International Journal of Research in Orthopaedics
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Latitud total hip replacement system in younger and older patients: a comprehensive multi-center assessment of clinical and functional outcomes
Get PDFBackground: Total hip arthroplasty (THA) is a standard treatment for end-stage hip disease. With rising demand across age groups, evaluating implant performance in younger and older patients is important. The Latitud total hip replacement system (HRS) is a novel implant,with no data on its safety and performance in younger patinets. Hence, We aimed to evaluate safety and functional outcomes of the Latitud HRS in younger (≤40 years) and older (>40 years) patients undergoing unilateral or bilateral THA.
Methods: This prospective multicenter study across 11 Indian centers enrolled 192 patients undergoing primary THA with the Latitud HRS, followed for 2 years. Primary outcomes were implant survivorship and revision rates; secondary outcomes were clinical improvement using Harris Hip Score (HHS), Oxford Hip Score (OHS), and adverse events.
Results: Of 192 patients, 67 were ≤40 years (55 unilateral, 12 bilateral) and 125 were >40 years (119 unilateral, 6 bilateral). Avascular necrosis predominated in younger patients, while osteoarthritis dominated older cases. At 2 years, OHS improved significantly in all groups: younger (unilateral 10.18±3.39 to 43.76±4.8; bilateral 8.75±2.83 to 43.08±4.01) and older (unilateral 8.06±4.67 to 43.69±4.68; bilateral 10.83±0.98 to 44.67±5.82). HHS also increased substantially: younger (unilateral 23.58±8.55 to 84.9±9.79; bilateral 19.71±10.93 to 89.4±5.07) and older (unilateral 18.16±12.13 to 86.38±7.89; bilateral 27.09±4.77 to 90). Implant survivorship was 100% in all except older unilateral (99.15%) due to one liner breakage.
Conclusion: The Latitud HRS demonstrated excellent survivorship and functional recovery across both age groups, supporting its safety and durability in Indian patients, including younger adults with high functional demands
Rare mimicry of bone tumors: systematic review of xanthogranulomatous osteomyelitis and its therapeutic implications
Get PDFXanthogranulomatous osteomyelitis (XO) is a rare chronic inflammatory lesion of bone that closely mimics malignant neoplasms. Its etiology and pathogenesis remain poorly defined, and only a small number of cases have been reported since the first description in 1984. The objective of this systematic review was to analyze all documented cases of XO to clarify clinical characteristics, diagnostic challenges, treatment strategies, and outcomes. A comprehensive search of PubMed, Scopus, and Embase, supplemented by reference screening, identified 26 well-documented cases. Data regarding demographics, anatomical distribution, clinical features, imaging findings, microbiology, pathology, treatment, and prognosis were extracted and synthesized. Patients ranged in age from 10 to 65 years, with a median of 32 years and a slight male predominance. The femur was the most frequently affected bone, followed by the tibia, ulna, humerus, pelvis, and spine. Pain and swelling were the predominant presenting features, while fever and systemic symptoms were less common but often led to misdiagnoses such as tuberculosis or malignancy. Imaging consistently suggested aggressive neoplasia, but histopathology confirmed the diagnosis in all cases, showing foamy histiocytes admixed with lymphocytes, plasma cells, and multinucleated giant cells. Microbiological cultures were positive in 35% of cases, most often Staphylococcus aureus, followed by Pseudomonas aeruginosa, Aspergillus spp., and Mycobacterium marinum. Treatment was primarily intralesional curettage with or without grafting, with wide resections performed only when malignancy could not be excluded preoperatively. Outcomes were uniformly favorable, with recurrence reported in only two cases after incomplete curettage. In conclusion, XO is a benign but deceptive entity that mandates biopsy for accurate diagnosis. Curettage with pathogen-specific antimicrobial therapy when indicated achieves excellent results, and multidisciplinary collaboration is essential to avoid unnecessary radical resections
Outcome of the treatment of developmental dysplasia of the hip after walking age with open reduction, varus derotation osteotomy with femoral shortening and acetabular osteotomy
Get PDFBackground: The principles of treatment of developmental dysplasia of hip after walking age are different than those of infants and neonates. The purpose of this study is to evaluate the radiographic and functional results of open reduction, varus derotation osteotomy with femoral and acetabular osteotomy of DDH in older children.
Methods: Between March 2021 and August 2023, 22 patients underwent one-stage triple procedure of open reduction, varus derotation osteotomy with femoral shortening and acetabular osteotomy for the treatment of DDH. Clinical outcomes were assessed using the modified McKay’s criteria. Radiographic assessment was made using Severin’s scoring system.
Results: The mean age at the time of operation was 5.068±1.8535 years (range 3–8 years) with male to female ratio 1:2.66. Mean preoperative acetabular index of the study population was 48.55±7.63 which significantly reduced to 23.68±2.93 postoperatively (p<0.05). The McKay’s score was excellent in 14 (63.6%) hips, good in 02 (9.1%) hips, fair in 01(4.5%) and poor in 05(22.7%) hips. The modified Severin’s class excellent was in 14 (63.6%) hips, good was in 02(9.1%) hips, fair is in 01 (4.5%) hip and poor was in 05 (22.7%) hips at the time of final evaluation as compared to none at the time of presentation.
Conclusions: Young children having DDH can be safely treated with an extensive one-stage procedure of open reduction, varus derotation osteotomy with femoral shortening and acetabular osteotomy, without increasing the risk of AVN. This one-stage surgical procedure for managing DDH patients after walking age also revealed acceptable clinical and radiological outcome
Age, gender, and site-specific variations in bone mineral density: a cross-sectional analysis of osteoporosis risk factors
Get PDFBackground: Osteoporosis is major health issue defined by decreased bone mineral density (BMD) and elevated fracture susceptibility. This study aimed to analyze age, gender, and site-specific variations in BMD and examine osteoporosis risk factors in an Indian population.
Methods: This study was conducted with cross sectional design on 77 participants (54 females, 23 males) aged 20-83 years undergoing 3 Dimensional quantitative computed tomography (QCT) for BMD assessment at a tertiary care hospital in India. BMD measurements of the spine and bilateral hips were analyzed along with demographic and clinical data. Statistical analyses included t-tests, multivariate logistic regression, correlation analysis, and Chi-square tests.
Results: The study revealed a high prevalence of osteoporosis (55.8%) and osteopenia (27.3%). Marked disparities in spine bone mineral density were noted between genders (p=0.023) and among age cohorts (p<0.0001). Age showed moderate negative relationship with spine BMD (r=-0.552, p<0.0001) and was recognized as a major predictor of osteoporosis (p<0.0001). Gender was not a significant predictor of osteoporosis after adjusting for age in our study.
Conclusions: This study highlights the critical role of age in BMD reduction and osteoporosis risk, with older individuals showing higher rates of osteoporosis. While gender differences in BMD were observed, age emerged as the primary predictor of osteoporosis risk. These findings emphasize the importance of age-related assessments in osteoporosis screening and management strategies
Functional outcome of displaced clavicle fractures treated with locking compression plate
Get PDFClavicle fractures, common in young, active individuals, often occur due to trauma or repetitive stress and account for about 2.6% to 5% of all fractures. These fractures typically happen in the midshaft and are often displaced. Historically, they were treated conservatively, but this approach often led to malunion and poor shoulder function. Recent studies show that surgical interventions, particularly with locking compression plates (LCP), improve healing, shoulder function, and reduce complications like non-union and malunion. Surgical treatments, such as open reduction internal fixation (ORIF) or closed reduction internal fixation (CRIF), are especially beneficial for displaced fractures or those with additional complications. LCPs provide better stability, especially in osteoporotic patients, although potential complications include screw loosening and infection. Overall, evidence supports surgical treatment with LCPs for better functional outcomes and fewer complications compared to nonoperative methods. This study is being done to assess functional outcome of clavicle fractures managed with open reduction with LCP. A prospective interventional study was conducted to assess functional outcome of clavicle fractures managed with ORIF with LCP. Constant-Murley score was evaluated before the treatment and were repeated after 6 weeks (T1), 12 weeks (T2) and 24 weeks (T3). The study involved 30 participants with an average age of 31.23 years, consisting of 80% males and 20% females. Of these, 53% had right-sided clavicular fractures, and 47% had left-sided fractures. Most surgeries were performed within 2-3 days of admission, with 93.33% of fractures showing union within 12 weeks. The constant Murley’s score, which measures functional outcomes, improved significantly over time: from 5.28 before surgery to 91.09 after 24 weeks. The functional outcome was graded excellent in 90% of patients. Statistical analysis showed significant improvement in scores post-surgery (p<0.001). Age had a weak positive correlation with better outcomes, while time from admission to surgery and time to union had strong negative correlations with functional outcomes. These findings suggest that faster surgery and quicker union lead to better functional recovery, and age has a slight impact on outcomes
Implant fixation on myositis mass masquerading as distal humerus: an intraoperative error
Get PDFMyositis ossificans is a non-neoplastic ossifying mass seen in association with a bony and soft tissue trauma. We present a case of myositis ossificans mass developed after a distal humerus fracture mimicking the shape of lateral humeral condyle which led to inappropriate fixation of implant over the mass. Preoperative planning, extensile surgical approach, complete excision of the mass and use of image intensifier are highlighted which will avoid complications like failure of fixation and recurrence
The hidden integration: J-sign patella as a predicting indicator for knee osteoarthritis and its therapeutic implications
Get PDFThe J-sign patella is an erroneous movement or tracking of the patella during knee movement, particularly when moving laterally during knee flexion, which can be symptomatic of patellar malalignment or instability, essential in developing and progressing knee osteoarthritis (KOA). The study aimed to determine the clinical significance of the J-sign patella as a diagnostic and prognostic tool in patients with KOA. The objective of this study was to comprehensively evaluate the clinical and pathophysiological importance of the J-sign patella in the onset, progression, and management of KOA, with a particular emphasis on its diagnostic, prognostic, and therapeutic implications. A systematic search was conducted to discover all relevant studies on the J-sign patella and its relation to the OA knee. Databases such as PubMed, Cochrane Library, and Scopus were used. A few research studies show the clinical significance of addressing J-sign patella in treating KOA
Clinical and radiological outcome of minimally invasive plate osteosynthesis in distal tibial fractures: a retrospective analysis
Get PDFBackground: Distal tibial fractures are a common injury that poses challenges in terms of treatment and outcomes. Minimally invasive plate osteosynthesis (MIPO) has emerged as a promising technique, reducing the need for large incisions while promoting faster recovery and fewer complications compared to traditional open reduction and internal fixation (ORIF). This study evaluates the clinical and radiological outcomes of MIPO in patients with distal tibial fractures.
Methods: A retrospective analysis of 40 patients who underwent MIPO for distal tibial fractures between November 2022 and November 2024 at a Tertiary healthcare center, was conducted. Fractures were classified according to the AO/OTA system. Outcomes such as fracture healing, functional recovery (measured using the AOFAS score), pain relief (assessed via the VAS), and complication rates were evaluated. Statistical analysis was performed using SPSS version 25, with p<0.05 considered significant.
Results: The mean age of the patients was 42.5±12.3 years. The majority of fractures were classified as type 43-A (70%). Fracture healing was achieved in 95% of cases by 24 weeks, with a mean time to union of 14.3±3.2 weeks. The AOFAS scores improved significantly from 72.5±13.1 at 6 weeks to 85.2±10.3 at 12 weeks (p<0.05). Pain reduction was also significant, with VAS scores decreasing from 6.25±2.14 at 6 weeks to 1.56±1.26 at 24 weeks (p<0.05). Complications were noted in 10% of cases, including superficial infection and delayed union.
Conclusions: MIPO offers favourable outcomes in the treatment of distal tibial fractures, with significant improvements in fracture healing, functional recovery, and pain reduction. The technique is associated with a low complication rate, making it a viable option for managing these fractures
Evaluation of the Ganga Hospital score in predicting outcomes of open tibial fractures
Get PDFBackground: Open tibial fractures, commonly caused by high-energy trauma, are associated with significant morbidity due to the bone’s subcutaneous location and role as a weight-bearing structure. The Ganga Hospital open injury severity score (GHOISS) is a tool used to assess the severity of open fractures and predict outcomes such as limb salvage or amputation, especially in resource-limited settings. Aim of the study was to evaluate the effectiveness of the GHOISS in predicting the outcomes of open tibial fractures.
Methods: This cross-sectional analytical study included patients with open tibial fractures admitted to the hospital. GHOISS was used to assess injury severity and predict the need for limb salvage or amputation. Functional outcomes were evaluated using the lower extremity functional score (LEFS). Data on injury mechanisms, fracture classification, treatment methods, and outcomes were collected and analysed.
Results: The GHOISS was found to be highly reliable in predicting outcomes. Lower GHOISS scores were associated with better functional outcomes and higher rates of limb salvage, while higher scores correlated with increased likelihood of amputation. LEFS scores correlated well with GHOISS, supporting its clinical validity.
Conclusions: The GHOISS is an effective tool for predicting the outcomes of open tibial fractures, improving clinical decision-making and patient management. It can lead to better functional outcomes and more efficient allocation of healthcare resources, particularly in resource-limited settings
GeneXpert versus histopathological examination and culture as a diagnostic tool for spinal tuberculosis: a comparative analysis
Get PDFBackground: Spinal tuberculosis, a common type of osteoarticular tuberculosis accounts for a significant proportion of extrapulmonary tuberculosis cases. This study compares the sensitivity, specificity of GeneXpert with histopathology and acid-fast bacilli (AFB) culture.
Methods: This study conducted at a tertiary health care and teaching institution from October 2018 to October 2023 included 60 patients with suspected spinal tuberculosis. Samples including vertebral tissue and pus, obtained by open biopsy, fluoroscopy or computed tomography (CT) guided percutaneous vertebral body biopsy were collected in sterile containers with 2-3 ml of saline and immediately sent for testing with GeneXpert and AFB culture. Histopathological samples were placed in 10% formalin prior to examination.
Results: When comparing GeneXpert with AFB culture, Sensitivity was found to be 82.2%, specificity 40.0%, positive predictive value (PPV) 80.4%, negative predictive value (NPV) 42.9% and accuracy was 71.7%. When comparing GeneXpert with histopathological examination (HPE), sensitivity was found to be 84.8%, specificity 50.0%, PPV 84.8%, NPV 50.0% and accuracy was 76.7%.
Conclusions: Despite longer diagnostic time as compared to GeneXpert, AFB culture is still the gold standard diagnostic modality