Assessment of Vitamin D status In Patients of Chronic Low Back Pain of Unknown Etiology.

Low back pain is very disabling and dispiriting because of the physical impediment it causes and its psychological effects. Innumerable factors have been implicated in its etiology. In spite of improvements in diagnostic modalities, a considerable number of such cases fall in the ambiguous zone of unknown etiology or 'idiopathic.'Early diagnosis of low back pain will allow effective prevention and treatment to be offered. This study was conducted to assess the contribution of vitamin D levels and other biochemical factors to chronic low back pain in such cases. All patients attending the orthopedics OPD for low back pain in whom a precise anatomical cause could not be localized, were prospectively enrolled in this study. We measured serum levels of glucose, calcium, phosphorus, uric acid, rheumatoid factor, C reactive protein, alkaline phosphatase, total protein, albumin and 25 (OH) D concentrations in 200 cases and 200 control samples. The patients showed significantly lower vitamin D levels compared to controls with p value < 0.0001. The maximum number of low back pain patients were in the age group of 31-50 years (42 %).The average BMI was 23.27 ± 5.17 kg/sq m, 73 % of total patient population were females and 27 % were known case of type 2 diabetes mellitus. Calcium, alkaline phosphatase, was positively correlated with vitamin D and glucose showed a negative correlation with vitamin D in the patient population. The problem of low back pain provides a challenge to health care providers. The problem in developing countries is compounded by ignorance to report for early treatment and occupational compulsions in rural areas and sedentary lifestyle in urban youth. The authors strongly recommend early frequent screening for vitamin D along with glucose, protein, albumin, calcium, phosphorus, CRP as part of general health checkup for non-specific body pain, especially low back pain.

Evaluation of pelvic fixation in neuromuscular scoliosis: a retrospective study in 55 patients.

The literature has described different indications for pelvic fixation in neuromuscular scoliosis. We retrospectively evaluated changes in pelvic obliquity for a minimum of two years among three groups: group I (initial pelvic obliquity >15 degrees; with pelvic fixation), group II (initial pelvic obliquity >15 degrees; without pelvic fixation), and group III (initial pelvic obliquity <15 degrees; without pelvic fixation). We used iliac screws for pelvic fixation in group I. There was significant postoperative improvement (p < 0.0001) in Cobb's angle and pelvic obliquity. There was no significant loss of correction in Cobb's angle, thoracic kyphosis, and lumbar lordosis among all three groups; however, group II showed significant correction loss in pelvic obliquity compared to groups I and III at final follow-up (p < 0.0001). Our results indicate that patients who have pelvic obliquity >15 degrees require pelvic fixation to maintain the correction and balance over time while obliquity <15 degrees does not require pelvic fixation.

Use of slide presentation software as a tool to measure hip arthroplasty wear.

The authors propose a manual measurement method for wear in total hip arthroplasty (PowerPoint method) based on the well-known Microsoft PowerPoint software (Microsoft Corporation, Redmond, Wash). In addition, the accuracy and reproducibility of the devised method were quantified and compared with two methods previously described by Livermore and Dorr, and accuracies were determined at different degrees of wear. The 57 hips recruited were allocated to: class 1 (retrieval series), class 2 (clinical series), and class 3 (a repeat film analysis series). The PowerPoint method was found to have good reproducibility and to better detect wear differences between classes. The devised method can be easily used for recording wear at follow-up visits and could be used as a supplementary method when computerized methods cannot be employed.

Hip and knee dislocation during femoral lengthening in congenital short femur: a rare case report.

Congenital short femur is a rare and complex deformity that is often associated with other anomalies. There are few reports of either hip or knee dislocations during femoral lengthening in congenital short femur predisposed by associated anomaly. However, there are probably no case reports of both hip and knee joint dislocation occurring in same case during femoral lengthening in congenital short femur. We have this case of congenital short femur, where both hip and knee dislocation occurs during femoral lengthening. We reviewed different article to understand the cause and avoid such unwanted complications in future.

Medium-term outcome of total hip replacement for dysplastic hips in Singapore.

PURPOSE: To review medium-term outcomes of 46 patients who underwent total hip replacement (THR) for osteoarthritis secondary to dysplastic hips. METHODS: Records of 58 hips in 6 men and 40 women aged 32 to 76 (mean, 62) years who underwent THR for osteoarthritis secondary to dysplastic hips and had been followed up for a mean of 4 (range, 2-8) years were retrospectively reviewed. The hips were classified according to the Crowe's grading, Sharp's acetabular angle, and centre-edge angle. The radiological uncoverage of acetabular cup (RUAC) index was calculated. The outcomes of THR were evaluated in terms of cup inclination, RUAC index, cup migration, lysis or loosening (radiolucency), heterotopic ossification, component incorporation and positioning, thigh pain, and subsidence. RESULTS: 51 of the hips were Crowe's type I, 6 were type II, and one was type IV. The mean acetabular angle was 46.3 degrees and the mean centre-edge angle was 15.4 degrees. The mean cup, head, and stem sizes were 50.4 mm, 28.7 mm, and 10.9 mm, respectively. The mean RUAC index was 16.9% and the mean cup inclination was 40.7 degrees. Radiolucency of 1 mm in the acetabular zone I was observed in 16 cases, but only one failed. For cemented and uncemented stems, the most common positioning was neutral and valgus, respectively. Five patients had complications of greater trochanter fracture, aseptic loosening, split calcar, stem loosening, and/or heterotopic ossification. CONCLUSION: Conventional THR can achieve good medium-term results in low-grade dysplastic hips.

Validation of a simple radiographic method to determine variations in pelvic and acetabular cup sagittal plane alignment after total hip arthroplasty.

BACKGROUND AND PURPOSE: Orientation of acetabular component, influenced by pelvic tilt, body position, and individual variations affects the outcome following total hip arthroplasty (THA). Currently available methods of evaluation are either imprecise or require advanced image processing. We analyzed intersubject and intrasubject variability of pelvic tilt, measured by sagittal sacral tilt (ST) and its relationship with acetabular component tilt (AT) by using a simple method based on standard radiographs. MATERIALS AND METHODS: ST was measured on lateral radiographs of pelvis including lumbosacral spine obtained in supine, sitting, standing, and lateral decubitus position for 40 asymptomatic THA patients and compared to computed tomography (CT) data obtained in supine position. AT was measured on lateral radiographs (measured acetabular tilt: MAT) in each position and compared to measurement of AT on CT and an indirectly calculated AT (CAT). RESULTS: Mean ST changed from supine to sitting, standing, and lateral decubitus positions as follows: 26.5 +/- 15.5 degrees (range 4.6-73.4 degrees ), 8.4 +/- 6.2 degrees (range 0.6-24.5 degrees ), and 13.4 +/- 8.4 degrees (range 0.1-24.2 degrees ; p < 0.0001, p = 0.002, p = 0.006). The MAT on radiographs was not significantly different from the MAT measured on CT (p = 0.002) and the CAT (p = 0.06). There is a good correlation between change in ST and MAT in sagittal plane (r = 0.93). CONCLUSION: Measurement of ST on radiographs is a simple and reliable method to track changes in pelvic tilt in different body positions. There is significant intersubject and intrasubject variation of ST and MAT with postural changes and it may explain causes of impingement or instability following THA, which could not be previously explained.