Patients undergoing total knee arthroplasty (TKA) with end-stage osteoarthritis of knee have secondary foot and ankle pathology. Some compensatory changes occur at ankle and subtalar joint secondary to malalignment and deformity at the knee joint. Purpose was to evaluate the changes in hindfoot malalignment and foot deformities in patients with advanced osteoarthritis of knee requiring TKA and effect of correction of knee deformities post TKA on foot/Ankle alignment. 61 consecutive patients with Kellgren-Lawrence grade IV osteoarthritis knee undergoing TKA were enrolled in a prospective blinded study. Demographic data, deformities at knee and ankle, hindfoot malalignment and functional outcome scores such as VAS, KSS, WOMAC scores, Foot and Ankle Disability Index (FADI) and Foot posture index (FPI) were recorded preoperatively and postoperatively at 6, 12 weeks and final follow up (range: 6–21 months; mean: 14.2months).Introduction
Methods
Collapse of femoral head associated with end-stage arthritis form hallmark of osteonecrosis of femoral head. Purpose was to assess efficacy of platelet rich plasma following core decompression in early stage of osteonecrosis of femoral head. Forty consecutive age, sex and BMI-matched patients of osteonecrosis were enrolled for this prospective randomized comparative double blinded clinical study. 19 patients belonged to intervention group (PRP with Core decompression) and 21 to control (Core decompression) group. 8ml of autologous PRP was injected into channels alongwith Calcium Chloride (4:1) after core decompression. Patients were assessed for outcome measures by pain score, functional and Harris Hip scores, Modified Kerboul angle (combined necrotic angle) in MRI. Patients were followed up after 6, 24 weeks and final follow up (mean 10.33 months).Introduction
Methods
The mobile-bearings were introduced in total knee arthroplasty (TKA) to improve the knee performance by simulating more closely ‘normal’ knee kinematics, and to increase the longevity of TKA by reducing the polyethylene wear and periprosthetic osteolysis. However, the superiority between posterior-stabilized mobile-bearing and fixed-bearing designs still remains controversial. The objective of the present study was to compare the mid-term results of Scorpio + Single Axis system (Stryker Howmedica Osteonics, Allendale, New Jersey) for the mobile-bearing knees and Duracon system (Stryker Howmedica Osteonics, Allendale, New Jersey) for the fixed bearing design with regard to clinical and roentgenographic outcome with special reference to any complications and survivorship. Prospective, randomized, double-blinded controlled study was carried out on 56 patients undergoing primary, unilateral total knee arthroplasty for osteoarthritis, who were divided into two groups. Group I received mobile-bearing knee prosthesis (29 patients) and Group 2 received fixed-bearing prosthesis (27 patients). The patients were assessed by a physical examination and knee scoring systems preoperatively, at a follow-up of three months, six months, and one year after surgery by independent researcher who was not part of the operating team, and was blinded as to the type of implant inserted. We used the Oxford knee score (OKS) and Knee society score (KSS), with Knee Society Knee Score (KSKS) and Knee Society Functional Score (KSFS) being the subsets. The questionnaire for OKS was printed in our national language, and handed over to the patient at each visit.Introduction
Methods
Bilateral total knee arthroplasty (TKA) results in substantial perioperative blood loss with increased morbidity. Tranexamic acid (TXA) administration in either intravenous or topical form has been found to be effective in reducing perioperative blood loss. The objective of the present study was to compare the efficacy of topical versus intravenous TXA in reducing perioperative blood loss. Prospective, randomized, double-blinded clinical trial was carried out on 70 patients undergoing bilateral TKA, who were divided into two groups. Group I received equivalent dose of TXA intravenously 30 minutes prior to deflation of tourniquet of first knee and another dose repeated after 2 hours. Group 2 received topical TXA in the dose of 15mg/kg dissolved in100 ml of normal saline which was applied into the joint for 10 minutes at the end of implant insertion. Outcome measures were total blood loss as (calculated from the difference between preoperative and postoperative day3 haemoglobin (Hb) or Hb prior to transfusion), total drain output and amount of blood transfusion.Introduction
Methods
There is no effective therapy available today that alters the pathobiologic course of osteoarthritis. Recent advances have shown Mesenchymal stem cells to be a potential disease modifying treatment. Considering the tissue differentiation property and vast paracrine effects of MSCs we proposed the present study to find out the safety and efficacy of Mesenchymal stem cells in osteoarthritis of knee joint. 12 patients with grade 1and2 bilateral osteoarthritis knee (Ahlbacks radiological grading) were selected. 8–10 ml of bone marrow was aspirated under strict aseptic precautions from the iliac spine. After the stem cell culture and expansion for 4–6 weeks the MSC suspension in 10xPBS was injected directly into the 24 knees by lateral approach. The outcome was evaluated by modified VAS score, WOMAC score, KOOS and MRI measurement of knee articular cartilage integrity by the modified WORMS score.INTRODUCTION
METHODS
Blood loss, pain and wound healing contribute significantly to the perioperative morbidity after total knee arthroplasty. Prospective randomized controlled studies are lacking, to our knowledge. The purpose of this study was to determine whether platelet rich plasma (PRP) might prevent blood loss and postoperative pain and expedite wound healing following TKA. Forty consecutive age, sex and BMI-matched patients who had unilateral or bilateral arthritis of the knee with similar deformity and preoperative range of motion were enrolled for this prospective randomized controlled double blinded clinical trial. Preoperative haemoglobin, range of motion, WOMAC and KSS scores were noted. Platelet-rich plasma was applied over the wound including the capsule, medial and lateral recesses in seventeen patients. Twentythree served as controls. Postoperative haemoglobin, blood loss, blood transfusion, VAS score, Wound score, KSS and WOMAC score were recorded and evaluated.Background:
Methods:
Patients with symptomatic osteoarthritis of the knee are typically obese and relatively less active and may be associated with cardiovascular deconditioning and increased risk of heart disease. Purpose of this study was to evaluate the impact of the total knee arthroplasty upon cardiovascular status of the patient, as indicated by assessment of the endothelial function and correlation of the same with the functional outcome. Endothelial function has been found to correlate with the cardiovascular health of an individual closely and therefore was chosen as a noninvasive means to study the same. This study was conducted prospectively in 34 patients of advanced Osteoarthritis of knee joint (11 males, 23 females) who underwent unilateral (25) or bilateral (9) total knee arthroplasty at a mean age of 59.2 + 9.7 years (range 40–77 years). All the patients underwent preoperative assessment of endothelial function by the method of flow mediated dilatation (FMD). We report the results at 2 to 3.5 years (mean, 3.0) follow-up. The reassessment of the endothelial function and functional outcome in terms of Knee society score were performed at follow up. We noted excellent improvement in Knee society score (mean 102.3 + 22.9 at 6 months, 152.5 + 19.8 at 18 months and 174.4 + 17.3 at 42 months compared to 65.4 + 30.3 preoperatively). There was good improvement in endothelial function at 6 months (29.98 + 19.28%) and excellent improvement (69.87 + 35.57%) at 18 months and (85.65 + 26.14%) at 42 months respectively. Significant improvement in endothelial function can result following total knee arthroplasty.
We reviewed 64 anterolateral decompressions performed on 63 patients with tuberculosis of the dorsal spine (D1 to L1). The mean age of the patients was 35 years (9 to 73) with no gender preponderance. All patients had severe paraplegia (two cases grade III, 61 cases grade IV). The mean number of vertebral bodies affected was 2.6; the mean pre-treatment kyphosis was 24.8° (7 to 84). An average of 2.9 ribs were removed in the course of 64 procedures. The mean time taken at surgery was 2.45 hours when two ribs were removed and 3.15 hours when three ribs were removed. Twelve patients (19%) showed signs of neurological recovery within seven days, 33 patients (52%) within one month and 12 patients (19%) after two months; but six patients (10%) showed no neurological recovery. Forty patients were followed up for more than two years. In 34 (85%) of these patients there was no significant change in the kyphotic deformity; two patients (5%) showed an increase of more than 20°.
