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ller's score at final follow-up for PR group was (23.36) and NPR group was (21.98),
value 0.001, which showed clear superiority of PR over NPR.
After a minimum follow-up of 10years, there were no differences in clinical results; however, the knee function score and patello-femoral function scoring was found to be significantly higher with patella resurfacing and it was persistent across all the subgroups we had included in the study-posterior stabilized/cruciate retaining or between implants made by two different manufacturers.
After a minimum follow-up of 10 years, there were no differences in clinical results; however, the knee function score and patello-femoral function scoring was found to be significantly higher with patella resurfacing and it was persistent across all the subgroups we had included in the study-posterior stabilized/cruciate retaining or between implants made by two different manufacturers.
The femoral component is generally aligned perpendicularly to the distal femoral intramedullary axis with conventional instruments. Various aids like computer navigation, patient-specific instrumentation and robotic surgery use the mechanical axis as the reference for the femoral component alignment. We studied the flexion of the distal femoral intramedullary axis compared to the mechanical axis using an interactive 3D tool in 407 Indian osteoarthritic knees undergoing total knee replacement to better understand optimal flexion alignment.
407 knees (301-Female, 106-Male) in Indian patients undergoing total knee replacement underwent CT scans. A 3D interactive knee system was used for 3D reconstruction and planning. Distal femoral flexion angle (DFFA) was calculated between the anatomic distal femoral (intramedullary) axis and the mechanical axis. Statistical analysis was performed using ANOVA test and Chi-square test using a data analysis tool pack (Analysis ToolPak by Excel Easy) additionally installed iafer to take the distal femoral cut between 2 and 3 degrees of flexion to mechanical axis, as it would ensure that the cut is within 3 degrees from the anatomic axis for 98% patients. Most surgeons routinely using navigation or similar aids take the cut at 0 degrees of flexion to the mechanical axis. This will lead to more than 3 degrees of extension with reference to the intramedullary axis in more than 39% patients. This would result in either an increase in femoral component sizing or an increased risk of notching.
Knee arthrodesis is a demanding technique regarding difficulties to achieve bone fusion, control of infection and its associated complications. The purpose of this study was to evaluate if knee arthrodesis should still be indicated after failed revision total knee replacement.
This was a retrospective study of 45 patients. Age, gender, follow-up, pathogens, Charlson comorbidity index, time from primary arthroplasty to arthrodesis, number of previous procedures, surgical technique, functional capability assessed by the SF-12 score, limb-length discrepancy after arthrodesis, presence of radiographic knee fusion, and complications were recorded.
The mean age at the time of operation was 72years. 29% of patients were men, 71% were women, and the mean follow-up was 8.5years. The average Charlson comorbidity index was 4.5. The most common microorganisms isolated were
(29%),
(22%), and
15%). In 20% of patients, no microorganism was identified, and in 37% of patients the infection was polymicrobial. Time from primary total knee arthroplasty to arthrodesis was 55months, and patients underwent a mean of 3.9 previous surgeries. The surgical technique used was an intramedullary long nail in 95.5%. Functionally, 93.3% of patients walked with weight bearing. The SF-12 was higher after arthrodesis (
< 0.05). Mean limb length discrepancy was 2.4cm. SEL120-34A research buy Among the group treated with long intramedullary nailing, 91.1% obtained tibiofemoral fusion. Complications occurred in 37.6% of patients.
Knee arthrodesis with a long intramedullary nail after failed infected revision total knee replacement has a high rate of fusion, but the complication rate is high.
Knee arthrodesis with a long intramedullary nail after failed infected revision total knee replacement has a high rate of fusion, but the complication rate is high.
With increasing numbers of primary total hip replacement (THR), there has been a substantial increase in revision total hip replacement (RTHR) surgeries. RTHR are complex joint reconstruction surgeries involving significant cost, expertise and infrastructure. With its significant socioeconomic impact, we need to keep a close watch on the epidemiological trends of these procedures.
We prospectively studied the first-time RTHR performed at our institution for a 7-year period (2011-2017). We looked at patient demographics, the workload of RTHR and its etiology. We reviewed the microbiological profiles of septic revisions.
Of the 1244 THR procedures performed, 260 (21%) were first-time revisions. The predominant cause of revisions was a prosthetic infection (38%) followed by aseptic loosening (33%), instability (15%), peri-prosthetic fracture (11%) and implant breakage (3%). In the aseptic loosening group, 55% of cases had primary cemented implant, 44% had only stem loosening, 31% had cup loosening and 25% had both cup and stem loosening. In the early, midterm, and late-failure groups, prosthetic infection remained the main cause of failure. In 60% of the septic revisions, the offending organisms could not be identified and of those identified most (77%) were gram negative.
In our study, the RTHR burden was 21%, which is similar to historic revision data from the west (1998-2001) and twice as compared to recent trends from the west (9-11%). Unlike western data, which show aseptic loosening (30-60%) as the predominant cause of hip revisions, in our study infection was the number one cause (38%).
In our study, the RTHR burden was 21%, which is similar to historic revision data from the west (1998-2001) and twice as compared to recent trends from the west (9-11%). Unlike western data, which show aseptic loosening (30-60%) as the predominant cause of hip revisions, in our study infection was the number one cause (38%).
In patients with rheumatoid arthritis (RA), some problems might occur in fracture healing; however, clinical evidence is limited. Therefore, we compared the time to union and complication rate of femoral fractures between RA and non-RA patients.
This study included 42 RA patients who underwent osteosynthesis for femoral trochanter or shaft fracture. For comparison with the RA group, 126 non-RA patients were selected as a control group. The RA group was divided into the trochanteric (RA group I) and shaft fracture group (RA group II) for comparison with each control group (control groups I and II). We analyzed risk factors for nonunion or delayed union and divided patients according to whether atypical or ordinary fracture in shaft fracture.
Time to union (
= 0.823) and complication rate (
= 0.440) did not differ significantly between RA group I and control group I. A significantly longer time to union (
= 0.001) and higher nonunion rate (
= 0.013) were observed in RA group II compared with control group II. The presence of RA (
= 0.040) and atypical femoral fracture (
= 0.006) were significant risk factors for nonunion or delayed union.
The high prevalence of atypical femoral fracture among the femur shaft fractures in the RA patients was considered a significant risk factor for nonunion and delayed union.
The high prevalence of atypical femoral fracture among the femur shaft fractures in the RA patients was considered a significant risk factor for nonunion and delayed union.
Open reduction and internal fixation (ORIF) with transarticular screws to stabilize Lisfranc injuries may increase the risk of arthritis or affect outcomes. Joint-preserving fixation using staples, bridge plating, or Lisfranc screws avoids iatrogenic articular damage. This study analyzes functional outcomes and complications in Lisfranc-injury patients who underwent joint-preserving fixation.
We conducted a retrospective review of patients treated for Lisfranc injury at a Level 1 trauma center from July 2008 to October 2015. Patients over 18 years of age, with no concomitant procedures in the lower extremities, were included. Functional outcomes were evaluated through American Orthopaedic Foot and Ankle Society (AOFAS) scores.
Fourteen patients met the inclusion criteria. The average followup time was 57 months (range 22-102 months). AOFAS scores averaged 80.4 (standard deviation [SD] 16) at the time of the latest followup, with time to return to regular activities averaging 34 weeks (SD 25 weeks). Five patients had their hardware removed, and two required subsequent fusion during the followup period. The single complication involved a screw backing out, with subsequent removal.
In this case series, joint-preserving fixation for Lisfranc injuries offered similar AOFAS scores as those reported for ORIF with transarticular screws but with a decreased rate of hardware removal and need for midfoot fusion.
In this case series, joint-preserving fixation for Lisfranc injuries offered similar AOFAS scores as those reported for ORIF with transarticular screws but with a decreased rate of hardware removal and need for midfoot fusion.
Lisfranc injuries are uncommon and can be challenging to manage. There is considerable variation in opinion regarding the mode of operative treatment of these injuries, with some studies preferring primary arthrodesis over traditional open reduction and internal fixation (ORIF). We aim to assess the clinical and radiological outcomes of the patients treated with ORIF in our unit.
This is a retrospective study, in which all 27 consecutive patients treated with ORIF between June 2013 and October 2018 by one surgeon were included with an average followup of 2.4years. All patients underwent ORIF with joint-sparing surgery by a dorsal bridging plate (DBP) for the second and third tarsometatarsal (TMT) joint, and the first TMT joint was fixed with transarticular screws. link2 Patients had clinical examination and radiological assessment and completed American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Foot Function Index (FFI) questionnaires.
Our early results of 22 patients (5 lost to followup) showed that 16 (72%) patients were pain free, walking normally without aids, and wearing normal shoes and 68% were able to run or play sports. The mean AOFAS midfoot score was 78.1 (63-100) and the average FFI was 19.5 (0.6-34). link3 Radiological assessment confirmed that only three patients had progression to posttraumatic arthritis at the TMT joints though only one of these was clinically symptomatic.
Good clinical and radiological outcomes can be achieved by ORIF in lisfranc injuries with joint-sparing surgery using DBP.
Good clinical and radiological outcomes can be achieved by ORIF in lisfranc injuries with joint-sparing surgery using DBP.
This study looks at the outcome of percutaneous quilting technique for the treatment of closed degloving injuries or Morel-Lavallée lesions (MLL).
Prospective single-centre nonrandomized case series.
Patients with MLL visiting our hospital between January 2012 and May 2018.
The method involves percutaneous single-stage suturing of skin and deep fascia with heavy, non-absorbable, non-braided sutures starting from periphery to centre.
Resolution of the lesion.
Twenty-two patients with MLL treated, which included 18 males and 4 females with an average age of 22 (range 16-52). Lesions varied in length from 12 to 60cm. The average time gap from the injury to drainage of the lesion was 7days (range 2-60days). We followed these cases weekly for 4weeks and then once a month until 6months and then at the end of the year. All 22 cases healed uneventfully.
Percutaneous drainage along with suturing of the skin and subcutaneous tissue to deep fascia prevents the discordant movement and obliterates the dead space-aiding apposition of the layers.
