An evaluation of peri-operative clinical, serological and radiological parameters in hip arthroplasties -a prospective observational study of Indian cohorts.

BACKGROUND: The scarcity of mortality data in our country led to systematic effort with aim of evaluating peri-operative parameters associated with mortality in hip arthroplasties to determine better fixation method and reducing avoidable variables. MATERIALS & METHODS: 252 consecutive patients (133 males and 119 females; Mean age 58.68 years) operated for hip arthroplasties (cemented & uncemented THR and bipolar hemiarthroplasty) were observed prospectively for 2 years. Heart-rate, O2 saturation and BP were recorded at specific surgical steps and post-operatively for 48 h. Post-operative Trop-T and 2D Echocardiography were done in all patients and D-Dimer and CTPA in indicated ones. All post-operative deaths were extensively studied. RESULTS: - Majority (63%) were operated for traumatic indications.48% belonged to ASA grade-1, 46% grade-2 and 4% grade-3. There was statistically significant association of diagnosis (traumatic aetiology), ASA grade 2, raised Troponin -T, raised D-dimer and pulmonary embolism with mortality. Mortality rate in our study at post-op 48 h was 5.5%, 30 day- 8% and 1-year mortality rate was 19%. With total of 14 deaths, 8 deaths (57.14%) occurred among 127 cemented arthroplasties and 6 deaths (42.86%) among 125 uncemented arthroplasties. CONCLUSIONS: Selection of implant (cemented or uncemented) made no difference in eventual mortality. Collaborative effort of orthopaedic surgeon, anaesthetist and experts from respective fields in elderly high-risk patient with vigilant post-operative surveillance for minimum 48 h would help in lowering mortality associated with hip arthroplasties.

Are we neglecting long-term effects of vertebral shortening on pulmonary function in spinal tuberculosis?

PURPOSE: In developing part of the world, it is common to see complete destruction of vertebral bodies in tuberculosis. Our study aims to assess the effect of spinal tuberculosis with vertebral shortening on pulmonary function. METHODS: Fifty cases of spinal TB (14 males, 36 females) managed both operatively and non-operatively, who presented to tertiary care institute between years 2011 and 2016 were assessed. Vertebral height loss was assessed by spinal deformity index (SDI). All patients underwent pulmonary function testing using same equipment sitting in upright position. RESULTS: Mean age was 27.9 years (27.9 ± 11.9). 11 patients with mean SDI of 2.7 ± 1.1 showed normal lung function. 36 patients showed restrictive pattern of which 12 were mild, 14 were moderate and 10 showed severe pattern with a mean SDI of 3.8 ± 1.2, 5.6 ± 1.3 and 6.1 ± 1.4, respectively. 3 cases showed obstructive pattern. As the apex of curve shifted proximally, FVC% reduced. Increase in SDI value was associated with a fall in the vital capacity and FEV1. Increase in the kyphotic angle was associated with a deleterious effect on PFT results. CONCLUSIONS: Risk stratification of pulmonary dysfunction resulting from vertebral body height loss due to kyphosis will emphasize the need for early detection of spinal tuberculosis before deformity occurs.

Is Bilateral Sequential Total Hip Replacement as Safe an Option as Staged Replacement? A Matched Pair Analysis of 108 Cases at a Tertiary Care Centre.

BACKGROUND: Rationale for symptomatic severe bilateral arthritis of the hip is sequential bilateral THR completed under the same anaesthesia. The rarity of procedures and apprehension of complications preclude the widespread use. MATERIALS AND METHODS: Retrospective analysis of prospectively collected data from 108 patients (216 hips) with bilateral arthritis who underwent total hip arthroplasties was done: out of which 54 patients (108 hips) underwent a single-stage sequential procedure (sequential group) and a matched group of 54 patients (108 hips) underwent a two-stage procedure at different admissions (staged group). Patients were matched according to age (± 2 years), gender, American Society of Anaesthesiologists classification, perioperative management protocol and diagnosis. The mean duration of follow-up for sequential group was 5.1 years while that of staged group was 5.3 years. RESULTS: Most patients (88.88%) were operated with uncemented implants having ceramic on ceramic bearing surfaces under spinal or general anaesthesia. The operating time, post-op limb length and functional outcomes of both groups were comparable. Although the total estimated blood loss was significantly less in the sequential group (502 ml) as compared to the staged group (570 ml), the mean blood transfusion requirement was significantly higher (1.6 units) in the sequential group as compared to that in the staged group (0.9 units). The mean cumulative length of hospital stay was significantly longer in the staged group (23 days) compared with the sequential group (16 days). CONCLUSION: Single-stage bilateral total hip arthroplasty is a safe and viable option when performed with expertise in appropriately selected patients without any surge in complications.

India Joining the World of Hip and Knee Registries: Present Status-A Leap Forward.

BACKGROUND: The number of joint replacements in India is set to grow at the highest rate in the world from 2020 to 2026. It is high time for India to have an efficient and credible registry to help curtail the clinical impact of implant failure at a very early stage by prompt reporting. METHODS: Indian Joint Registry has been established by ISHKS with new data forms for reporting. These new detailed forms record, in addition to previous form, component-wise details of implants. Additional useful features include Linking with unique ID like PAN or Aadhaar, thromboprophylaxis, untoward intra-operative event, IJR consent and type of anaesthesia. RESULTS: There were 712 registered surgeons in IJR database till June 2020. Total TKRs being reported to registry increased from 1019 in 2006 to 27,000 in 2019. Majority of the patients (98.5%) were diagnosed with osteoarthritis knee. Company-wise distribution unveils that Johnson & Johnson DePuy represents the highest implant usage at over 37%. There has been increased utilisation of uncemented THR over cemented THR from 2006 to 2019. Dual-mobility THRs have gained ground as surgeon preference for the choice of implant. CONCLUSION: Effective use of quality registries can lead to better health outcomes at a lower cost for the society. An effective, responsive and sustainable registry in India offers many benefits and should be considered as a key objective. Making the registry function in India successfully will undoubtedly require multi-pronged efforts, but can deliver many benefits both to the patient and to the nation as a whole.

Reconstruction of First Metatarsal Bone Loss Following Osteomyelitis by a Modified Masquelet Technique: A Case Report.

INTRODUCTION: The literature regarding reconstruction of foot bone defects is limited. The reconstruction of diaphyseal bone defects is technically challenging and is often associated with poor outcomes. Associated osteomyelitis adversely affects the healing rates following a reconstruction procedure. CASE REPORT: We report a case of a 62-year-old male with lytic lesion involving the head of first metatarsal and proximal part of proximal phalanx following osteomyelitis treated with a two-stage reconstruction utilizing a modification of Masquelet's-induced membrane technique. A follow-up at 24 months post-surgery revealed a fully incorporated fibular graft with satisfactory functional outcomes. CONCLUSION: This two-stage modification of Masquelet technique provided an effective method to reconstruct the defect and restoration of the metatarsal length using minimal hardware to achieve a good functional recovery of the patient.

A case report of Poland Syndrome with Absent Limb Anomalies.

INTRODUCTION: Poland Syndrome(PS) is a rare congenital condition associated with the absence of unilateral chest wall muscles and sometimes ipsilateral symbrachydactyly (abnormally short and webbed fingers). The condition typically presents with unilateral absence of the sternal portion of the pectoralis major muscle which may or may not be associated with a hypoplasia of the breast, an ipsilateral webbing of the fingers (cutaneous syndactyly) and agenesis of 2, 3, 4, and 5 ipsilateral costal cartilages, and athelia. CASE REPORT: We report a 13-year-old patient with an atypical variant of PS without any limb anomalies. In view of the good function of the upper limb, no surgical treatment was offered, and the patient and his family were counseled regarding the condition. A follow-up of the patient at 2 years revealed that the patient is still asymptomatic with good functional status of the upper limb. CONCLUSION: It is hoped that this paper will further improve our understanding of this rare syndrome and its atypical presentations.