Total Hip Replacement in Avascular Necrosis of Femoral Head

Background

A study was conducted to evaluate the role of total hip replacement in cases of advanced avascular necrosis of the head of femur in patients admitted to two tertiary care military hospitals. 20 patients reporting with avascular necrosis of femoral head were taken for study.

Methods

Out of 20 patients, 16 were males and 4 were females. In 7 cases there was history of chronic alcohol intake and among them one patient was on steroids for long time for the treatment of bronchial asthma. 2 patients developed avascular necrosis of the femoral head following pregnancy and in two cases, it was post-traumatic. In the remaining nine cases, no cause was found and were so considered idiopathic. They were evaluated pre-operatively and total hip replacement was done in all twenty cases.

Results

Patients were evaluated using Harris hip score. There was improvement of the score in all cases.

Conclusion

Total hip replacement is a boon for patients of advanced avascular necrosis of femoral head.Key Words: Avascular necrosis, Total hip arthroplasty, Harris hip score     

Densitometric evaluation might prevent failure of knee artroplasty for aseptic loosening: An 8-year observational controlled study

Objectives:

To study the correlation between quantitative ultrasound (QUS) expressed as stiffness index (SI) and the risk of aseptic loosening of knee arthroplasty.

Methods:

An observational retrospective controlled study was performed on 85 female patients (mean age: 73.3 years) divided into 2 groups from January 2007 to March 2015 and carried out at the Orthopedic Rehabilitation Unit, Casa di Cura Eremo, Arco, Trento, Italy. Group A included 42 patients who had undergone a revision of knee prosthesis for aseptic-loosening, and group B included 43 age-matched patients who underwent primary replacement of the knee without following aseptic loosening. Patients in both groups were evaluated for SI with Achilles - QUS system at the same side of the surgery.

Results:

In group A, 20/42 patients (47.6%) had an SI T-score below -2.5. In group B, 14/43 (32.5%) patients had a SI T-score below -2.5. The difference between the 2 groups was statistically significant (p=0.015).

Conclusion:

Stiffness index appears to be an important predictor of aseptic loosening of the knee prosthesis. Therefore, densitometric evaluation, including SI, may be recommended before surgical knee replacement.Periprosthetic bone loss is the most common complication of arthroplasty. Some degree of bone loss is present in every failed total knee arthroplasty.1 There are several factors leading to bone loss including wear debris and stress shielding. The implantation of exogenous material into the organism causes foreign body reactions characterized by the activation of macrophages and consequent release of a myriad of bio reactive agents (reactive oxygen intermediates, degradative enzymes and acids). The reaction ends in the formation of foreign body giant cells at the material interface and the consequences can be devastating. Biomaterial surface properties play an important role in the development of the reaction. One of the primary causes of damage is the production of particulate wear debris, which is the consequence of the articular motion. Wear debris is able to induce inflammation at the interface between implants and bone, and osteolysis is the final result.2 Extremely high blood metal ion levels have been found in patients after arthroplasty, even in asymptomatic patients with a stable prosthesis, but the ion levels were significantly higher in patients with severe bone loss.3 Another factor is represented by the stress shielding: in a healthy person the bone will remodel in response to the loads it is placed under, therefore, the absence of the load causes bone loss. In addition to prosthetic shapes and sizes, implant fixation methods (including surface treatments), clinical installation, interface micromotions, and periprosthetic high hydraulic pressure can play a role in the mobilization of the prosthesis.4 Previous osteoporosis may be an important cause of failure of prosthetic implants: it has been demonstrated that low systemic bone mineral density (BMD) evaluated with dual x-ray absorptiometry (DXA) increases migration, and delays osseointegration of cementless femoral stems in women who had underwent cementless total hip arthroplasty.5,6 Quantitative ultrasound (QUS) is a recent developed technique that can assess both bone mass and architecture densitometry.7 Frediani et al8 in 2006 compared QUS (Achilles Express) and DXA for the evaluation of vertebral fracture risk: 764 post-menopausal women with non-traumatic vertebral fractures versus 770 post-menopausal women with normal morphometry were evaluated. The authors concluded that both QUS and DXA were able to discriminate women with from women without fracture and were independent predictors of fracture. Moreover, BMD and stiffness were both able to indicate the risk of fracture.8 The aim of this study is to investigate the correlation between bone mass evaluated with practicable QUS, and the risk of aseptic loosening of knee arthroplasty.     

Ceramic on Ceramic or Ceramic-on-polyethylene for Total Hip Arthroplasty: A Systemic Review and Meta-analysis of Prospective Randomized Studies

Background:

Wear debris of polyethylene has become a restraining factor of the durability for total hip arthroplasty (THA). Ceramic on ceramic (COC) has better wear resistance while the squeaking sound and prosthesis fracture are of concern. It is still a controversy that bearing couples are better for THA.

Methods:

We performed a systematic review of all English articles identified from PubMed (1966-), Embase (1980-) and the Cochrane Library. Clinical outcomes, complications, revision rates, and radiographic outcomes of COC-THA and ceramic on polyethylene (COP)-THA were compared and evaluated.

Results:

Eight prospective randomized trials enrolling a total of 1508 patients and 1702 THA surgeries were identified. Our results demonstrated the prosthesis fracture and the squeaking sound is significantly higher in COC group and higher wear rate of the COP. Hip function, loosening rate, dislocation rate, revision rate, and the osteolysis rate were comparable between two groups. According to Grading of Recommendations Assessment, Development and Evaluation system assessment, the strength of evidence was high for prosthesis fracture, dislocation, osteolysis, and moderate for radiolucent line or loosening, hip noise, and revision.

Conclusions:

Up to now, there is insufficient evidence to identify any clinical advantage of COC compared with COP. Longer follow-up of larger randomized trial is needed to clarify the outcomes.     

Cemented hemiarthroplasty in traumatic displaced femoral neck fractures and deep vein thrombosis: is there really a link?

INTRODUCTION

Traumatic displaced femoral neck fractures in the elderly can be treated with cemented or uncemented hemiarthroplasty with good outcomes. Earlier studies reported a higher incidence of deep vein thrombosis (DVT) associated with cemented prostheses in elective total hip or knee arthroplasty. In addition, the hypercoagulable state after a traumatic femoral neck fracture and possible thrombogenic properties of bone cement could put these patients at greater risk for thromboembolism. We aimed to compare the incidence of DVT and progression to pulmonary embolism (PE) or mortality in cemented and uncemented hemiarthroplasty.

METHODS

The data of 271 patients treated with cemented or uncemented hemiarthroplasty after a traumatic displaced femoral neck fracture was retrospectively analysed for the incidence of DVT. The level of thrombosis, progression to PE and mortality were compared.

RESULTS

There were 133 (49.1%) patients with cemented hemiarthroplasty, while 138 (50.9%) had uncemented hemiarthroplasty. The patients had an average age of 76.6 (range 53–99) years and 11 (4.1%) patients had DVT. There were no significant differences in development of DVT, level of thrombosis, PE and mortality regardless of whether a cemented or an uncemented prosthesis was used.

CONCLUSION

Cemented hemiarthroplasty is not associated with higher risks of DVT, PE or mortality in patients with traumatic displaced femoral neck fracture. Cemented prostheses can be safely used for this group of patients.     

Clinical Appraisal of Indigenous Below Knee Endoskeletal Carbon Fibre Prosthesis

Background

Amputation is a catastrophe, which results in physical, social, psychological and economic handicap. Provision of suitable prosthesis (artificial limb) is a major step towards rehabilitation of these patients.

Methods

With an aim to provide comfortable, prosthesis to these patients, Artificial Limb Centre (ALC) Pune, developed Below Knee Carbon Fibre Shaft Endo-Skeletal (BK ES CF) Prosthesis in collaboration with DEBEL, Bangalore, a DRDO establishment. 815 Below Knee Amputee patients have been provided with the newly developed Endo-skeletal prostheses at ALC Pune till 31 Dec 2003. New BK ESCF prosthesis was evaluated for its performance by feedback received from 500 patients.

Results

More than 86% patients were satisfied with the performance of new prosthesis and they achieved almost normal gait.

Conclusion

The performance of new BK ESCF prostheses was excellent and it achieved good clientele satisfaction.Key Words: Prosthesis, Endoskeletal, Rehabilitation, Performance, Clientele satisfaction     

Crown Cementing Strategy for Naval Divers

Background

A large number of personnel working in hyperbaric environment such as divers and submariners during escape drills report to the out patient department with split teeth, displacement of restoration and pain during ascent after diving. These symptoms are probably attributable to dental barotraumas. Therefore, a need was felt to undertake a study in this area, with a specific interest for treating these patients.

Methods

Sixty extracted single rooted premolar teeth were prepared and full cast crowns were cemented. Out of these, 20 were prepared with zinc phosphate, 20 with glassionomer and 20 with resin cement. After seven days of storage, each of the teeth in experimental group was pressure cycled 15 times to 3 atmospheres after which the force required to dislodge the crowns was tested on an Instron testing machine.

Result

A significant difference was found (student''s t test p value < 0.01) between the force required to dislodge the crowns with zinc phosphate cemented control group (141.70 ± 38.62) and experimental group (16.92 ± 10.13). Similarly a significant difference was observed in the glassionomer cemented control group (184.33 ± 25.33) and experimental group (90.50 ± 34.07). On the other hand, no difference was found between the resin cemented control group (289.15 ± 81.48) and experimental (279.43±87.48) group.

Conclusion

Within the limitations of this study and based on the results, it was concluded that environmental pressure cycling affected the retention of crowns cemented with zinc phosphate and glassionomer cement. Panavia resin cement used in this study appeared to be unaffected by environmental pressure cycling. On the basis of the results of this study, dental surgeons should consider cementing fixed prosthesis with resin cements for patients who are exposed to marked variations in environmental pressure, such as divers and submariners during escape drills.Key Words: Barodontalgia, Crowns, Luting cements     

Spiral CT Angiography: Applications in Neurovascular Imaging

Background

The advent of Spiral Computed Tomographic (CT) angiography has provided the patients a non-invasive, accurate and fast modality of imaging the vasculature.

Methods

Spiral CT angiography was performed in 30 patients to evaluate intracranial circulation using standard protocols of data acquisition. The images were processed and reconstructed in 3-dimension to delineate anatomy and pathology accurately.

Results

The study established that CT angiography is an accurate modality for evaluating the intracranial circulation in a variety of abnormalities. It is safe both in terms of being non-invasive and exposure to radiation. It has a distinct advantage over other non-invasive modalities of imaging like MRI in the evaluation of patients with metallic stents and clips.

Conclusion

CT angiography has tremendous potential in imaging the intracranial vasculature. It is unquestionably safer than catheter angiography as it avoids arterial puncture and intra-arterial catheter manipulation. It is fast and capable of producing excellent 3-dimensional images of the intracranial vasculature.Key Words: Neurovascular imaging, Spiral CT, CT Angiography     

Reliability of limb alignment measurement for high tibial osteotomy with a navigation system

Objective

High tibial osteotomy (HTO) is one treatment option for young and active patients with unicompartmental osteoarthritis. The success of this procedure substantially depends on the degree of correction of the mechanical axis. Computer-assisted navigation systems are believed to improve the precision of axis correction through intraoperative real-time monitoring. This study investigates the accuracy of limb alignment measurements with a navigation system on a cadaver specimen.

Materials and methods

The measurements were performed on a well-preserved cadaver specimen with a mechanical leg axis of 4° varus. Data was collected during the HTO workflow. Repeated serial measurements were undertaken by four different surgeons. After these measurements, different landmarks were deliberately set at the wrong place to examine the influence of mistakes during registration.

Results

There was a high intra-and interobserver reliability with a mean mechanical leg axis of 3.9° ± 0.7° and a mean error of 0.6°. The grossly incorrect placement of landmarks for knee and ankle center resulted in an incorrect mechanical leg axis of 1° valgus up to 10° varus.

Conclusion

The computer-assisted navigation system provided precise information about the mechanical leg axis, irrespective of the observer''s experience.     

Incidence and risk factors for development of venous thromboembolism in Indian patients undergoing major orthopaedic surgery: results of a prospective study

Introduction

The incidence of venous thromboembolism (VTE) in Western populations undergoing major orthopaedic surgery without any thromboprophylaxis has been reported to range from 32% to 88%. There is however limited information on incidence of VTE in Indian patients and most of the Indian patients undergoing these surgeries do not receive any form of prophylaxis regardless of their risk profile.

Methods

A prospective study was performed on 147 patients undergoing major orthopaedic surgery for total knee replacement (TKR), total hip replacement (THR), and proximal femur fracture fixation (PFF) without any prophylaxis. These patients were profiled for presence of the known risk factors responsible for development of VTE. A duplex ultrasound on both lower limbs was done 6 to 10 days after surgery. Twenty three patients underwent THR, 22 patients underwent TKR, and 102 underwent surgery for PFF. The patients were assessed clinically for any signs of deep venous thrombosis (DVT) and pulmonary embolism (PE). A helical CT scan was done in case of suspicion of PE and a duplex ultrasound was done in case of clinical suspicion of DVT irrespective of the stage of study.

Results

The overall incidence of VTE was 6.12% and that of PE was 0.6%. The risk factors that were found to be significantly responsible for development of VTE (p < 0.05) were: immobility greater than 72 hours, malignancy, obesity, surgery lasting more than two hours.

Conclusion

The study reconfirms the belief that DVT has a lower incidence in Indian patients as compared with other ethnic groups.     

Tracheo-esophageal Puncture (TEP) for Voice Rehabilitation in Laryngectomised Patients Blom-singer? Vs Provox? Prosthesis : Our Experience

Background

Stage III and IV cancers of larynx and hypopharynx often require total laryngectomy which leaves the patient with severe communication handicap. In such laryngectomised patients tracheo-esophageal puncture is the best way for voice rehabilitation using either Blom-Singer® prosthesis or Provox® indwelling valve.

Methods

A prospective comparative study of Blom-Singer® prosthesis and Provox® indwelling valves placed in Tracheo-esophageal Punctures (TEP) for voice rehabilitation following total laryngectomy was carried out at the Tata Memorial Hospital, Mumbai and Malignant Diseases Treatment Centre of Armed Forces, to assess their efficacy. This report comprises of our experience in 41 (39 males and two females) laryngtectomees who underwent TEP of which 15 patients were fitted with low pressure Blom-Singer® prostheses and 26 with Provox® indwelling prostheses.

Results

Prostheses related problems like granuloma formation, leakage, candidal growth over the valves and prosthetic decay were significantly less in the patients fitted with Provox® prosthesis. Dislodgement of prosthesis with closure of the tract or persistent fistula formation and creation of false passage, while reinsertion were problems encountered in the Blom-Singer group. After three months, speech assessment revealed a better quality of voice production and patient compliance in maintaining the prosthesis in the case of Provox® indwelling valve.

Conclusion

In Indian scenario where illitracy amongst the patients hinders in maintainence of Blom-Singer® prosthesis, Provox® indwelling value is an appropriate choice for voice rehabilitation.Key Words: Tracheo-esophageal puncture (TEP), Blom-Singer® prosthesis, Provox® Valve     

Improvement of hip abductor muscle weakness after lumbar decompressive surgery

Introduction.

Degenerative lumbar spinal disorder is common in Japan, and the L5 nerve root is commonly involved in this disorder. The symptoms of L5 radiculopathy are irradiating lateral leg pain, and numbness and weakness of tibialis anterior and the hip abductor muscle. There has been only one report on the results of surgery for hip abductor muscle weakness caused by degenerative lumbar spinal disorder.

Patients and methods.

In this study, we analyzed the strength of the hip abductor muscle before and after decompressive surgery in 26 cases and the relationship between the lumbar disc herniation (LDH) and lumbar spinal canal stenosis (LSCS) groups.

Results.

Of the total 26 cases, muscle strength improved in 23 cases (88%), with complete recovery in 17 cases (65%). In the LDH group, the improvement rate was 92%. In the LSCS group, the improvement rate was 68%. Although the improvement rate for the LDH group was higher than that for the LSCS group, the difference was not significant (P = 0.054).

Discussion.

Decompressive surgery may be an effective method to improve hip abductor muscle weakness in degenerative lumbar spinal disorder.     

Short-term outcome after posterior versus lateral surgical approach for total hip arthroplasty - a randomized clinical trial*

Purpose

Currently, total hip replacement (THR) is most commonly performed via a posterior or a direct lateral approach, but the impact of the latter on the invention''s outcome has yet not been quantified.

Methods

We compared the short-term outcome of cementless THR using the both approaches in a prospective, randomized controlled trial. 60 patients with unilateral osteoarthritis were included. Outcome assessment was performed one day before surgery and one week, four weeks, six weeks and 12 weeks after surgery, respectively, using the Harris Hip score as primary objective.

Results

We found no significant difference in the intraindividual Harris Hip Score improvement at the pre-and three months post-operative assessments between both treatment groups (p = 0.115). However, Harris Hip scores and most functional and psychometric secondary endpoints showed a consistent tendency of a slightly better three months result in patients implanted via the posterior approach. In contrast a significant shorter operating time of the direct lateral approach was recorded (67 minutes versus 76 minutes, p < 0.001).

Conclusion

In our opinion this slightly better short-term functional outcome after posterior approach is not clinical relevant. However, to make definitive conclusions all clinical relevant factors (i.e. mid- to long-term function, satisfaction, complication rates and long-term survival) have to be taken into account. Level of evidence: I - therapeutic     

Hip Fractures: The St Ann's Bay Regional Hospital Experience

Objectives:

To study the outcome of hip fractures in a cohort of patients from two different time periods (2002–2003 and 2006–2008).

Methods:

Patients treated for hip fractures at the St Ann''s Bay Regional Hospital, which provides orthopaedic care for the parishes of St Ann, St Mary and Portland, were retrospectively analysed between 2002–2003 and 2006–2008.

Results:

A significant increase in the recorded incidence of hip fractures, from 19 in the 2002–2003 time period to 101 in the 2006–2008 time period was noted. There was a drastic fall in the in-hospital mortality rate (43% in the 2002–2003 time period compared to 4.5% in the 2006–2008 time period). In the 2006–2008 period, 82.9% of patients were ambulant at discharge compared to 36% from the 2002–2003 time period.

Conclusion:

Early surgical fixation is necessary to allow rapid mobilization in these patients for whom the consequences of bed rest would otherwise be devastating.     

Can hormone replacement therapy prior to oocyte donation cycle in women with premature ovarian failure improve pregnancy rate?

Background

Infertility is an important issue in women with Premature Ovarian Failure (POF). With no conclusive treatment available to enhance fertility in these women, it is the use of donor eggs with In-Vitro Fertilization (IVF) which can fulfil their desire to become a mother in a novel way. Hormone replacement therapy (HRT) in POF apart from correcting the endocrine defect also helps in improving the milieu of the uterus by improving its vascularisation and the sub endometrial blood flow. We thus aimed to carry out a study to find out whether hormone replacement therapy if administered prior to the oocyte donation cycle in patients of premature ovarian failure improves the pregnancy rate.

Methods

A comparative study was carried out incorporating 46 subjects with 23 in each group. Group A received HRT prior to their oocyte donation cycle while the second group entered into the oocyte donation programme directly after an artificially induced menstruation.

Results

It was observed that, although the HRT group had a slightly higher pregnancy rate, with a better mean endometrial thickness as compared to the non HRT group it was not statistically significant.

Conclusions

Institution of hormone replacement therapy does improve the vascularisation of the uterus, corrects the histologic features of the uterine lining and makes the endometrium receptive but whether it enhances the pregnancy rate needs to be elucidated with further studies.     

Reconstruction of Cranial Defects in Armed Forces Personnel - Our Experience

Background

The aim of this study was to evaluate the efficacy of heat cured ‘poly methyl methacrylate resin prosthesis and to assess the acceptability of the indigenously manufactured titanium mini bone plate and screws in patients treated for repair of cranial defects.

Methods

17 patients with cranial defect were treated for reconstruction of the skull defect with two types of implants i.e. Acrylic resin plate prosthesis and titanium minibone plates, either in combination or singularly. In these cases, the skull defects resulted from trauma (88.23%) or due to ablative tumour surgery (11.96%). Acrylic implant was used in 12 cases (70.85%), titanium plates and screws in 2 cases (11.76%) and a combination of both of the above in 3 cases (17.64).

Results

The primary reconstruction was carried out in 2 cases (11.96%) and secondary reconstruction was done in 15 cases (88.23%). Majority of the cases underwent secondary reconstruction because of the initial surgical emergency requiring quick debulking and closure. In 2 cases where primary reconstruction was done, the second surgery could be avoided with gratifying results.

Conclusion

70.85% underwent reconstruction with polymethyl methacrylate resin prosthesis and in the rest either titanium plates were used singly or in combination. Only in one patient, there was rejection of the implant due to infection. In 94% cases the graft was well taken up with excellent results.Key Words: Cranial reconstruction, Mini bone plates, Cranial prosthesis     

Development of computerized color vision testing as a replacement for Martin Lantern

Background

Development and standardization of computerized color vision testing as a replacement for Martin Lantern test. Non-randomized comparative trial.

Methods

All candidates of SSB, Allahabad, reporting for SMB underwent color vision testing at the eye dept by computerized eye test and currently available tests.

Results

All candidates were subjected to Ishihara chart testing and those found to be CP III were subjected to the confirmatory test on Martin Lantern and the Software. Candidates requiring CP I standards for eligibility were tested on the same on Martin Lantern and on the new software method. On comparison between the Standard Martin Lantern and the Software, the results were consistent and comparable with 82 patients testing CP I on the Martin Lantern and 81 on the software. Of the CP III patients, 253 tested positive on the Standard lantern test as compared to 251 on the software and of the CP IV group, 147 tested positive on the Standard lantern and 149 by the software method.

Conclusion

It was found that the software replicated the existing Martin Lantern accurately and consistently. The Martin Lantern Software can be used as a replacement for existing old Lanterns which are not in production since the early 20th century.     

Clinical evaluation of overdenture retention using indigenous dental implants

Background

The continuous resorption of the alveolar ridge after extraction of all the teeth can eventually result in a jaw anatomy which offers inadequate support for the dentures. This resorption can render the prosthesis inadequate in terms of both function and esthetics.

Methods

A study was conducted where 50 edentulous, denture-wearing patients, of either sex, were given mandibular implant overdentures, using their existing denture. The implants used were one piece implants with an integrated ball and socket joint for retention. A healing time of 3–4 months was given before loading.

Results

Implant failure was seen in 11 cases during the healing phase. A success rate of 78% was seen in this study during an observation period of 6 months. This success rate is significantly low as compared to global records where a success rate of 87–98% is documented. The patients were asked to grade the overdenture as poor, satisfactory, good and excellent in categories of masticatory efficiency, speech and overall comfort. 71.79% patients rated the overall comfort as excellent and the same percentage of patients rated the speech as good.

Conclusion

Implant retained overdentures help in improving the masticatory efficiency, speech and overall comfort of the patient as compared to conventional dentures.     

Effects of high voltage electrical stimulation on the rate of pH decline,meat quality and color stability in chilled beef carcasses

Objective

To determine the effects of high voltage electrical stimulation (HVES, 800 Voltage) on rapid decreases in pH values and improvements in meat quality.

Methods

A total of 50 beef carcasses were applied, divided into two groups, one as a control and another for HVES. Meat quality was evaluated based on M. longissimus dorsi by examining pH and temperature levels at 1, 2, 5, 10 and 24 h, while color stability was examined seven days after slaughter.

Results

HVES decreased the pH values of the meat and accelerated rigor mortis (P<0.05). HVES caused differences in instrumental color values compared with the control groups across the ageing period at 4 °C.

Conclusion

the HVES had positive effects on meat quality and color stability, in contrast to undesirable consumer preferences.