High Medium-Term Survivorship of Cruciate-Retaining Total Knee Arthroplasties (110 Knees) for Valgus Deformity.

The main purpose of this article is to evaluate the clinical outcomes and survivorship of cruciate-retaining (CR) knee arthroplasties for valgus deformity. This article is retrospective consecutive series of 110 valgus knees using CR implants with a minimum 2-year follow-up. Deformity correction was achieved using stepwise sequential soft tissue releases (iliotibial band, popliteus tendon, lateral collateral release through sliver femoral condylar osteotomy). Demographic data, range of movement, and degrees of deformity were collected. The Oxford Knee Score (OKS) was used as patients' reported outcome measure at final follow-up. One-hundred and four patients (110 knees) were included (87 females/17 males) with mean age of 68.7 years. Primary diagnosis was osteoarthritis in 85 patients and rheumatoid arthritis in 19 patients. Mean follow-up was 5.5 years (median: 5 years; range: 2-14 years). Preoperative valgus deformity was measured radiographically using the mechanical tibiofemoral angle with a mean 18.6° (standard deviation [SD]: 7.5; range: 11-38°). At final follow-up, mechanical tibiofemoral angle was 3.8° (SD: 1.97; range: 2-8°). A p-value was <0.0001 and mean OKS was 42 (SD: 5.4; range: 36-48) suggesting satisfactory patients' reported outcomes with no implant revision for any cause. CR implants for valgus knees using staged soft tissue releases including sliver condylar osteotomy had excellent medium-term survivorship and satisfactory patient reported outcome measures. The Level of Evidence for this study is IV.

Bilateral proximal tibia stress fracture following bilateral distal femoral hemiepiphysiodesis - A rare complication.

Correction of lower limb deformities by hemiepiphyseodesis with 8-plates is gaining popularity among deformity surgeons. Complications including metal failure, recurrence of deformity have been reported but stress fracture has not been reported. We have encountered bilateral proximal metaphyseal tibia stress fractures following correction of valgus deformity of both knees by hemiepiphyseodesis of distal femur following inadvertent overcorrection to a varus deformity following loss of follow up. The varus deformity has been reversed by guided growth of distal femoral physis resulting in fracture union and normal gait pattern. We herewith emphasize the importance of timely follow up with removal of 8 plates for hemiepiphysiodesis in deformity correction to prevent unexpected complication. We are reporting a rare complication of proximal tibial stress fractures following distal femur hemiepiphysiodesis done for valgus deformity with 8-plates.

Difference in trochanteric thickness between well-aligned and malaligned polished collarless stem.

BACKGROUND: Surgical techniques and instruments are continuously evolving to improve placement of components in ideal position. We investigated if there is difference in greater trochanter thickness between the stems in satisfactory position and stems in malposition and to assess the ideal thickness of trochanter for femoral stem placement in neutral position as under reaming of trochanter can result in stem malposition. METHODS: Measurement of greater trochanteric thickness in 95 hip replacements (posterior approach) was performed by a junior doctor and two hip fellows using the trauma CAD/PACS software. The stem was considered neutral if the central axis of femur passes through the distal tip of stem in AP and in varus if the tip of stem was lateral to the femoral shaft axis. RESULTS: 79 patients had stem in satisfactory position and 16 patients in varus malposition. Mean trochanteric thickness was 12.6 mm (+/-0.56 mm 95%CI, Median 12.5 mm, SD 2.5 mm) in neutral stems while mean thickness in the varus stem was 18.4 mm (+/-1.01 mm 95%CI, Median 17.8 mm, SD 2 mm). There was statistical significant difference between both groups with p< 0.0001 with intra-observer correlation at 99% between the senior personal while correlation was at 80% between the senior personnel and junior doctor. No statistically significant difference was noted in measurements between the senior personal. CONCLUSIONS: The study confirms the significant difference in greater trochanteric thickness between the well aligned and misaligned femoral components. The study raises the possibility that trochanteric thickness can be used as an accessory surgical aid to check if sufficient broaching has been done laterally to allow the stem to be seated in neutral position with an ideal remnant thickness of 12.5 mm. A surgical instrument can be developed to measure the intraoperative thickness of the trochanter which can be a useful tool for young hip surgeons for better placement of components.

Effect of phase separation on the kinetics of photocurrent relaxation in Sn-Sb-Se glassy films.

The effects of phase separation on the structure and photoconductivity kinetics in Sn(x)Sb(20)Se(80-x) (x = 10,11,12.5) glassy films have been studied. Crystalline peaks for SnSe(2), Sn(2)Sb(4)Se(8) and Sn(4)Sb(4)Se(10) phases are found in x = 12.5 films, while Sb(2)Se(3) is the other major phase revealed from x-ray diffraction studies. The optical gap remains constant at 1.55 eV for x = 10,11 samples and then decreases to 1.50 eV for the x = 12.5 film, while a blueshift in reflectivity maxima (R(max)) has been observed with Sn content. An increase in room temperature conductivity and a decrease in dc activation energy with Sn content have been observed. Bimolecular recombination is the dominant recombination process under steady state illumination for all of the samples. Decay of photocurrent (after cessation of light) fits well to a stretched exponential function; the decay time constant and dispersion parameter have been discussed. The growth of network connectivity with an increase in compositional/configurational disorder induces states in the mobility gap and affects the structure of band tails. These results have been interpreted in the light of the barrier cluster model developed for chalcogenide glasses.

Evaluation of the growth inhibitory activities of Triphala against common bacterial isolates from HIV infected patients.

The isolation of microbial agents less susceptible to regular antibiotics and the rising trend in the recovery rates of resistant bacteria highlights the need for newer alternative principles. Triphala has been used in traditional medicine practice against certain diseases such as jaundice, fever, cough, eye diseases etc. In the present study phytochemical (phenolic, flavonoid and carotenoid) and antibacterial activities of aqueous and ethanol extracts of Triphala and its individual components (Terminalia chebula, Terminalia belerica and Emblica officinalis) were tested against certain bacterial isolates (Pseudomonas aeruginosa, Klebsiella pneumoniae, Shigella sonnei, S. flexneri, Staphylococcus aureus, Vibrio cholerae, Salmonella paratyphi-B, Escherichia coli, Enterococcus faecalis, Salmonella typhi) obtained from HIV infected patients using Kirby-Bauer's disk diffusion and minimum inhibitory concentration (MIC) methods. T. chebula was found to possess high phytochemical content followed by T. belerica and E. officinalis in both aqueous and ethanol extracts. Further, most of the bacterial isolates were inhibited by the ethanol and aqueous extracts of T. chebula followed by T. belerica and E. officinalis by both disk diffusion and MIC methods. The present study revealed that both individual and combined aqueous and ethanol extracts of Triphala have antibacterial activity against the bacterial isolates tested.