Impact of Covid-19 pandemic on arthroplasty services and early experience after resuming surgeries at a 'non Covid' center.

BACKGROUND: The aim of this study is to assess the impact of Covid-19 crisis on hip and knee joint replacement surgeries at a high volume tertiary care hospital in the Indian National Capital Region and to evaluate the early experience of resumption of arthroplasty services. METHODS: Institutional records of the arthroplasty cases, operated between 1st March to 31 August of 2019 (Group A, pre-Covid) and 2020 (Group B, pandemic year) were compared retrospectively over numerous parameters including the complications within six weeks of surgery. RESULTS: There was a significant drop (by 82.53 %) in the total number of arthroplasty surgeries in Group B (62) as compared with Group A (355). Average number of arthroplasties per month were 59.17 ± 12.93 and 10.67 ± 13.29 in Group A and Group B respectively (p < 0.001). There was a significant increase in postoperative complication rate 7/355 (1.97 %) in Group A vs 7/62 (11.29 %) in Group B during pandemic (p < 0.002), along with a higher 30-days mortality rate 2/355 (3.22 %) vs 2/62 (0.56 %). Pandemic year also saw an increased readmission rate (4.83 %) vs (0.56 %) and postoperative ICU transfer rate (1.61 %) vs (0.56 %) in comparison with pre-Covid year. CONCLUSION: In the pandemic, arthroplasty services got severely affected at our center. With nearly six fold increase in complication rates, higher 30-days mortality and increased readmission rates, caution is advised in resuming arthroplasty surgeries without robust evaluation of cases. Whether undetected Covid-19 infection or poor pre-existing disease control due to lockdown can be linked to these results is a matter of further research with larger multicenter studies.

Changes in Shoulder Rotator Strength After Arthroscopic Capsulolabral Reconstruction in Patients With Anterior Shoulder Instability.

BACKGROUND: The correlation between isokinetic internal and external rotation (IR and ER) strength and functional outcomes in patients with anterior shoulder instability treated by arthroscopic capsulolabral reconstruction (ACR) has not been studied. PURPOSE: To analyze isokinetic IR and ER strength and their correlation with clinical outcomes in patients with anterior shoulder instability treated by ACR. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between January 2004 and June 2015, a total of 104 patients who underwent ACR for anterior shoulder instability were analyzed. The mean peak torque (PT) in IR (IRPT) and ER (ERPT), PT deficit (PTD; %) relative to the opposite healthy shoulder, and PT ratio (PTR; ERPT/IRPT) were calculated before and 1 year after surgery. Functional scores were evaluated before surgery and at every follow-up visit. Recurrence and postoperative apprehension during ER at 90° of arm abduction were evaluated at 1 year and the final follow-up (76.6 ± 64.4 months). RESULTS: IR and ER strength were measured for 68 of 104 patients at 1 year after surgery. ERPT and IRPT were less on the involved side than on the uninvolved side before surgery (0.29 ± 0.10 vs 0.33 ± 0.10 N·m/kg, respectively, for ERPT [P = .002]; 0.36 ± 0.14 vs 0.41 ± 0.16 N·m/kg, respectively; for IRPT [P = .01]). At 1 year after surgery, IRPT on the involved side recovered (0.40 ± 0.20 N·m/kg), whereas ERPT remained weak (0.30 ± 0.13 N·m/kg) relative to the baseline value. PTD in IR (PTDIR) improved to 2.2% ± 24.4% (P = .012), whereas PTD in ER (PTDER) showed no improvement (13.5% ± 13.8%; P = .569). PTR on the involved side improved from 1.07 ± 1.71 to 0.86 ± 0.23 at 1 year (P < .001). All functional scores improved significantly at the final follow-up. At 1 year, 9 of 68 (13.2%) patients showed positive apprehension. PTDIR and PTDER on the involved side were worse in patients with positive apprehension than in those with negative apprehension (P = .039 and .014, respectively). PTDER was worse than PTDIR in patients with positive apprehension at 1 year (P = .022). CONCLUSION: For those with anterior shoulder instability, preoperative IR and ER strength of the involved shoulder were lower than those of the uninvolved shoulder. IRPT recovered, whereas ERPT remained weak after ACR. To prevent positive apprehension after surgery, IR and ER strengthening exercises are important, with more emphasis on exercises for ER.

Impending spontaneous head neck dissociation caused by anteverted cup: A case report on reverse bottle opener effect and review of literature.

Modularity in total hip arthroplasty (THA) not only allows adjustments of leg length and offset but also simplifies the revision. It allows limited revision of various components and decreases surgical morbidity of complete revision. Despite benefits, modularity is associated with risks like corrosion and component dissociation. Dissociation between head and neck taper is rare and the cause is attributed to taper corrosion, revision, stem subsidence, pumping phenomenon, injury and closed reduction of dislocated THA. We report a case of late-onset impending head-neck dissociation in a THA caused by a well-fixed anteverted cup with polyethylene liner wear by "reverse bottle opener effect." To our knowledge, this is the most late-onset reported case of head-neck dissociation, occurring after 13yrs of index surgery.

Rare Asymptomatic Posterior Dislocation of Mobile Bearing Insert in Unicondylar Knee Arthroplasty: A Case Report.

Dislocation of polyethylene insert is a common complication of mobile bearing uniconylar knee arthroplasty (UKA). Dislocation, when occurs is common in anterior, lateral or medial direction. The authors report a case of posterior dislocation in which patient remained asymptomatic and the dislocation was detected in a routine follow-up radiograph done at 18 months after surgery. UKA was subsequently converted into total knee arthroplasty and patient had a stable knee at two years follow-up with no signs of loosening or instability. Posterior meniscal bearing dislocation may remain asymptomatic and continued examination with high index of suspicion is needed to disclose such complications in the absence of symptoms.

Is Anatomical Healing Essential for Better Clinical Outcome in Type II SLAP Repair? Clinico-Radiological Outcome after Type II SLAP Repair.

BACKGROUND: We hypothesized that anatomical healing in superior labrum anterior to posterior (SLAP) repair is associated with good clinical outcome. The purposes of this study were to assess the failure rate of anatomical healing after arthroscopic repair of SLAP lesions using computed tomography arthrography (CTA), investigate correlation of the rate with clinical outcomes, and identify prognostic factors for anatomical failure following SLAP repair. METHODS: We retrospectively evaluated the outcome of 43 patients at a minimum follow-up of 1 year after arthroscopic surgery for SLAP lesions or SLAP lesions associated with Bankart lesions. Twenty-eight patients underwent isolated SLAP repair and 15 patients underwent Bankart repair with SLAP repair. The anatomical outcome was assessed using CTA at 1 year after surgery. Clinical outcomes including visual analogue scale for pain and satisfaction and Constant score were assessed at the final follow-up. We investigated clinical failure that was defined as stiffness, loss of maximum rotation, deterioration of pain, and/or need for revision of surgery. RESULTS: Anatomical failure occurred in 32.6% of patients (14/43), whereas 16.3% of patients (7/43) had clinical failure. Clinicoradiological assessment revealed that clinical failure occurred only in 7.1% of patients (1/14) with unhealed SLAP lesions, whereas it occurred in 20.7% of patients (6/29) with healed SLAP lesions. Isolated SLAP repair resulted in a higher risk of anatomical failure (risk ratio, 7.0) than combined SLAP repair (p = 0.015). Nonoverhead activities were associated with higher risk of anatomical failure (risk ratio, 2.9; p = 0.041). Patients above 35 years of age had more risk of anatomical failure (risk ratio, 3.5; p = 0.010). Clinical outcomes significantly improved regardless of anatomical failure (p < 0.001) and were not significantly different between unhealed and healed repairs (all p > 0.05). CONCLUSIONS: Since patients with unhealed SLAP lesions had less clinical failure than patients with healed SLAP lesions, anatomical healing does not seem essential for better clinical outcome of SLAP II repair, especially in patients with higher healing failure risk (isolated SLAP repair, nonoverhead activities, and above 35 years of age). Therefore, we believe the indications of SLAP repair should be narrowed to avoid overtreatment.