A systematic review on the potential value of synovial fluid biomarkers to predict clinical outcomes in cartilage repair treatments.

OBJECTIVE: Multiple biochemical biomarkers have been previously investigated for the diagnosis, prognosis and response to treatment of articular cartilage damage, including osteoarthritis (OA). Synovial fluid (SF) biomarker measurement is a potential method to predict treatment response and effectiveness. However, the significance of different biomarkers and their correlation to clinical outcomes remains unclear. This systematic review evaluated current SF biomarkers used in investigation of cartilage degeneration or regeneration in the knee joint and correlated these biomarkers with clinical outcomes following cartilage repair or regeneration interventions. METHOD: PubMed, Institute of Science Index, Scopus, Cochrane Central Register of Controlled Trials, and Embase databases were searched. Studies evaluating SF biomarkers and clinical outcomes following cartilage repair intervention were included. Two researchers independently performed data extraction and Quality Assessment of Diagnostic Accuracy Score 2 (QUADAS-2) analysis. Biomarker inclusion, change following intervention and correlation with clinical outcome was compared. RESULTS: 9 studies were included. Study heterogeneity precluded meta-analysis. There was significant variation in sampling and analysis. 33 biomarkers were evaluated in addition to microRNA and catabolic/anabolic ratios. Five studies reported on correlation of biomarkers with six biomarkers significantly correlated with clinical outcomes following intervention. However, correlation was only demonstrated in isolated studies. CONCLUSION: This review demonstrates significant difficulties in drawing conclusions regarding the importance of SF biomarkers based on the available literature. Improved standardisation for collection and analysis of SF samples is required. Future publications should also focus on clinical outcome scores and seek to correlate biomarkers with progression to further understand the significance of identified markers in a clinical context. REGISTRATION NUMBER: PROSPERO CRD42022304298. Study protocol available on PROSPERO website.

Physician and patient perceptions of surgical procedures for osteoarthritis of the knee in the United States, Europe, and Japan: results of a real-world study.

BACKGROUND: Osteoarthritis (OA) is the most common form of arthritis, with the knee being the joint most frequently affected, and symptomatic knee OA affecting around one quarter of the general population. For patients who do not respond to non-pharmacologic or pharmacologic treatment, surgery is a recommended option. The objectives of this study were to compare the willingness of patients with knee OA to undergo surgery, together with reasons for delaying surgery, and factors affecting successful outcomes. METHODS: A point-in-time survey was conducted in 729 primary care physicians, rheumatologists, orthopedic surgeons, and 2,316 patients with knee OA across three geographical regions: Japan, the United States (US), and Europe (EUR: France, Spain, Italy, Germany, and the United Kingdom), in order to garner their perceptions of knee surgery. Regression models were used to identify factors that might affect patients' and physicians' perceptions of surgery, including severity of OA (mild/moderate/severe), number of affected joints, surgery status, and willingness to undergo or delay surgery. RESULTS: Baseline demographics were similar between US and EUR, although patients in Japan were more likely to be female, older, and only 7% in fulltime employment. We found that few patients with end-stage knee OA, across all regions, but particularly Japan, were willing to undergo surgery (Japan 17%, US 32%, EUR 38%), either through fear, or the lack of awareness of the risk/benefits. Moreover, surgeons are prepared to delay surgery in elderly or unwilling patients, due to their dissatisfaction with the outcome, and may defer surgery in younger patients due to the need for future revision. We also identified a disconnect between physicians, of whom over 80% consider improved functioning to be the most important outcome of surgery, and patients, who seek pain relief (Japan 60%, US 35%, EUR 14%). Since physicians across all regions considered pain reduction to be an indication of surgery success (Japan 27%, US 47%, EUR 43%), this may indicate a need for improved communication to patients on the potential benefits of surgery. CONCLUSION: Managing the expectations of patients undergoing surgery remains an important goal in the treatment of knee OA and may help guide physician choice.

Challenges and solutions to returning to clinical training after research: a multidisciplinary survey of integrated academic trainees in West Yorkshire, United Kingdom.

BACKGROUND: Time out of clinical training can impact medical trainees' skills, competence and confidence. Periods of Out of Programme for Research (OOPR) are often much longer than other approved mechanisms for time of out training. The aim of this survey study was to explore the challenges of returning to clinical training following OOPR, and determine potential solutions. METHODS: All current integrated academic training (IAT) doctors at the University of Leeds (United Kingdom) and previous IAT trainees undertaking OOPR in the local region (West Yorkshire, United Kingdom)(n = 53) were invited to complete a multidisciplinary survey. RESULTS: The survey was completed by 33 participants (62% response rate). The most relevant challenges identified were completing the thesis whilst transitioning back to clinical work, the rapid transition between full-time research and clinical practice, a diminished confidence in clinical abilities and isolation from colleagues. Potential solutions included dedicated funds allocated for the renewal of lapsed skills, adequate notice of the clinical rotation to which trainees return, informing clinical supervisors about the OOPR trainee returning to practice and a mandatory return to standard clinical days. CONCLUSIONS: Addressing these issues has the potential to improve the trainee experience and encourage future trainees to take time out of training for research activities.

Cementless fixation in medial unicompartmental knee arthroplasty: a systematic review.

PURPOSE: The aim of this study was to evaluate clinical outcome, failures, implant survival, and complications encountered with cementless fixation in unicompartmental knee arthroplasty (UKA). METHODS: A systematic review of the literature on cementless fixation in UKA was performed according to the PRISMA guidelines. The following database was comprehensively searched: PubMed, Cochrane, Medline, CINAHL, Embase, and Google Scholar. The keywords "unicompartmental", "unicondylar", "partial knee arthroplasty", and "UKA" were combined with each of the keyword "uncemented", "cementless" and "survival", "complications", and "outcome". The following data were extracted: demographics, clinical outcome, details of failures and revisions, cumulative survival, and complications encountered. The risk of bias of each study was estimated with the MINORS score and a further scoring system based on the presence of the primary outcomes. RESULTS: From a cohort of 63 studies identified using the above methodology, 10 papers (1199 knees) were included in the final review. The mean follow-up ranged from 2 to 11 years (median 5 years). The 5-year survival ranged from 90 to 99 % and the 10-year survival from 92 to 97 %. There were 48 revisions with an overall revision rate of 0.8 per 100 observed component-years. The most common cause of failure was progression of osteoarthritis in the retained compartment (0.9 %). The cumulative incidence of complications and revisions was comparable to that reported in similar studies on cemented UKAs. The advantages of cementless fixation include faster surgical time, avoidance of cementation errors, and lower incidence of radiolucent lines. CONCLUSIONS: Cementless fixation is a safe and effective alternative to cementation in medial UKA. Clinical outcome, failures, reoperation rate, and survival are similar to those reported for cemented implants with lower incidence of radiolucent lines. LEVEL OF EVIDENCE: IV.

Lateral unicompartmental knee replacement for the treatment of arthritis progression after medial unicompartmental replacement.

PURPOSE: Lateral progression of arthritis following medial unicompartmental knee arthroplasty (UKA), although infrequent, is still the most common reason for revision surgery. Treatment options normally include conversion to total knee arthroplasty. An alternative strategy for some patients may be addition of a lateral UKA. We report the first results of staged bi-compartmental UKA (Bi-UKA) strategy. METHODS: We retrospectively selected from our UKA database patients who underwent a lateral UKA to treat a symptomatic lateral osteoarthritis progression after a medial UKA. The analysis included a clinical and radiological assessment of each patient. RESULTS: Twenty-five patients for a total of 27 knees of staged Bi-UKA were carried out in a single centre. The mean time interval between primary medial UKA and the subsequent lateral UKA was 8.1 years (SD ± 4.6 years). The mean age at the time of the Bi-UKA was 77.1 years (SD ± 6.5 years). The median hospital stay was 3 (range 2-9 days) days, and the mean follow-up after Bi-UKA was 4 years (SD ± 1.9 years). The functional scores showed a significant improvement as compared to the pre-operative status (paired t test, p = 0.003). There were no radiological evidences of failure. None of the patients needed blood transfusion, and there was no significant complications related to the surgical procedure without further surgeries or revisions at final follow-up. CONCLUSIONS: These results suggest that addition of a lateral UKA for arthritis progression following medial UKA is a good option in appropriately selected patients. LEVEL OF EVIDENCE: Observational study without controls, Level IV.

Comparison of outcomes after UKA in patients with and without chondrocalcinosis: a matched cohort study.

PURPOSE: Chondrocalcinosis can be associated with an inflammatory arthritis and aggressive joint destruction. There is uncertainty as to whether chondrocalcinosis represents a contraindication to unicompartmental knee arthroplasty (UKA). This study reports the outcome of a consecutive series of patients with chondrocalcinosis and medial compartment osteoarthritis treated with UKA matched to controls. METHODS: Between 1998 and 2008, 88 patients with radiological chondrocalcinosis (R-CCK) and 67 patients with histological chondrocalcinosis (H-CCK) were treated for end-stage medial compartment arthritis with Oxford UKA. One-to-two matching was performed to controls, treated with UKA, but without evidence of chondrocalcinosis. Functional outcome and implant survival were assessed in each group. RESULTS: The mean follow-up was 10 years. The mean Oxford Knee Score (OKS) at final follow-up was 43, 41 and 41 in H-CCK, R-CCK and control groups (change from baseline OKS was 21, 18 and 15, respectively). The change was significantly higher in H-CCK than in control but was not significantly different in R-CCK. Ten-year survival was 96 % in R-CCK, 86 % in H-CCK and 98 % in controls. Although the survival in H-CCK was significantly worse than in control, only one failure was due to disease progression. CONCLUSION: The presence of R-CCK does not influence functional outcome or survival following UKA. Pre-operative radiological evidence of CCK should not be considered to be a contraindication to UKA. H-CCK is associated with significantly improved clinical outcomes but also a higher revision rate compared with controls. LEVEL OF EVIDENCE: Case control study, Level III.

Five-year experience of cementless Oxford unicompartmental knee replacement.

PURPOSE: Cementless unicompartmental knee replacement (UKR) was introduced to address some of the problems that can occur following cemented UKR. The aim of this study was to report the 5-year experience of the first 512 medial cementless Oxford UKR implanted by two surgeons for the recommended indications. METHODS: The first consecutive 512 cementless Phase 3 Oxford UKRs implanted by two surgeons for the recommended indications between June 2004 and October 2013 were prospectively identified and followed up independently. All the procedures were carried out through a minimally invasive approach without eversion or dislocation of the patella. Patients were assessed clinically pre-operatively and at 1, 2, 5, 7 and 10 years after surgery with functional outcome scores and radiographs. RESULTS: There were eight reoperations of which six were revisions giving a 5-year survival of 98 % (95 % CI 94-100 %). At a mean follow-up of 3.4 years (1.0-10.2), the mean OKS was 43 (SD 7), AKSS (objective) was 81 (SD 13), and AKSS (functional) was 86 (SD 17). The first 120 cases had a minimum follow-up of 5 years (mean 5.9; range 5-10.2). In these patients, the mean OKS was 41 (SD 8), AKSS (objective) was 81 (SD 14), and AKSS (functional) was 82 (SD 18). There were no femoral radiolucencies and no complete tibial radiolucencies. 11 % of tibial components had partial radiolucent lines; the remaining 89 % had no radiolucencies. CONCLUSION: The clinical results are as good as or better than those previously reported for cemented fixation. The radiographic results are better with secure bony attachment to the implants in every case. LEVEL OF EVIDENCE: IV.

Adenoviral vector encoding soluble Flt-1 engineered human endometrial mesenchymal stem cells effectively regress endometriotic lesions in NOD/SCID mice.

This study was undertaken to study the efficiency of Adsflt-1 engineered human eutopic mesenchymal stem cells (MSCs) secreting anti-angiogenic sFlt-1 as a targeted cell-based therapy for endometriosis (EM). Eutopic MSCs were transduced with Adsflt-1/AdV0 viral vectors and were evaluated for expression and secretion of sFlt-1. EM was created in NOD/SCID mice using subcutaneous implantation techniques. Four doses of 10(6) MSC-Adsflt-1/MSC-AdV0 were administered to the model and therapeutic anti-angiogenic ability was analyzed by lesion size measurement, microvessel density, immunohistochemistry and real-time reverse transcriptase-PCR analysis. Approximately 86% of transduced MSCs expressed and secreted sFlt-1. MSC-Adsflt-1-treated animals exhibited significant reduction (52.8±1.8%) in size of endometriotic lesions. We observed a 2.3-fold decrease in the number and a 10-fold decrease in the size of endometrial glands in MSC-Adsflt-1-treated animals. A two-fold decrease in stromal cell densities was also observed in MSC-Adsflt-1-treated animals compared with the MSC-AdV0 group. Specific positive immunostaining for MSC marker, CD146 and sFlt-1 in the lesion sites of the MSC-Adsflt-1 group suggests possible homing of transduced MSCs, their survival and secretion of sFlt-1 at the target sites. A marked reduction in size of microvessels and microvessel density within endometriotic lesions and surrounding host subcutaneous layers was observed in MSC-Adsflt-1 group along with significantly downregulated expression of transcripts for vascular endothelial growth factor, fetal liver kinase 1 and matrix metalloproteinases (2 and 9). Our findings indicate the efficacy of a novel eutopic MSC-Adsflt-1 therapy in EM study models. Evaluating long-term effects of genetically modified MSCs in vivo is essential in translating MSC-Adsflt-1 therapy to the clinics.

Presentation and In-Hospital Outcome in First Attack of Acute Coronary Syndrome among Diabetic and Non-Diabetic People.

This was a prospective and observational study. One hundred and sixty five consecutive patients (75 diabetic and 90 were non-diabetic) admitted to coronary care unit in Rangpur Medical College and Hospital, Rangpur from December 2011 to June 2012 with the diagnosis of first attack of acute coronary syndrome were included in this study. Patients were selected considering the inclusion and exclusion criteria, Symptom time, typical or atypical chest pain, Dysponea, palpitation, cardiogenic shock, cardiac arrest, vital signs and Killip classes were regarded as presentation at admission. Outcome parameters observed during the hospital stay were in-hospital mortality, cardiogenic shock, congestive cardiac failure, symptomatic arrhythmias, cardiac arrest, recurrent ischemia and hospital stay. The results were obtained by calculating 'p' value by 'z' test, 't' test, chi-square test, as appropriate to see the difference between two groups. The results thus obtained were plotted on table, pie-chart, line chart, bar-diagram etc. as appropriate p value <0.05 was considered significant. In the study, diabetic patients presented with acute coronary syndrome at earlier age (p=053). Body Mass Index was significantly more in diabetic group (25.053 ± 2.1428 vs. 24.0822 kg/m² ± 2.233 kg/m², p=0.0045). Atypical chest pain (40% vs. 24.4%, p=0.0323), Dysponea (53.3 vs. 36.7%, p=0.0315), cardiac shock (17.33 vs. 6.7%, p=0.03236) and symptom duration before presentation (31.067 ± 42.5 hours vs. 19.44 ± 30.3 hours, p=0.0471) were significantly more observed in diabetic group. In respect of outcome, diabetic patients experienced more recurrent ischemia (24% vs. 16.67%, p=0.0524) and heart failure (36% vs. 22.2%, p=0.05). Hospital stay was also found significantly higher in diabetic group (5.097 ± 1.023 vs. 4.097 ± 1.009, p=0.0078). Atypically presented group suffered significantly more from congestive heart failure p=0.0392. Triglyceride level (230.7 ± 61.7 vs. 180.1 ± 39.1, p<0.001) were significantly more in diabetic group. The mean value of Hba1C in diabetic patients was 8.0278 ± 10.44965%. This study suggested that atypical chest pain, dysponea and cardiac shock were more in diabetic group at presentation. Recurrent ischemia, heart failure and hospital stay were more in diabetic group as outcome.

Left Ventricular Diastolic Dysfunction is More Common in Patients of Uncontrolled Diabetes Mellitus.

There is a relationship between the left ventricular diastolic dysfunction with uncontrolled diabetes mellitus. A cross sectional study was designed to see the association of uncontrolled diabetes mellitus with diastolic dysfunction of the heart. The study was conducted from April 2012 to March 2013 in the department of cardiology, Mymensingh Medical College Hospital, Mymensingh. Sixty cases were selected as study population; twenty one patients were in Group I with good glycaemic controlled of HbA1C <7% and 39 patients were in Group II with poorly controlled diabetes mellitus having HbA1C ≥ 7%. In the study population male were 43(71.70%) and female were 17(28.30%). Mean age in the two groups were 49.05 ± 6.34 years vs. 53.64 ± 5.38 years, which was not significant difference. Duration of diabetes was <10 years and ≥ 10 years in two groups. Glycaemic status (percentage of HbA1C) was 6.55 ± 0.29% vs. 8.72 ± 1.01% in controlled and uncontrolled diabetic patient groups respectively which was significant difference. Diastolic dysfunction was found more in uncontrolled diabetic patient (patients having HbA1C% ≥ 7%) than controlled diabetic patients (HbA1C <7%). Grade I diastolic dysfunction was in uncontrolled and controlled glycaemic status were 33(84.60%) and 04(19.00%). The difference was statistically significant. Diastolic dysfunction in type 2 diabetic subjects was significantly higher as compared to the well control group (p<0.001). And this study concluded as - Diastolic dysfunction is more common in patient with poorly controlled diabetes mellitus.

Determinants of revision and functional outcome following unicompartmental knee replacement.

OBJECTIVE: Unicompartmental Knee Replacement (UKR) has important advantages over total knee replacement (TKR) but has a higher revision rate. Outcomes vary between centres, suggesting that risk factors for revision may be modifiable with changes to patient selection or operative technique. The objective of this study was to determine factors affecting revision, patient-reported outcome and satisfaction following UKR. METHOD: 25,982 cases from three national databases were analysed. Multilevel multivariable regression models were used to examine the effect of patient and surgical factors on implant survival, patient-reported outcome and satisfaction at 6 months and 8 years following UKR. RESULTS: Of the 25,982 cases, 3862 (14.9%) had pre-operative and 6-month Oxford Knee Scores (OKS). Eight-year survival was 89.1% (95% confidence intervals (CI) 88.3-89.9). OKS increased from 21.9 (SD 7.6) to 37.5 (SD 9.5). Age (Hazard ratio (HR) 0.96 (95% CI 0.96-0.97) per year), male gender (HR 0.86 (95% CI 0.76-0.96)), unit size (HR 0.92 (95% CI 0.86-0.97) per case up to 40 cases/year) and operating surgeon grade (HR 0.78 (95% CI 0.67-0.91) if consultant) predicted improved implant survival. Older patients (≥ 75 years), and those with lower deprivation levels had superior OKS and satisfaction (adjusted mean difference 0.14 (95% CI 0.09-0.20) points per year of age and 0.93 (95% CI 0.60-1.27) per quintile of deprivation). Ethnicity, anxiety and co-morbidities also affected patient-reported outcome. CONCLUSIONS: This study has identified important predictors of revision and patient-reported outcome following UKR. Older patients, who are least likely to be offered UKR, may derive the greatest benefits. Improved understanding of these factors may improve the long-term outcomes of UKR.

Association of hip and pelvic geometry with tibiofemoral osteoarthritis: multicenter osteoarthritis study (MOST).

OBJECTIVE: Lateral tibiofemoral osteoarthritis (OA) is overall less common than medial tibiofemoral OA, but it is more prevalent in women. This may be explained by sex differences in hip and pelvic geometry. The aim of this study is to explore sex differences in hip and pelvic geometry and determine if such parameters are associated with the presence of compartment-specific knee OA. METHODS: This case-control study reports on 1,328 hips/knees from 664 participants and is an ancillary to the Multicenter Osteoarthritis Study (MOST). Of the 1,328 knees, 219 had lateral OA, 260 medial OA, and 849 no OA. Hip and pelvic measurements were taken from full-limb radiographs on the ipsilateral side of the knee of interest. After adjusting for covariates, means were compared between sexes and also between knees with medial and lateral OA vs no OA using separate regression models. RESULTS: Women were shown to have a reduced femoral offset (FO) (mean 40.9 mm vs 45.9 mm; P = 0.001) and more valgus neck-shaft angle (mean 128.4° vs 125.9°; P < 0.001) compared to men. Compared to those with no OA, knees with lateral OA were associated with a reduced FO (P = 0.012), increased height of hip centre (HHC) (P = 0.003), more valgus neck-shaft angle (P = 0.042), and increased abductor angle (P = 0.031). Knees with medial OA were associated with a more varus neck-shaft angle (P = 0.043) and a decreased abductor angle (P = 0.003). CONCLUSION: These data suggest anatomical variations at the hip and pelvis are associated with compartment-specific knee OA and may help to explain sex differences in patterns of knee OA.

Trans-patella tendon approach for domed lateral unicompartmental knee arthroplasty does not increase the risk of patella tendon shortening.

PURPOSE: Shortening of the patella tendon has been noted after total knee arthroplasty and has been associated with diminished functional outcomes. Traumatic and/or ischaemic injury peri-operatively are suggested causes. The Oxford domed lateral unicompartmental knee arthroplasty (UKA) requires a vertical incision through the patella tendon to facilitate orientation of the proximal tibial saw cut; this may induce scarring or impair vascularity of the tendon and can cause shortening. This study investigated the hypothesis that the trans-patella tendon incision increases the incidence of patella tendon shortening after domed lateral UKA when compared to flat lateral UKA performed without the trans-patella tendon incision. METHODS: The radiographs of 50 patients who underwent domed lateral UKA, using the trans-patella tendon approach, and a cohort of 30 patients who underwent flat lateral UKA, in which an incision through the patella tendon was not employed, were reviewed retrospectively. The patella tendon length (PTL) and the Insall-Salvati ratio were measured. In addition, pre-operative and post-operative clinical scores were recorded using both the OKS and AKSS. A change in PTL of greater than or equal to 10 % was considered to be significant. RESULTS: In the domed lateral UKA group, 13 patients demonstrated a >10 % change in the PTL at 1-year post-surgery (2 shortened and 11 lengthened). In the flat lateral UKA group, nine patients demonstrated a significant change in the PTL at 1-year post-surgery (2 shortened and 7 lengthened). CONCLUSION: This study demonstrated that using a trans-patella approach during lateral domed UKA surgery did not significantly increase patella tendon shortening and did not result in reduced clinical outcomes.

Serum magnesium in hospital admitted diabetic patients.

Magnesium depletion has a negative impact on glucose homeostasis and insulin sensitivity in diabetic patients. Low plasma magnesium concentration is a highly specific indicator of poor magnesium status. This case control study was conducted in Mymensingh Medical College Hospital, Bangladesh, from May 2011 to April 2012. This study was done to assess the serum magnesium level in diabetic and non-diabetic patients and to find out the association between serum magnesium, blood glucose and duration of diabetes mellitus. Serum magnesium concentrations were determined in 50 diabetics and 50 age and sex matched non-diabetic patients or attendants for controls. Among the case and control group 32 were male and 18 were female. Mean age of control group was 54.42±2.33 and study group was 55.78±2.43 years. Duration of diabetes of case group in which 50% of patients have diabetes for up to 4 years, 18% of patients have diabetes for 5-9 years, 5% of patients have for 10-14 years and 2% of patients have diabetes for 15 years and above. Serum magnesium concentrations below the normal reference range for study group was 44% and control group was 6%. The mean serum magnesium level of study group was 0.70±0.01mmol/L and that of control group was 0.83±0.02mmol/L. So, the difference in serum magnesium level between two groups were statistically highly significant (p = 0.001). Correlation between FBS and SML of study group, which is negative (r = - 0.182). There is opposite relation among the characteristics as r is negative. And also correlation between 2HAFB and SML of study group, which is negative (r = - 0.06). There is opposite relation among the characteristics as r is negative.

Posterior dislocation of the Oxford knee meniscal bearing: a treatment option.

Unicompartmental knee replacement (UKR) is now established as a treatment for medial compartment arthritis. The Oxford UKR (Biomet Orthopedics, Inc, Warsaw, IN, USA) has a mobile-bearing system, which minimizes wear. This has been shown to provide excellent long-term results. Dislocation of the mobile-bearing device is rare with an incidence of 1 in 200 (0.5 %). The treatment usually involves exploration of the knee through the original anteromedial incision, removal of the dislocated bearing and rectification of the underlying cause for the dislocation. We describe two cases of a posterior dislocation in which the mobile bearing could not be retrieved and was left in situ. In both cases a good outcome was achieved. We conclude that in extremely rare cases where a dislocated bearing has migrated posteromedially and cannot be retrieved, it can be left in place rather than exploring the joint acutely through a separate posterior incision.

Patient recall of surgical information after day case knee arthroscopy.

PURPOSE: Day case knee arthroscopy is frequently performed on dedicated lists designed to optimise the throughput of patients. This could affect patient recall of clinical information with clinical, ethical and medicolegal consequences. The purpose of this study was to assess patient recall after knee arthroscopy and identify potential contributory factors. METHODS: Seventy-two patients undergoing day case knee arthroscopy were provided with information about their surgery post-operatively and tested for recall of the information prior to discharge. All patients underwent cognitive assessment when information was delivered and again when tested. Patient recall was correlated with demographic and anaesthetic factors and a multivariate regression model was used to identify risk factors for reduced recall. RESULTS: Recall overall was poor. Significant independent risk factors for reduced recall were reduced cognitive state at the time of information delivery and a shorter time between surgery and information delivery. Duration of anaesthesia, use of sedatives and use of opiate analgesia were not significantly correlated with recall. CONCLUSIONS: Information recall after day case knee athroscopy may be suboptimal. Allowing more time between surgery and information delivery may improve recall. However, this may be difficult during the course of a busy list and surgeons should consider using additional techniques to improve patient recall after surgery to reduce the risk of patient anxiety or non-compliance. LEVEL OF EVIDENCE: IV.

Preoperative pain location is a poor predictor of outcome after Oxford unicompartmental knee arthroplasty at 1 and 5 years.

PURPOSE: Indications for unicompartmental knee arthroplasty (UKA) vary between units. Some authors have suggested, and many surgeons believe, that medial UKA should only be performed in patients who localise their pain to the medial joint line. This is despite research showing a poor correlation between patient-reported location of pain and radiological or operative findings in osteoarthritis. The aim of this study is to determine the effect of patient-reported preoperative pain location and functional outcome of UKA at 1 and 5 years. METHODS: Preoperative pain location data were collected for 406 knees (380 patients) undergoing Oxford medial UKA. Oxford Knee Score, American Knee Society Scores and Tegner activity scale were recorded preoperatively and at follow-up; 272/406 (67 %) had pure medial pain, 25/406 (6 %) had pure anterior knee pain, and 109/406 (27 %) had mixed or generalised pain. None had pure lateral pain. The primary outcome interval is 1 year; 132/406 patients had attained 5 years by the time of analysis, and their 5-year data are presented. RESULTS: At 1 and 5 years, each group had improved significantly by each measure [mean ΔOKS 15.6 (SD 8.9) at year 1, 16.3 (9.3) at year 5]. There was no difference between the groups, nor between patients with and without anterior knee pain or isolated medial pain. CONCLUSIONS: No correlation is demonstrated between preoperative pain location and outcome. We conclude that localised medial pain should not be a prerequisite to UKA and that it may be performed in patients with generalised or anterior knee pain.

Medial femoral head border is a reliable and reproducible reference for axis determination for femoral component of unicompartmental knee arthroplasty.

PURPOSE: The femoral component should be implanted parallel to the mechanical axis in unicompartmental knee arthroplasty. It was hypothesised that a line between medial femoral condyle centres and medial border of femoral head will be parallel to the mechanical axis; this study set out to examine this hypothesis. METHODS: One hundred X-rays in fifty patients were included for this study. Long-leg standing X-rays including hip and ankle with patellae facing forwards were obtained. On these films, we measured the angle, α, between mechanical axis and the line between the femoral head centre and knee centre (medial mechanical axis), and the angle, ß, between the medial mechanical axis and a line between medial femoral condyle and femoral head centre. RESULTS: The average value of α was 0.1 ± 0.5° and the average value of ß 3.0° ± 0.3°. These data indicate that mechanical axis and medial mechanical axis are virtually parallel to each other. CONCLUSION: As medial femoral head border is easily identified fluoroscopically, it is a reliable landmark for orientating the femoral component of medial UKA.

Demographics and cell types of bronchial carcinoma of a tertiary care hospital in Bangladesh.

Geographical and socio-economic factors such as climate, culture, ethnic origin, diet and life style such as smoking have been noted to influence the occurrence of bronchial carcinoma. We conducted this study to document the frequency of various histological types of bronchial carcinoma and correlated it with their demographic characteristics. This descriptive study was carried out among admitted patient with the suspicion of Bronchial carcinoma from January 2010 to January 2011 in medicine units of Mymensingh Medical College Hospital, Mymensingh. Among those only 30 consecutive histopathologically &/or cytological confirmed cases of Bronchial carcinoma were included in the study. No age, gender, environmental or occupational limits were applied for the selection of patients. Patients already diagnosed by some other hospital presenting to our unit with complications were not included in the study. Age rang were 26-70 years. Majority of patients i.e. 63.33% (n=19) were found to be in their fourth and sixth decade of life. Males were 86.66% (n=26) as compared to females 13.44% (n=4) and male to female ratio were 6.5:1. The majority of the patients were belonged to urban areas 63.34% (n=19), while 36.66% (n=11) came from the Rural population. In this study smokers were 86.66% (n=26) and nonsmokers were 13.33% (n=4). In Occupational distribution farmers were 33.33% (n=10), service holders were 20% (n=6), businessman were 16.66% (n=5), all the female were house wife 13.33% (n=4). Specimens for histopathological study were collected by trans-thoracic needle aspiration under CT or ultrasono-guided. The results of cell types in histopathologically proven 30 Bronchial carcinoma patients were; 10(33.36%) adenocarcinoma, 7(23.33%) squamous cell carcinoma, 6(20%) small cell carcinoma, 4(13.33%) large cell carcinoma and 3(10%) non-small cell carcinoma.

Impact of metabolic syndrome in acute myocardial infarction at hospital.

The study was aimed to find out the impact of metabolic syndrome in patients with acute myocardial infarction during hospital stay. This prospective study was carried out in coronary care unit, Mymensingh Medical College Hospital from August 2009 to May 2010. Patients were followed up for minimum 3 days to maximum 6 days after admission. Variables of this study were age, sex, smoking, anterior AMI, inferior AMI, Non STEMI, hyperglycemia, low high density lipoprotein (HDL), raised blood pressure, high triglyceride (TG), waist circumference, recurrent non fatal MI, heart failure (Killip class), arrhythmia (VT, VF), ejection fraction (EF), family history of cardiovascular (CV) risk factors. Considering inclusion and exclusion criteria total 100 patients were included and divided into two groups, Group A - Acute Myocardial Infarction (AMI) with Metabolic Syndrome (MS) and Group B - Acute Myocardial Infarction (AMI) without Metabolic Syndrome (MS). Investigations included ECG, FBS, fasting lipid profile, cardiac enzyme (troponin I) and echocardiography (2D & M mode). The data were analyzed by computer software SPSS version 12. Chi-square test, t test, ANOVA test was used as test of significance. Among the study population (n=100), female were 12.0%. Mean age of study population was 53.3±10.6 years vs. 47.5±11.3 years. Distribution of metabolic syndrome components in study population, High TG (?150mg/dl) was more prevalent (81.1% vs. 25.8%). Heart failure (Killip class) was significantly more in metabolic syndrome patients than those without metabolic syndrome (46.0 % vs. 20%). LV ejection fraction also lowers in metabolic syndrome patients (46.76±8.34 vs. 50.45±7.50) with MI. Among the components of metabolic syndrome, hyperglycemia had strongest association for development of heart failure (OR 3.05; 95% CI 0.80-12.14).