor. Anterior knee pain was present in 4.6% (2/44 knees). The survival was 93.2% at 12.3 years. One patient (1.8%) had spin-out of the rotating bearing. No knee had osteolysis or progressive radiolucent lines on X-rays. Conclusion: LCS implant has given good survival (93.2% at 12.3 years) with low rates of spin-out and anterior knee pain and no incidence of osteolysis. Limited flexion post surgery (104°) with only 12% managing to sit cross legged on the floor is a drawback.
  2,482 107 2
Outcome of subvastus approach in elderly nonobese patients undergoing bilateral simultaneous total knee arthroplasty: A randomized controlled study
Sanjeev Jain, Sandeep Wasnik, Amber Mittal, Chintan Hegde
January-February 2013, 47(1):45-49
DOI:10.4103/0019-5413.106900  PMID:23532447
Background: Subvastus approach in total knee arthroplasty (TKA) spares the quadriceps and may assist in faster rehabilitation. The present randomised controlled study was conducted to determine if the subvastus approach results in early recovery, faster mobilization, shorter hospital stay, and improved function. Materials and Methods: 100 patients undergoing simultaneous bilateral TKA were randomized into two groups: subvastus group and medial parapatellar group. The patients were assessed clinically using VAS, time to straight leg raise, ability to stand with walker, ability to use a commode chair, ability to climb stairs, flexion at discharge, and day of discharge. Perioperative blood loss and duration of surgery were also compared. The patient were kept on same pain management and physiotherapy protocol. The evaluation was done at day 0,1,3 and at discharge. Statistical analyses tested the null hypotheses of no differences in patients treated with either group at 95% significance level ( P < 0.05). Results: The VAS score was significantly lower in subvastus group on day 1 and day 3. Also mean hospital stay was 2.04 days less in subvastus group. Patients with subvastus approach were able to perform straight leg raising 0.44 days earlier. Though time to stand with walker was same for both groups, the ability to use commode chair, and climb stairs was significantly early ( P < 0.05) in the subvastus group. The average flexion at the time of discharge in subvastus and parapatellar group were 100.8 and 96.8°, respectively. The mean perioperative blood loss in subvastus group and parapatellar group were 343 ml and 372 ml, respectively. Average surgical time required for subvastus approach and parapatellar approach were 108.5 and 94.3 min, respectively. Conclusions: Subvastus approach produce appreciably less pain and faster mobilization due to lesser insult to quadriceps, thus assisting in early rehabilitation, shorter hospital stay, less expenditure, and more patient satisfaction.
  2,432 125 6
Midterm results of cruciate retaining total knee arthroplasty in patellectomized patients
Vivek Dahiya, Himanshu Gupta, Ashok Rajgopal, Attique Vasdev
January-February 2013, 47(1):31-34
DOI:10.4103/0019-5413.106891  PMID:23532189
Background : Total knee arthroplasty (TKA) in patellectomized patients gives inferior results when compared with those in which the patella is present. The literature is ambiguous about the role of cruciate retaining or sacrificing implants for these knees. In this study, we assessed the midterm results of TKA in patellectomized knees using a cruciate retaining implant. Materials and Methods: Thirty three patients with a prior patellectomy underwent a cruciate retaining TKA and were followed up for an average of 9.3 years (range 2-14 years). At each followup visit, they were evaluated clinically, radiologically and by the Hospital for Special Surgery Scoring System. Results: Twenty one knees did not have any pain or difficulty in climbing stairs, 10 knees were slightly painful on stairs but pain free on walking on flat ground and two knees experienced mild to moderate pain on walking up and down stairs as well as on flat ground. The average range of motion preoperatively was 87° , which postoperatively increased to 118° . The average Hospital for Special Surgery Knee scores increased from 52 to 89 points. None of the knees showed any progressive radiolucencies or evidence of any loosening/osteolysis or fractures in followup. Conclusion: Cruciate retaining TKA offers good results at midterm followup in patients with a prior patellectomy.
  2,167 105 4
Tibial cleaning method for cemented total knee arthroplasty: An experimental study
Peter Helwig, Lukas Konstantinidis, Anja Hirschmüller, Verena Miltenberger, Kerstin Kuminack, Norbert P Südkamp, Oliver Hauschild
January-February 2013, 47(1):18-22
DOI:10.4103/0019-5413.106887  PMID:23531916
Background: The survival rate of cemented knee prosthesis depends among other factors on optimal cement-bone contact, nevertheless no standard exists for cementing technique of tibial components. The aim of this study was to determine which tibial surface preparation technique leads to the best bone-cement contact. Materials and Methods: Human tibial plateau specimens were cleaned in four different ways before cementing: a) no cleaning, b) manual syringe irrigation, c) fracture brush cleaning, and d) pulsatile jet-lavage. The specimens were cut into transverse sections and the bone cement contact distance was calculated for every 10 mm and the cement penetration depth was measured. Both values were statistically analyzed (ANOVA). Results: The longest bone-cement contact (62 mm) was seen after PJL, the shortest (10.6 mm) after no cleaning at all. The deepest cement penetration (4.1 mm) again was seen after PJL, the least (0.7 mm) after no cleaning. Statistically, PJL yielded the longest bone-cement contact and deepest cement penetration. Conclusion: The results supports the use of pulsatile jet-lavage before cementing tibial components in knee arthroplasty.
  2,156 87 1
Results of uncemented distal locked prosthesis in revision hip arthroplasty with proximal femoral bone loss: A retrospective study
Sanjay Agarwala, Hari Ram Jhunjhunwala, Jawahir A Pachore, Siddharth B Joglekar, Krishna Kiran Eachempati
January-February 2013, 47(1):83-86
DOI:10.4103/0019-5413.106918  PMID:23533020
Introduction: Management of bone loss is a challenge in revision total hip arthroplasty (THA). A retrospective review was performed to study the use of uncemented distal locked prosthesis in cases with proximal femoral bone loss. Materials and Methods: Uncemented stems with distal interlocking were used in 65 hips during revision THAs with 38 hips having Paprosky IIIB/IV defects between January 1998 and February 2004. There were 48 males and 17 females in the study with an average age of 53 years (range 30-80 years). Radiographic and clinical outcome evaluation using the Harris hip score (HHS) were performed. Results: An improvement in HHS (mean: 33 points) was observed at final followup (mean: 9 years). Regeneration of proximal bone stock was observed without signs of loosening or subsidence and none of the stems were revised. Three patients developed recurrent dislocation while one had a stem subsidence of 1cm following removal of interlocking bolts. Conclusion: Uncemented distal locked prosthesis provide adequate stability in revision THA, aiding the reconstruction of bony deficiencies while avoiding the disadvantages of fully porous or cemented implants.
  2,023 116 3
Indian Journal of Orthopaedics : Journey continues
Anil K Jain, Sudhir Kumar
January-February 2013, 47(1):1-5
DOI:10.4103/0019-5413.106881  PMID:23533296
  1,966 165 -
Posttraumatic pseudoaneurysm of popliteal artery following total knee arthroplasty
Sanjay R Agarwala, Ganesh S Mohrir, Sharukh J Dotivala
January-February 2013, 47(1):101-103
DOI:10.4103/0019-5413.106929  PMID:23531641
We report a case of posttraumatic false aneurysm of popliteal artery after a total knee arthroplasty in an 82-year-old woman. This case is characterized by the distinct history of trauma to the popliteal fossa in the immediate postoperative period and the location of false aneurysm. In addition, the clinical symptoms were similar to those of deep vein thrombosis. The ultrasonographic examination and computed tomography (CT) angiography confirmed the diagnosis on 6 th day after the surgery. Ultrasonographic examination 1 day later revealed no increase in the size of false aneurysm. She was treated with open surgical repair. Presenting the difficulty in the diagnosis, unusual location, etiology, and its management is the intention of this case report.
  1,994 77 3
Influence of bilateral sequential total knee arthroplasty on functional recovery
Rajesh N Maniar, Jayesh V Baviskar, Tushar Singhi, Parul Maniar, Ravi Nayak
January-February 2013, 47(1):23-30
DOI:10.4103/0019-5413.106890  PMID:23532139
Background: Main concerns of patients undergoing bilateral surgery is the quantum of pain and the progress of functional recovery. We studied functional recovery in terms of pain, range of motion (ROM), SF12, WOMAC scores and a unique TUG (timed up and go) test for patients undergoing unilateral total knee arthroplasty (U/L-TKA) and sequential bilateral total knee arthroplasty (B/L-TKA). Materials and Methods: Three groups of 77 consecutive patients (91 knees) were retrospectively compared. They were B/L TKA group (28 knees: 14 patients), Unilateral TKA group with contralateral knee nonoperated i.e., U/L-TKA group (42 knees) and Unilateral TKA with contralateral TKA already done i.e., U/L + C/L TKA group (21 knees). Patients were assessed preoperatively and on postoperative days 3, 5, 14, 42, 90 and 1 year. Results: The WOMAC score was statistically better preoperatively in the U/L + C/L TKA group, and SF12 MCS score was statistically better preoperatively in the B/L-TKA group. The TUG test time in the B/L-TKA group was statistically longer on days 3 and 5 as compared to other groups and became comparable by day 14. The TUG score became better than the preoperative value by day 42 in the B/L-TKA group, which took 90 days in other groups. Conclusion: The early functional recovery of bilateral TKA patient lags behind that of unilateral TKA patient for the first 5 days, becomes equal by the 14 th day and remains equal till 1 year after surgery. Bilateral TKA patients regain their preoperative functional status by 6 weeks against 3 months for unilateral TKA. The operative status of the contralateral knee makes no difference to early functional recovery after unilateral TKA. With bilateral TKA, there is no difference in pain and ROM parameters.
  1,903 135 1
Effect of total knee arthroplasty on type II diabetes mellitus and hypertension: A prospective study
Shrinand V Vaidya, Arvind Arora, Ambarish A Mathesul
January-February 2013, 47(1):72-76
DOI:10.4103/0019-5413.106913  PMID:23532862
Context: Advanced osteoarthritis of knee joint if bilateral, severely restricts patient mobility. This acts as an aggravating factor for pre existing comorbid elements of metabolical syndrome (MS) like Type II diabetes mellitus and hypertension as patients are unable to carry out therapeutic walks. Successfully implanted total knee arthroplasty (TKA) increases physical activity and enables to carry out therapeutic walks thus may help in better control of type II diabetes mellitus and hypertension. The objective of this prospective study was to find whether TKA for osteoarthritis knee had any effect to improve blood glucose levels and reduce blood pressure. Materials and Methods: A prospective study was done in which patients operated for tricompartmental osteoarthritis of knee with associated comorbidities like Type II diabetes mellitus or hypertension during a period of 2008 and 2009 were studied. One hundred and twenty patients were enrolled (55 diabetics, 65 hypertensives) who met our inclusion criteria. Preoperative knee society score, lower extremity activity scale fasting blood glucose level and systolic and diastolic blood pressure were compared with one year followup values. The KSS and LEAS scores were analysed by the Wilcoxon signed ranked test, while the fasting blood glucose (FBG) levels and systolic and diastolic blood pressure levels were analysed by paired 't' test. Results: The reduction of systolic blood pressure by 8 mmHg (t = 5.6, P value < 0.05) and diastolic blood pressure by 6 mmHg ( t = 7.6, P value < 0.05) was recorded which was statistically significant. However, no statistically significant effect on fasting blood glucose levels was observed ( t = -0.77, P value = 0.442). KSS improved in DM from preoperative 29 to 86 and LEAS improved from 6.7 to 11.3. Conclusions: Authors are of the opinion that successful total knee replacement results in increased physical activity and reduces blood pressure (systolic and diastolic) in hypertensives. However, the same is not seen in blood glucose level. Increased physical activity and reduced dependence on NSAIDS postoperatively, may be contributing in reduction of systolic and diastolic blood pressure. Further studies in this aspect are necessary.
  1,914 111 2
Intraoperative CT navigation for glenoid component fixation in reverse shoulder arthroplasty
Ashok S Gavaskar, K Vijayraj, SD Muthukumar Subramanian
January-February 2013, 47(1):104-106
DOI:10.4103/0019-5413.106935  PMID:23531710
CT navigation has been shown to improve component positioning in total shoulder arthroplasty. The technique can be useful in achieving strong initial fixation of the metal backed glenoid in reverse shoulder arthroplasty. We report a 61 years male patient who underwent reverse shoulder arthroplasty for rotator cuff arthropathy. CT navigation was used intraoperatively to identify best possible glenoid bone and to maximize the depth of the fixation screws that anchor the metaglene portion of the metal backed glenoid component. Satisfactory positioning of screws and component was achieved without any perforation or iatrogenic fracture in the scapula. CT navigation can help in maximizing the purchase of the fixation screws that dictate the initial stability of the glenoid component in reverse shoulder arthroplasty. The technique can be extended to improve glenoid component position [version and tilt] with the availability of appropriate software.
  1,890 70 1
Tourniquets in orthopedic surgery
Vinay Kumaraswamy, Saurabh Singh, Nitin Sharma, Ravindra P Singh
January-February 2013, 47(1):111-111
DOI:10.4103/0019-5413.106939  PMID:23533297
  1,605 207 1
A vascular complication in computer navigated total knee arthroplasty
Sandesh Gulhane, Ian Holloway, Mathew Bartlett
January-February 2013, 47(1):98-100
DOI:10.4103/0019-5413.106927  PMID:23531499
The use of computer navigation has the potential to improve implant position in total knee arthroplasty (TKA), but pin fixation of reference arrays introduces an additional potential source of complications. We report a case of vascular injury related to the insertion of a femoral pin during navigated TKA.
  1,734 62 3
Comparision of blood loss between computer assisted and conventional total knee arthroplasty
Paras Kumar Mohanlal, Nemandra Sandiford, John A Skinner, SR Samsani
January-February 2013, 47(1):63-66
DOI:10.4103/0019-5413.106906  PMID:23532765
Background: Bleeding during total knee arthroplasty (TKA) can cause significant morbidity and mortality. One proposed benefit of computer assisted TKA is decreased bleeding as the femoral canal is not invaded. This study assessed blood loss between computer assisted surgery (CAS) and conventional TKA. Materials and Methods: 73 consecutive patients (37 males, 36 females) underwent primary TKA between 2006 and 2009. Thirty eight patients underwent navigated TKA and 35 underwent conventional TKA for symptomatic osteoarthritis of the knee. These patients were matched for age, gender, and body mass index (BMI). Average age was 70.3 years (range 47-91 years). Mean BMI was 30 (range 17-49). Average preoperative hemoglobin was 13.26 g/dL (range 8.7-18.4 g/dL) in the navigated group and 13.47 g/dL (range 9.6-15.8 g/dL) in the conventional group ( P = 0.9). Average tourniquet time was 110 min (range 90-150 min) in the navigated group and 96.7 min (range 60-145 min) in the conventional group ( P = 0.77). Results: Average postoperative hemoglobin in the navigated group was 10.34 g/dL (range 7.5-14.8 g/dL) and in the conventional group was 10.03 g/dL (range 7.5-12.2 g/dL) ( P = 0.17). Six patients in both groups required blood transfusions. The mean drain collection was 599 mL (range 150-1370 mL) in the navigated group and 562 mL (range 750-1000 mL) in the conventional group ( P = 0.1724). These results suggest that there is no significant reduction in blood loss in CAS TKA. Conclusion: These results suggest that there is no significant difference in blood loss in CAS TKA and conventional TKA. This study also highlights the heterogeneity of methods used in studies related to CAS TKA. We believe that there is a need for a large multicenter prospective randomized controlled trial to be performed before a consensus can be reached on the influence of CAS techniques on blood loss during primary TKA.
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Author's reply
Jai Prakash Sharma, Rashmi Salhotra
January-February 2013, 47(1):111-112
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