A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report.

BACKGROUND: Plantar fasciitis is one of the commonest, and most frustrating, foot ailments seen in a regular orthopaedic clinic. There are a number of modalities available to treat this condition, of which corticosteroid injection is, perhaps, the most popular. However, recent years have seen an increased interest in the use of platelet-rich plasma (PRP) injections in various clinical situations such as plantar fasciitis. METHODS: We undertook a prospective non-randomized study to compare the efficacy of traditional corticosteroid injection (Steroid group) to PRP injection (PRP group), in a cohort of patients. RESULTS: We studied both groups of patients before and after the injections using Visual Analogue Score (VAS), the Foot & Ankle Disability Index (FADI) and American Foot and Ankle Score (AFAS). Our study confirms that there is significant clinical improvement in PRP group at three months after the injection. CONCLUSION: The use of PRP injection can be an attractive alternative in the treatment of disabling, recalcitrant plantar fasciitis. STUDY DESIGN: Cohort study. LEVEL OF CLINICAL EVIDENCE: Level 3.

High-flexion mobile-bearing knees: impact on patellofemoral outcomes in 159 patients.

Ethnic cultural demands of the patient have encouraged surgeons to use high-flexion designs. It has been speculated that these high-flexion designs may produce higher incidence of patellofemoral complications over conventional designs. We wish to report 5- to 7-year follow-up of this design with special emphasis on patellofemoral outcomes. We performed a prospective study involving 159 patients who underwent computer-assisted simultaneous bilateral total knee arthroplasty (TKA) with high-flexion design. Patients were evaluated clinically using Knee Society score (KSS), Western Ontario and McMaster University Osteoarthritis (WOMAC) score, and Hospital for Special Surgery patella score with a minimum follow-up period of 5 years. At last follow-up, mean scores were KSS (88.7), WOMAC (48.5), and HSS (86.7). All the scores improved postoperatively. Average preoperative range of motion was 108 degrees, which improved to 132 degrees postoperatively. There was no evidence of loosening or spin out in our study. Our study shows that TKA done using high-flexion rotating platform design results in near normal patellofemoral tracking patterns with improvement in function. The level of evidence of the study is IV.

Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid.

The use of tranexamic acid (TA) in total knee arthroplasty is well documented. However, there is limited evidence to suggest the use of TA in simultaneous bilateral computer assisted total knee arthroplasty (CATKA). We, therefore, studied the effect of TA, in simultaneous bilateral computer assisted total knee arthroplasty, in terms of blood transfusion, routes of administration and complications. We divided 90 patients into three groups. Group I patients received intravenous normal saline alone (IVNS group). Group II received intravenous TA alone (IVTA group). Group III received intraarticular TA alone (IATA group). Our study confirms that there is significant benefit of using TA but no difference between the intravenous or intraarticular routes of administration.

Outcome of subvastus approach in elderly nonobese patients undergoing bilateral simultaneous total knee arthroplasty: A randomized controlled study.

BACKGROUND: Subvastus approach in total knee arthroplasty (TKA) spares the quadriceps and may assist in faster rehabilitation. The present randomised controlled study was conducted to determine if the subvastus approach results in early recovery, faster mobilization, shorter hospital stay, and improved function. MATERIALS AND METHODS: 100 patients undergoing simultaneous bilateral TKA were randomized into two groups: subvastus group and medial parapatellar group. The patients were assessed clinically using VAS, time to straight leg raise, ability to stand with walker, ability to use a commode chair, ability to climb stairs, flexion at discharge, and day of discharge. Perioperative blood loss and duration of surgery were also compared. The patient were kept on same pain management and physiotherapy protocol. The evaluation was done at day 0,1,3 and at discharge. Statistical analyses tested the null hypotheses of no differences in patients treated with either group at 95% significance level (P < 0.05). RESULTS: The VAS score was significantly lower in subvastus group on day 1 and day 3. Also mean hospital stay was 2.04 days less in subvastus group. Patients with subvastus approach were able to perform straight leg raising 0.44 days earlier. Though time to stand with walker was same for both groups, the ability to use commode chair, and climb stairs was significantly early (P < 0.05) in the subvastus group. The average flexion at the time of discharge in subvastus and parapatellar group were 100.8 and 96.8°, respectively. The mean perioperative blood loss in subvastus group and parapatellar group were 343 ml and 372 ml, respectively. Average surgical time required for subvastus approach and parapatellar approach were 108.5 and 94.3 min, respectively. CONCLUSIONS: Subvastus approach produce appreciably less pain and faster mobilization due to lesser insult to quadriceps, thus assisting in early rehabilitation, shorter hospital stay, less expenditure, and more patient satisfaction.

Use of bone graft substitute in the treatment for distal radius fractures in elderly.

INTRODUCTION: Fractures of the distal radius in elderly patients are often associated with metaphyseal defects that can lead to collapse, malunion and therefore decreased function. An alternative approach to simple reduction is to fill the defects with materials that can provide structural support. METHODS: We used synthetic hydroxyapatite (HA) in unstable fractures of the distal radius in thirty-one elderly patients, of which four patients lost to follow-up, leaving twenty-seven patients for this study. All subjects underwent closed reduction with K-wire fixation and HA augmentation. They were followed up at 8- and 16-week intervals post-operatively to assess the functional outcome using patient-related wrist evaluation [PRWE], clinical outcome and radiological outcome. RESULTS: At mean 16 weeks, our results show that patients treated with this method showed no metaphyseal defect, no collapse and had satisfactory clinical outcome as assessed by PRWE. CONCLUSION: We believe that fixation with hydroxyapatite augmentation for fractures of the distal radius in elderly patients is an attractive therapeutic option. This experience has changed our clinical practice.

The "Shetty test" in ankle injuries: validation of a novel test to rule out ankle fractures.

Ankle sprains are by far the commonest ankle injuries. The traditional clinical approach, to any ankle injury, is a clinical examination followed by radiological examination. We have developed a simple clinical test to rule out fractures in ankle injuries and thereby eliminating the necessity for radiological examination. Our test is simple, reproducible, economic, time saving and avoids potential radiation exposure risks.