Survival of total hip arthroplasty (THA) in sickle cell disease.

BACKGROUND: The objective of this study was to evaluate the outcome of THA done in patients with sickle cell disease at a single center, and compare with rest of the world before we could recommend routine THA in SCD patients. METHODS: In 92 patients, 117 THAs were performed in sickle cell patients. Seventy-six (76) patients had homozygous hemoglobin (Hgb SS) disease, whereas sixteen had sickle cell trait (Hgb AS). Patients with Grade III Ficat and above avascular necrosis of the head of femur (ANFH) with cementless porous-coated proximal femur fixation were included in this analysis. Harris hip score was modified (MHHS) and used for assessment of improvement and visual analog scale score (VAS), for pain assessment. RESULT: VAS improved from average pre-operative mean of 7 (7-9) to 2.5 (1-5). The average pre-operative MHHS was 44 (32-63), and it improved to 79 (71-88) in the final mean follow-up of 12.4 (4-18) years. Nine patients (9.7%) had complications and revision surgery was required in seven (5.9%) for aseptic loosening. CONCLUSION: Our analysis shows that THA in sickle cell disease is safe with average 12 years of follow-up, indicating that surgery in these young patients (≤ 25 years) is safe and should not be delayed.

Osteoporosis-related simultaneous four joints fractures and dislocation after a seizure: a case report.

A case of steroid-induced osteoporosis-related multiple fractures and dislocations are described after a seizure is reported. Patient had two years history of steroid use with no supplement or antiresorptive therapy. There was a delay in the diagnosis which affected an otherwise good outcome in such situations. It is recommended that patients on steroid should be given calcium, vitamin D, and an antiresorptive. Furthermore, a meticulous clinical examination is required in patients who are on steroids and suffer epileptic seizures to rule out skeletal injury.

Osteoarthritis of knee: correlation between radiographic and arthroscopic findings.

The objective of this study was to correlate radiologic changes to arthroscopic findings in patients with osteoarthritis of the tibiofemoral joint. The study group consisted of 105 patients, 52 men and 53 women, with a mean age of 51 +/- 9.3 years (range, 39-83 years), with symptomatic tibiofemoral joint osteoarthritis (TFOA). X-rays were graded according to Kellgren and Lawrence grading (KLG) by 2 independent board-certified radiologists. All patients had arthroscopy, and findings were recorded and analyzed per Outerbridge classification (OC). Approval of the Institutional Research and Ethical Committee was obtained. Statistical analysis was done using the Statistical Package for the Social Sciences, version 17 (SPSS Inc., Chicago, IL, USA). In men, the correlation of KLG to OC was more than 75% in grade II and joints appeared as grade IV, but with grades I and III, it was 66% and 57% (P = 0.05). In men in KLG groups I and III, the joints appeared to have milder affliction, but arthroscopy revealed otherwise. In women, the only correlation was of KLG grade IV to OC grade IV. In women, joint affliction was more severe than was predicted by the KLG (P = 0.01). This study shows that radiologic lagging occurs behind arthroscopic findings, especially in women and in apparent early arthritis in roentgenograms (lower radiologic grades). X-rays of the knee per se might give a false impression of a milder disease.