Sciatic nerve palsy after direct anterior approach for total hip replacement.

SummarySciatic nerve injury after total hip replacement is rare with a reported incidence of about 0.09%-3.7%. The most commonly reported causes include traction on the nerve during reduction, compression of the nerve from subfascial haematoma, significant leg lengthening, improper retractor placement, thermal burns from cautery and extraneous cement. We present a case of complete sciatic nerve palsy in a patient operated on using direct anterior approach (DAA). To date, there are no reports describing sciatic nerve palsy secondary to haematoma immediately after primary arthroplasty through the DAA. We performed an MRI of lumbosacral spine with both hips, which revealed a haematoma. Consequently, we promptly took the patient to the operation theatre for re-exploration. Using the same approach, we dislocated the hip and removed the clots. By the end of 2 weeks, the patient was able to dorsiflex the ankle and had fully recovered from sciatic nerve palsy.

Biomedical,clinical and environmental applications of platinum-based nanohybrids: An updated review.

Platinum nanoparticles (Pt NPs) have numerous applications in various sectors, including pharmacology, nanomedicine, cancer therapy, radiotherapy, biotechnology and environment mitigation like removal of toxic metals from wastewater, photocatalytic degradation of toxic compounds, adsorption, and water splitting. The multifaceted applications of Pt NPs because of their ultra-fine structures, large surface area, tuned porosity, coordination-binding, and excellent physiochemical properties. The various types of nanohybrids (NHs) of Pt NPs can be fabricated by doping with different metal/metal oxide/polymer-based materials. There are several methods to synthesize platinum-based NHs, but biological processes are admirable because of green, economical, sustainable, and non-toxic. Due to the robust physicochemical and biological characteristics of platinum NPs, they are widely employed as nanocatalyst, antioxidant, antipathogenic, and anticancer agents. Indeed, Pt-based NHs are the subject of keen interest and substantial research area for biomedical and clinical applications. Hence, this review systematically studies antimicrobial, biological, and environmental applications of platinum and platinum-based NHs, predominantly for treating cancer and photo-thermal therapy. Applications of Pt NPs in nanomedicine and nano-diagnosis are also highlighted. Pt NPs-related nanotoxicity and the potential and opportunity for future nano-therapeutics based on Pt NPs are also discussed.

Acetabular Screw in Close Proximity to the Posterior Branch of the Internal Iliac Artery in Revision Hip Surgery with Intrapelvic Migration of Acetabular Component: Preoperative Placement of a Fogarty Catheter in the Internal Iliac Artery (Case Report).

Revision of an intrapelvic migration of the acetabular component of a total hip is a challenging surgery due to the risk of injury to the pelvic viscera. The primary concern is vascular injury due to the risk of mortality and limb loss. The researchers present one case where the acetabular screw was near the posterior branch of the internal iliac artery. A Fogarty catheter was placed in the internal iliac artery preoperatively, and the amount of fluid to inflate the catheter and completely block the artery was determined. The catheter was kept in a deflated condition. The hip reconstruction was performed, and there was no incidence of vascular injury during the procedure; hence, the Fogarty catheter was removed postsurgery. The placement of a Fogarty catheter in the at-risk vessel provides the freedom to proceed with the hip reconstruction through the standard approach. In case of an inadvertent event of a vascular injury, it can be inflated with the predetermined amount of saline to check the bleeding until the vascular surgeons take over the case.

Single-stage long-stem total knee arthroplasty in severe arthritis with stress fracture: a systematic review.

PURPOSE: Proximal tibia stress fractures present a challenge when performing total knee arthroplasty (TKA) in knee arthritis (KA). The literature on treatment modalities for stress fractures with arthritis is varied and not systematically reviewed. We aimed to answer the questions: (1) Is long-stem TKA sufficient for stress fractures in arthritic knees? (2) Should stress fracture and KA be addressed simultaneously? (3) What is the role of augmentative procedures in stress fractures with knee arthritis? (4) Can a unified algorithm be established? METHODS: The PubMed and Cochrane databases were searched for keywords such as stress fracture, knee arthritis and total knee arthroplasty, published from January 1995 to 29 May 2022. A total of 472 records were screened down to 13 articles on the basis of our selection criteria. Ten data items were recorded from the included studies. The methodological index for non-randomised studies (MINORS) score for the included studies was 17 ± 3. RESULTS: We found long-stem TKA to be sufficient for most cases and advocated for single-stage treatment of stress fractures and arthritis. Augmentative procedures play a role in the treatment, and a unified algorithm was drafted to guide treatment. CONCLUSION: Single-stage management of advanced KA with a stress fracture causes less morbidity than a staged procedure. Long-stem TKA, with or without an augmentative procedure, is an excellent option.

Bioinspired NiO Nanospheres: Exploring In Vitro Toxicity Using Bm-17 and L. rohita Liver Cells, DNA Degradation, Docking, and Proposed Vacuolization Mechanism.

The present work demonstrated a novel Cleome simplicifolia-mediated green fabrication of nickel oxide nanoparticles (NiO NPs) to explore in vitro toxicity in Bm-17 and Labeo rohita liver cells. As-fabricated bioinspired NiO NPs were characterized by several analytical techniques. X-ray diffraction (XRD) revealed a crystalline face-centered-cubic structure. Fourier transform infrared spectroscopy (FTIR), ultraviolet-visible diffuse reflectance spectroscopy (UV-DRS), Raman spectroscopy, and X-ray photoelectron spectroscopy (XPS) confirmed NiO formation. The chemical composition was confirmed by energy-dispersive X-ray spectroscopy (EDS) and X-ray photoelectron spectroscopy. Brunauer-Emmett-Teller (BET) revealed the mesoporous nature. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) revealed the formation of 97 nm diameter nanospheres formed due to the congregation of 10 nm size particles. Atomic force microscopy (AFM) revealed the nearly isotropic behavior of NiO NPs. Further, a molecular docking study was performed to explore their toxicity by binding with genetic molecules, and it was found that the docking energy was about -9.65284 kcal/mol. On evaluating the in vitro toxicity of NiO NPs for Bm-17 cells, the study showed that when cells were treated with a high concentration of NPs, cells were affected severely by toxicity, while at a lower concentration, cells were affected slightly. Further, on using 50 µg/mL, quick deaths of cells were observed due to the formation of more vacuoles in the cells. The DNA degradation study revealed that NiO NPs are significantly responsible for DNA degradation. For further confirmation, trypan blue assay was observed for cell viability, and morphological assessment was performed using inverted tissue culture microscopy. Further, the cytotoxicity of NiO NPs in L. rohita liver cells was studied. No toxicity was observed at 1 mg/L of NiO NPs; however, when the concentration was 30 and 90 mg/L, dark and shrank hepatic parenchyma was observed. Hence, the main cause of cell lysis is the increased vacuolization in the cells. Thus, the present study suggests that the cytotoxicity induced by NiO NPs could be used in anticancer drugs.

Joint preservation surgery in grade 2 and 3 giant cell tumors of bone around the knee.

OBJECTIVE: To evaluate the clinical and functional outcomes of joint preservation surgery in high-grade giant cell tumors (GCT) around the knee joint. METHODS: A retrospective review of 25 patients of high-grade GCT (Campanacci grade 2 and 3) involving proximal tibia or distal femur managed by extended curettage, bone grafting, and stabilization with knee spanning external fixator between 2016 and 2018 was done. The radiographic outcomes, functional outcomes (Musculoskeletal Tumor Society [MSTS] score for lower limb), and complications including donor site morbidity were evaluated. RESULTS: The mean age of the patient population was 24.04 years with an average follow-up period of 30.24 months. Fourteen patients had involvement of distal femur, and 11 involved proximal tibia. There were 16 cases of grade 2 lesions and 9 cases of grade 3 lesions. Twenty-four out of the 25 patients had radiological consolidation of graft, while one patient had graft subsidence. Twenty-two out of 25 patients had full extension and knee flexion more than 100 degrees. The mean MSTS score was 25.2. Three patients had an MSTS score under 20. All three patients had an extension lag with a restricted range of motion. CONCLUSION: Joint preservation surgery, when done in line with the basic principles of tumor surgery, gives good radiographic and functional outcomes even in grade 2 and 3 giant cell tumors of bone around the knee and should be attempted before replacement surgeries.

Biogenesis and Application of Nickel Nanoparticles: A Review.

Biogenic synthesis of Nanoparticles (NPs) is attractive due to their ecological benefits and cheap, rapid, and sustainable nature. Among them, Nickel Oxide NPs (NiO-NPs) are acquired for their varied catalytic and clinical applications, as they have antibacterial, antifungal, cytotoxic, anticancer, antioxidant, remediation, and enzyme inhibition properties. Though several chemical-dependent methods were applied for the fabrication of nanoparticles, due to their substantial disadvantages, mainly toxicity and higher cost synthesis methods, the more secure, greener, eco-friendly, cost-effective, and synthetic methods are in demand. Greener approaches can take away the arduousness and complications of physicochemical methods. The present review is aimed at displaying the recent advancement related to the catalytic activity, antimicrobial activity, cytotoxicity, and antioxidant application of green synthesized Nickle. In this study, nickle oxide nanoparticles have been highlighted along with their sustainable synthesis options.

Correlation Between Modic Changes and Bacterial Infection: A Causative Study.

STUDY DESIGN: Prospective nonrandomized study. OBJECTIVE: Objective of the study was to ascertain etiological correlation between Modic changes (MC) and bacterial infection through 16s DNA sequencing in patients with chronic low backache. SUMMARY OF BACKGROUND DATA: Modic changes are common on magnetic resonance imaging (MRI) of patients with low back pain and are strongly associated with low back pain. Various factors are associated with the etiology; of these, degeneration and mechanical factors are most common. Some studies have also found etiological relation between MC and infection. MATERIAL AND METHOD: The study involved 20 patients of either sex (age range, 20-65 years) who were investigated for blood count, erythrocyte sedimentation rate, and quantitative C-reactive protein. The intervertebral disc removed during discectomy from each patient was sent for polymerase chain reaction (PCR) study. We have targeted the conserved gene of the bacteria (ie, 16s ribosomal DNA) and used a universal eubacteria nested-amplification protocol that may detect picograms of bacterial DNA. RESULT: Among the 20 cases of patients who had low back pain and MC in MRI, 13.5% showed raised leucocytosis, 28.6% showed raised erythrocyte sedimentation rate, 72.7% showed raised quantitative C-reactive protein, and 90% of the disc sample showed presence of bacteria in PCR study. CONCLUSION: MC may have an infective etiology. LEVEL OF EVIDENCE: 4.

Biodegradable poly(ε-caprolactone) as a controlled drug delivery vehicle of vancomycin for the treatment of MRSA infection.

Biodegradable poly(ε-caprolactone) (PCL) is developed as a controlled drug delivery vehicle of vancomycin (VMC) with the advantage of avoiding a second surgery. The PCL-VMC hybrid, prepared through a solution route, is used as a delivery vehicle for vancomycin for controlling MRSA osteomyelitis as well as healing the cavity simultaneously in an experimental study. An in vitro study is conducted to optimize vancomycin impregnation in the PCL-VMC hybrid. An in vitro study on drug release from the hybrid material is investigated in phosphate buffer saline showing steady and sustained release of the drug. The release kinetics is fitted with several models and a non-Fickian nature is established following the Korsmeyer-Peppas model. Spectroscopic techniques and morphology observations reveal the cause of sustained release to be the strong interaction between the drug and the polymer. The results of the antibacterial assay show that the loading of vancomycin into the PCL matrix is able to maintain the activity of the pure drug. For the in vivo study, a unicortical defect is created in the metaphysis of the distal femur in rabbits. After contaminating the defect with MRSA, the 1st group of rabbits were treated with pure polymer, the 2nd group of rabbits were treated with normal saline (PBS), the 3rd group of rabbits were treated with pure VMC and in the last group of rabbits PCL-VMC was placed. Rabbits are assessed by clinical, radiological, histological, gross examination and bacterial load assays. Infection persisted throughout the period of study for both the pure polymer and PBS treated rabbits while rabbits treated with the PCL-VMC hybrid do not show any sign of infection. The VMC treated group rabbits show mild infection for the 1st week of the study; however, the infection becomes gradually more severe with time. Serial histology confirms the formation of new bone without any inflammation and necrosis for the rabbits treated with PCL-VMC. Importantly, the PCL-VMC hybrid bioadsorbs after delivery of the drug and thereby avoids the second surgery to remove the conventional implant.