Revolutionizing Back Pain Management: Is Epidural Platelet-Rich Plasma the Superior Choice Over Steroids?

Background and objective Low back discomfort is one of the main factors that restrict physical activity, and it is becoming more and more common. Surgery is the best option when all other conservative treatment methods have failed, but it is not a panacea. While local anesthetic-free and combined epidural steroid injections have been used for many years, their usefulness is limited to shorter periods. In the field of orthopedics, platelet-rich plasma (PRP) has gained widespread recognition as an adjuvant component. PRP has been applied to improve tissue repair, both soft and hard. This comparative study aimed to evaluate the potential of PRP as a therapy for low back pain (LBP). Methods We included 64 adult individuals with complaints of LBP. They were classified into two groups: group A underwent a single injection in the afflicted lumbar intervertebral disc (IVD) level with 1.5 ml of methylprednisolone, 1.5 ml 2% lidocaine, and 0.5 ml of saline under rigorous aseptic precautions; in contrast, group B was administered a single injection of 3 milliliters of autologous PRP. Patients' scores on the visual analog scale (VAS), the Modified Oswestry Disability Questionnaire (MODQ), and the Straight Leg Raising Test (SLRT) were assessed before and during therapy. Results The data gathered were subjected to statistical analysis. Statistically significant differences were found in the VAS scores between group A (methylprednisolone group) and group B (PRP group) post-one hour (6.0 ±0.74 vs. 6.92 ±0.57) and after three months (5.2 ±0.65 vs. 3.26 ±0.79). Conclusions Our study revealed gradual progressive improvement in the symptoms of patients in the PRP group as indicated by scores on SLRT, VAS, and MODQ. The results were comparable to those who received methylprednisolone injections. There was a statistically significant difference in VAS scores between the two groups, with the PRP group reporting a higher degree of pain reduction, showing that PRP is an effective alternative to epidural steroid infiltration in managing chronic LBP.

Persistent Pain and Purulent Discharge: A Case of Infected Bipolar Hemiarthroplasty.

Prosthetic joint infection (PJI) remains a significant complication following joint arthroplasty, necessitating prompt recognition and intervention to optimize patient outcomes. This case report describes a 65-year-old male who presented with persistent pain, swelling, and purulent discharge from the right hip, three years post-bipolar hemiarthroplasty following a road traffic accident. Clinical examination revealed signs suggestive of PJI, prompting surgical intervention with total hip arthroplasty. Postoperatively, the patient experienced resolution of symptoms and satisfactory recovery. This case underscores the challenges associated with infected joint arthroplasty and highlights the importance of a multidisciplinary approach for effective management. Early diagnosis, appropriate surgical intervention, and comprehensive postoperative care are essential for minimizing morbidity associated with PJIs and optimizing patient outcomes.

A Comprehensive Review of Current Management Trends in Medial Compartment Arthritis of the Knee Joint.

Medial compartment arthritis of the knee joint presents a significant clinical challenge, with diverse management options ranging from nonsurgical interventions to various surgical procedures. This comprehensive review synthesizes current evidence on the management trends in medial compartment arthritis, highlighting both nonsurgical approaches such as physical therapy, pharmacological interventions, and intra-articular injections as well as surgical interventions, including arthroscopic debridement, high tibial osteotomy, and knee arthroplasty. Through a comparative analysis of efficacy, complication rates, and patient outcomes, this review underscores the importance of tailoring treatment strategies to individual patient characteristics and preferences. Furthermore, emerging techniques and technologies promise to advance the field, necessitating ongoing research efforts to refine treatment algorithms and establish standardized guidelines. By adopting a multidisciplinary approach and integrating evidence-based practices, clinicians can optimize the management of medial compartment arthritis and enhance patient care outcomes.

A Comprehensive Review on Managing Fracture Calcaneum by Surgical and Non-surgical Modalities.

This comprehensive review delves into the multifaceted landscape of calcaneal fractures, thoroughly examining their aetiology, clinical presentation, and diverse management strategies. Encompassing surgical and non-surgical approaches, the review scrutinises critical aspects such as patient compliance, rehabilitation protocols, and long-term follow-up considerations. Surgical modalities, propelled by recent innovations like minimally invasive techniques and advanced fixation materials, are juxtaposed with non-surgical interventions, emphasising the pivotal role of patient education and adherence to optimise outcomes. The synthesis of critical findings underscores the need for individualised care and multidisciplinary collaboration in clinical practice. Moreover, the review outlines recommendations for healthcare practitioners and identifies promising areas for future research, including biomechanical studies and telerehabilitation. This comprehensive exploration aims to contribute to the ongoing evolution of calcaneal fracture management, ultimately enhancing patient care and outcomes in this complex orthopaedic realm.

Injections of Platelet-Rich Plasma: An Emerging Novel Biological Cure for Low Back Pain?

Autologous platelet-rich plasma (PRP) injections have emerged as a new biological intervention for many musculoskeletal conditions, such as low back pain (LBP), and have garnered significant attention in recent research endeavors. The recognition of PRP's use is progressively growing; nonetheless, comprehensive clinical validation is required to establish its uses and efficiency. This article offers a thorough evaluation regarding the assurance as well as the efficacy of PRP therapy in the management of low back pain. It specifically focuses on the analysis of clinical trials undertaken in this field.

Total Hip Arthroplasty in Ankylosing Spondylitis: A Case Report of Ankylosed Hip.

Ankylosing spondylitis (AS) is a chronic inflammatory arthritic disease that primarily affects the axial skeleton, and its association with the secondary development of osteoarthritis (OA) in peripheral joints, particularly the hips, is increasingly recognized. This case report elucidates the diagnostic and therapeutic challenges encountered in a patient with bilateral hip osteoarthritis secondary to AS. The patient's medical history included AS and a failed attempt at core decompression of the left hip joint. The patient was managed with total hip arthroplasty (THA) on the left side due to persistent symptoms. Total hip arthroplasty on the left side involved a meticulous surgical approach, addressing the unique challenges posed by underlying ankylosis. The procedure was conducted uneventfully, with the implantation of a modular femoral head, uncemented femoral stem, and modular shell. Postoperatively, the patient experienced significant pain relief and improved functionality. Successful rehabilitation and management were integral to the overall positive outcome. This case report highlights the complex interplay between AS and hip osteoarthritis, emphasizing the importance of tailored diagnostic and therapeutic strategies. Successful total hip arthroplasty in the setting of AS-related hip osteoarthritis suggests that joint replacement can be effective, but ongoing research is necessary to optimize surgical planning and long-term outcomes in this patient population.

Bilateral Anterior Cruciate Ligament Reconstruction Using Gracilis and Semitendinosus Graft by Single-Staged Approach.

A bilateral anterior cruciate ligament (ACL) tear is one of the rare injuries that is seen in orthopaedics practice. Although few single-staged bilateral ACL ruptures have also been documented, most bilateral ACL ruptures happen on two different occasions. Although there isn't a clear consensus, there have been accounts of both single-staged and two-staged reconstruction of bilateral ACL ruptures in the literature. This case report provides surgeons with options to consider while treating this unusual injury. A 35-year-old woman with bilateral anterior cruciate ligament injuries presented with an MRI of her left knee suggestive of a complete ACL tear with a Medial meniscus tear in the left knee, and an MRI of her right knee showed a complete ACL tear. The patient underwent arthroscopic ACL reconstruction in a single stage for both knees. Six months after her surgery, she had met all the rehabilitation goals and was cleared to resume her daily activities. The patient preoperatively had a visual analogue scale (VAS) score of 8, and postoperative assessment, her VAS score reduced to 2. ACL reconstruction in one stage and two stages were the surgical treatment modalities described in the literature. Concurrent rehabilitation of both ACL repairs is more economical, reduces hospital stay, and helps in early recovery, but it may result in severe quadriceps deconditioning. Double-staged surgeries are less demanding, with a shorter duration of surgery that can be performed by a less experienced surgeon. As single-staged bilateral ACL reconstruction is a less expensive option that reduces hospital stays and aids in early recovery for this rare patient population, it may be a great therapy option compared to two-staged bilateral ACL reconstruction.