Open Reduction with Collateral Ligaments Reconstruction in Neglected Elbow Dislocation – A Case Report

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 57-60 | Made Winatra Satya Putra, Anak Agung Gde Yuda Asmara

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.636

Author: Made Winatra Satya Putra [1], Anak Agung Gde Yuda Asmara [1]

[1] Department of Orthopaedics and Traumatology, General Hospital Prof. IGNG Ngoerah, Faculty of Medicine Udayana University, Bali, Indonesia

Address of Correspondence

Dr. Made Winatra Satya Putra,
JL. Diponegoro, Dauh Puri Klod, Bali, Indonesia.
E-mail: borthopaedi@gmail.com

Abstract

Neglected elbow dislocations pose a challenge to orthopedic surgeons, leading to contracture and functional limitations. This case involves a 51-year-old female patient experiencing pain and stiffness in her left elbow for the past 5 months due to neglected dislocation. Previous traditional treatment showed no improvement. Disuse atrophy was suspected, prompting open reduction, ligament reconstruction, and a 3-week temporary pinning. The intervention aimed to address the late-presenting unreduced elbow, utilizing autograft for ligament reconstruction. The subsequent supervised physiotherapy played a crucial role in restoring functional, stable, and painless elbow movement. This case underscores the importance of timely intervention in neglected elbow dislocations to prevent disability and enhance the quality of life for affected individuals.
Keywords: Neglected elbow dislocation, ligament reconstruction, autograft.

References

1. Kone SG, Bana A, Dogba EG. Neglected elbow dislocation with conservation of elbow function, concerning a case in Abidjan (Ivory Coast). Open J Orthop 2018;8:127-31.
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5. Coulibaly NF, Tiemdjo H, Sane AD, Sarr YF, Ndiaye A, Seye S. Posterior approach for surgical treatment of neglected elbow dislocation. Orthop Traumatol Surg Res 2012;98:552-8.

How to Cite this article: Putra MWS, Asmara AAGY. Open Reduction with Collateral Ligaments Reconstruction in Neglected Elbow Dislocation – A Case Report. Journal of Clinical Orthopaedics 2024;January-June:9(1)57-60.

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Surgical Duration Increases the Risk of Infection Following Total Knee Arthroplasty

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 22-27 | Jamie C Heimroth, Max L Willinger, Nipun Sodhi, B A Ariel Henig, Alain E Sherman, Jonathan R Danoff

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.626

Author: Jamie C Heimroth [1], Max L Willinger [1], Nipun Sodhi1, B A Ariel Henig [2], Alain E Sherman [3], Jonathan R Danoff [1]

[1] Department of Orthopedic Surgery, Long Island Jewish Medical Center, New York, USA,
[2] Department of Orthopedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra, New York, USA,
[3] Department of Orthopedic Surgery, Lenox Hill Hospital, New York, USA.

Address of Correspondence

Dr. Jonathan Danoff,
Department of Orthopedic Surgery, Long Island Jewish Medical Center, New York, USA.
Email: jdanoff@northwell.edu

Abstract

Introduction: Risk stratification is used in total joint arthroplasty (TKA) to optimize outcomes and minimize complications. Modifiable risk factors such as surgical duration can be influenced by surgeons; however, under certain circumstances, prolonged surgery cannot be avoided. While previous studies have investigated the impact of surgical duration on post-operative complications, we felt that research was lacking in comparing both surgical duration and tourniquet time and the rate of infection following a TKA. Our learning objective was to investigate the risk of surgical site infections (SSIs) and periprosthetic joint infections (PJIs) from prolonged (1) surgical duration or (2) tourniquet time during primary TKAs.
Materials and Methods: A multicenter health-care system database consisting of 15 hospitals was queried for all patients undergoing TKA between March 2020 and December 2020. Patient demographics, comorbidities, and infection data were collected. The surgical duration and tourniquet time were calculated for each patient undergoing a TKA and compared against the rate of PJI or SSI rate. PJI was defined based on the 2018 musculoskeletal infection society (MSIS) criteria, and superficial SSI was defined as any infection that did not meet MSIS criteria.
Results: Of the 2511 patients who underwent primary TKA, 19 were found to have an infection. Average surgical duration of 126.17 min for patients with an infection compared to 103.44 min without infection (P = 0.02). There was a significantly increased infection rate with increased surgical duration after univariate analysis. Patients who developed any infection had an average tourniquet time of 78.5 min, whereas those without infections had an average of 62.14 min (P = 0.004). Infection rate began to increase once the surgical duration reached 70 min; however, the infection rate increase per 10-min increments was not statistically significant (P = 0.09). The infection rate began to increase at 50 min of tourniquet time and significantly increased as tourniquet time increased (P = 0.004).
Conclusion: Surgical duration is associated with an increased risk of infection following TKA. Our study demonstrated tourniquet time had a greater impact on infection. There are many circumstances that lead to increased surgical and tourniquet duration, including increased body mass index, and severe deformity. Surgeons should consider deflating the tourniquet as soon as the critical parts of the surgery are complete to decrease the risk of post-operative infections.
Keywords: Total knee replacement, infection, knee joint, tourniquets.

References

1. Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: Current concepts and outlook. EFORT Open Rev 2019;4:482-94.
2. Kapadia BH, McElroy MJ, Issa K, Johnson AJ, Bozic KJ, Mont MA. The economic impact of periprosthetic infections following total knee arthroplasty at a specialized tertiary-care center. J Arthroplasty 2014;29:929-32.
3. Colston J, Atkins B. Bone and joint infection. Clin Med (Lond) 2018;18:150-4.
4. Eka A, Chen AF. Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Ann Transl Med 2015;3:233.
5. Gold PA, Garbarino LJ, Anis HK, Neufeld EV, Sodhi N, Danoff JR, et al. The cumulative effect of substance abuse disorders and depression on postoperative complications after primary total knee arthroplasty. J Arthroplasty 2020;35:S151-7.
6. Naranje S, Lendway L, Mehle S, Gioe TJ. Does operative time affect infection rate in primary total knee arthroplasty? Clin Orthop Relat Res 2015;473:64-9.
7. Scigliano NM, Carender CN, Glass NA, Deberg J, Bedard NA. Operative time and risk of surgical site infection and periprosthetic joint infection: A systematic review and meta-analysis. Iowa Orthop J 2022;42:155-61.
8. Anis HK, Sodhi N, Klika AK, Mont MA, Barsoum WK, Higuera CA, et al. Is operative time a predictor for post-operative infection in primary total knee arthroplasty? J Arthroplasty 2019;34:S331-6.
9. Badawy M, Espehaug B, Fenstad AM, Indrekvam K, Dale H, Havelin LI, et al. Patient and surgical factors affecting procedure duration and revision risk due to deep infection in primary total knee arthroplasty. BMC Musculoskelet Disord 2017;18:544.
10. Bohl DD, Ondeck NT, Darrith B, Hannon CP, Fillingham YA, della Valle CJ. Impact of operative time on adverse events following primary total joint arthroplasty. J Arthroplasty 2018;33:2256-62.e4.
11. Duchman KR, Pugely AJ, Martin CT, Gao Y, Bedard NA, Callaghan JJ. Operative time affects short-term complications in total joint arthroplasty. J Arthroplasty 2017;32:1285-91.
12. Wang Q, Goswami K, Shohat N, Aalirezaie A, Manrique J, Parvizi J. Longer operative time results in a higher rate of subsequent periprosthetic joint infection in patients undergoing primary joint arthroplasty. J Arthroplasty 2019;34:947-53.
13. Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg Br 1995;77:250-3.
14. Arthur JR, Spangehl MJ. Tourniquet use in total knee arthroplasty. J Knee Surg 2019;32:719-29.
15. Li X, Yin L, Chen ZY, Zhu L, Wang HL, Chen W, et al. The effect of tourniquet use in total knee arthroplasty: Grading the evidence through an updated meta-analysis of randomized, controlled trials. Eur J Orthop Surg Traumatol 2014;24:973-86.
16. Zak SG, Yeroushalmi D, Long WJ, Meftah M, Schnaser E, Schwarzkopf R. Does the use of a tourniquet influence outcomes in total knee arthroplasty: A randomized controlled trial. J Arthroplasty 2021;36:2492-6.
17. Parvizi J, Tan TL, Goswami K, Higuera C, della Valle C, Chen AF, et al. The 2018 definition of periprosthetic hip and knee infection: An evidence-based and validated criteria. J Arthroplasty 2018;33:1309-14.e2.
18. Anis HK, Rothfusz CA, Eskildsen SM, Klika AK, Piuzzi NS, Higuera CA, et al. Does surgical trainee participation affect infection outcomes in primary total knee arthroplasty? J Surg Educ 2022;79:993-9.
19. Hegde V, Bracey DN, Johnson RM, Dennis DA, Jennings JM. Tourniquet use improves cement penetration and reduces radiolucent line progression at 5 years after total knee arthroplasty. J Arthroplasty 2021;36:S209-14.
20. Ahmed I, Chawla A, Underwood M, Price AJ, Metcalfe A, Hutchinson CE, et al. Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery. Bone Joint J 2021;103-B:830-9.
21. Magan AA, Dunseath O, Armonis P, Fontalis A, Kayani B, Haddad FS. Tourniquet use in total knee arthroplasty and the risk of infection: A meta-analysis of randomised controlled trials. J Exp Orthop 2022;9:62.
22. Pinsornsak P, Pinitchanon P, Boontanapibul K. Effect of different tourniquet pressure on postoperative pain and complications after total knee arthroplasty: A prospective, randomized controlled trial. J Arthroplasty 2021;36:1638-44.
23. Silver R, de la Garza J, Rang M, Koreska J. Limb swelling after release of a tourniquet. Clin Orthop Relat Res 1986;206:86-9.

How to Cite this article: Heimroth JC, Willinger ML, Sodhi N, Henig BAA, Sherman AE, Danoff JR. Surgical Duration Increases the Risk of Infection Following Total Knee Arthroplasty. Journal of Clinical Orthopaedics 2024;January-June:9(1):22-27.

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Bacterial Spectrum Analysis of Pediatric Septic Arthritis in Sanglah General Hospital (2019-2021): A Case Series

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 61-69 | Ida Bagus Anom Krishna Caitanya, Made Agus Maharjana, Nyoman Gede Grenata Nanda Ustriyana

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.638

Author: Ida Bagus Anom Krishna Caitanya [1], Made Agus Maharjana [1], Nyoman Gede Grenata Nanda Ustriyana [1]

[1] Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof Ngoerah General Hospital, Denpasar, Indonesia

Address of Correspondence

Dr. Ida Bagus Anom Krishna Caitanya,
Department of Orthopaedics and Traumatology, Faculty of Medicine Udayana University, Prof Ngoerah General Hospital, Denpasar, Indonesia.
E-mail: borthopaedi@gmail.com

Abstract

This case series presents five pediatric patients diagnosed with septic arthritis in Sanglah General Hospital from 2019 to 2021. The most common infecting organism was Staphylococcus aureus, comprising 66.7% of all infections. Other organisms described in literatures are Salmonella, Staphylococcus epidermidis, Enterobacter cloacae, and Mycobacterium tuberculosis. Antibiotic treatment should be started as soon as the diagnosis is suspected and modified once the organism isolated from the synovial fluid (SF) has been characterized. Unfortunately, in many cases, despite a high clinical suspicion of SA, the diagnosis cannot be confirmed because the SF is sterile on bacterial culture. This may lead to difficulties in patient management. The case series also analyzed the possible causes of negative culture results. The data showed three cases with no pathogen organism detected, which can be turned to false negative that ruled out the infection cause of the arthritis. The study suggests that in the future, other techniques might prove useful in increasing the sensitivity of the detection of bacterial infection, such as Polymerase chain reaction and detection of antibodies against the teichoic acid staphylococcal cell wall component. The detection and identification of Kingela kingae in synovial fluid have improved significantly since the development of PCR. The specificity of these assays relies on the ability of the PCR to generate only the expected amplification product. The duration of the laboratory to process is also a factor that affects the result. The study concludes that early diagnosis and prompt treatment are crucial in achieving good functional outcomes in pediatric septic arthritis.
Keywords: septic arthritis, pediatric patients, bacterial spectrum, diagnosis, culture methods

References

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8. Slinger R, Moldovan I, Bowes J, Chan F. Polymerase chain reaction detection of Kingella kingae in children with culture-negative septic arthritis in eastern Ontario. Paediatr Child Health 2016;21:79-82.
9. Spyridakis E, Gerber JS, Schriver E, Grundmeier RW, Porsch EA, St Geme JW, et al. Clinical Features and outcomes of children with culture-negative septic arthritis. J Pediatric Infect Dis Soc 2019;8:228-34.
10. Anino-Fernández J, Ramírez-Huaranga MA, Mínguez-Sanchez MD. False negatives of synovial fluid in septic arthritis. Reumatol Clin 2016;12:114-5.
11. Hujazi I, Oni D, Arora A, Muniz G, Khanduja V. The fate of acutely inflamed joints with a negative synovial fluid culture. Int Orthop 2012;36:1487-92.
12. Chan MM, Tse TS, Wan YC, Wah Hung Y, Fan JC. A rare and uncommon complication after use of hydrogen peroxide (H2O2): A review of use of H2O2 in orthopaedics. J Orthop Trauma Rehabil 2020;27:247-51.

How to Cite this article: Caitanya IBAK, Maharjana MA, Ustriyana NGGN. Bacterial Spectrum Analysis of Pediatric Septic Arthritis in Sanglah General Hospital (2019-2021): A Case Series. Journal of Clinical Orthopaedics 2024;January-June:9(1):61-69.

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Current Concept Update on Robotic Technology in Arthroplasty- A Narrative review

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 35-41 | Shobit Deshmukh, Vaibhav Bagaria

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.630

Author: Shobit Deshmukh [1], Vaibhav Bagaria [1]

[1] Department of Orthopedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Vaibhav Bagaria,
Department of Orthopedics, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India.
E-mail: drbagaria@gmail.com

Abstract

Ensuring precise prosthesis positioning is one of the key elements for improving long-term survival rates in knee arthroplasty. The evolution of Total knee arthroplasty surgeries from Computer assisted navigation to robotic assisted techniques has improved the precision of bone preparation, component positioning and has reduced alignment outliers and surgeon-related errors. The present article gives an overview of the existing robotic arthroplasty systems available.
The present review describes the types of robots, their classification system, comparisons between various robotic assisted devices available in the market. This review highlights the key steps involved in using various systems, current concepts and the future scope of development in this field. This review also proposes the concept of intelligent alignment philosophy which is more patient specific combining different philosophies.
Keywords– Robotic Assisted techniques, current updates, intelligent alignment, total knee arthroplasty

References

1. Nunley RM, Nam D, Berend KR, Lombardi AV, Dennis DA, Della Valle CJ, et al. New total knee arthroplasty designs: Do young patients notice? Clin Orthop Relat Res 2015;473:101-8.
2. Bozic KJ, Kurtz SM, Lau E, Ong K, Chiu V, Vail TP, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010;468:45-51.
3. McClelland JA, Webster KE, Ramteke AA, Feller JA. Total knee arthroplasty with computer-assisted navigation more closely replicates normal knee biomechanics than conventional surgery. Knee 2017;24:651-6.
4. Figueroa F, Parker D, Fritsch B, Oussedik S. New and evolving technologies for knee arthroplasty-computer navigation and robotics: State of the art. J ISAKOS 2018;3:46-54.
5. St Mart JP, Goh EL. The current state of robotics in total knee arthroplasty. EFORT Open Rev 2021;6:270-9.
6. Banks SA. Haptic robotics enable a systems approach to design of a minimally invasive modular knee arthroplasty. Am J Orthop (Belle Mead NJ) 2009;38 2 Suppl:23-7.
7. Zlotnicki JP, O’Malley MJ. Learning curve for robot-and computer-assisted knee and hip arthroplasty. In: Robotics in Knee and Hip Arthroplasty. Cham: Springer International Publishing; 2019. p. 37-43.
8. Mont MA, Cool C, Gregory D, Coppolecchia A, Sodhi N, Jacofsky DJ. Health care utilization and payer cost analysis of robotic arm assisted total knee arthroplasty at 30, 60, and 90 days. J Knee Surg 2021;34:328-37.
9. Jacofsky DJ, Allen M. Robotics in arthroplasty: A comprehensive review. J Arthroplasty 2016;31:2353-63.
10. Shatrov J, Foissey C, Kafelov M, Batailler C, Gunst S, Servien E, et al. Functional alignment philosophy in total knee arthroplasty-rationale and technique for the Valgus morphotype using an image based robotic platform and individualized planning. J Pers Med 2023;13:212.
11. Shatrov J, Battelier C, Sappey-Marinier E, Gunst S, Servien E, Lustig S. Functional alignment philosophy in total knee arthroplasty-rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning. SICOT J 2022;8:11.
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13. Kazarian GS, Lawrie CM, Barrack TN, Donaldson MJ, Miller GM, Haddad FS, et al. The impact of surgeon volume and training status on implant alignment in total knee arthroplasty. J Bone Joint Surg Am 2019;101:1713-23.
14. Goh GS, Lohre R, Parvizi J, Goel DP. Virtual and augmented reality for surgical training and simulation in knee arthroplasty. Arch Orthop Trauma Surg 2021;141:2303-12.
15. Jiang H, Xiang S, Guo Y, Wang Z. A wireless visualized sensing system with prosthesis pose reconstruction for total knee arthroplasty. Sensors (Basel) 2019;19:2909.
16. Hazratwala K, Brereton SG, Grant A, Dlaska CE. Computer-assisted technologies in arthroplasty: Navigating your way today. JBJS Rev 2020;8:e0157.
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How to Cite this article: Deshmukh S, Bagaria V. Current Concept Update on Robotic Technology in Arthroplasty. Journal of Clinical Orthopaedics 2024 January-June;9(1):35-41

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Expert Consensus on the Significance of Intravenous Iron using Ferric Carboxymaltose Perioperatively and in Elective Major Orthopedic Surgeries

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 42-51 | Mohan Desai, Punit Jain, Surendar Singh Bava, Swarnendu Samanta, K R Prathap Kumar, Anand Galagali, Santhosh Shetty, Atul Panghate, Ashish Arbat, Satish Sonar, Attique Vasdev, Prashant Tonape, Miten Sheth, Ashraf Shaikh, Sachin Suryawanshi, Ketan Kulkarni

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.000

Author: Mohan Desai [1], Punit Jain [2,3], Surendar Singh Bava [1], Swarnendu Samanta [4], K R Prathap Kumar [5], Anand Galagali [6], Santhosh Shetty [7], Atul Panghate [1], Ashish Arbat [8,9], Satish Sonar [10], Attique Vasdev [11], Prashant Tonape [12], Miten Sheth [13], Ashraf Shaikh [1], Sachin Suryawanshi [14], Ketan Kulkarni [15]

[1] Department of Orthopedics, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India,
[2] Department of Hematology Oncology and Stem Cell Transplant, Apollo Hospitals, Navi Mumbai, Maharashtra, India,
[3] HematCare-Speciality Hematology Clinic, Powai, Mumbai, India,
[4] Department of Orthopedics, Peerless Hospital, Kolkata, West Bengal, India,
[5] Department of Orthopedics, Sunrise Group of Hospitals, Kochi, Kerala, India,
[6] Department of Orthopedics Surgery Manipal Hospital, Bengaluru, Karnataka, India,
[7] Department of Arthroplasty and Joint Replacement, Surana Group of Hospitals, Malad, Mumbai, Maharashtra, India,
[8] Department of Joint Replacement Surgery, Jehangir Hospital, Pune, Maharashtra, India,
[9] Department of Orthopedics, Oyster and Pearl Hospital, Pune, Maharashtra, India,
[10] SportsMed Arthroscopy and Shoulder Surgery Centre, Nagpur, Maharashtra, India,
[11] Department of Orthopaedics, Institute of Musculoskeletal Disorders and Orthopaedics, Medanta – The Medicity, Gurugram, Haryana, India,
[12] Department ofArthroscopy and Joint Replacement Surgery, Sterling Multispeciality Hospital, Nigadi, Pradhikaran, Pune, Maharashtra, India,
[13] The Knee Clinic, Mumbai, Maharashtra, India,
[14] Medical Services, Emcure Pharmaceuticals Ltd, Mumbai, Maharashtra, India,
[15] Medical Services, Emcure Pharmaceuticals Ltd, Pune, Maharashtra, India.

Address of Correspondence
Dr. Ketan Kulkarni,
Medical Services, Emcure Pharmaceuticals Ltd, Pune, Maharashtra, India.
E-mail: Ketan.Kulkarni@emcure.com

Abstract

Anemia has emerged as a significant healthcare crisis in India and often remains undiagnosed, with broad implications across all age groups. Iron deficiency remains the most important and correctable cause of anemia in our country. It often leads to significant morbidity during major operative procedures such as hip and knee arthroplasties, due to the substantial intraoperative bleeding associated with these procedures. To address this challenge and mitigate complications related to blood transfusions, peri-operative iron therapy, notably parenteral iron therapy, has become common practice. Nevertheless, there is a lack of consensus on managing peri-operative anemia and the role of ferric carboxymaltose (FCM) in pre-operative and post-operative orthopedic surgeries in India. A group of 14 experts, primarily orthopedic surgeons and an hematologist in India, convened an in-person expert group meeting. Their primary focus was on the approach of FCM in managing anemia in elective orthopedic surgeries within the diverse landscape of the Indian healthcare system. The consensus strongly advocated using FCM as a rapid and adequate source of iron replacement, especially in cases of significant pre-operative and post-operative anemia in patients undergoing elective orthopedic surgery.
Keywords: Pre-operative, post-operative, orthopedic surgery, anemia, ferric carboxymaltose.

References

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How to Cite this article: Desai M, Jain P, Bava S, Samanta S, Kumar KRP, Galagali A, Shetty S, Panghate A, Arbat A, Sonar S, Vasdev A, Tonape P, Sheth M, Shaikh A, Suryawanshi S, Kulkarni K. Expert Consensus on the Significance of Intravenous Iron using Ferric Carboxymaltose Perioperatively and in Elective Major Orthopedic Surgeries. Journal of Clinical Orthopaedics 2024 January-June;9(1):42-51.

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Comparative Study of BMD in Type 2 Diabetic and Non-diabetic Male Patients

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 28-34 | Jata Shankar Kumar, Mohd Danish, Vikash Singh

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.628

Author: Jata Shankar Kumar [1], Mohd Danish [1], Vikash Singh [1]

[1] Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.

Address of Correspondence
Dr. Mohd Danish,
Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com

Abstract

Introduction: Osteoporosis and diabetes are both common human diseases. The prevalence of both is increasing individually and in combination, due to better detection methods and changing definitions. Due to the different pathogenesis of Type 1 and Type 2 diabetes mellitus (T2DM), one of which is a predominant autoimmune process while the other mainly a metabolic disorder, it is not surprising that there is no uniform entity of diabetic bone disease as such, although such term has been proposed in the past but never gained momentum. Paradoxically, an increased risk of osteoporotic fracture in T2DM has been repeatedly demonstrated and this was independent of bone mineral density (BMD). This association with fracture adds uncertainty around the actual association between diabetes mellitus and BMD.
This study aims to study the population of diabetes at tertiary care center when they are compared with non-diabetics in terms of BMD.
Aims of Study: The aim of this study was to determine the prevalence of osteopenia and osteoporosis in T2DM and non-diabetic male patients using Dual Energy X-ray absorptiometry (DEXA scan).
Materials and Methods: Patients for the study included male patients between 40 and 60 years of age group attending outpatient department, health checkup, and admitted in the ward of Saifee Hospital, Department of Medicine. In 200 (100 type 2 diabetic males and 100 non-diabetic males), DEXA Scan was performed in the Department of Imaging, Saifee Hospital from June 2017 to April 2019.
Results: Type 2 diabetics were significantly associated with the presence of osteoporosis compared to non-diabetics (P = 0.001). Type 2 diabetics were significantly associated with body mass index (BMI) >25 (P = 0.0) and diabetics had a significantly higher BMI compared to non-diabetics (P = 0.0001). Type 2 diabetics above 50 years of age were significantly associated with osteoporosis (P = 0.000) and diabetics with osteoporosis were significantly older compared to diabetics without osteoporosis (P = 0.0018).
Conclusion: The study concluded that there is a correlation between T2DM, increasing age, glycemic control, increased BMI, increased calcium levels, and decreased BMD. Thus, physician treating diabetes must anticipate decreased BMD and rule out or correct all of these factors in patients of diabetes to prevent the complications of decreased BMD in these groups of patients. Therefore, early detection and treatment of osteoporosis/osteopenia by estimation of BMD in Type 2 diabetic males, strict diabetic control with target hemoglobin A1c <6.5, weight control with target BMI <25, supplementation with Vitamin D3 should be advocated.
Keywords: Diabetes, osteoporosis, dual-energy X-ray absorptiometry scan.

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How to Cite this article: Kumar JS, Danish M, Singh V. Comparative Study of BMD in Type 2 Diabetic and Non-diabetic Male Patients. Journal of Clinical Orthopaedics 2024 January-June;9(1):28-34.

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Potpourri – Recent and Relevant Literature in Periprosthetic Fractures Around the Knee

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 52-56 | Clevio Desouza, Nicholas Antao

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.634

Author: Clevio Desouza [1, 2], Nicholas Antao [2]

[1] Centre for Bone and Joints, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Holy Spirit Hospital, Andheri, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Clevio Joao Baptista Desouza,
Centre for Bone and Joints, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
E-mail: ceviod@gmail.com

Abstract

Knee replacement stands as an effective treatment for alleviating pain and restoring function in cases of degenerative joint conditions. The escalating prevalence of knee replacements reflects their acknowledged success. Despite being a relatively uncommon complication, periprosthetic fractures surrounding total knee arthroplasties present intricate challenges, demanding proficiency in both arthroplasty and trauma reconstructive techniques from treating surgeons. The confluence of increased life expectancy and elevated functional expectations among elderly individuals may contribute to a heightened occurrence of periprosthetic fractures. Among these fractures, supracondylar fractures of the femur emerge as the most prevalent. This comprehensive review delves into the classification and diverse treatment modalities available for addressing periprosthetic fractures around total knee arthroplasties.
Keywords: Total Knee Arthroplasty, Replacement, Femur, Periprosthetic fractures

References

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12. Lari A, Kashif S, AlMukaimi A. Arthroscopic retrograde intramedullary nailing of periprosthetic fractures after total knee arthroplasty-technique, safety, and outcomes. Arthroplast Today 2022;17:47-52.
13. Park YG, Kang H, Song JK, Lee J, Rho JY, Choi S. Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty. J Orthop Surg Res 2021;16:433.
14. Antao NA, Londhe S, Toor R, Shirishkar R, Aiyer S. Short-term results of a novel management of supracondylar fracture with coexisting osteoarthritis with bifold fixation and total knee arthroplasty. Arthroplasty. 2021 Dec 4;3(1):44.
15. Hassan S, Swamy GN, Malhotra R, Badhe NP. Periprosthetic fracture of the distal femur after total knee arthroplasty; Prevalence and outcomes following treatment. J Bone Joint Surg (Br) 2012;94-B:6.
16. Norrish AR, Jibri ZA, Hopgood P. The LISS plate treatment of supracondylar fractures above a total knee replacement: A case-control study. Acta Orthop Belg 2009;75:642-8.
17. Ebraheim NA, Sochacki KR, Liu X, Hirschfield G, Liu J. Locking plate fixation of periprosthetic femur fractures with and without cerclage wires. Orthop Surg 2013;5:183-7.
18. Hoffman MF, Jones CB, Sietsema DL, Koenig SJ, Tornetta P 3rd. Outcome of periprosthetic distal femoral fractures following knee arthroplasty. Injury 2012;43:1084-9.
19. Ehlinger M, Adam P, Abane L, Rahme M, Moor BK, Arlettaz Y, et al. Treatment of periprosthetic femoral fractures of the knee. Knee Surg Sports Traumatol Arthrosc 2011;19:1473-89.
20. Bezwada HP, Neubauer P, Baker J, Israelite CL, Johanson NA. Periprosthetic supracondylar femur fractures following total knee arthroplasty. J Arthroplasty 2004;19:453-8.
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22. Bong MR, Egol KA, Koval KJ, Kummer FJ, Su ET, Iesaka K, et al. Comparison of the LISS and a retrograde-inserted supracondylar intramedullary nail for fixation of a periprosthetic distal femur fracture proximal to a total knee arthroplasty. J Arthroplasty 2002;17:876-81.
23. Kilicoglu OI, Akgül T, Sağlam Y, Yazıcıoğlu O. Comparison of locked plating and intramedullary nailing for periprosthetic supracondylar femur fractures after knee arthroplasty. Acta Orthop Belg 2013;79:417-21.
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How to Cite this article: Desouza C, Antao N. Potpourri – Recent and Relevant Literature in Periprosthetic Fractures Around the Knee. Journal of Clinical Orthopaedics 2024;January-June:9(1):52-56.

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Infection After Total Knee Arthroplasty: Does Timing of Pre-operative Antibiotics Matter?

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 17-21 | Timothy J Walden, Max L Willinger, Jamie C Heimroth, Adam Strigenz2, Alain Sherman, Jonathan R Danoff

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.624

Author: Timothy J Walden [1,2,3], Max L Willinger [1,2,3], Jamie C Heimroth [1,2,3], Adam Strigenz2, Alain Sherman [1], Jonathan R Danoff [1,2,3]

[1] Northwell Orthopedics, New Hyde Park, New York, USA,
[2] North Shore University Hospital, New York, USA,
[3] Zucker School of Medicine, Hempstead, New York, USA.

Address of Correspondence

Dr. Jonathan R. Danoff,
270-05 76th Ave, New Hyde Park, NY 11040,
E-mail: jdanoff@northwell.edu

Abstract

Background: Since the 2003 NIH consensus statement, the use of prophylactic antibiotics in total knee arthroplasty (TKA) has been the standard of care. Some studies recommend antibiotic administration within 1 h of skin incision, but no specific time frame has been delineated. The objective of this study was to determine if timing of pre-operative antibiotics is associated with post-operative infection after TKA.
Materials and Methods: An institutional database from a multi-center health-care system was queried with ICD-10 codes and reviewed for patients undergoing primary TKA between March 2020 and December 2020. The rate of superficial surgical site infection (SSI) and periprosthetic joint infection (PJI) was compared with pre-operative antibiotic timing. PJIs were defined based on 2018 MSIS criteria and superficial SSIs were other infections that did not meet MSIS criteria. Antibiotic timing was separated into 15-min cohorts from 0 min before skin incision to over 45 min before incision. Further comparison between patients who received antibiotics within 30 min of incision with those who received antibiotics greater than 30 min prior was performed.
Results: Of the 2511 patients who underwent primary TKA, 19 were found to have post-operative infections. There were 7 SSIs, and 12 PJIs, 16 of the post-operative infections occurred when patients received antibiotics <30 min before incision. There was no significant difference in SSIs or PJIs between each 15-min time interval of antibiotic administration (P = 0.45) or between the 30-min time intervals (P = 0.09).
Conclusion: Our study demonstrates no difference in post-operative infection based on pre-operative antibiotic timing. As long as antibiotics are given within 60 min of incision, preferentially 30–60 min before incision, their timing does not have a significant effect on post-operative infection following TKA.
Keywords: Pre-operative antibiotics, periprosthetic joint infection, superficial skin infection, total knee arthroplasty, complications

References

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13. Badge H, Churches T, Xuan W, Naylor JM, Harris IA. Timing and duration of antibiotic prophylaxis is associated with the risk of infection after hip and knee arthroplasty. Bone Jt Open 2022;3:252-60.
14. American Academy of Orthopaedic Surgeons. Information Statement: Recommendations for the Use of Intravenous Antibiotic Prophylaxis in Primary Total Joint Arthroplasty. Available from: https://www.aaos.org/about/papers/advistmt/1027.asp

How to Cite this article: Walden TJ, Willinger ML, Heimroth JC, Strigenz A, Sherman A, Danoff JR. Infection After Total Knee Arthroplasty: Does Timing of Pre-operative Antibiotics Matter? Journal of Clinical Orthopaedics 2024;January-June:9(1):17-21.

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Functional Outcome of Distal Humerus Intra-articular Fractures Treated with Pre-contoured Anatomical Locking Plates

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 10-16 | Swapnil Chitnavis

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.622

Author: Swapnil Chitnavis [1]

[1] Department of Orthopedics, Seth G. S. Medical College & K. E. M. Hospital, Parel, Maharashtra, India

Address of Correspondence

Dr. Swapnil Chitnavis,
Department of Orthopaedics, Seth G. S. Medical College & K. E. M. Hospital, Parel, Mumbai, India.
Email – swapnilchitnavis@gmail.com

Abstract

Introduction: The most difficult therapeutic challenge is treating humerus fractures, which might result in a subpar functional outcome. It is anticipated that early mobilization, anatomic reduction, and internal fixation will enhance the functional results. The purpose of this study is to assess the functional result, intercondylar fixation rate, and anatomically pre-contoured locking plate treatment of a distal humerus fracture.
Material and Method: This prospective research included patients with type 13-C2 distal humerus fractures, regardless of sex, who were hospitalized. Using the modified triceps tongue flap method, all patients received open reduction and internal fixation with anatomic pre-contoured locking plates and screws. Patients underwent 6 months of follow-up after surgery. They had follow-up evaluations using the Mayo Elbow Performance Score (MEPS) for clinical, radiological, and functional assessments. The Chi-square test was used to analyze the outcomes.
Observations: Males accounted for the majority of injuries (66.7% vs. 33.3%). The age distribution was 36.93 ± 14.67. Traffic accidents were the most common cause of injuries (66.7%). The most frequently affected side was the right upper limb (76.7%). Eighty percent of the patients had MEPS scores that were excellent or good overall. At the fracture site, the radiological union took an average of 10.2 ± 2.11 weeks. In the 6th week, the mean extension-flexion arc was 32.06°–104.06°, and in the 6th month, it was 11.55°–124.16°. Early superficial infection (3.3%), malunion (3.3%), ulnar neuropraxia (3.3%), and chronic osteomyelitis (3.3%) were the consequences. In conclusion, the functional result of the elbow was effectively preserved in distal humerus fractures treated with anatomic pre-contoured locking plates.
Keywords: Elbow joint, distal humerus intra articular fractures, bone plates, articular range of motion, osteomyelitis, MEPS, pre-contoured anatomical locking plate.

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How to Cite this article: Chitnavis S. Functional Outcome of Distal Humerus Intra-articular Fractures Treated with Pre-contoured Anatomical Locking Plates. Journal of Clinical Orthopaedics 2024 January-June;9(1):10-16.

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Is Potential Malnutrition Associated with Increased Morbidity in Total Hip and Knee Joint Arthroplasty? A Prospective Cohort Study

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Journal of Clinical Orthopaedics | Vol 9 | Issue 1 |  January-June 2024 | page: 04-09 | William James Caughey, Faseeh Zaidi, Christoper Jarred Shepherd, Claudia Rivera-Rodriguez, Rocco P Pitto

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.620

Author: William James Caughey [1,2], Faseeh Zaidi [1,2], Christoper Jarred Shepherd [1], Claudia Rivera-Rodriguez [3], Rocco Paolo Pitto [1,2]

[1] Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand,
[2] Department of Surgery, University of Auckland, Auckland, New Zealand,
[3] Department of Statistics, University of Auckland, Auckland, New Zealand.

Address of Correspondence
William James Caughey,
Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand.
E-mail: wjcaughey@gmail.com

Abstract

Introduction: Malnutrition is considered a risk factor for post-operative complications in total hip and knee arthroplasty, though prospective studies to investigate this assumption are lacking. The aims of this study were to prospectively analyze the 90-day post-operative complications, post-operative length of stay (LOS), and readmission rates of patients undergoing primary total hip and total knee arthroplasty using albumin, total lymphocyte count (TLC), and transferrin as serum markers of potential malnutrition.
Materials and Methods: Six hundred and three primary hip and 823 primary knee arthroplasties over a 3-year period from a single center were prospectively analyzed. Body mass index, demographic, and comorbidity data were recorded. Complications were categorized as surgical site infection (SSI), venous thromboembolism (VTE) (deep vein thrombosis and pulmonary embolus), implant-related (such as dislocation), and non-implant-related (such as pneumonia). Outcomes were compared between groups, with malnutrition, defined as serum albumin <3.5 g/dL.
Results: Potential malnutrition was present in 9.3% of the study population. This group experienced a longer average LOS at 6.5 days compared to the normal albumin group at 5.0 days (P = 0.003). SSI rate was higher in the malnourished group (12.5 vs. 7.8%, P = 0.02). There was no difference between the two groups in implant-related complications (0.8 vs. 1.0%, P = 0.95) medical complications (7.8 vs. 13.3%, P = 0.17), rate of VTE (2.3 vs. 2.7%) or 90-day readmission rate (14.1 vs. 17.0%, P = 0.56). TLC and transferrin were not predictive of any of the primary outcomes measured (P > 0.05). Pacific Island (P < 0.001), Indian (P = 0.02), and Asian (P = 0.02) patients had lower albumin than NZ European.
Conclusion: This study demonstrates an association between low albumin levels and increased post-operative LOS and SSI in total joint arthroplasty, providing support for the consideration of pre-operative nutritional screening.
Keywords: Knee arthroplasty, hip arthroplasty, malnutrition, post-operative complications, hypoalbuminemia.

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How to Cite this article: Caughey WJ, Zaidi F, Shepherd CJ, Rivera-Rodriguez C, Pitto RP. Is Potential Malnutrition Associated with Increased Morbidity in Total Hip and Knee Joint Arthroplasty? A Prospective Cohort Study. Journal of Clinical Orthopaedics 2024 January-June;9(1):04-09.

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