International Journal of Research in Orthopaedics
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Study of degenerative (non-lytic) spondylolisthesis grade 1 and 2 in axial MRI images
Get PDFBackground: The traditional imaging assessment of lumbar spondylolisthesis is in sagittal images noting movement of upper body over the lower body. It omits change at the facet.
Methods: The present observational, study included 35 patients with degenerative lumbar spondylolisthesis(non-lytic). Radiological analysis of all MRI images was done by 4 independent spinal surgeons and 2 radiologists. The study focused on the axial MRI images and changed relation between the superior articular process and inferior articular process and relation between inferior articular process and canal with thecal sac (traversing root).
Results: Majority of DS had sagittal oriented facets (71.43%). In 7 cases at the L3/4 and in 19 cases at L4/5 level both facet joints had sagittal orientation with forward (ventral) movement of IAP. The IAP was found to be encroaching or in close proximity of traversing root. In 1 patient at L3/4 and 6 patients at L4/5 joint was sagittal unilaterally, may be causing compression of the neural elements unilaterally, while on coronal side the IAP and SAP had a normal alignment and not causing neural encroachment
Conclusions: We need to concentrate on relation of IAP vs SAP at facet as seen in axial images of facet
Comparison of effectiveness of intraoperative subperiosteal versus periarticular analgesic cocktail injection for post operative analgesia in patients undergoing total knee arthroplasty
Get PDFBackground: Early postoperative pain management is pivotal in patients undergoing Total knee arthroplasty. The advantage of Local infiltration analgesia is its ability to provide control of pain without interfering with motor strength of the lower extremity, thereby allowing early mobilization of patients. This study compares the effectiveness of local analgesic cocktail injection given through subperiosteal vs. periarticular routes.
Methods: The study included 30 patients admitted for primary total knee arthroplasty. They were grouped into two groups based on different injection sites. Group A included patients who received subperiosteal injection and Group B included patients who received periarticular injection, under spinal anaesthesia. The difference in pain among the two groups, using VAS at 12, 24, 48, and 72 hrs postoperatively, postoperative range of movements, and Functional outcome using IKDC score at the end of 6 months were assessed and compared between the two groups.
Results: The mean VAS scores at 12, 24, 48, and 72 hrs were 0.87±0.35, 1.47±0.52, 1.80±0.41, 1.07±0.46 in subperiosteal group and 2.00±0.53, 2.47±0.52, 2.80±0.56, 1.93±0.59 in periarticular group. The 6 months postoperative IKDC scores were 51.34±0.41 and 51.04±0.61 respectively.
Conclusions: Subperiosteal cocktail injection can significantly reduce the postoperative pain and result in early recovery of range of movements, compared with periarticular cocktail injection in patients undergoing Total knee arthroplasty. But the long-term functional outcomes were comparable among both the groups
Functional outcome after arthroscopic mosaicplasty for localized osteochondral defects in the knee
Get PDFBackground: Articular cartilage is complex tissue that is able to withstand tremendous amount of force over many cycle but does not have the ability to heal even after minor injury. Treatment recommendation for articular cartilage injury and arthritis includes non-operative and operative management. Mosaicplasty is a reconstructive osteochondral grafting procedure for the treatment of articular defects of the knee. Mosaicplasty entails transplantation of small cylindrical osteochondral grafts from the non-weight bearing area of the femoral condyles and transplanting them in a mosaic like fashion into a prepared defect site on the weight-bearing surfaces of the same knee.
Methods: The present study was carried out in 30 patients in our hospital prospectively to determine the functional outcome results after arthroscopic mosaicplasty for localized osteochondral defects in the knee. We conducted a prospective study on 30 patients of osteochondral defect of knee. Patients were presented with pain and recurrent swelling in the knee after sustaining twisting injury in the knee. Diagnostic arthroscopy was done and the osteochondral defects is localized and treated with mosaicplasty. The graft is harvested arthoscopically from the non-weight bearing part of the femoral condyles using a harvester. Follow up of these patients is done according to Tenger Lysholm knee scoring scale at 03 months, 06 months after surgery.
Results: In our study 93.33% patients showed good to excellent results and 7% patients had fair and poor results.
Conclusions: Advantage of arthroscopic mosaicplasty includes implantation of hyaline cartilage without the need for any suture or adhesive, need for smaller incision minimally invasive and very less complications. Associated injuries like ACL/PCL or meniscal tear can be addressed in the same procedure. To conclude arthroscopic mosaicplasty is excellent procedure to address the focal articular cartilage injuries of knee.
Mechanisms of action of native collagen type II and Aflapin® on the pathophysiology of osteoarthritis and their evidences
Get PDFOsteoarthritis (OA) is a degenerative and chronic inflammatory disease that affects the entire joint tissue such as articular cartilage, synovial membrane, subchondral bone, and ligaments. Imbalance between anabolism and catabolism lead to degradation of articular cartilage which may further initiate inflammatory cascades. There is an interplay of mechanical and immune-mediated injuries that lead to cartilage destruction and inflammation in OA. The mainstay of OA treatment involves drugs like paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) which provide symptomatic relief in many cases; but are unable to inhibit disease progression. Also, long-term use of these drugs, is associated with major safety concerns. Native collagen type II (NC-II) and Aflapin, especially when used in combination, can slow down the disease progression in OA and serve as a safer and effective treatment option for OA. NC-II is non-hydrolyzed collagen having intact triple helix structure with active epitopes and antigenicity. Aflapin is a novel synergistic composition of Boswellia serrata gum resin having higher composition of 3-O-acetyl-11-keto-betaboswellic acid (AKBA). Various experimental studies have demonstrated the mechanisms by which both these agents exert their benefit in OA. Further, multiple clinical studies have demonstrated the efficacy and safety of NC-II and Aflapin, when used individually or as a combination. This is a narrative review of the pathophysiology of OA, current treatment modalities, and non-clinical and clinical evidence of the beneficial effects of NC-II and Aflapin in the management of OA
Aneurysmal cyst of the thumb in young adults: about an exceptional case
Get PDFThe aneurysmal bone cyst is a benign, locally aggressive tumour. It affects children and young adults with a preference for the long bones and the vertebrae, rarely the hand. Involvement of the thumb is exceptional, the author reports an observation in a young 18-year-old patient, complaining of a painful swelling of the right thumb. The positive diagnosis is evoked on radiography, confirmed by the histology after surgical biopsy. Radical excision was opted for our patient, who, unlike conservative treatments, seems to avoid recurrence
Isolated traumatic hip dislocation along with ipsilateral femur shaft fracture: rare case report with review of literature
Get PDFHip dislocation accompanied by an ipsilateral fracture of femur shaft is an uncommon injury usually seen after high-velocity trauma and often coincides with multiple systemic injuries. This case report describes a 27-year-old male who suffered a posterior hip dislocation and ipsilateral fracture of femur shaft following a motorcycle-car collision accident with no associated fractures of the acetabulum and femoral neck. He was treated with fixator-assisted hip reduction and intramedullary femur interlock nailing in lateral position in a same setting. The advantage of this method is that the rate of AVN of femoral head is decreased by decreasing the overall timing of surgery and it also allow early successful reduction of the hip. The risk of AVN should be explained to the patient beforehand even if the surgery is done within 6 hours. This case highlights the importance of timely intervention and effective surgical techniques in managing such complex injuries and also aims to share our experience in managing such rare injuries and review the existing literature on this rare injury
Comparison of OpenSim and AnyBody modeling system™ predictions in biomechanical modeling of upper extremities
Get PDFBackground: The study of muscle forces in upper extremities is pivotal for advancements in biomechanical modeling, contributing significantly to the field of orthopedics, rehabilitation, and sports science. Despite the prominence of OpenSim and AnyBody modeling system™ in this domain, a gap persists in comparative analyses specifically targeting muscle force predictions in upper extremity motions.
Methods: This study compares the predictions of muscle forces in static elbow flexion, shoulder flexion, and shoulder abduction using OpenSim and AnyBody modeling systemTM, hypothesizing significant differences in predictions attributable to their distinct modeling methodologies and assumptions. This work utilized generic models without subject-specific data and conducted simulations in both software environments, focusing on the magnitude and activation of major muscle forces under predefined kinematics.
Results: OpenSim and AnyBody modeling systemTM produced similar results when simulating elbow flexion, with both software predicting forces in the major muscles required to maintain the posture. However, discrepancies were observed between the two software for muscle force predictions during the shoulder flexion and abduction movements. AnyBody modeling systemTM appeared to be more robust as it included all the upper extremity muscles and predicted the major muscles forces required for these movements more accurately compared to OpenSim.
Conclusions: The results of this study show significant differences in muscle force predictions between OpenSim and AnyBody modeling systemTM, attributed to the unique modeling approaches, especially in representing muscle-tendon complexes and joint dynamics
Blood management in total knee arthroplasty: an exploratory study regarding the use of drain and tranexamic acid in two types of instrumentation
Get PDFBackground: This study investigates how presence or absence of drain or tranexamic acid (TXA) in 2 different types of instrumentation with invasion/sparing femoral canal affects hemoglobin drop after total knee arthroplasty (TKA).
Methods: This was a retrospective observational study that included 736 individuals divided in five groups, regarding conventional instrumentation (CI) or patient specific instrumentation (PSI), presence or absence of drain and TXA. Mean percentage of hemoglobin drop after the first postoperative day was compared for each group.
Results: Patients submitted to CI using drain and no TXA revealed the highest value (21,3%±9,1; p<0,001). Groups who received TXA and drain was not used, presented the lowest blood loss. Moreover, with the introduction of TXA PSI lost its advantage over CI.
Conclusions: TKA using CI, without drain and with TXA administration showed better results, reducing mean percentage of hemoglobin drop after surgery
Direct lateral approach for hemiarthroplasty: a case series
Get PDFWorldwide, hip fractures are a public health concern. The primary course of treatment for displaced femoral neck fractures is still surgery. Even now, hemiarthroplasty remains a highly preferred surgical procedure. The most popular methods for gaining access to the hip joint are the direct lateral and posterior approaches. Aim of this series is to research the short-term functional results, risks, and disadvantages of the direct lateral approach to the hip. Patients with traumatic neck of femur fracture coming to the Department of Orthopaedics, Calcutta National Medical College and Hospital and was elected for bipolar hemiarthroplasty as treatment option. Among the 12 cases 9 were males and 3 were females. The value of z is 2.4495. The value of p is 0.01428. The result is significant at p<0.05. Garden’s classification - there were 2 cases of type 3 garden and 10 cases of type 4 garden fractures. The value of z is 3.266. The value of p is 0.00108. The result is significant at p<0.05. Though there is a chance of iatrogenic gluteal nerve and vascular injury -which we did not encounter in our case - the direct lateral approach exposes the hip joint to a sufficient but limited degree. However, the risk of post-operative hip dislocation is minimal because the rotator cuff of the hip joint is preserved; none of the 12 cases that were chosen had this condition
Association of calcaneal spur in patients with plantar faciitis
Get PDFBackground: A benign and self-limiting condition, degeneration at the root of the plantar fascia at the medial calcaneal tuberosity of the heel is the etiology of plantar fasciitis. Calcaneal spurs are tiny, fibro-cartilaginous triangular projections. These are found in the calcaneum and can be of varied sizes. However, the degree of coexistence of the two conditions has not been established and the evidence is quite low. Knowing these associations would provide valuable insights and aid in better management protocols.
Methods: The study included 131 patients who were diagnosed with plantar fasciitis and a control group of 131 cases (who underwent heel X-ray and assessments for some other reason). The history and physical examination were the main factors used to diagnose plantar fasciitis. To check for the existence of calcaneal spurs and other heel pathologies in both groups, X-rays were taken.
Results: All patients suffered from heel tenderness and stretch pain in the plantar fasciitis group. The 84 cases (64.12%) in the plantar fasciitis group and 25 cases (19.08%) in the control group were noted to have calcaneal spurs. The difference in the incidence of calcaneal spur was found to be statistically significant (p<0.05). The mean age was noted to be significantly higher in the subgroup of calcaneal spur cases, in the plantar fasciitis group (p<0.05).
Conclusions: The incidence of calcaneal spur was noted to be significantly higher with plantar fasciitis versus control group, indicating an association between the two conditions