Total Hip Arthroplasty in 52 Active Advanced Tubercular Arthritic Hips.

BACKGROUND: The role of total hip arthroplasty (THA) in healed tuberculosis (TB) of the hip has been reported with success in the past. However, the role and success of THA in active TB of the hip has remained controversial. METHODS: We retrospectively evaluated a prospective study of 52 THAs done for active TB of the hip in 51 patients. The protocol includes 3-6 months of effective preoperative and 9-18 months postoperative anti-TB therapy. All THAs were performed by the same surgeon (author 1). The selection criteria excluded patients with poor immunity, HIV +ve patient, and presence of discharging sinus. The type of THA implant includes 12 cemented, 38 uncemented, and 2 hybrid fixations. RESULTS: The mean follow-up was 10.5 years (2-29). Six patients were (6 THAs) lost to follow up after 4 years, including 2 deaths unrelated to TB or THA. There was no reactivation of TB. Mean Harris Hip Score improved from preop 31.77 (20-51) to postop 88 (72-100) in the last follow-up. Two patients had delayed wound healing up to 21 days postop with no evidence of subsequent episode till last follow-up. There was no case of dislocation, neurological complication in any patient. Seven THAs underwent revision for aseptic loosening unrelated to TB. CONCLUSION: Single-stage THA is safe in active advanced tubercular arthritic hips with good immunity status under cover of effective anti-TB therapy using strict preop selection protocol.

Central Fracture-Dislocation of the Hip with Ipsilateral Femoral Neck Fracture in an Elderly Patient with Parkinsonism Managed with Dual Mobility Total Hip Arthroplasty: A Case Report and Review of Literature.

Introduction: The combination of a central fracture-dislocation of the hip, acetabulum fracture, and neck of the femur fracture is a rare injury, with a few reports described in the literature. Guidelines regarding managing this type of injury in single or multiple stages, the requirement of acetabular augmentation with plates, metal rings or cages, and the implant selection in elderly patients are not adequately defined while planning a total hip arthroplasty (THA). The successful management of such a complex fracture pattern in an elderly patient with neurodegenerative disorder is described in our case report. Case Report: An 81-year-old male presented to our outpatient department with a 2-month-old neglected post-traumatic central fracturedislocation of the right hip with an ipsilateral femoral neck fracture. The patient had a known case of Parkinson's disease on treatment with oral medication. A single-stage hybrid THA with dual mobility (DM) prosthesis was done with femoral head autograft acetabular impaction bone grafting. The patient was mobilized full weight bearing with the support of a walker on the 2nd post-operative day. At the 1-year follow-up the functional Harris hip score was 87. Radiographs revealed a well-healed acetabular fracture with the incorporation of a bone graft. No signs of implant loosening were observed. We did not encounter any complications such as dislocation, infection, and heterotrophic ossificans. Conclusion: Management of central fracture-dislocation of the hip with delayed one-staged THA has a good functional outcome. DM cup is essential in patients with parkinsonism and other neurodegenerative disorders.

Pigmented Villonodular Synovitis Presenting as a Popliteal Cyst.

INTRODUCTION: Pigmented villonodular synovitis is an uncommon disease characterized by hyperplastic synovium, large effusions and bone erosions. It commonly mimics other conditions. As a result, the diagnosis may remain elusive, as the classic signs of tenderness and effusion are not specific. Occasionally, PVNS presents as a popliteal cyst, which may divert attention from intra-articular pathology. In this article, we describe a case of pigmented villonodular synovitis that presented with a popliteal cyst as the chief problem. CASE REPORT: A twelve year old boy presented to us with a history of a gradually enlarging mass in the left popliteal fossa since eighteen months. He complained of restriction of terminal knee flexion, but he had no pain. After clinical examination and imaging the mass was interpreted as being either a popliteal cyst or chronic hematoma without ruling out the possibility of soft tissue sarcoma. An open excisional biopsy of the lesion was performed which revealed a reddish-brown cystic-nodular mass communicating with the knee joint. The histology was consistent with that of pigmented villonodular synovitis. We performed an arthroscopic synovectomy 3 weeks later. Abnormal synovium found in all compartments of the knee was removed. Histology from the intra-articular lesion was also consistent with a diagnosis of pigmented villonodular synovitis. CONCLUSION: A swelling in the popliteal region may be due to various etiologies. The cause should be thoroughly investigated. Along with clinical examination and imaging the tissue must be subjected to histopathological examination. Pigmented villonodular synovitis can rarely present as a popliteal cyst. In such a situation, treatment consists of dealing with intra-articular and extra-articular pathology.

High sensitive C-reactive protein-Effective tool in determining postoperative recovery in lumbar disc disease.

BACKGROUND: It is common in medical practice to see patients having persistent pain and radiculopathy even after undergoing discectomy surgery. Inflammatory cytokines, such as interleukins are produced at the site of disc herniation and are now considered responsible for the pain perceived by the patient. This study has used high sensitive C-reactive protein (HSCRP) assay for predicting inflammation around the nerve roots on very same principle, which has used HSCRP for predicting coronary artery diseases in current clinical practice. Thus, purpose of this study is to test whether HSCRP can stand as an objective tool to predict postoperative recovery in patients undergoing lumbar discectomy. That is, to study association between preoperative HSCRP blood level and postoperative recovery with the help of modified Oswestry Back Disability Score. MATERIALS AND METHODS: A study group consisting of 50 cases of established lumbar disc disease and control group of 50 normal subjects, matched with the study group. Both the study and control groups were subjected to detailed evaluation with the help of modified Oswestry Low Back Pain Scale both pre and postoperatively at 3 months, 6 months and 1-year. The preoperative blood samples were analyzed to assess the HSCRP concentration. All the cases underwent surgery over a period of 1-year by the same surgeon. RESULTS: The level of HSCRP in the study group was between 0.050- and 0.710 mg/dL and in the control group, 0.005-0.020 mg/dL. There was highly significant positive correlation between preoperative HSCRP level and postoperative score at P < 0.005. Cases with HSCRP level in the range of 0.1820 ± 0.079 mg/dL, showed better recovery (score improved > 10 points), while those with HSCRP level in the range of 0.470 ± 0.163 mg/dL, showed poor recovery (score improved < 10 points). CONCLUSION: HSCRP will serve as a good supplementary prognostic marker for operative decision making in borderline and troublesome cases of lumbar disc disease.

One-stage long-stem total knee arthroplasty for arthritic knees with stress fractures.

PURPOSE. To evaluate the outcome of one-stage long-stem total knee arthroplasty (TKA) for patients with arthritic knees and tibiofemoral stress fractures. METHODS. Records of 11 men and 18 women aged 47 to 78 (mean, 66) years who underwent fixed-bearing posterior-stabilised TKA for osteoarthritis or rheumatoid arthritis of the knee with tibial (n=31) and femoral (n=3) stress fractures were reviewed. All the tibial fractures involved the proximal half. There were 7 associated fibular stress fractures. Of the 31 knees with tibial stress fractures, 26 and 5 manifested varus and valgus deformity, respectively. RESULTS. The mean follow-up period was 51 (range, 24-96) months. The mean tibiofemoral angle improved from 23.2 to 1.9 degrees varus. The mean Knee Society knee score improved from 38.5 (range, 15- 63) to 89.6 (range, 80-95) [p<0.05]. The mean Knee Society functional score improved from 25.5 (range, 0-40) to 86.5 (range, 60-100) [p<0.05]. All fractures were united at the last follow-up. No complications were encountered. CONCLUSION. One-stage long-stem TKA restores limb alignment and facilitates fracture healing, with excellent outcome.

Sprengel's deformity of the shoulder: Current perspectives in management.

Sprengel's deformity or congenital elevation of scapula is a complex deformity of the pectoral girdle, and results in symptomatic cosmetic and functional disability. Several studies have attempted to analyze the three-dimensional aspects of this deformity; optimal methodologies of quantification and surgical correction techniques have been debated since the condition was first described. This article presents a concise review of the exact pathoanatomy, clinical presentation, imaging techniques, and surgical procedures described in the management of this condition.