Reintroduction of Hip and Knee Arthroplasty Through COVID-19 Pandemic: Experience at a High-Volume Hip and Knee Arthroplasty Centre in India.

Background: COVID-19 was declared as a pandemic in March 2020. Government of India declared a countrywide lockdown on 24 March 2020. All elective surgeries including Hip and Knee arthroplasty were postponed in view of pandemic. Gradually cases were resumed after stepwise unlock measures. The aim of this study is to assess how hip and knee arthroplasty surgeries were affected during first wave of pandemic, and how situation was tackled by an arthroplasty unit of a tertiary-care hospital in India. Methods: This study was a single-centre retrospective observational study. Data pertaining to patient demographic details, surgery, preoperative screening for COVID-19, duration of hospital stay, and post-op 30-day complications were collected from hospital records and analyzed. These data were compared with 2019 data. Results: There was significant decrease (88.45%) in total number of hip and knee arthroplasty cases between March 2020 and November 2020 as compared to the same duration in 2019. 30-day mortality was only 2 deaths both who died due to COVID-19-related complications. Duration of stay in hospital and post-operative complications were not statistically and significantly affected. There was a statistically significant increase in tourniquet time compared to the previous year. If deaths due to COVID-19 are excluded, there was statistically no significance difference in 30-day mortality rate. Conclusion: Following strict local policy for patient selection and reducing the number of post-operative patient visits to the hospital allowed us to perform hip and knee arthroplasty safely with minimum COVID-19-related mortality and morbidity. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-023-00930-6.

Knee Osteoarthritis with Old Untreated Patella Fracture Treated with Single Stage Total Knee Arthroplasty - A Case Series of Two Cases.

Introduction: Total knee arthroplasty (TKA) is one of the most successful procedures for osteoarthritis (OA), but when associated with an old patella fracture, the knee arthroplasty becomes complex due to discontinuity in extensor mechanism. Moreover, in elderly patients, early mobilization and avoiding multiple surgeries are important to prevent associated morbidity. This is the first instance of a case series being reported where an untreated patella fracture >3-months-old with knee OA has been managed with single stage TKA. Case Report: Two patients, both with OA of knee and untreated patellar fractures, presented to us with knee pain. A 74-year-old lady having 6-months-old untreated right patella fracture without extensor lag was our first patient and a 57-years-old lady having 2-years-old patella fracture non-union with extensor lag of 30° was our second patient. Both were assessed and a decision to perform total knee replacement was taken. Patient with extensor lag required reconstruction of the extensor mechanism whereas the one without extensor lag was treated as a normal routine total knee replacement. Conclusion: Elderly patients with untreated patella fracture and degenerative knee OA can be considered for single stage TKA, with decision on patella management based on the presence or absence of extensor lag. Rehabilitation is faster with single surgery and also there are decreased risks and complications associated with multiple surgeries.

Conjoint Lumbosacral Nerve Root-A Case Report.

INTRODUCTION: Conjoint nerve root is embryological nerve root anomaly mainly involving lumbosacral region. The anomalous roots present primarily as a bifid, conjoined structure arising from a wide area of the dura. Because of their size and attachment to surrounding structures, they are uniquely susceptible to trauma. The effects of compression and entrapment are amplified in the presence of stenosis of the lateral recesses where developmental changes and disc herniations deplete the available reserve space [1]. CASE REPORT: We report a case of conjoint lumbosacral nerve root which was missed on MRI and diagnosed intra-operatively. CONCLUSION: The importance of the case report lies in the fact that one must be aware of finding conjoint nerve root directly while operating and do appropriate level of surgery, misinterpretation can lead to devastating results.

Malakoplakia of Proximal Tibia- A Case Report.

INTRODUCTION: Malakoplakia is chronic granulomatous disorder resulting from an abnormal immunological response resulting in accumulation of histiocytes [1].It normally involves the urinary bladder, colon, skin etc. But bone is rarely involved. Only seven cases have been reported in the literature. Ours is the first case involving the tibia. CASE REPORT: We report a rare case of malakoplakia of bone of upper end tibia in a 24 year old female with 1 month complaints of pain in the knee. CONCLUSION: The importance of this case report lies in the fact that malakoplakia can mimic benign lytic lesion and we need not be over aggressive while treating these patients. These can be treated with course of antibiotics [2].