Skin Numbness after Total Knee Arthroplasty: Complication or Side-Effect?

BACKGROUND: Peri-incisional numbness occurs frequently after Total Knee Arthroplasty (TKA), yet its impact on clinical outcomes remains controversial. With some studies reporting 100% incidence and patients often perceiving it as a minor inconvenience, its categorisation as a complication is controversial. This study investigates the prevalence and temporal changes of numbness post-TKA to refine the informed consent process and improve patient satisfaction. MATERIAL AND METHODS: A convenience sample of patients who underwent primary cemented TKA was studied. Demographic data, scar length, tourniquet time, and WOMAC scores were collected. Patients were grouped based on time from surgery, and areas of numbness for light touch and pinprick sensations measured. RESULTS: The study included 49 patients with a mean age of 68.9 years. While all patients reported numbness, the area decreased for both pinprick and light touch sensations over time. No significant correlation was found between WOMAC scores and the area of numbness. DISCUSSION: Numbness post-TKA is common, and the affected area contracts over time, implying a natural healing process. The study's findings challenge the perception of numbness as a complication and emphasise the importance of informed consent in managing patient expectations. CONCLUSIONS: 1. Postoperative numbness around the incision site following TKA is a common occurrence with minimal clinical impact on patients. 2. It is important to inform patients that this numbness will improve, although some residual numbness may remain.

Increasing incidence of slipped capital femoral epiphysis in Trinidad and Tobago: A 50-year review.

Slipped Capital Femoral Epiphysis (SCFE) is a physeal disorder of the proximal femur. Misdiagnosis and late treatment are associated with poorer outcomes. The epidemiology and delays in treatment of the disease between 1968 and 2018 were investigated in North Trinidad. The number of cases presenting annually has increased over the decades and the incidence between 2008-2018 was 2.2 cases per 100 000 per year. Almost 70% of cases were above the 95th percentile for body weight. Delay in treatment from onset of symptoms was 278 ± 258 days. Awareness of the risk factors and clinical presentation of SCFE may facilitate early diagnosis and treatment, and prevent severe hip disability in adulthood.

En bloc Surgical Excision of an Arteriovenous Malformation in the Foot: A Case Report and Review of the Literature.

Introduction: Arteriovenous malformations (AVM) are developmental vascular malformations consisting of abnormal arteriovenous shunts surrounding a central nidus. These lesions are relatively uncommon, comprising just 7% of all benign soft-tissue masses. Most AVMs occur in the brain, neck, pelvis, and lower extremity and rarely manifest in the foot. When they do form in the foot, non-specific pain and the absence of clinical features contribute to the high rate of misdiagnosis on initial presentation. Although surgical excision combined with embolotherapy has emerged as the preferred treatment for large AVM, controversy exists over the best treatment for small lesions in the foot. Case Presentation: A 36-year-old Afro-Caribbean man was referred to the clinic with a 2-year history of increasing pain in his forefoot, affecting his ability to stand or walk comfortably. There was no history of trauma, and despite changing his footwear, the patient continued to have significant pain. Clinical examination was unremarkable except for mild tenderness over the dorsum of his forefoot, and radiographs were normal. A magnetic resonance scan reported an intermetatarsal vascular mass but could not exclude malignancy. Surgical exploration and en bloc excision confirmed the mass to be an AVM. One year post-surgery, the patient remains pain-free with no evidence of recurrence. Conclusions: The rarity of AVM in the foot, combined with normal radiographs and non-specific clinical signs, contributes to the long delay in diagnosing and treating these lesions. Surgeons should have a low threshold for obtaining magnetic resonance imaging in cases of diagnostic uncertainty. En bloc surgical excision is an option for treating small suitably located lesions in the foot.

Revision Total Hip Arthroplasty in Jehovah's Witnesses at a Public Hospital: Practical Recommendations for a Low-Resource Setting.

Revision total hip arthroplasty (THA) is a major reconstructive procedure traditionally associated with significant blood loss. Jehovah's Witnesses (JW) do not accept blood or blood product transfusions because of their religious beliefs. When confronted with a JW patient requiring a complex arthroplasty procedure, surgeons face moral and ethical questions and may be reluctant to perform surgery. A successful outcome depends on several factors including surgical and anesthetic expertise, a range of revision implants, and a multimodal blood management protocol. While these resources are readily available in a developed country, in many of the developing Caribbean islands, the healthcare system is underfunded and under-resourced. Here, we describe our experience performing a revision THA on a JW patient in the Caribbean. Through this case report, we aim to illustrate our approach to blood management by exploring the fundamental elements that were employed in a low-resource setting. We believe that the extrapolation of these crucial principles to the broader category of primary arthroplasty in the general population can be used to reduce the rate of blood transfusion, increase access to surgery, and improve outcomes.

An 8-YEAR analysis of bone tumours in a Caribbean island.

BACKGROUND: An epidemiologic analysis of bone tumours in Trinidad & Tobago. METHODS: A retrospective analysis of primary and secondary bone tumours, site of origin and demographic data was conducted. RESULTS: 63 bone tumours were analysed and included 27 primary benign (43%), 12 primary malignant (19%), 19 metastatic (30%) and 5 by contiguous spread (8%). The most common malignant primary tumour was the osteosarcoma (n = 7), originating from the femur in mostly males in the 11-20 age group. There was 1 chondrosarcoma, 2 fibrosarcomas and 2 plasmacytomas. Benign tumours consisted of 8 osteochondromas, 2 osteomas, 3 giant cell tumours, 3 bone cysts and 11 cases of fibrous dysplasia. CONCLUSION: Bone tumours are rare with a low incidence of 1.125 per 100,000 population annually and malignant tumours being even rarer at an incidence of 0.18 per 100,000 population annually. There is need for better documentation and data registries in Trinidad and Tobago.