Infection risk stratification in total knee joint arthroplasty using a new scoring system.

Periprosthetic joint infection (PJI) is a catastrophic complication of total knee arthroplasty (TKA) adding significant costs to the health care system with increasing morbidity and mortality. The goal of this study was to develop a prognostic scoring system that could risk-stratify patients undergoing TKA for the risk of PJI. The study included 150 patients who underwent primary TKA from June 2012 to February2016. There were 60 patients in group I who were not risk stratified using the scoring system, while 90 patients were assigned to group II and were prospectively assigned scores based on the scoring system. Points were assigned for each pre-op variable and a scoring chart was developed. Group II patients scoring 4 or more were counseled to optimize their modifiable risk factors before proceeding with surgery. Retrospective chart review was done for patients in group I to find out their risk score for the study purpose. Nine out of 60 patients in group I were found to have score above 4 based on the chart review, of which 4 patients got infected (P<0.05). None of the group II patients got infected after TKA. In conclusion, our scoring system is an objective scoring system for preoperative risk stratification of patients undergoing TKA, thus helping identification and optimization of the risk factors preoperatively to decrease the risk of PJI.

Clinical outcome, functional outcome and patient satisfaction after cruciate retaining total knee arthroplasty for stiff arthritic knee - A short term outcome study.

BACKGROUND: Various authors have shown that Cruciate Retaining (CR) Total Knee Arthroplasty (TKA) has better long-term survivorship compared to Posterior Stabilized (PS), however most arthroplasty surgeons tend to use PS knees in patients with severe deformity and stiffness. There is limited data correlating stiffness and CR versus PS design. The aim of our study was to assess the outcome of CR TKA for patients with stiff arthritic knee. MATERIALS & METHODS: We evaluated the results of 30 knees with osteoarthritis and inflammatory arthritis and preoperative stiffness (ROM 15-90°), who had been treated with CR TKA with a mean follow up of 2 years. The primary outcome variable measures were improvement in the flexion, flexion deformity (FFD) and overall improvement in the arc of motion. Patients were also evaluated by Knee Society Score (KSS), WOMAC score and 5-point Likert scale for patient satisfaction. RESULT: At the time of final follow-up, the mean arc of motion improved from 75° preoperatively to 108° postoperatively and it was statistically significant (p < 0.001). Similar improvement was noted for FFD (15.43° to 0.83° (p < 0.001)), maximum flexion from 90.9° to 109.1° (p < 0.001), KSS clinical from 37.67 to 87.47 (p < 0.001), KSS functional from 58.5 to 93.83 (p < 0.001), WOMAC from 76.73 to 7.63 (p < 0.001). Further, the Likert Scale for patient satisfaction was excellent for 90% of the patients. CONCLUSION: This study clearly shows that the routine use of PS design for complex stiff knees has questionable scientific intent and standard CR TKA design in stiff knees can produce excellent outcome. Since there is slight preponderance of data pointing towards improved longevity with CR design, it would be a better option for the patients with longer life expectancy.

Arthroscopic ACL reconstruction using patellar bone tendon autograft and Rigidfix fixation - A midterm functional outcome.

BACKGROUND: Arthroscopic reconstruction of torn Anterior Cruciate Ligament (ACL) with bone patellar tendon bone autograft (BTB) has become the gold standard in treating ACL tear with high success rate. The purpose of this study was to prospectively evaluate the functional outcome after arthroscopic ACL reconstruction using BTB via Rigidfix femoral fixation. MATERIALS AND METHOD: We evaluated the result of 21 knees that have been treated with arthroscopic ACL reconstruction using BTB autograft for femoral fixation and bioabsorbable interference screw for tibia from March 2014 to August 2015. The mean follow up period was 18 months. RESULTS AND CONCLUSION: The Lysholm score postoperatively was 89.04. 23.8% of the 21 patients have good to excellent outcome, 66.7% patients have good to fair outcome and 9.5% patient have fair outcome. LEVEL OF EVIDENCE: IV.

Tuberculous tenosynovitis presenting as finger drop: a case report and a systematic review of the literature.

BACKGROUND: Isolated tuberculous tenosynovitis and bursitis are rare among musculoske let al tuberculosis, but it is one of the major causes for chronic tendon sheath infection in developing countries. In hand, it is usually presented as a compound palmer ganglion (radio ulnar bursa), tenosynovitis of the flexer tendon sheaths and very few cases of tubercular tenosynovitis affecting the extensor tendons also are reported. CASE PRESENTATION: We are reporting a rare case of tuberculous extensor tenosynovitis with rupture of the extensor digitorum tendon in an elderly Indian man. This case report and review meets the ethical standard of the journal. CONCLUSION: Delayed diagnosis of tuberculous tenosynovitis is due to numerous differential diagnoses and slow progression. For all chronic synovitis around the wrist, consider Mycobacterial infection as an important differential diagnosis. Early diagnosis, radical excision combined with multidrug antituberculous therapy gives good functional results.

Extended trochanteric osteotomy: current concepts review.

BACKGROUND: Revision total hip arthroplasty is a technically demanding procedure which has gained importance for more than two decades. It was a nightmare for revision surgeons during its initial years of inception before the advent of extended trochanteric osteotomy (ETO). This technique gains access to the femoral medullary canal without compromising the bone stock and aids removal of primary implant and cement mantle without further damaging the parent bone. Like any other surgery, ETO does have certain limitations and complications as reported by various authors. Though it has been routinely used by revision surgeons, thorough knowledge of technical details of ETO is still lacking. So this review article is aimed at addressing the indications, surgical procedure, fixation technique, implant selection and complication of ETO which has been presented over a period of years by various authors. METHODS: We searched in the most commonly used portals like MEDLINE (PubMed) and Google scholar using appropriate terminologies for the literature regarding the various preoperative, intraoperative and postoperative clinical scenarios in which revision surgeons utilized ETO. RESULTS AND CONCLUSION: ETO is an important tool in the revision surgeon's armamentarium and can be used in variety of clinical scenarios and for various intraoperative needs and goals. Awareness about biomechanics of ETO, indications, implants selection, fixation techniques and complications is paramount for good intraoperative and postoperative outcome. ETO by posterior approach continues to be a work horse approach for most revision surgeons all over the world.