Knee Arthrodesis Using Dual-Plate Construct is Following Failed Distal Femur Megaprosthesis-A Case Report.

Introduction: Knee arthrodesis following failed total knee arthroplasty is a viable limb salvage option, and this procedure is reserved for failed two-stage revision surgery in severe comorbid patients with irreparable extensor mechanism disruption, severe instability, and extensive soft tissue loss. Knee arthrodesis using a dual-plate construct has been scarcely reported. We report a case of knee arthrodesis using a dual-plate construct in a male in his 20s who presented to us with a broken distal femur megaprosthesis. Case Report: An anterior midline incision was given. The cement mantle and broken prosthetic components were removed. The bone surfaces were freshened up and fixed using two orthogonal locking plates. After 4 months, there was a solid fusion in the knee, and the patient started walking independently with a short limb gait. The patient was advised limb lengthening for a shortening of 3 cm, but he denied it and managed with a shoe raise. After 4 years, he was pain free, and radiographs revealed a solid knee fusion. The patient was fully satisfied with the procedure, and he resumed manual work. Conclusion: This case report revealed that knee arthrodesis using a dual-plate construct is an economically viable salvage option for failed distal femur megaprosthesis.

Does indirect decompression by oblique lateral interbody fusion produce similar clinical and radiological outcomes to direct decompression by open transforaminal lumbar interbody fusion.

Objectives: Open transforaminal lumbar interbody fusion (O-TLIF) remains the most popular and widely practiced lumbar fusion method even today, providing direct decompression. Oblique lateral interbody fusion (OLIF) is a novel retroperitoneal approach that allows placement of a large interbody cage which provides an indirect neural decompression, and screws can be placed minimal invasively or through the Wiltse OLIF (W-OLIF) approach. We aim to find out the short-term efficacy of W-OLIF to O-TLIF in terms of radiological and clinical outcomes in patients of lumbar degenerative diseases. Materials and Methods: Fifty-two patients were divided equally into two groups (group O-TLIF and group W-OLIF). Several parameters were measured, such as the spinal cord cross-sectional area (SC-CSA), foraminal cross-sectional area (F-CSA), disc height (DH), foraminal height (FH), Schizas grade for stenosis, and Meyerding's grading for olisthesis. Functional scores were measured using the visual analog scale (VAS) for low back pain (LBP) and lower limbs, Oswestry Disability Index. All parameters were repeat measured at 3 months follow-up. Statistical analysis was done using SPSS software. Results: Both groups were similar in composition preoperatively. There was significant improvement in all clinical and radiological parameters post-surgery in either group. However, at 3 months, The DH, FH, FSA, and VAS (LBP) were better in the W-OLIF group than in O-TLIF. Procedure-related complications were seen in both groups (15% in the O-TLIF group and 19% in the W-TLIF group), but only one patient in O-TLIF required revision due to cage migration. Conclusion: Similar improvement occurs in most of the clinical and radiological parameters in the W-OLIF group compared to the O-TLIF group. Few radiological parameters such as the DH, FH, and F-CSA and the VAS (LBP) correction are superior in the W-OLIF group in the short-term follow-up. We conclude that indirect decompression by W-OLIF provides equivalent, if not better, results than the traditional O-TLIF lumbar fusion.

Primary Aneurysmal Bone Cyst in the Iliac Bone: A Case Report.

Introduction: Aneurysmal bone cysts (ABCs) are non-neoplastic expansile, vascular, osteolytic benign tumors in the long bone, spine, and sternum. The location in the pelvis is sparse. Case Report: A 12-year-old female presented with pain in her left pelvis for 6 months. On radiological examination, we found an expansile balloting lytic lesion involving almost the whole ilium and sparing the hip joint. There were multiple fluid levels seen on magnetic resonance imaging. The initial biopsy suggested ABC. Curettage and bone grafting were done along with electrocauterization and chemical cauterization. At 1-year follow-up, she is doing well without any complaints. Conclusion: This case report demonstrates a rare ABC of the ilium that was managed with curettage and bone grafting.

Joint awareness among total hip arthroplasty patients operated through anterior approach versus posterior approach: a systematic review and meta-analysis.

PURPOSE: The aim of this systematic review and meta-analysis was to compare joint awareness in patients who underwent total hip arthroplasty (THA) via the anterior approach (AA) versus the posterior approach (PA). The hypothesis was that patients who underwent THA via AA would have better forgetfulness of the artificial joint. METHODS: A comprehensive search of major literature databases and bibliographic details was conducted to identify studies evaluating the forgotten joint score (FJS-12) in total hip arthroplasty (THA) patients operated through the anterior approach (AA) and posterior approach (PA). Out of 234 studies identified, seven studies met the inclusion criteria for review. The Newcastle-Ottawa Scale was used to evaluate the quality of evidence and the risk of bias in the included studies. The FJS-12 was evaluated at three months, one year, and beyond 2 years. RESULTS: The mean FJS-12 at > 2 years was 82.03 in the AA group and 80.32 in the PA group. The forest plot analysis (n = 819 patients) revealed no significant difference in FJS-12 score between these two approaches (MD 2.13, 95% CI [- 1.17, 5.42], p = 0.21; I2 = 60%). However, the joint awareness was significantly lesser in the AA group at 3 months (MD 12.56, 95% CI [9.58, 15.54], p < 0.00001, I2 = 0%) and 1 year (MD 9.55, 95% CI [7.85, 11.24], p < 0.0001, I2 = 0%). CONCLUSIONS: After analyzing the available literature, it was found that THA patients operated through the AA approach have significantly lower joint awareness than those operated through the PA approach in the first year of surgery. However, there is no significant difference in joint awareness between these two approaches after 2 years. LEVEL OF EVIDENCE: III.

Ethics in Clinical Orthopedic Surgery.

Introduction: Orthopedic surgeons, owing to their specialized role, have a set of medical and moral responsibilities that span beyond the confines of the operating room. The primary objective of this exploration is to emphasize the pivotal ethical and professional standards that these surgeons should uphold. Methodology: We derived key ethical and professional aspects by reviewing standard medical practices, professional guidelines, and through consultations with senior orthopedic professionals. These aspects covered both the conduct inside the surgery room and the interpersonal relations outside. Results: Several core areas of conduct were identified.Patient-Centered Care: Prioritizing the holistic well-being of the patient.Communication: Ensuring that all communications are both transparent and respectful.Informed Consent: Properly securing consent after ensuring the patient is adequately informed.Confidentiality: Taking measures to safeguard patient information.Professional Behavior: Upholding the highest standards of professional conduct.Continuous Learning: Remaining committed to updating skills and enhancing competence.Interpersonal Relations: Building healthy and constructive relationships with industry representatives, professional peers, and hospital staff.Personal Life Balance: Recognizing the importance of a balanced personal and professional life for holistic well-being. Conclusion: For Orthopedic surgeons, strict adherence to the outlined ethical and professional principles is essential. Such commitment not only ensures the trust and safety of patients but also serves to maintain and elevate the prestigious standing of the orthopedic community in the broader medical landscape.

Ethical Practice for Postgraduate Students in Orthopedics: Nurturing Professionalism and Patient Care.

Background: In the domain of orthopedics, ethical practice significantly influences professionalism and the quality of patient care delivered by postgraduate students. This narrative review aimed to investigate the implementation and impact of an ethics-centric curriculum tailored for orthopedic postgraduate students. Methods: The proposed curriculum incorporates methodologies such as case-based learning, interactive discussions, and dedicated mentoring sessions, focusing on the unique ethical challenges encountered in orthopedics. Results: Introducing the curriculum provided postgraduate students with a robust foundation in ethical principles, enhancing effective communication, and fostering better doctor-patient relationships. Consequently, the students displayed an increased aptitude in navigating intricate ethical dilemmas in their clinical practice. Conclusion: There is a crucial need for continuous ethics education in orthopedics. Creating a supportive learning environment is essential to cultivate professionalism and promote patient-centered care. This study underscores the transformative potential of ethics training in molding orthopedic professionals who are both competent and deeply committed to maintaining the highest ethical standards.

A novel technique of reconstruction of the distal tibia using allograft after resection of giant cell tumor: A case report with literature review.

Giant cell tumor (GCT) of the distal tibia can result in significant bone loss and soft tissue compromise, which can present a challenge for reconstruction. Various techniques have been described for the reconstruction of large defects, including the use of allografts. In this article, we describe a novel technique of reconstruction of a large defect in the distal tibia using two femoral head allografts after resection of GCT. The technique involves using two femoral head allografts, which are shaped to fit the defect and secured with a locking plate and screws. Using this technique, we present a case report of a patient with GCT of the distal tibia who underwent resection and reconstruction. At the 18-month follow-up, the patient had good functional outcomes and no evidence of tumor recurrence. This technique offers a viable option for reconstructing large defects in the distal tibia after GCT resection, particularly in cases where autograft is not available or not feasible. Further studies are needed to evaluate the long-term outcomes and complications associated with this technique.

Emerging role of bone scintigraphy single-photon emission computed tomography/computed tomography in foot pain management.

Foot and ankle joints being weight-bearing joints are commonly subjected to wear and tear and are prone to traumatic and other pathologies. Most of these foot and ankle pathologies present with pain. The diagnosis of pathology and localization of pain generators is difficult owing to the complex anatomy of the foot and similar clinical presentation. This makes the management of foot pain clinically challenging. Conventional anatomical imaging modalities are commonly employed for evaluation of any anatomical defect; however, these modalities often fail to describe the functional significance of the anatomical lesions, especially in presence of multiple lesions which is common in ankle and foot; however, hybrid single-photon emission computed tomography/computed tomography (SPECT/CT) by virtue of its dual modalities, that is, highly sensitive functional imaging and highly specific anatomical imaging can serve as a problem-solving tool in patient management. This review attempts to describe the role of hybrid SPECT/CT in overcoming the limitation of conventional imaging and describes its potential application in the management of foot and ankle pain.

Safety and Efficacy of Tranexamic Acid in Hip Hemiarthroplasty for Fracture Neck Femur: a Systematic Review and Meta-analysis.

Purpose: Although numerous systematic reviews and meta-analyses have established the efficacy of tranexamic acid (TXA) in hip fracture surgeries, the included studies in those reviews have included all types of surgical interventions ranging from fixation to arthroplasty. Hip hemiarthroplasty is usually indicated in the elderly patients with femoral neck fracture and these patients have associated severe comorbidities and cognitive impairment. These subsets of patients with femoral neck fracture needs appropriate perioperative care and judicious use of antifibrinolytics. There is no meta-analysis evaluating the safety and efficacy of intravenous TXA in these patients. Methods: Searches of PubMed, Embase and Cochrane Central Register of Controlled Trials databases revealed 102 studies on TXA in hip fracture surgeries. After screening, eight studies were found to be suitable for review. The primary objective of this meta-analysis was to compare blood transfusion rate between TXA vs. control in hip hemiarthroplasty. The secondary objectives were total blood loss, postoperative haemoglobin, surgical duration, length of hospital stay and side effects (VTE, readmission and 30 days mortality). Results: There were one RCT, one prospective cohort study and six retrospective studies. All studies recruited the elderly patients. Intravenous (IV) TXA administration resulted in significant reduction in requirement of blood transfusion (12.7% vs. 31.9%; OR 0.28; 95% CI 0.17-0.46; p < 00,001; I 2 = 73%). The TXA group had significantly decreased total blood loss (MD - 100.31; 95% CI - 153.79, - 46.83; p < 0.0002). The postoperative Hb in the TXA group was significantly higher than the control group (MD 0.53; 95% CI 0.35, 0.71; p < 0.00001). There was no significant difference in the incidences of VTE (0.97% vs. 0.73%, OR 1.27; p = 0.81; I 2 = 64%) and readmission rate (9.2% vs. 9.64%; OR 0.79; p = 0.54), but 30-d mortality rate was significantly lower in the TXA group (3.41% vs. 6.04%; OR 0.66; p = 0.03). Conclusions: Intravenous TXA is efficacious in the reduction of blood loss and transfusion need in hip hemiarthroplasty surgery for hip fracture, without increased risk of VTE. The blood conservation protocol led to decreased 30 days mortality in these fragile elderly patients. Level of evidence: III.

Perioperative mortality and morbidity of hip fractures among COVID-19 infected and non-infected patients: A systematic review and meta-analysis.

PURPOSE: Hip fractures among elderly patients are surgical emergencies. During COVID-19 pandemic time, many such patients could not be operated at early time because of the limitation of the medical resources, the risk of infection and redirection of medical attention to a severe infective health problem. METHODS: A search of electronic databases (PubMed, Medline, CINAHL, EMBASE and the Cochrane Central Register of Controlled Trials) with the keywords "COVID", "COVID-19″, "SARS-COV-2", "Corona", "pandemic", "hip fracture", "trochanteric fracture" and "neck femur fracture" revealed 64 studies evaluating treatment of hip fracture in elderly patients during COVID-19 pandemic time. The 30-day mortality rate, inpatient mortality rate, critical care/special care need, readmission rate and complications rate in both groups were evaluated. Data were analyzed using Review Manager (RevMan) V.5.3. RESULTS: After screening, 7 studies were identified that described the mortality and morbidity in hip fractures in both COVID-19 infected (COVID-19 +) and non-infected (COVID-19 -) patients. There were significantly increased risks of 30-day mortality (32.23% COVID-19 + death vs. 8.85% COVID-19 - death) and inpatient mortality (29.33% vs. 2.62%) among COVID-19 + patients with odds ratio (OR) of 4.84 (95% CI: 3.13 - 7.47, p < 0.001) and 15.12 (95% CI: 6.12 - 37.37, p < 0.001), respectively. The COVID-19 + patients needed more critical care admission (OR = 5.08, 95% CI: 1.49 - 17.30, p < 0.009) and they remain admitted for a longer time in hospital (mean difference = 3.6, 95% CI: 1.74 - 5.45, p < 0.001); but there was no difference in readmission rate between these 2 groups. The risks of overall complications (OR = 17.22), development of pneumonia (OR = 22.25), and acute respiratory distress syndrome/acute respiratory failure (OR = 32.96) were significantly high among COVID-19 + patients compared to COVID-19 - patients. CONCLUSIONS: There are increased risks of the 30-day mortality, inpatient mortality and critical care admission among hip fracture patients who are COVID-19 +. The chances of developing pneumonia and acute respiratory failure are more in COVID-19 + patients than in COVID-19 ‒ patients.

Do Spinopelvic Parameters Relate with Secondary Hip Spine Syndrome in Secondary Hip Arthritis?

Background: The prevalence of low back pain (LBP) with primary osteoarthritis (OA) hip undergoing total hip replacement (THA) has been studied. However, secondary OA hip affects younger individuals where changes in the sagittal spinal parameters (SSPs) could be reversible to reduce LBP. The study aims to document changes in clinical and radiological parameters following THA. Methods: Thirty patients with secondary OA hip were included in the prospective analysis, excluding anyone with previous spine/hip surgery of known spinal diseases, including deformity, inflammatory or infective pathology. Visual analog scale for (VAS) hip and LBP, Oswestry disability index (ODI), and Harris core (HHS) along with SSPs were measured at baseline and three months and analyzed. Results:  Mean age was 42.8 ± 8.9 years which 17 unilateral (U/L) and 13 bilateral (B/L) OA. Overall, no significant changes were seen in SSPs that included pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), pelvic incidence-lumbar lordosis (PI-LL) was seen except for an improvement in the sagittal vertical axis (SVA) [40.22 ± 36.67 to 24.06 ± 21.93, p < 0.001]. However, clinical variables such as VAS hip and LBP, ODI, and HHS improved post-hip THA. Similar findings were seen in sub-group analysis when U/L affected were compared to B/L affected. Conclusion: The sagittal SSPs except SVA does not change significantly following THA in patients with secondary OA, though LBP improves clinically. Hence, we assume routine measurement of these parameters is not mandatory when planning for THA in these patients.

A New Classification System for Acetabular Bone Defect Evaluation in Posttraumatic Acetabular Nonunion and Malunion.

Introduction: There is no distinct classification system to evaluate the bone defect in previously managed acetabular fractures. We propose a new classification system for bone defect evaluation in a previously managed acetabular fracture that will be helpful for total hip arthroplasty (THA). Materials and Methods: The preoperative pelvis radiographs of 99 THA patients with previous acetabular fractures with at least 2 years of follow-up were evaluated by 10 experienced surgeons (Paprosky and new classification systems). As per the new classification system, the five types of bone defects are circumferential, posterior wall, posterior column, both column defect, and anterior column. The interobserver and intraobserver reliability was calculated, and a consensus management plan based on the recommendation of the observers was formulated. Results: There was fair interobserver reliability for Paprosky classification (alpha coefficient 0.39) and substantial interobserver reliability for the new classification (alpha co-efficient 0.71). There was a substantial intraobserver agreement for the new classification (kappa value 0.80) and moderate intraobserver agreement for Paprosky classification (kappa value 0.55). Sixty-nine patients who were treated as per the management plan of the observers reported significant improvement in modified Harris hip score (improved from 25 to 85.88, p < 0.001). 89.7% of patients reported good to excellent outcomes. Overall best health as per EQ-5D VAS was obtained in THA following anterior column fracture (EQ-5D VAS 97.5), and relatively poor health was obtained after THA of posterior column nonunion (EQ-FD VAS 80). Conclusions:  The new classification system for bone defect evaluation in previously treated acetabular fractures is valid and reliable. The proposed surgical plan for the management of bone defects in THA provided good to excellent outcomes.

Effect of osteoarthritic knee flexion deformity correction by total knee arthroplasty on sagittal spinopelvic alignment in Indian population.

BACKGROUND: Sagittal alignment of the spine, pelvis, and lower extremities is essential for maintaining a stable and efficient posture and ambulation. Imbalance in any element can result in compensatory changes in the other elements. Knee flexion is a compensatory mechanism for spinopelvic sagittal alignment and is markedly affected in severe knee osteoarthritis (OA). The correction of knee flexion deformity (KFD) by total knee arthroplasty (TKA) can lead to complementary changes in the sagittal spinopelvic parameters (SSPs). AIM: To determine the SSP changes in patients with knee OA, with or without KFD undergoing TKA. METHODS: The study was conducted in 32 patients who underwent TKA. A neutral standing whole-spine lateral radiograph was performed before surgery and 3 mo after surgery in these patients. Subjects were divided into two groups (Group 1 obtained > 10° corrections in KFD; group B obtained < 10° correction). The pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), lumbar lordosis (LL), and sagittal vertical axis (SVA) were measured. RESULTS: The median of change in PT, PI, SS, LL, and SVA was 0.20 mm, 1.00 mm, 2.20 mm, -0.40 mm, and 6.8 mm, respectively. The difference in the change in SSPs between the two groups was statistically non-significant. CONCLUSION: SSPs, such as PI, PT, SS, LL, and SVA, do not change significantly following TKA in end-stage knee OA despite a significant correction (> 10°) in KFD.

Safety and efficacy of perioperative tranexamic acid infusion in acetabular fracture fixation: A randomized placebo-controlled double-blind prospective study.

INTRODUCTION: Open reduction and internal fixation of acetabular fracture is associated with significant blood loss. Although Tranexamic acid (TXA) infusion effectively reduces perioperative blood loss and transfusion requirements in elective orthopedic surgery, its efficacy in major orthopedic trauma surgery is controversial. MATERIAL AND METHODS: Sixty-three patients undergoing open reduction and internal fixation of acetabular fracture were randomized into either TXA (n = 36) or placebo (n = 27) group. TXA group received a bolus dose of TXA (10 mg/kg) 15 min prior to incision, followed by another similar dose after 3 h of surgery. The placebo group received the same volume of normal saline similarly. All patients were operated on by a single pelviacetabular surgeon with a uniform perioperative protocol. The intraoperative blood loss, drain output, the number of blood transfusions, postoperative hemoglobin (Hb) drop, and hematocrit (Hct) drop were calculated. RESULTS: Both groups were similar in relation to age, sex, BMI, preoperative Hb, the timing of surgery, fracture pattern, operative time, and surgical approaches. The mean postoperative Hb was 10.35 ± 1.36 gm% in TXA group and 9.74 ± 1.98 gm% in placebo group (p-value 0.158). There were no differences in intraoperative blood loss (438.11 ml vs. 442.81, p=.947), drain output (131.94 ml vs. 129.63, p=.870), and blood transfusion (8 patients vs. five patients, p=.719) between the groups. The drop in Hb and Hct in the postoperative period was also statistically not significant between the groups. CONCLUSION: There is no significant reduction in blood loss and blood transfusion with the use of intravenous Tranexamic acid in open reduction and internal fixation of acetabular fractures.

Retrograde Intramedullary Nailing and Locked Plating for the Treatment of Periprosthetic Supracondylar Femur Fractures: A Meta-Analysis and Quantitative Review.

Background: As the prevalence of Total Knee Arthroplasty increases, there is still debate over the preferred method of treatment of supracondylar periprosthetic femoral fractures. The aim of this study was to compare two of the common methods of fixation: Locked Plating and Retrograde Intramedullary Nailing with respect to nonunion, delayed union and surgical revision rate. Methods: A comprehensive database search via Pubmed was conducted, yielding 16 eligible studies. Six of those studies were comparative and were used in the meta-analysis section. All 16 studies were used in the pooled sample analysis section. The primary outcome analyzed was nonunion and delayed union rate while the secondary outcome was the surgical revision rate. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by comparing incidences of nonunion and delayed union, and surgical revision rates among the studies. Results: The meta-analysis showed that there is no statistically significant difference among the two groups in terms of nonunion and delayed union rate (OR = 1.43, CI = 0.74, 2.74, P=0.28), but there is a significant difference in the surgical revision rate favoring locked plating over retrograde intramedullary nailing (OR = 2.71, CI = 1.42, 5.17, P=0.003). The pooled sample analysis showed that there is no significant difference in the nonunion and delayed union rates (P=0.210) or the surgical revision rates (P=0.038). Conclusion: Both locked plating and Retrograde Intramedullary Nailing are reliable options for treating supracondylar femoral fractures around Total Knee Arthroplasty. Locked plating demonstrated a trend towards decreased nonunion and delayed union rates and a significantly lower surgical revision rate in the meta-analysis.

Impact of limb length discrepancy on functional outcome in total knee arthroplasty patients: a prospective cohort study.

BACKGROUND: Limb length alteration following total knee arthroplasty (TKA) has been under-reported. Few studies have shown a significant association between limb length discrepancy (LLD) and poor functional outcome. This prospective study evaluated the impact of radiographic and perceived LLD on functional outcome in TKA. The variables affecting LLD were also evaluated. METHODS: The preoperative and postoperative limb lengths of TKA patients (112 knees, 81 patients, KL grade ≥ 3) were measured in full-length digital radiographs. The Hip-Knee-Ankle (HKA) angles were also measured. The functional outcome (Western Ontario and McMaster Universities Arthritis Index) and perception about LLD were evaluated after six months. RESULTS: The mean preoperative radiographic LLD in the unilateral and bilateral TKA groups was 0.75 cm ± 0.60 cm and 0.58 cm ± 0.52 cm (P = 0.197), respectively. Similarly, postoperative LLD was 0.76 cm ± 0.85 cm in the unilateral group and was 0.59 cm ± 0.92 cm (P = 0.402) in the bilateral group. Only 19.7% of patients had postoperative radiographic LLD of ≥ 10 mm, and 80.2% of patients had LLD of < 10 mm. The functional outcome was significantly affected when LLD exceeded 10 mm (correlation coefficient 0.54, P < 0.001). Linear regression analysis revealed no significant effects of age, sex, height, weight, BMI, preoperative LLD and difference in deformity between the limbs on postoperative LLD. 34.5% of patients perceived LLD in the preoperative period, which decreased to 3.7% in the postoperative period. Perceived LLD did not correlate to radiographic LLD and functional outcome. CONCLUSIONS: There is no significant difference in radiographic LLD between unilateral and bilateral TKA. The functional outcome is adversely affected by radiographic LLD of ≥ 10 mm. Age, sex, BMI, preoperative LLD and difference in deformity angle do not affect the LLD. About one-third of patients perceive LLD in the preoperative period, which improves significantly after TKA. LEVELS OF EVIDENCE: II.

Satisfaction and Health-Related Quality of Life Following Hip and Knee Arthroplasty Surgeries in Indian Patients: A Cross-Sectional Study.

Introduction: Recently, the patient-reported outcome measures (PROMs) have been considered as the most important assessment tool for surgical outcome evaluation in arthroplasty. However, no study from the Indian subcontinent has evaluated the PROM in the total hip (THA) and knee (TKA) arthroplasties. Materials and Methods: This cross-sectional study evaluated the health-related quality of life (HRQoL) of 1244 North Indian patients following primary THA and TKA who had at least one-year follow-up. This study included 617 patients with 664 THA and 627 patients with 1152 TKA. The patients were asked to answer the EQ-5D-5L questionnaires and EQ-VAS in their own languages. The EQ-5D-5L values were used to derive level frequency scores (LFS) with validated Indian norms of EuroQoL. Results: Ninety percent of THA and 82% of TKA patients rated excellent HRQoL using EQ-VAS. The regression analysis revealed age, gender, etiology and brand of prosthesis had a significant impact on EQ-5D-5L following THA. However, gender and simultaneous bilateral surgery were found to be important predictors of outcome in TKA. The mean value of LFS for THA was 0.95 ± 0.12 and TKA was 0.88 + 0.24 (p < 0.001). However, There was no difference in LFS between THA and TKA when only elderly patients (> 60 years) were considered (p = 0.168). Conclusion: THA patients reported better HRQoL than TKA in the Indian subcontinent. One of the factors for a better outcome in hip arthroplasty was the relatively younger age of the patients. Patients above 60 years of age reported similar levels of statisfactior in both THA and TKA. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00589-x.

Intraarticular viscosupplementation following arthroscopic anterior cruciate ligament reconstruction: A systematic review.

Background: Pain, swelling and joint stiffness are the major problems following arthroscopic ACL reconstruction (ACLR) surgery that restrict early return to sports and athletic activities. The patients often receive prolonged analgesic medications to control the inflammatory response and resume the pre-injury activities. This systematic review aims to evaluate the safety and efficacy of intraarticular (IA) hyaluronic acid (HA) injection following ACLR. Material and methods: A literature search of electronic databases and a manual search of studies reporting clinical effectiveness of IA HA following ACLR was performed on 1st November 2020. The quality of the methodology and risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool and Newcastle-Ottawa scale for randomized-controlled trial and prospective cohort studies, respectively. Results: Of 324 studies retrieved, four studies (3 RCTs and one prospective cohort study) were found to be suitable for inclusion in this review. These studies had a low to moderate risk of bias. There were 182 patients in the HA group and 121 patients in the control group. The demographic characteristics of the patients were similar in all studies. The pooled analysis of studies evaluating pain at different follow up periods (2-week, 4-6 weeks, 8-12 weeks) after ACLR revealed no significant difference between the HA and control groups (p > 0.05). The knee swelling was significantly less in the HA group at two weeks (MD -7.85, 95% CI: [-15.03, -0.68], p = 0.03, I2 = 0%), but no such difference was noted after 4-6 weeks and 8-12 weeks. The functional outcome score was not significantly different between the groups (SMD 0.00, 95% CI: 0.38 to 0.38, p = 0.99, I2 = 0%). Conclusions: Although the individual study demonstrated a short-term positive response regarding pain control and swelling reduction, the pooled analysis did not find any clinical benefit of IA HA injection following ACLR surgery. Level of evidence: II.

Dual-Plating in Distal Femur Fracture: A Systematic Review and Limited Meta-analysis.

INTRODUCTION: Although lateral locking plate has shown promising results in distal femur fracture, there are high rates of varus collapse and implant failure in comminuted metaphyseal and articular fractures. This systematic review evaluates the functional outcomes and complications of dual plating in the distal femur fracture. MATERIALS AND METHODS: Manual and electronic search of databases (PubMed, Medline Embase and Cochrane Central Register of Controlled Trials) was performed to retrieve studies on dual plate fixation in the distal femur fracture. Of the retrieved 925 articles, 12 were included after screening. RESULTS: There were one randomized-controlled, four prospective and seven retrospective studies. A total of 287 patients with 292 knees were evaluated (dual plating 213, single plating 76, lost to follow-up 3). The nonunion and delayed union rates following dual plate fixations were up to 12.5% and 33.3%, respectively. The mean healing time ranged from 11 weeks to 18 months. Good to excellent outcome was observed in 55-75% patients. There was no difference between the single plate and dual plate fixation with regards to the functional outcomes (VAS score, Neer Score and Kolmert's standard) and complications. Pooled analysis of the studies revealed a longer surgical duration (MD - 16.84, 95% CI - 25.34, - 8.35, p = 0.0001) and faster healing (MD 5.43, 95% CI 2.60, 8.26, p = 0.0002) in the double plate fixation group, but there was no difference in nonunion rate (9.2% vs. 0%, OR 4.95, p = 0.13) and blood loss (MD - 9.86, 95% CI - 44.97, 25.26, p = 0.58). CONCLUSION: Dual plating leads to a satisfactory union in the comminuted metaphyseal and articular fractures of the distal femur. There is no difference between the single plate and dual plate with regards to nonunion rate, blood loss, functional outcomes and complications. However, dual fixation leads to faster fracture healing at the cost of a longer surgical duration.