Primary Total Knee Replacement using Rotating Hinge Implants in Poliomyelitis: A Case Series and Review of the Literature.

Introduction: The results of primary total knee replacement (TKR) using hinge implants performed in the Indian population with post-polio residual paresis (PPRP) are unknown. The purpose of this study was to report the outcome of primary rotating hinge TKR in Indian patients with PPRP at a minimum follow-up of 12 months. Materials and Methods: We retrospectively reviewed the clinical and radiological records of six patients treated with primary rotating hinge TKR. Pre-and post-operative (at final follow-up) knee range of motion (ROM), knee sagittal deformity, knee society score (KSS), and Oxford knee score (OKS) were compared to determine improvement in function. Results: Six rotating hinge TKRs (five female and one male patient) were analyzed for this study. At a mean follow-up of 27 ± 22 months (range, 12-71 months), the mean pre-operative KSS of 50.6 ± 2.5 significantly improved (P < 0.0001) to 72.5 ± 1.6, and the mean pre-operative OKS of 23.6 ± 1.6 significantly improved (P < 0.0001) to 35.3 ± 1.7. The mean pre-operative knee ROM of 94° ± 10° changed to 92° ± 4° (P = 0.64) and the mean pre-operative sagittal deformity of 7° ± 23.5° changed to -3° ± 2.5° (P = 0.32) at final follow-up. None of the knees had any intra- or post-operative complications or showed radiologic evidence of post-operative loosening, subsidence, or periprosthetic radiolucent lines at the final follow-up. Conclusion: Rotating hinge TKR gave excellent clinical and radiological results at a mean follow-up of 27 months in the present study. Despite TKR being a technically challenging procedure in patients with poliomyelitis-affected limbs, a rotating hinge design, along with meticulous surgical technique, can significantly improve function in such patients.

Post-surgical Pyoderma Gangrenosum after Total Knee Arthroplasty: A Rare Case Report and Literature Review.

Introduction: Pyoderma gangrenosum (PG) following a primary total knee arthroplasty (TKA) surgery is extremely rare, with very few cases reported in the literature. Case Report: We report our clinical experience of a 65-year-old female who developed PG following a primary TKA surgery. Corticosteroids and local wound care with vacuum-assisted closure dressing helped achieve rapid improvement in the wound condition. Conclusion: Post-surgical PG in TKA can be challenging with limited evidence for its definitive treatment. A high degree of suspicion and a multidisciplinary management approach will help in the timely diagnosis and optimization of treatment for this condition.

Sexual activity at 1 year after total hip arthroplasty in Indian patients.

PURPOSE: This study aimed to report changes in sexual activity and related difficulties and concerns among Indian patients at the end of 1-year after primary total hip arthroplasty (THA). MATERIALS AND METHODS: A detailed questionnaire related to sexual difficulty, frequency, position, satisfaction, stress, and concerns pre- and postoperatively was administered through an in-person interview at 1-year post-THA. RESULTS: Preoperatively, 77% of patients reported difficulties in sexual activities, which reduced significantly (p < 0.0001) to 30% at the end of 1-year post-operatively. A majority of patients reported no change in the frequency (56.5%) or satisfaction with their sexual activity (54%), and moderate to severe stress (53%) related to sexual activity at 1 year postoperatively. A significantly higher percentage (p = 0.01) of female patients (63%) reported changing their coital position postoperatively due to difficulty in leg positioning when compared to male patients (37.5%). Most patients (69%) were not able to procure information on sexual activity after THA surgery. and only 17.5% of patients discussed the topic with their surgeon. CONCLUSION: Although THA significantly reduced difficulty in sexual activity, most patients reported no change in the frequency of sexual activity or sexual satisfaction, had moderate to severe stress regarding sex, and were primarily concerned about safety of coital position and fear of dislocation at the end of 1-year postoperatively. Pre- and postoperative counselling by their surgeons will provide the patient with relevant information and help reduce anxiety and stress, improve satisfaction, and enhance the overall sexual health of the patient undergoing primary THA.

Management of Infected Total Knee Arthroplasty by a New Innovative Customized Articulating Knee Spacer: An Early Experience.

INTRODUCTION: Management of infected total knee arthroplasty (TKA) is a challenge to patient and surgeon alike. Two-stage exchange is the universally acclaimed method to tackle this problem. Various spacer devices are available for the first stage surgery for local delivery of antibiotics. Here, we report our experience with management of infected TKA patients with our indigenously designed and produced knee spacer. CASE REPORT: Between 2012 and 2013, 28 patients with infected total knee replacement (TKR) have been managed by our indigenous knee spacer. Minimal spacer-related complications and a stable knee joint with range of motion up to 100° were noted in these patients. After a mean period of 6-8 weeks, the spacer was removed and definitive TKR fixation done. At a mean follow-up of 4-months post second stage definitive surgery, patients were infection free with no evidence of recurrence of infection. CONCLUSION: Our new innovative customized articulating knee spacer, which has intramedullary stem extension, has potential to significantly reduce spacer-related complications along with providing improved knee function.

Hip arthroplasty in failed intertrochanteric fractures in elderly.

BACKGROUND: Failed intertrochanteric fractures in elderly patients are surgical challenge with limited options. Hip arthroplasty is a good salvage procedure even though it involves technical issues such as implant removal, bone loss, poor bone quality, trochanteric nonunion and difficulty of surgical exposure. MATERIALS AND METHODS: 30 patients of failed intertrochanteric fractures where hip arthroplasty was done between May 2008 and December 2011 were included in study. 13 were males and 17 were females with average age of 67.3 years. There were 2 cemented bipolar arthroplasties, 19 uncemented bipolar, 4 cemented total hip arthroplasty and 5 uncemented total hip arthroplasties. 16 patients had a trochanteric nonunion, which was treated by tension band principles. Total hip was considered where there was acetabular damage due to the penetration of implant. RESULTS: The average followup was 20 months (range 6-48 months). Patients were followed up from 6 to 48 months with average followup of 20 months. None of the patients were lost to followup. There was no dislocation. All patients were ambulatory at the final followup. CONCLUSION: A predictable functional outcome can be achieved by hip arthroplasty in elderly patients with failed intertrochanteric fractures. Though technically demanding, properly performed hip arthroplasty can be a good salvage option for this patient group.