Evaluation of the Outcome of Osteoarthritis among Patients Undergoing Total Knee Replacement.

Background: To assess the outcome of osteoarthritis among patients undergoing total knee replacement (TKR). Materials and Methods: One hundred and four subjects with one hundred and fifty-two cemented total knee arthroplasties have been analyzed in the current research. Functional assessment was carried out using the preoperative and postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) score and its five subscales: pain, other symptoms, function in activity of daily living (ADL), function in sport and recreation (Sport/Rec), and knee-related quality of life (QOL). Results: A significant improvement in the KOOS symptom score was seen with score grade changing to excellent from poor. The average postoperative KOOS symptom score occurred to be 89.9198, whereas the mean preoperative KOOS score was 30.7960 with a mean difference of 59.02385. The mean postoperative KOOS pain score was 94.6304 and the mean preoperative KOOS score was 18.4831 with a mean difference of 76.14731. A significant improvement in the KOOS pain score was seen with score grade changing to excellent from poor. Sixty patients of 104 (57.7%) had an excellent satisfaction level with a postoperative range of motion, twenty-eight patients (26.9%) had a good, eleven patients (10.6%) had a fair, and five patients (4.8%) had a poor satisfaction level with a postoperative range of motion. Conclusion: Surgery for a TKR is successful in reducing individuals' pain and restoring their functional ability. Preoperative expectations and KOOS subscale scores are factors in patients' satisfaction, which is determined a year following surgery.

Prevalence of Psychiatric Morbidity and Stress Burden among Patients with Limb Fracture.

Background: To assess the prevalence of psychiatric morbidity and stress burden among the patients with limb fractures and compare them with age and gender matched control group. Materials and Methods: The cross-sectional study was conducted on 25 patients each of lower and upper limb fractures, presenting 2 weeks or more after the fracture to orthopedics OPD of Dayanand Medical College and Hospital. Psychiatric manifestations and stress burden were assessed using Mini International Neuropsychiatric Interview (M.I.N.I.), perceived stress scale (PSS), and impact of event scale-revised (IES-R) on the patients. It was compared to an equal number of age and gender matched normal control group. Results: Majority of the patients with limb fractures were male (70%). The upper limb fracture was in age group of 18-30 years (52%), and those with lower limb fracture were >50 years of age (48%). Most common psychiatric morbidity seen in patients was major depressive disorder (52%) which was statistically significant in comparison with control group. The impact of trauma on patients resulted in avoidance and hyperarousal symptoms significantly in lower limb fracture patients than upper limb ones (P < 0.05). Conclusions: The long bone injuries in patient cause significant psychiatric morbidity which increases the stress burden in such patients due to immobility and pain.

Synovial Hemangioma of the Knee Management and Excellent Outcome 2 Years after Arthroscopic Synovectomy in a 25-year-old Male with a 20-year History.

INTRODUCTION: Synovial hemangioma is a rare condition with <200 published case reports in world literature and is frequently misdiagnosed, leading to diagnostic delay of many years. This delay is even more significant if the patient comes from a rural background with a dearth of medical facilities in the area. This case had a lag of nearly 20 years from the time of onset of symptoms and the required management which is the maximum reported for any synovial hemangioma since most of them have been found and treated in adolescents. CASE REPORT: We present a case of an atypical synovial hemangioma in a 25-year-old Indian male from a poor socioeconomic background with a delay of 20 years who had both recurrent knee effusions and long-standing knee pain but kept ignoring his symptoms. It was managed by arthroscopic synovectomy. The patient reported to us after 2 years after the surgery with a painless knee and full range of movement. CONCLUSION: Synovial hemangioma mostly affects the knee joint, showing recurrent bloody effusions without a history of trauma. If there are no intermittent effusions, the diagnosis will be even more difficult. In cases of non-specific symptoms and long-standing knee pain of many years, the diagnosis of a synovial hemangioma should also be considered. In this particular case, magnetic resonance imaging was used to evaluate the patient after the plain radiographs and showed characteristic lace-like or linear patterns. Diagnostic arthroscopy and surgical excision were done in the same sitting, and biopsy was sent to the histopathology laboratory which confirmed our diagnosis. Although this patient had the disease since 20 years and presented late, he had little degeneration of cartilage at the time of arthroscopy. The functional outcome at 2-year follow-up was excellent, and he had no disability, effusion and was pain free.

Endovascular management of traumatic pseudoaneurysm: Short & long term outcomes.

BACKGROUND: Pseudoaneurysms as result of orthopaedic injuries are a known clinical entity. But with increase in operative interventions and use of implants, its incidence is bound to increase. It is important to detect this complication at the earliest to avoid any limb or life threatening problems. Selective angiography is a minimally invasive technique to pin point the diagnosis and at the same time allow for therapeutic embolization/stenting of the pseudo aneurysm. METHODS: A retrospective review of inpatients from January 2007 to January 2013 requiring transarterial embolization/stenting for pseudoaneurysm in the limbs. All patients had evidence of pseudoaneurysm as proved by radiological findings. Angiographic intervention in a cath lab was performed, following which patients were monitored for morbidity and mortality benefits on short and long term follow up. RESULTS: Out of the total 13 patients; 7 adults and 1 child underwent embolisation with polyvinyl alcohol particle/soft metal coil, whereas the remaining 5 adults underwent revascularisation with covered stent. The mean age of patients in our case series was 41.92 ± 18.89 years. The mean follow up period of the group was 14.61 ± 12.21 months. All but one patients showed significant clinical improvement with endovascular management with no procedure related mortality. CONCLUSION: Endovascular management is the modality of choice in comparison to other procedures for traumatic pseudoaneurysms in both paediatric and adult patients.