Submitted Date: 20 Aug 2024, Review Date: 05 Sep 2024, Accepted Date: 12 Sep 2024 & Published Date: 10 Dec 2024
Author: Abhishek Nighot [1], Niharika Virkar [2]
[1] Department of Orthopaedics, Hip and Knee Arthroplasty Unit, SAANVI Orthopaedics, Mumbai, Maharashtra, India.
[2] Department of Hand and Microsurgery, Pinnacle Hospital, Thane, Maharashtra, India.
Address of Correspondence
Dr. Abhishek Nighot,
Department of Orthopaedics, SICOT Fellow in Hip and Knee Arthroplasty, SAANVI Orthopaedics, Mumbai, Maharashtra, India.
E-mail: abhisheknighot43@gmail.com
Abstract
Introduction: Total knee arthroplasty (TKA) is a proven solution for end-stage knee arthritis, yet traditional mechanical alignment (MA), which aims for a neutral mechanical axis, leaves up to 20% of patients dissatisfied postoperatively. Kinematic alignment (KA) has emerged as an alternative, focusing on restoring the patient’s native anatomy and joint line orientation, achieving balance without extensive soft-tissue releases. Methods: This article examines the principles of KA and compares it with MA regarding safety, outcomes, and biomechanical balance through a literature review comprising various retrospective studies, randomized controlled trials, and systemic reviews. KA relies on the patient’s unique femoral morphology to guide bone cuts, achieving natural alignment and ligament balance. Evidence suggests that KA offers comparable if not superior, functional outcomes, with higher Oxford knee scores and forgotten joint scores while maintaining similar implant survivorship. Studies also show KA leads to better compartmental balance, reduced knee adduction moments, and more natural gait mechanics. The compartmental pressure alignment knee classification highlights KA’s ability to balance the knee across various lower limb phenotypes. Conclusion: Although KA shows promise, challenges remain. Concerns about tibial varus have been addressed, with studies confirming no compromise in implant stability or survival. However, long-term data are needed to validate KA’s durability and define its role for specific patient groups.
This article provides a comprehensive overview of KA’s benefits and limitations, offering guidance for surgeons seeking evidence-based alignment strategies. It underscores KA’s potential as a personalized approach in TKA, bridging gaps in satisfaction and functional outcomes while maintaining safety. Keywords: Kinematic alignment, mechanical alignment, arthroplasty, osteoarthritis.
References
1. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clin Orthop Relat Res 2010;468:57-63.
2. Griffin FM, Insall JN, Scuderi GR. Accuracy of soft tissue balancing in total knee arthroplasty. J Arthroplasty 2000;15:970-3.
3. Rivière C, Iranpour F, Auvinet E, Aframian A, Asare K, Harris S, et al. Mechanical alignment technique for TKA: Are there intrinsic technical limitations? Orthop Traumatol Surg Res 2017;103:1057-67.
4. Beckers G, Meneghini RM, Hirschmann MT, Kostretzis L, Kiss MO, Vendittoli PA. Ten flaws of systematic mechanical alignment total knee arthroplasty. J Arthroplasty 2024;39:591-9.
5. Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: Is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012;470:45-53.
6. Rivière C, Harman C, Boughton O, Cobb J. The kinematic alignment technique for total knee arthroplasty. In: Rivière C, Vendittoli PA, editors. Personalized Hip and Knee Joint Replacement. Ch. 16. Cham, CH: Springer; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565753
7. Roth JD, Howell SM, Hull ML. Native knee laxities at 0°, 45°, and 90° of flexion and their relationship to the goal of the gap-balancing alignment method of total knee arthroplasty. J Bone Joint Surg Am 2015;97:1678-84.
8. Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: Two-year clinical results. Bone Joint J 2014;96-B:907-13.
9. Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: A prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2017;25:1743-8.
10. Howell SM, Shelton TJ, Hull Ml. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty 2018;33:3678-84.
11. Howell SM, Akhtar M, Nedopil AJ, Hull ML. Reoperation, implant survival, and clinical outcome after kinematically aligned total knee arthroplasty: A concise clinical follow-up at 16 years. J Arthroplasty 2024;39:695-700.
12. Van Essen J, Stevens J, Dowsey MM, Choong PF, Babazadeh S. Kinematic alignment results in clinically similar outcomes to mechanical alignment: Systematic review and meta-analysis. Knee 2023;40:24-41.
13. Laende EK, Richardson CG, Dunbar MJ. A randomized controlled trial of tibial component migration with kinematic alignment using patient-specific instrumentation versus mechanical alignment using computer-assisted surgery in total knee arthroplasty. Bone Joint J 2019;101-B:929-40.
14. Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Joint J 2017;99-B:640-6. Erratum in: Bone Joint J 2021;103-B:1641.
15. Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018;26:1629-35.
16. MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB. Coronal plane alignment of the knee (CPAK) classification. Bone Joint J 2021;103-B:329-37.
How to Cite this article: Nighot A, Virkar N. The Promise of Kinematic Alignment in TKA: Game- Changer or Gimmick? Journal of Clinical Orthopaedics July-December 2024;9(2):100-104.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-12-10 16:37:022025-04-25 05:29:47The Promise of Kinematic Alignment in TKA: Game-changer or Gimmick?
Submitted Date: 16 Aug 2024, Review Date: 27 Sep 2024, Accepted Date: 12 Oct 2024 & Published Date: 10 Dec 2024
Author: Ashish S Phadnis [1], Saurabh S Ranjalkar [2], Vijay Kumar [3], Prathamesh Sangare [2], Shashank Gabhe [4]
[1] Department of Orthopaedic Surgery, Jupiter Hospital Thane, Maharashtra, India,
[2] Department of Orthopaedic Surgery, HBT Trauma Hospital, Jogeshwari (E), Mumbai, Maharashtra, India,
[3] Department of Orthopaedic Surgery, ESIC hospital and Dental College, Rohini West, Delhi, India,
[4] Dr Gabhe’s Bones and Joints Clinic, Thane, Maharashtra, India
Address of Correspondence
Dr. Saurabh S Ranjalkar,
Department of Orthopaedic Surgery, HBT Trauma Hospital, Jogeshwari(E), Mumbai, Maharashtra, India
E-mail: saurabh.ranjalkar93@gmail.com
Abstract
Introduction: Primary total knee replacement (TKR) is one of the most commonly performed orthopedic procedures. With the increasing prevalence of obesity and advancing age of the population, it is imperative to know whether the obese patients have inferior or equivalent outcomes as opposed to non-obese patients. Hence, this study was planned to learn the functional and radiological outcomes of TKR surgery in obese and non-obese patients. Materials and Methods: This prospective observational study included 64 adult patients 32 obese (body mass index [BMI] >30) and 32 non-obese (BMI <30) operated for TKR surgery. Functional outcome was assessed by patient-reported outcome measures using Oxford knee score (OKS) and short form-12 (SF-12) quality of life questionnaires at 6 weeks postoperatively. Radiological outcomes were assessed using pre- and post-operative radiograph and bilateral lower limb scanogram. Results: On comparing the mean hospital stay, that of obese patients was 8.16 days and that of non-obese patients was 6.72 days (significant). The OKS improved from 14.19 to 37.44 in the obese group and from 14.75 to 38.59 in non-obese group. In obese patients, the physical component of SF-12 score improved from 23.92 to 53.6 postoperatively, and that in non-obese patients went from 27.29 to 53.08. The mean mental component of SF-12 score improved from 48.59 to 56.37 postoperatively in obese patients, in non-obese patients it improved from 53.02 to 57.94 postoperatively (significant). Hip-knee-ankle axis in obese patients on the right side improved from 171.18° to 176.82° (significant), left side from 171.31° to 176.71° whereas in non-obese patients right side from 171.89° to 176.94°, left side from 171.82° to 176.66°. Comorbidities were seen more in obese patients (diabetes 21 of 32 cases, hypertension 17 of 32 cases) than in non-obese patients (diabetes 12 of 32 cases, hypertension 16 of 32 cases). Superficial surgical site infection (SSI) in about 3 of 32 obese patients, whereas no SSI was found in non-obese patients. Conclusion: The present study assesses the patients’ perception of their outcomes which are important in clinical decision-making. There was no significant difference found in patient perceived parameters, functional and radiological outcomes at end of 6 months following TKR surgery in both obese and non-obese patients. Keywords: Total knee replacement, body mass index, obese.
References
1. Jester R, Rodney A. The relationship between obesity and primary total knee replacement: A scoping review of the literature. Int J Orthop Trauma Nurs 2021;42:100850.
2. Garellick G, Malchau H, Herberts P, Hansson E, Axelsson H, Hansson T. Life expectancy and cost utility after total hip replacement. Clin Orthop Relat Res 1998;346:141-51.
3. Lau EC, Cooper C, Lam D, Chan VN, Tsang KK, Sham A. Factors associated with osteoarthritis of the hip and knee in Hong Kong Chinese: Obesity, joint injury, and occupational activities. Am J Epidemiol 2000;152:855-62.
4. Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, et al. Osteoarthritis: New insights. Part 1: The disease and its risk factors. Ann Intern Med 2000;133:635-46.
5. Cooper C. Occupational activity and the risk of osteoarthritis. J Rheumatol Suppl 1995;43:10-2.
6. Bray GA. Overweight is risking fate. Definition, classification, prevalence, and risks. Ann N Y Acad Sci 1987;499:14-28.
7. Fehring TK, Odum SM, Griffin WL, Mason JB, McCoy TH. The obesity epidemic: Its effect on total joint arthroplasty. J Arthroplasty 2007;22(6 Suppl 2):71-6.
8. Namba RS, Paxton L, Fithian DC, Stone ML. Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 2005;20:46-50.
9. Dowsey MM, Liew D, Stoney JD, Choong PF. The impact of pre-operative obesity on weight change and outcome in total knee replacement: A prospective study of 529 consecutive patients. J Bone Joint Surg Br 2010;92:513-20.
10. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: The incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008;466:1710-5.
11. Chesney D, Sales J, Elton R, Brenkel IJ. Infection after knee arthroplasty a prospective study of 1509 cases. J Arthroplasty 2008;23:355-9.
12. Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 2009;24:84-8.
13. Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res 2009;467:1577-81.
14. Ayyar V, Burnett R, Coutts FJ, Van der Linden ML, Mercer TH. The influence of obesity on patient reported outcomes following total knee replacement. Arthritis 2012;2012:185208.
15. Agur AM, Dalley AF. Grant’s Atlas of Anatomy. 12th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2009.
16. World Health Organization. Obesity: Preventing and Managing the Global Epidemic Report of a WHO Consultation; 2000. Available from: https://www.who.int/nutrition/publications/obesity/who_trs_894/en/index.html [Last accessed on ??? July 2011].
17. Amin AK, Patton JT, Cook RE, Brenkel IJ. Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Br 2006;88:335-40.
18. Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, et al. Hands-on robotic unicompartmental knee replacement: A prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br 2006;88:188-97.
19. Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS. The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am 2004;86:1609-15.
20. CORI Surgical System: Smith+Nephew USA. Available from: https://www.smith-nephew.com/en-us/health-care-professionals/products/orthopaedics/cori [Last accessed on 2023 Jun 18].
21. Foran JR, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford DS. Total knee arthroplasty in obese patients: A comparison with a matched control group. J Arthroplasty 2004;19:817-24.
22. Jiganti JJ, Goldstein WM, Williams CS. A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop Relat Res 1993;289:175-9.
23. Miric A, Lim M, Kahn B, Rozenthal T, Bombick D, Sculco TP. Perioperative morbidity following total knee arthroplasty among obese patients. J Knee Surg 2002;15:77-83.
24. Deshmukh RG, Hayes JH, Pinder IM. Does body weight influence outcome after total knee arthroplasty? A 1-year analysis. J Arthroplasty 2002;17:315-9.
25. Stickles B, Phillips L, Brox WT, Owens B, Lanzer WL. Defining the relationship between obesity and total joint arthroplasty. Obes Res 2001;9:219-23.
26. Stevens-Lapsley JE, Petterson SC, Mizner RL, Snyder-Mackler L. Impact of body mass index on functional performance after total knee arthroplasty. J Arthroplasty 2010;25:1104-9.
27. Bin Abd Razak HR, Chong HC, Tan AH. Obesity does not imply poor outcomes in Asians after total knee arthroplasty. Clin Orthop Relat Res 2013;471:1957-63.
How to Cite this article: Phadnis AS, Ranjalkar SS, Kumar V, Sangare P, Gabhe S. Evaluation of Functional and Radiological Outcome of Total Knee Replacement Surgery in Obese V/S Non-obese Patients. Journal of Clinical Orthopaedics July-December 2024;9(2):95-99.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-12-10 16:18:522025-04-25 05:28:24Evaluation of Functional and Radiological Outcome of Total Knee Replacement Surgery in Obese V/S Non-obese Patients
[1] Department of Orthopedics, V. N. Desai Hospital, Santacruz East, Mumbai, Maharashtra, India.
[2] Department of Orthopedics,Holy Spirit Hospital, Mahakali Caves Road, Andheri East, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Pushkar Khandekar,
Department of Orthopaedics, V. N. Desai Hospital, Santacruz East, Mumbai, Maharashtra, India.
E-mail: drpushkarkhandekar@gmail.com
Abstract
Mucoid degeneration of the anterior cruciate ligament (MD-ACL), once thought to be a rare entity, is seen not so uncommonly in present day orthopaedic practice. Several hypotheses attempt to explain this entity. Clinically, it presents as knee pain with limitation of flexion or extension. There is no specific test available to clinically diagnose MD-ACL. Magnetic Resonance Imaging (MRI) remains the imaging modality of choice to diagnose MD-ACL. Therefore, a high index of suspicion is necessary to be able to diagnose this condition. This article reviews the available literature about the etio-pathological aspects of MD-ACL, its clinical features, radiological and arthroscopic findings, as well as various treatment modalities available. Keywords: Mucoid degeneration, anterior cruciate ligament, knee, arthroscopy, MRI.
References
1. Nicolas Himpe, Pieter Berger, Hilde Vandenneucker. Mucoid degeneration of the anterior cruciate ligament. Complete resection as equivalent treatment to partial resection. Acta Orthop Belg. 2020;86(2):272–9.
2. Scranton PE Jr F EL. Mucoid degeneration of the patellar ligament in athletes. . J Bone Joint Surg Am. 1992 Mar;74(3):435–7.
3. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Mucoid cystic degeneration of the cruciate ligament. Clinical J Bone Joint Surg [Br]. 1999.
4. Pandey V, Suman C, Sharma S, Rao S, Kiran Acharya K, Sambaji C. Mucoid degeneration of the anterior cruciate ligament: Management and outcome. Indian J Orthop. 2014 Mar;48(2):197–202.
5. Makino A, Pascual-Garrido C, Rolón A, Isola M, Muscolo DL. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Knee Surgery, Sports Traumatology, Arthroscopy. 2011 Mar 1;19(3):408–11.
6. Hotchen AJ, Demetriou C, Edwards D, Melton JTK. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. Vol. 32, Journal of Knee Surgery. Georg Thieme Verlag; 2019. p. 577–83.
7. Khanna G, Sharma R, Bhardwaj A, Gurdutta HS, Agrawal DK, Rathore AS. Mucoid degeneration of the anterior cruciate ligament: Partial arthroscopic debridement and outcomes. Journal of Arthroscopy and Joint Surgery. 2016 Jan;3(1):28–33.
8. Fernandes JL, Viana SL, Mendonça JLF, Freitas FMO, Bezerra ASA, Lima GAS, et al. Mucoid degeneration of the anterior cruciate ligament: magnetic resonance imaging findings of an underdiagnosed entity. Acta radiol. 2008 Feb 1;49(1):75–9.
9. Mcintyre J, Moelleken S, Tirman P. A RT I C L E Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Vol. 30, Skeletal Radiol. 2001.
10. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin S Il. Arthroscopic Treatment of Mucoid Hypertrophy of the Anterior Cruciate Ligament. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2008 Jun;24(6):642–9.
11. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR, Bergin D. Anterior Cruciate Ligament Ganglia and Mucoid Degeneration: Coexistence and Clinical Correlation [Internet]. Vol. 182, AJR. 2004. Available from: www.ajronline.org
12. Salvati F RFLNPMBAMC. Mucoid metaplastic-degeneration of anterior cruciate ligament . J Sports Med Phys Fitness. 2008 Dec;48(4):483-7.
13. Cho S Do, Youm YS, Lee CC, Seo DK, Kim TW. Mucoid degeneration of both ACL and PCL. Clin Orthop Surg. 2012;4(2):167–70.
14. Hotchen AJ, Melton JTK. Radiofrequency Ablation for Mucoid Degeneration of the Anterior Cruciate Ligament. Arthrosc Tech. 2018 May 1;7(5):e459–63.
15. DJ DrR, SH DrA. Correlation of notch width index in knees with mucoid degeneration of anterior cruciate ligament to normal knees. International Journal of Orthopaedics Sciences. 2021 Jul 1;7(3):368–72.
16. Napoli A, Wulf MI, Bruno CH. Case 10672 Anterior cruciate ligament mucoid degeneration: MR findings. 2013;
17. Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, et al. Association of mucoid degeneration of the anterior cruciate ligament at MR imaging with medial tibiofemoral osteoarthritis progression at radiography: Data from the osteoarthritis initiative. Vol. 287, Radiology. Radiological Society of North America Inc.; 2018. p. 912–21.
18. Vaishya R, Esin Issa A, Agarwal AK, Vijay V. Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration: A Review. Cureus. 2017 Sep 13;
19. Lee JW, Ahn JT, Gwak HG, Lee SH. Clinical outcomes of arthroscopic notchplasty and partial resection for mucoid degeneration of the anterior cruciate ligament. J Clin Med. 2021 Jan 2;10(2):1–9.
20. Loganathan DrD, Sundar S DrS, Sundar DrS, Sahanand DrS, Rajan DrD V. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. International Journal of Orthopaedics Sciences. 2018 Oct 1;4(4):875–80.
21. Lancaster TF, Kirby AB, Beall DP, Wolff JD, Wu DH. Mucoid degeneration of the anterior cruciate ligament: a case report. J Okla State Med Assoc. 2004;97(8):326–8.
22. Saravanan P, Sundararajan T. Management of mucoid degeneration of anterior cruciate ligament. Int J Orthop. 2018;8(2):36.
23. Amiel D, Billings E, Harwood FL. Collagenase activity in anterior cruciate ligament: protective role of the synovial sheath [Internet]. 1990. Available from: www.physiology.org/journal/jappl
24. Pande S, Kushwah AP. S, Nelson SS, Saxena A, Kumar S. MUCOID DEGENERATION OF THE ANTERIOR CRUCIATE LIGAMENT : A CASE REPORT. J Evol Med Dent Sci. 2015 Jun 1;4(44):7689–91.
25. J.J. Hensen, E.G. Coerkamp, J.L. Bloem, A.M. De Schepper. Mucoid degeneration of the anterior cruciate ligament JBR-BTR [Internet]. 2007. Available from: https://www.researchgate.net/publication/6143682
26. Solís GS, Waghchoure C, Vinagre G. Symptomatic ACL mucoid degeneration in middle-age athletes. Vol. 31, Journal of Orthopaedics. Reed Elsevier India Pvt. Ltd.; 2022. p. 67–71.
27. Jung KH, Cho S Do, Park KB, Youm YS. Relation between mucoid degeneration of the anterior cruciate ligament and posterior tibial slope. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2012 Apr;28(4):502–6.
28. Youm YS, Cho S Do, Cho HY, Jung SH. Relationship between mucoid degeneration of the anterior cruciate ligament and posterior tibial slope in patients with total knee arthroplasty. Knee Surg Relat Res. 2016 Mar 1;28(1):34–8.
29. Cha JH, Lee SH, Shin MJ, Choi BK, Bin S Il. Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation. Skeletal Radiol. 2008 Sep;37(9):821–6.
30. Fealy S, Kenter K, Dines JS, Warren RF. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2001;17(9):1–4.
31. Nelissen RGHH. Retain or sacrifice the posterior cruciate ligament in total knee arthroplasty? A histopathological study of the cruciate ligament in osteoarthritic and rheumatoid disease. J Clin Pathol. 2001 May 1;54(5):381–4.
32. Boisrenoult P, Lintz F, Dejour D, Pujol N, Beaufils P. Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament: Medium Term Follow-Up Results About 29 Cases. Journal of Bone &amp; Joint Surgery, British Volume. 2011;93-B(SUPP II).
33. Morice A, Coupry A, Lintz F, Robert H. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: Clinical and knee laxity outcomes in 23 cases. Orthopaedics and Traumatology: Surgery and Research. 2013 Oct;99(6):693–7.
34. Ventura D, Nuñez JH, Joshi-Jubert N, Castellet E, Minguell J. Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament. CiOS Clinics in Orthopedic Surgery. 2018 Sep 1;10(3):307–14.
35. Choubey R, Jain A. Mucoid Degeneration of the Anterior Cruciate Ligament: A Case Report and Review of Literature. J Orthop Case Rep [Internet]. 5(3):87–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27299081
36. Celikyay F, Yuksekkaya R, Bilgic E. A retrospective comparison of ACL tear and mucoid degeneration MRI findings and an emphasis on evaluating of ACL, Blumensaat, and PCL Angles. J Belg Soc Radiol. 2020;104(1).
37. Chudasama CH, Chudasama VC, Prabhakar MM. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Indian J Orthop. 2012 Sep;46(5):561–5.
38. Narvekar A, Gajjar S. Mucoid Degeneration of the Anterior Cruciate Ligament. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2004;20(2):141–6.
39. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: Selecting the best treatment option. Orthopaedics and Traumatology: Surgery and Research. 2010 Jun;96(4):400–6.
40. Kusano M, Horibe S, Tanaka Y, Yonetani Y, Kanamoto T, Shiozaki Y, et al. Early reconstruction should be considered in younger patients with symptomatic mucoid degeneration of the anterior cruciate ligament. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2015 Jul;2(3):95–7.
41. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Skeletal Radiol. 2021 Sep 1;50(9):1837–43.
42. Shelly MJ, Dheer S, Kavanagh EC. Metastatic adenocarcinoma of the lung mimicking mucoid degeneration of the anterior cruciate ligament. Ir J Med Sci. 2010 Jun;179(2):309–11.
43. El Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Mucoid degeneration of the anterior cruciate ligament: A case report. Pan African Medical Journal. 2013 Jun 20;15.
44. Choukimath SK, Kodi H, Nedumparampil MM, Pilar A, Pruthviraj PA, Krishnan R, et al. Mucoid Degeneration of Anterior Cruciate Ligament—A Systematic Approach for Debulking. Arthrosc Tech. 2024;
45. Pimprikar M V., Patil HG. Anterior Cruciate Ligament Ganglion and Decompression of Mucoid Degeneration Using a “Figure-of-4 Position.” Arthrosc Tech. 2024;
46. Hensen JJ CEBJDSA. Mucoid degeneration of the anterior cruciate ligament. Journal of Belgian Society of Radiology. 2007 May;90(3):192–3.
47. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Knee Surg Relat Res. 2021 Dec 1;33(1).
How to Cite this article: Korday S, Khandekar P, Kantawala S, Antao N. Mucoid Degeneration of Anterior Cruciate Ligament – A Review of Literature. Journal of Clinical Orthopaedics July-December 2024;9(2):38-43.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-12-10 15:15:452025-04-25 05:22:42Mucoid Degeneration of Anterior Cruciate Ligament – A Review of Literature
[1] Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India,
[3] Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India
[4] Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India
Address of Correspondence
Dr. Sachin Kale
Professor and Head of Unit, Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India.
Email: sachinkale@gmail.com
Abstract
Femoral neck fractures have significant orthopedic difficulty, particularly in younger patients with high-energy trauma. The femoral neck system improves rotational stability, allows for controlled dynamic compression, and is less invasive than cannulated cancellous screws. However, steep learning curves, more significant starting expenditures, and more long-term data still need to be addressed. Emerging technologies, such as robotic-assisted surgeries and personalized implants created with artificial intelligence and 3D printing, can transform fracture therapy by boosting accuracy, lowering complications, and improving patient-specific care. Future advances will improve results and patient happiness. Keywords: Femoral neck fractures, femoral neck system, cannulated screws, rotational stability, angular stability, minimally invasive surgery, fracture fixation, osteoporotic fractures, clinical outcomes, implant innovations.
How to Cite this article: Kale S, Vatkar A, Dhar S, Bhor P, Phadnis A, Jayaram R. Evolution of Femoral Neck Implants: In Search of the Perfect Implant. Journal of Clinical Orthopaedics July-December 2024;9(2):01-05.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-12-10 15:01:512025-04-25 05:21:36Evolution of Femoral Neck Implants: In Search of the Perfect Implant
Submitted Date: 10 Oct 2024, Review Date: 15 Nov 2024, Accepted Date: 20 Nov 2024 & Published Date: 10 Dec 2024
Author: Pramod Bhor [1], Sawankumar H. Pawar [1], Dnyanada Kutumbe [1], Arvind Vatkar [1], Sachin Kale [2]
[1] Department of Orthopaedics, Fortis Hiranadani Hospitals, Vashi, Navi Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India,
Address of Correspondence
Dr. Sawankumar H. Pawar
Associate Consultant, Department of Orthopaedics, Fortis Hiranadani Hospitals, Vashi, Navi Mumbai, Maharashtra, India.
Email- drsawanortho@gmail.com
Abstract
Severe varus deformity of the knee is a complex condition that is managed with scrupulous pre-operative planning and intraoperative technique, more so in cardiac-risk patients. Robotic-assisted total knee replacement (TKR) has emerged as an exciting option for improving precision and better outcomes in complex cases. The authors report a case of Robotic-assisted TKR in a 65-year-old patient suffering from severe varus deformity of the knee and multiple significant cardiac comorbidities. Keywords: Robotic assisted TKR, Severe varus deformity, Cardiac risk
References
1. Kochhar T, Thakral R. Role of robotics in total knee arthroplasty: A clinical review. J Orthop Surg 2020;28:1-7.
2. Marchand RC, Sodhi N. Does robotic arm-assisted TKA result in improved clinical outcomes? J Knee Surg 2019;32:1020-7.
3. Alrajeb R, Zarti M, Shuia Z, Alzobi O, Ahmed G, Elmhiregh A. Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol. 2024 Apr;34(3):1333-1343. doi: 10.1007/s00590-023-03798-2. Epub 2023 Dec 22. PMID: 38133653; PMCID: PMC10980635.
4. van der List, J. P., Chawla, H., Joskowicz, L., & Pearle, A. D. (2016). Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 24(11), 3482–3495. https://doi.org/10.1007/s00167-016-4305-9
5. Khlopas A, Chughtai M, et al. The learning curve associated with robotic total knee arthroplasty. J Arthroplast 2018;33:1761-7.
How to Cite this article: Bhor P, Pawar SH, Kutumbe D, Vatkar A, Kale S. Robotic-Assisted Total Knee Replacement in a Patient with Severe Varus Deformity and High Cardiac Risk. Journal of Clinical Orthopaedics July-December 2024;9(2):129-131.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-12-10 14:44:572025-04-25 05:30:25Robotic-Assisted Total Knee Replacement in a Patient with Severe Varus Deformity and High Cardiac Risk
[1] Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India,
[3] Department of Orthopaedics, Fortis Hiranandani Hospital, Mumbai, Maharashtra, India,
[4] Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India.[5] Mehra Hospital and Research Institute, Lucknow, Uttar Pradesh, India,
Address of Correspondence
Dr. Arvind Vatkar,
Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India.
E-mail: vatkararvind@gmail.com
Abstract
Spinal gout is an uncommon form of gout that is distinguished by the deposition of monosodium urate (MSU) crystals in the spine, resulting in severe pain and potential neurological impairments. Despite its rarity, spinal gout can be difficult to diagnose because of its vague symptoms and similarities to other spinal illnesses. This study delves into the epidemiology, clinical aspects, and diagnostic problems of spinal gout, focusing on the Indian setting. Diagnostic methods such as X-ray, computed tomography (CT), and magnetic resonance imaging are investigated, with a focus on dual-energy CT for identifying MSU deposits. The treatment options vary from conservative maintenance with non-steroidal anti-inflammatory drugs and urate-lowering medication to surgical intervention in situations of neurological damage. Keywords: Spinal gout, tophaceous gout, lumbar spine, diagnostic challenges, hyperuricemia.
References
1. Richette P, Bardin T. Gout. Lancet 2010;375:318-28.
2. Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P, et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006;65:1301-11.
3. Kuo CF, Grainge MJ, See LC, Yu KH, Luo SF, Zhang W, et al. Epidemiology and management of gout in Taiwan: A nationwide population study. Arthritis Res Ther 2015;17:13.
4. Misra DP, Sharma A, Dharmanand BG, Chandrashekara S. The epidemiology of rheumatic diseases in India. Indian J Rheumatol 2024;19:54-61.
5. Singh JA. Racial and gender disparities among patients with gout. Curr Rheumatol Rep 2013;15:307.
6. Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention: A systematic review of the literature. Curr Opin Rheumatol 2011;23:192-202.
7. Choi HK, Stone JH. Epidemiology of gout. In: A Clinician’s Pearls & Myths in Rheumatology. Cham: Springer International Publishing; 2023. p. 513-7.
8. Schlesinger N. Diagnosis of gout. Minerva Med 2007;98:759-67.
9. Khanna I, Pietro R, Ali Y. What has dual energy CT taught us about gout? Curr Rheumatol Rep 2021;23:71.
10. Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther 2006;8 Suppl 1:S2.
11. van Durme CM, Wechalekar MD, Landewé RB, Pardo Pardo J, Cyril S, van der Heijde D, et al. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database Syst Rev 2021;12:CD010120.
12. Nazwar TA, Bal’afif F, Wardhana DW, Panjaitan C. Understanding spinal gout: A comprehensive study of 88 cases and their clinical implications. J Craniovertebr Junction Spine 2024;15:133-40.
How to Cite this article: Kale S, Vatkar A, Dhar S, Bhor P, Phadnis A, Samant P, Mehra S. Spinal Gout: A Comprehensive Review of Clinical Features, Diagnostic Challenges, and Management Strategies in Spinal Gout. Journal of Clinical Orthopaedics July-December 2024;9(2):35-37.
http://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.png00editor.jcorthhttp://jcorth.com/wp-content/uploads/2016/10/BOS-LOGO.pngeditor.jcorth2024-12-10 14:37:432025-04-25 05:22:36Spinal Gout: A Comprehensive Review of Clinical Features, Diagnostic Challenges, and Management Strategies in Spinal Gout
The Promise of Kinematic Alignment in TKA: Game-changer or Gimmick?
/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 2 | July-December 2024 | page: 100-104 | Abhishek Nighot, Niharika Virkar
DOI: https://doi.org/10.13107/jcorth.2024.v09i02.682
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2024; The Author(s).
Submitted Date: 20 Aug 2024, Review Date: 05 Sep 2024, Accepted Date: 12 Sep 2024 & Published Date: 10 Dec 2024
Author: Abhishek Nighot [1], Niharika Virkar [2]
[1] Department of Orthopaedics, Hip and Knee Arthroplasty Unit, SAANVI Orthopaedics, Mumbai, Maharashtra, India.
[2] Department of Hand and Microsurgery, Pinnacle Hospital, Thane, Maharashtra, India.
Address of Correspondence
Dr. Abhishek Nighot,
Department of Orthopaedics, SICOT Fellow in Hip and Knee Arthroplasty, SAANVI Orthopaedics, Mumbai, Maharashtra, India.
E-mail: abhisheknighot43@gmail.com
Abstract
Introduction: Total knee arthroplasty (TKA) is a proven solution for end-stage knee arthritis, yet traditional mechanical alignment (MA), which aims for a neutral mechanical axis, leaves up to 20% of patients dissatisfied postoperatively. Kinematic alignment (KA) has emerged as an alternative, focusing on restoring the patient’s native anatomy and joint line orientation, achieving balance without extensive soft-tissue releases.
Methods: This article examines the principles of KA and compares it with MA regarding safety, outcomes, and biomechanical balance through a literature review comprising various retrospective studies, randomized controlled trials, and systemic reviews. KA relies on the patient’s unique femoral morphology to guide bone cuts, achieving natural alignment and ligament balance. Evidence suggests that KA offers comparable if not superior, functional outcomes, with higher Oxford knee scores and forgotten joint scores while maintaining similar implant survivorship. Studies also show KA leads to better compartmental balance, reduced knee adduction moments, and more natural gait mechanics. The compartmental pressure alignment knee classification highlights KA’s ability to balance the knee across various lower limb phenotypes.
Conclusion: Although KA shows promise, challenges remain. Concerns about tibial varus have been addressed, with studies confirming no compromise in implant stability or survival. However, long-term data are needed to validate KA’s durability and define its role for specific patient groups.
This article provides a comprehensive overview of KA’s benefits and limitations, offering guidance for surgeons seeking evidence-based alignment strategies. It underscores KA’s potential as a personalized approach in TKA, bridging gaps in satisfaction and functional outcomes while maintaining safety.
Keywords: Kinematic alignment, mechanical alignment, arthroplasty, osteoarthritis.
References
1. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clin Orthop Relat Res 2010;468:57-63.
2. Griffin FM, Insall JN, Scuderi GR. Accuracy of soft tissue balancing in total knee arthroplasty. J Arthroplasty 2000;15:970-3.
3. Rivière C, Iranpour F, Auvinet E, Aframian A, Asare K, Harris S, et al. Mechanical alignment technique for TKA: Are there intrinsic technical limitations? Orthop Traumatol Surg Res 2017;103:1057-67.
4. Beckers G, Meneghini RM, Hirschmann MT, Kostretzis L, Kiss MO, Vendittoli PA. Ten flaws of systematic mechanical alignment total knee arthroplasty. J Arthroplasty 2024;39:591-9.
5. Bellemans J, Colyn W, Vandenneucker H, Victor J. The Chitranjan Ranawat award: Is neutral mechanical alignment normal for all patients? The concept of constitutional varus. Clin Orthop Relat Res 2012;470:45-53.
6. Rivière C, Harman C, Boughton O, Cobb J. The kinematic alignment technique for total knee arthroplasty. In: Rivière C, Vendittoli PA, editors. Personalized Hip and Knee Joint Replacement. Ch. 16. Cham, CH: Springer; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK565753
7. Roth JD, Howell SM, Hull ML. Native knee laxities at 0°, 45°, and 90° of flexion and their relationship to the goal of the gap-balancing alignment method of total knee arthroplasty. J Bone Joint Surg Am 2015;97:1678-84.
8. Dossett HG, Estrada NA, Swartz GJ, LeFevre GW, Kwasman BG. A randomised controlled trial of kinematically and mechanically aligned total knee replacements: Two-year clinical results. Bone Joint J 2014;96-B:907-13.
9. Calliess T, Bauer K, Stukenborg-Colsman C, Windhagen H, Budde S, Ettinger M. PSI kinematic versus non-PSI mechanical alignment in total knee arthroplasty: A prospective, randomized study. Knee Surg Sports Traumatol Arthrosc 2017;25:1743-8.
10. Howell SM, Shelton TJ, Hull Ml. Implant survival and function ten years after kinematically aligned total knee arthroplasty. J Arthroplasty 2018;33:3678-84.
11. Howell SM, Akhtar M, Nedopil AJ, Hull ML. Reoperation, implant survival, and clinical outcome after kinematically aligned total knee arthroplasty: A concise clinical follow-up at 16 years. J Arthroplasty 2024;39:695-700.
12. Van Essen J, Stevens J, Dowsey MM, Choong PF, Babazadeh S. Kinematic alignment results in clinically similar outcomes to mechanical alignment: Systematic review and meta-analysis. Knee 2023;40:24-41.
13. Laende EK, Richardson CG, Dunbar MJ. A randomized controlled trial of tibial component migration with kinematic alignment using patient-specific instrumentation versus mechanical alignment using computer-assisted surgery in total knee arthroplasty. Bone Joint J 2019;101-B:929-40.
14. Matsumoto T, Takayama K, Ishida K, Hayashi S, Hashimoto S, Kuroda R. Radiological and clinical comparison of kinematically versus mechanically aligned total knee arthroplasty. Bone Joint J 2017;99-B:640-6. Erratum in: Bone Joint J 2021;103-B:1641.
15. Niki Y, Nagura T, Nagai K, Kobayashi S, Harato K. Kinematically aligned total knee arthroplasty reduces knee adduction moment more than mechanically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018;26:1629-35.
16. MacDessi SJ, Griffiths-Jones W, Harris IA, Bellemans J, Chen DB. Coronal plane alignment of the knee (CPAK) classification. Bone Joint J 2021;103-B:329-37.
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Evaluation of Functional and Radiological Outcome of Total Knee Replacement Surgery in Obese V/S Non-obese Patients
/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 2 | July-December 2024 | page: 95-99 | Ashish S Phadnis, Saurabh S Ranjalkar, Vijay Kumar, Prathamesh Sangare, Shashank Gabhe
DOI: https://doi.org/10.13107/jcorth.2024.v09i02.680
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2024; The Author(s).
Submitted Date: 16 Aug 2024, Review Date: 27 Sep 2024, Accepted Date: 12 Oct 2024 & Published Date: 10 Dec 2024
Author: Ashish S Phadnis [1], Saurabh S Ranjalkar [2], Vijay Kumar [3], Prathamesh Sangare [2], Shashank Gabhe [4]
[1] Department of Orthopaedic Surgery, Jupiter Hospital Thane, Maharashtra, India,
[2] Department of Orthopaedic Surgery, HBT Trauma Hospital, Jogeshwari (E), Mumbai, Maharashtra, India,
[3] Department of Orthopaedic Surgery, ESIC hospital and Dental College, Rohini West, Delhi, India,
[4] Dr Gabhe’s Bones and Joints Clinic, Thane, Maharashtra, India
Address of Correspondence
Dr. Saurabh S Ranjalkar,
Department of Orthopaedic Surgery, HBT Trauma Hospital, Jogeshwari(E), Mumbai, Maharashtra, India
E-mail: saurabh.ranjalkar93@gmail.com
Abstract
Introduction: Primary total knee replacement (TKR) is one of the most commonly performed orthopedic procedures. With the increasing prevalence of obesity and advancing age of the population, it is imperative to know whether the obese patients have inferior or equivalent outcomes as opposed to non-obese patients. Hence, this study was planned to learn the functional and radiological outcomes of TKR surgery in obese and non-obese patients.
Materials and Methods: This prospective observational study included 64 adult patients 32 obese (body mass index [BMI] >30) and 32 non-obese (BMI <30) operated for TKR surgery. Functional outcome was assessed by patient-reported outcome measures using Oxford knee score (OKS) and short form-12 (SF-12) quality of life questionnaires at 6 weeks postoperatively. Radiological outcomes were assessed using pre- and post-operative radiograph and bilateral lower limb scanogram.
Results: On comparing the mean hospital stay, that of obese patients was 8.16 days and that of non-obese patients was 6.72 days (significant). The OKS improved from 14.19 to 37.44 in the obese group and from 14.75 to 38.59 in non-obese group. In obese patients, the physical component of SF-12 score improved from 23.92 to 53.6 postoperatively, and that in non-obese patients went from 27.29 to 53.08. The mean mental component of SF-12 score improved from 48.59 to 56.37 postoperatively in obese patients, in non-obese patients it improved from 53.02 to 57.94 postoperatively (significant). Hip-knee-ankle axis in obese patients on the right side improved from 171.18° to 176.82° (significant), left side from 171.31° to 176.71° whereas in non-obese patients right side from 171.89° to 176.94°, left side from 171.82° to 176.66°. Comorbidities were seen more in obese patients (diabetes 21 of 32 cases, hypertension 17 of 32 cases) than in non-obese patients (diabetes 12 of 32 cases, hypertension 16 of 32 cases). Superficial surgical site infection (SSI) in about 3 of 32 obese patients, whereas no SSI was found in non-obese patients.
Conclusion: The present study assesses the patients’ perception of their outcomes which are important in clinical decision-making. There was no significant difference found in patient perceived parameters, functional and radiological outcomes at end of 6 months following TKR surgery in both obese and non-obese patients.
Keywords: Total knee replacement, body mass index, obese.
References
1. Jester R, Rodney A. The relationship between obesity and primary total knee replacement: A scoping review of the literature. Int J Orthop Trauma Nurs 2021;42:100850.
2. Garellick G, Malchau H, Herberts P, Hansson E, Axelsson H, Hansson T. Life expectancy and cost utility after total hip replacement. Clin Orthop Relat Res 1998;346:141-51.
3. Lau EC, Cooper C, Lam D, Chan VN, Tsang KK, Sham A. Factors associated with osteoarthritis of the hip and knee in Hong Kong Chinese: Obesity, joint injury, and occupational activities. Am J Epidemiol 2000;152:855-62.
4. Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, et al. Osteoarthritis: New insights. Part 1: The disease and its risk factors. Ann Intern Med 2000;133:635-46.
5. Cooper C. Occupational activity and the risk of osteoarthritis. J Rheumatol Suppl 1995;43:10-2.
6. Bray GA. Overweight is risking fate. Definition, classification, prevalence, and risks. Ann N Y Acad Sci 1987;499:14-28.
7. Fehring TK, Odum SM, Griffin WL, Mason JB, McCoy TH. The obesity epidemic: Its effect on total joint arthroplasty. J Arthroplasty 2007;22(6 Suppl 2):71-6.
8. Namba RS, Paxton L, Fithian DC, Stone ML. Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 2005;20:46-50.
9. Dowsey MM, Liew D, Stoney JD, Choong PF. The impact of pre-operative obesity on weight change and outcome in total knee replacement: A prospective study of 529 consecutive patients. J Bone Joint Surg Br 2010;92:513-20.
10. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: The incidence, timing, and predisposing factors. Clin Orthop Relat Res 2008;466:1710-5.
11. Chesney D, Sales J, Elton R, Brenkel IJ. Infection after knee arthroplasty a prospective study of 1509 cases. J Arthroplasty 2008;23:355-9.
12. Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE. Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 2009;24:84-8.
13. Dowsey MM, Choong PF. Obese diabetic patients are at substantial risk for deep infection after primary TKA. Clin Orthop Relat Res 2009;467:1577-81.
14. Ayyar V, Burnett R, Coutts FJ, Van der Linden ML, Mercer TH. The influence of obesity on patient reported outcomes following total knee replacement. Arthritis 2012;2012:185208.
15. Agur AM, Dalley AF. Grant’s Atlas of Anatomy. 12th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2009.
16. World Health Organization. Obesity: Preventing and Managing the Global Epidemic Report of a WHO Consultation; 2000. Available from: https://www.who.int/nutrition/publications/obesity/who_trs_894/en/index.html [Last accessed on ??? July 2011].
17. Amin AK, Patton JT, Cook RE, Brenkel IJ. Does obesity influence the clinical outcome at five years following total knee replacement for osteoarthritis? J Bone Joint Surg Br 2006;88:335-40.
18. Cobb J, Henckel J, Gomes P, Harris S, Jakopec M, Rodriguez F, et al. Hands-on robotic unicompartmental knee replacement: A prospective, randomised controlled study of the acrobot system. J Bone Joint Surg Br 2006;88:188-97.
19. Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS. The outcome of total knee arthroplasty in obese patients. J Bone Joint Surg Am 2004;86:1609-15.
20. CORI Surgical System: Smith+Nephew USA. Available from: https://www.smith-nephew.com/en-us/health-care-professionals/products/orthopaedics/cori [Last accessed on 2023 Jun 18].
21. Foran JR, Mont MA, Rajadhyaksha AD, Jones LC, Etienne G, Hungerford DS. Total knee arthroplasty in obese patients: A comparison with a matched control group. J Arthroplasty 2004;19:817-24.
22. Jiganti JJ, Goldstein WM, Williams CS. A comparison of the perioperative morbidity in total joint arthroplasty in the obese and nonobese patient. Clin Orthop Relat Res 1993;289:175-9.
23. Miric A, Lim M, Kahn B, Rozenthal T, Bombick D, Sculco TP. Perioperative morbidity following total knee arthroplasty among obese patients. J Knee Surg 2002;15:77-83.
24. Deshmukh RG, Hayes JH, Pinder IM. Does body weight influence outcome after total knee arthroplasty? A 1-year analysis. J Arthroplasty 2002;17:315-9.
25. Stickles B, Phillips L, Brox WT, Owens B, Lanzer WL. Defining the relationship between obesity and total joint arthroplasty. Obes Res 2001;9:219-23.
26. Stevens-Lapsley JE, Petterson SC, Mizner RL, Snyder-Mackler L. Impact of body mass index on functional performance after total knee arthroplasty. J Arthroplasty 2010;25:1104-9.
27. Bin Abd Razak HR, Chong HC, Tan AH. Obesity does not imply poor outcomes in Asians after total knee arthroplasty. Clin Orthop Relat Res 2013;471:1957-63.
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Mucoid Degeneration of Anterior Cruciate Ligament – A Review of Literature
/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 2 | July-December 2024 | page: 38-43 | Sujit Korday , Pushkar Khandekar , Suhail Kantawala , Nicholas Antao
DOI: https://doi.org/10.13107/jcorth.2024.v09i02.658
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2024; The Author(s).
Submitted Date: 01 Nov 2024, Review Date: 10 Nov 2024, Accepted Date: 28 Nov 2024 & Published Date: 10 Dec 2024
Author: Sujit Korday [1], Pushkar Khandekar [1], Suhail Kantawala [2], Nicholas Antao [2]
[1] Department of Orthopedics, V. N. Desai Hospital, Santacruz East, Mumbai, Maharashtra, India.
[2] Department of Orthopedics,Holy Spirit Hospital, Mahakali Caves Road, Andheri East, Mumbai, Maharashtra, India.
Address of Correspondence
Dr. Pushkar Khandekar,
Department of Orthopaedics, V. N. Desai Hospital, Santacruz East, Mumbai, Maharashtra, India.
E-mail: drpushkarkhandekar@gmail.com
Abstract
Mucoid degeneration of the anterior cruciate ligament (MD-ACL), once thought to be a rare entity, is seen not so uncommonly in present day orthopaedic practice. Several hypotheses attempt to explain this entity. Clinically, it presents as knee pain with limitation of flexion or extension. There is no specific test available to clinically diagnose MD-ACL. Magnetic Resonance Imaging (MRI) remains the imaging modality of choice to diagnose MD-ACL. Therefore, a high index of suspicion is necessary to be able to diagnose this condition. This article reviews the available literature about the etio-pathological aspects of MD-ACL, its clinical features, radiological and arthroscopic findings, as well as various treatment modalities available.
Keywords: Mucoid degeneration, anterior cruciate ligament, knee, arthroscopy, MRI.
References
1. Nicolas Himpe, Pieter Berger, Hilde Vandenneucker. Mucoid degeneration of the anterior cruciate ligament. Complete resection as equivalent treatment to partial resection. Acta Orthop Belg. 2020;86(2):272–9.
2. Scranton PE Jr F EL. Mucoid degeneration of the patellar ligament in athletes. . J Bone Joint Surg Am. 1992 Mar;74(3):435–7.
3. Kumar A, Bickerstaff DR, Grimwood JS, Suvarna SK. Mucoid cystic degeneration of the cruciate ligament. Clinical J Bone Joint Surg [Br]. 1999.
4. Pandey V, Suman C, Sharma S, Rao S, Kiran Acharya K, Sambaji C. Mucoid degeneration of the anterior cruciate ligament: Management and outcome. Indian J Orthop. 2014 Mar;48(2):197–202.
5. Makino A, Pascual-Garrido C, Rolón A, Isola M, Muscolo DL. Mucoid degeneration of the anterior cruciate ligament: MRI, clinical, intraoperative, and histological findings. Knee Surgery, Sports Traumatology, Arthroscopy. 2011 Mar 1;19(3):408–11.
6. Hotchen AJ, Demetriou C, Edwards D, Melton JTK. Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures. Vol. 32, Journal of Knee Surgery. Georg Thieme Verlag; 2019. p. 577–83.
7. Khanna G, Sharma R, Bhardwaj A, Gurdutta HS, Agrawal DK, Rathore AS. Mucoid degeneration of the anterior cruciate ligament: Partial arthroscopic debridement and outcomes. Journal of Arthroscopy and Joint Surgery. 2016 Jan;3(1):28–33.
8. Fernandes JL, Viana SL, Mendonça JLF, Freitas FMO, Bezerra ASA, Lima GAS, et al. Mucoid degeneration of the anterior cruciate ligament: magnetic resonance imaging findings of an underdiagnosed entity. Acta radiol. 2008 Feb 1;49(1):75–9.
9. Mcintyre J, Moelleken S, Tirman P. A RT I C L E Mucoid degeneration of the anterior cruciate ligament mistaken for ligamentous tears. Vol. 30, Skeletal Radiol. 2001.
10. Kim TH, Lee DH, Lee SH, Kim JM, Kim CW, Bin S Il. Arthroscopic Treatment of Mucoid Hypertrophy of the Anterior Cruciate Ligament. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2008 Jun;24(6):642–9.
11. Bergin D, Morrison WB, Carrino JA, Nallamshetty SN, Bartolozzi AR, Bergin D. Anterior Cruciate Ligament Ganglia and Mucoid Degeneration: Coexistence and Clinical Correlation [Internet]. Vol. 182, AJR. 2004. Available from: www.ajronline.org
12. Salvati F RFLNPMBAMC. Mucoid metaplastic-degeneration of anterior cruciate ligament . J Sports Med Phys Fitness. 2008 Dec;48(4):483-7.
13. Cho S Do, Youm YS, Lee CC, Seo DK, Kim TW. Mucoid degeneration of both ACL and PCL. Clin Orthop Surg. 2012;4(2):167–70.
14. Hotchen AJ, Melton JTK. Radiofrequency Ablation for Mucoid Degeneration of the Anterior Cruciate Ligament. Arthrosc Tech. 2018 May 1;7(5):e459–63.
15. DJ DrR, SH DrA. Correlation of notch width index in knees with mucoid degeneration of anterior cruciate ligament to normal knees. International Journal of Orthopaedics Sciences. 2021 Jul 1;7(3):368–72.
16. Napoli A, Wulf MI, Bruno CH. Case 10672 Anterior cruciate ligament mucoid degeneration: MR findings. 2013;
17. Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, et al. Association of mucoid degeneration of the anterior cruciate ligament at MR imaging with medial tibiofemoral osteoarthritis progression at radiography: Data from the osteoarthritis initiative. Vol. 287, Radiology. Radiological Society of North America Inc.; 2018. p. 912–21.
18. Vaishya R, Esin Issa A, Agarwal AK, Vijay V. Anterior Cruciate Ligament Ganglion Cyst and Mucoid Degeneration: A Review. Cureus. 2017 Sep 13;
19. Lee JW, Ahn JT, Gwak HG, Lee SH. Clinical outcomes of arthroscopic notchplasty and partial resection for mucoid degeneration of the anterior cruciate ligament. J Clin Med. 2021 Jan 2;10(2):1–9.
20. Loganathan DrD, Sundar S DrS, Sundar DrS, Sahanand DrS, Rajan DrD V. Mucoid degenerated anterior cruciate ligament (ACL) managed by arthroscopic ACL reconstruction: A case series. International Journal of Orthopaedics Sciences. 2018 Oct 1;4(4):875–80.
21. Lancaster TF, Kirby AB, Beall DP, Wolff JD, Wu DH. Mucoid degeneration of the anterior cruciate ligament: a case report. J Okla State Med Assoc. 2004;97(8):326–8.
22. Saravanan P, Sundararajan T. Management of mucoid degeneration of anterior cruciate ligament. Int J Orthop. 2018;8(2):36.
23. Amiel D, Billings E, Harwood FL. Collagenase activity in anterior cruciate ligament: protective role of the synovial sheath [Internet]. 1990. Available from: www.physiology.org/journal/jappl
24. Pande S, Kushwah AP. S, Nelson SS, Saxena A, Kumar S. MUCOID DEGENERATION OF THE ANTERIOR CRUCIATE LIGAMENT : A CASE REPORT. J Evol Med Dent Sci. 2015 Jun 1;4(44):7689–91.
25. J.J. Hensen, E.G. Coerkamp, J.L. Bloem, A.M. De Schepper. Mucoid degeneration of the anterior cruciate ligament JBR-BTR [Internet]. 2007. Available from: https://www.researchgate.net/publication/6143682
26. Solís GS, Waghchoure C, Vinagre G. Symptomatic ACL mucoid degeneration in middle-age athletes. Vol. 31, Journal of Orthopaedics. Reed Elsevier India Pvt. Ltd.; 2022. p. 67–71.
27. Jung KH, Cho S Do, Park KB, Youm YS. Relation between mucoid degeneration of the anterior cruciate ligament and posterior tibial slope. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2012 Apr;28(4):502–6.
28. Youm YS, Cho S Do, Cho HY, Jung SH. Relationship between mucoid degeneration of the anterior cruciate ligament and posterior tibial slope in patients with total knee arthroplasty. Knee Surg Relat Res. 2016 Mar 1;28(1):34–8.
29. Cha JH, Lee SH, Shin MJ, Choi BK, Bin S Il. Relationship between mucoid hypertrophy of the anterior cruciate ligament (ACL) and morphologic change of the intercondylar notch: MRI and arthroscopy correlation. Skeletal Radiol. 2008 Sep;37(9):821–6.
30. Fealy S, Kenter K, Dines JS, Warren RF. Mucoid degeneration of the anterior cruciate ligament. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2001;17(9):1–4.
31. Nelissen RGHH. Retain or sacrifice the posterior cruciate ligament in total knee arthroplasty? A histopathological study of the cruciate ligament in osteoarthritic and rheumatoid disease. J Clin Pathol. 2001 May 1;54(5):381–4.
32. Boisrenoult P, Lintz F, Dejour D, Pujol N, Beaufils P. Arthroscopic Treatment of Mucoid Degeneration of the Anterior Cruciate Ligament: Medium Term Follow-Up Results About 29 Cases. Journal of Bone &amp; Joint Surgery, British Volume. 2011;93-B(SUPP II).
33. Morice A, Coupry A, Lintz F, Robert H. Reduction plasty for hypertrophic anterior cruciate ligament mucoid degeneration: Clinical and knee laxity outcomes in 23 cases. Orthopaedics and Traumatology: Surgery and Research. 2013 Oct;99(6):693–7.
34. Ventura D, Nuñez JH, Joshi-Jubert N, Castellet E, Minguell J. Outcome of arthroscopic treatment of mucoid degeneration of the anterior cruciate ligament. CiOS Clinics in Orthopedic Surgery. 2018 Sep 1;10(3):307–14.
35. Choubey R, Jain A. Mucoid Degeneration of the Anterior Cruciate Ligament: A Case Report and Review of Literature. J Orthop Case Rep [Internet]. 5(3):87–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/27299081
36. Celikyay F, Yuksekkaya R, Bilgic E. A retrospective comparison of ACL tear and mucoid degeneration MRI findings and an emphasis on evaluating of ACL, Blumensaat, and PCL Angles. J Belg Soc Radiol. 2020;104(1).
37. Chudasama CH, Chudasama VC, Prabhakar MM. Arthroscopic management of mucoid degeneration of anterior cruciate ligament. Indian J Orthop. 2012 Sep;46(5):561–5.
38. Narvekar A, Gajjar S. Mucoid Degeneration of the Anterior Cruciate Ligament. Arthroscopy – Journal of Arthroscopic and Related Surgery. 2004;20(2):141–6.
39. Lintz F, Pujol N, Dejour D, Boisrenoult P, Beaufils P. Anterior cruciate ligament mucoid degeneration: Selecting the best treatment option. Orthopaedics and Traumatology: Surgery and Research. 2010 Jun;96(4):400–6.
40. Kusano M, Horibe S, Tanaka Y, Yonetani Y, Kanamoto T, Shiozaki Y, et al. Early reconstruction should be considered in younger patients with symptomatic mucoid degeneration of the anterior cruciate ligament. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2015 Jul;2(3):95–7.
41. Ahuja A, Parekh C, Salomon A, Lawande M, Daftary A. Role of ultrasound-guided decompression in management of mucoid degeneration of the anterior cruciate ligament. Skeletal Radiol. 2021 Sep 1;50(9):1837–43.
42. Shelly MJ, Dheer S, Kavanagh EC. Metastatic adenocarcinoma of the lung mimicking mucoid degeneration of the anterior cruciate ligament. Ir J Med Sci. 2010 Jun;179(2):309–11.
43. El Kadi KI, Marcaillou F, Blanc S, Salloum B, Dimontagliari C, Boutayeb F. Mucoid degeneration of the anterior cruciate ligament: A case report. Pan African Medical Journal. 2013 Jun 20;15.
44. Choukimath SK, Kodi H, Nedumparampil MM, Pilar A, Pruthviraj PA, Krishnan R, et al. Mucoid Degeneration of Anterior Cruciate Ligament—A Systematic Approach for Debulking. Arthrosc Tech. 2024;
45. Pimprikar M V., Patil HG. Anterior Cruciate Ligament Ganglion and Decompression of Mucoid Degeneration Using a “Figure-of-4 Position.” Arthrosc Tech. 2024;
46. Hensen JJ CEBJDSA. Mucoid degeneration of the anterior cruciate ligament. Journal of Belgian Society of Radiology. 2007 May;90(3):192–3.
47. Sweed T, Mussa M, El-Bakoury A, Geutjens G, Metcalfe A. Management of mucoid degeneration of the anterior cruciate ligament: a systematic review. Knee Surg Relat Res. 2021 Dec 1;33(1).
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Evolution of Femoral Neck Implants: In Search of the Perfect Implant
/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 2 | July-December 2024 | page: 01-05 | Sachin Kale, Arvind Vatkar, Sanjay Dhar, Pramod Bhor, Ashish Phadnis, Rohan Jayaram
DOI: https://doi.org/10.13107/jcorth.2024.v09i02.640
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2024; The Author(s).
Submitted Date: 11 Jul 2024, Review Date: 08 Aug 2024, Accepted Date: 12 Sep 2024 & Published Date: 10 Dec 2024
Author: Sachin Kale [1], Arvind Vatkar [2, 3], Sanjay Dhar [1], Pramod Bhor [2], Ashish Phadnis [4], Rohan Jayaram [1]
[1] Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India,
[3] Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India
[4] Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India
Address of Correspondence
Dr. Sachin Kale
Professor and Head of Unit, Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India.
Email: sachinkale@gmail.com
Abstract
Femoral neck fractures have significant orthopedic difficulty, particularly in younger patients with high-energy trauma. The femoral neck system improves rotational stability, allows for controlled dynamic compression, and is less invasive than cannulated cancellous screws. However, steep learning curves, more significant starting expenditures, and more long-term data still need to be addressed. Emerging technologies, such as robotic-assisted surgeries and personalized implants created with artificial intelligence and 3D printing, can transform fracture therapy by boosting accuracy, lowering complications, and improving patient-specific care. Future advances will improve results and patient happiness.
Keywords: Femoral neck fractures, femoral neck system, cannulated screws, rotational stability, angular stability, minimally invasive surgery, fracture fixation, osteoporotic fractures, clinical outcomes, implant innovations.
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Robotic-Assisted Total Knee Replacement in a Patient with Severe Varus Deformity and High Cardiac Risk
/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 2 | July-December 2024 | page: 129-131 | Pramod Bhor, Sawankumar H. Pawar, Dnyanada Kutumbe, Arvind Vatkar, Sachin Kale
DOI: https://doi.org/10.13107/jcorth.2024.v09i02.696
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2024; The Author(s).
Submitted Date: 10 Oct 2024, Review Date: 15 Nov 2024, Accepted Date: 20 Nov 2024 & Published Date: 10 Dec 2024
Author: Pramod Bhor [1], Sawankumar H. Pawar [1], Dnyanada Kutumbe [1], Arvind Vatkar [1], Sachin Kale [2]
[1] Department of Orthopaedics, Fortis Hiranadani Hospitals, Vashi, Navi Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India,
Address of Correspondence
Dr. Sawankumar H. Pawar
Associate Consultant, Department of Orthopaedics, Fortis Hiranadani Hospitals, Vashi, Navi Mumbai, Maharashtra, India.
Email- drsawanortho@gmail.com
Abstract
Severe varus deformity of the knee is a complex condition that is managed with scrupulous pre-operative planning and intraoperative technique, more so in cardiac-risk patients. Robotic-assisted total knee replacement (TKR) has emerged as an exciting option for improving precision and better outcomes in complex cases. The authors report a case of Robotic-assisted TKR in a 65-year-old patient suffering from severe varus deformity of the knee and multiple significant cardiac comorbidities.
Keywords: Robotic assisted TKR, Severe varus deformity, Cardiac risk
References
1. Kochhar T, Thakral R. Role of robotics in total knee arthroplasty: A clinical review. J Orthop Surg 2020;28:1-7.
2. Marchand RC, Sodhi N. Does robotic arm-assisted TKA result in improved clinical outcomes? J Knee Surg 2019;32:1020-7.
3. Alrajeb R, Zarti M, Shuia Z, Alzobi O, Ahmed G, Elmhiregh A. Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Eur J Orthop Surg Traumatol. 2024 Apr;34(3):1333-1343. doi: 10.1007/s00590-023-03798-2. Epub 2023 Dec 22. PMID: 38133653; PMCID: PMC10980635.
4. van der List, J. P., Chawla, H., Joskowicz, L., & Pearle, A. D. (2016). Current state of computer navigation and robotics in unicompartmental and total knee arthroplasty: a systematic review with meta-analysis. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 24(11), 3482–3495. https://doi.org/10.1007/s00167-016-4305-9
5. Khlopas A, Chughtai M, et al. The learning curve associated with robotic total knee arthroplasty. J Arthroplast 2018;33:1761-7.
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Spinal Gout: A Comprehensive Review of Clinical Features, Diagnostic Challenges, and Management Strategies in Spinal Gout
/in Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorthJournal of Clinical Orthopaedics | Vol 9 | Issue 2 | July-December 2024 | page: 35-37 | Sachin Kale, Arvind Vatkar, Sanjay Dhar, Pramod Bhor, Ashish Phadnis, Prakash Samant, Shivam Mehra
DOI: https://doi.org/10.13107/jcorth.2024.v09i02.656
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2024; The Author(s).
Submitted Date: 01 Aug 2024, Review Date: 28 Sep 2024, Accepted Date: 12 Oct 2024 & Published Date: 10 Dec 2024
Author: Sachin Kale [1], Arvind Vatkar [2], Sanjay Dhar [1], Pramod Bhor [3], Ashish Phadnis [4], Prakash Samant [1], Shivam Mehra [5]
[1] Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India,
[3] Department of Orthopaedics, Fortis Hiranandani Hospital, Mumbai, Maharashtra, India,
[4] Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India.[5] Mehra Hospital and Research Institute, Lucknow, Uttar Pradesh, India,
Address of Correspondence
Dr. Arvind Vatkar,
Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India.
E-mail: vatkararvind@gmail.com
Abstract
Spinal gout is an uncommon form of gout that is distinguished by the deposition of monosodium urate (MSU) crystals in the spine, resulting in severe pain and potential neurological impairments. Despite its rarity, spinal gout can be difficult to diagnose because of its vague symptoms and similarities to other spinal illnesses. This study delves into the epidemiology, clinical aspects, and diagnostic problems of spinal gout, focusing on the Indian setting. Diagnostic methods such as X-ray, computed tomography (CT), and magnetic resonance imaging are investigated, with a focus on dual-energy CT for identifying MSU deposits. The treatment options vary from conservative maintenance with non-steroidal anti-inflammatory drugs and urate-lowering medication to surgical intervention in situations of neurological damage.
Keywords: Spinal gout, tophaceous gout, lumbar spine, diagnostic challenges, hyperuricemia.
References
1. Richette P, Bardin T. Gout. Lancet 2010;375:318-28.
2. Zhang W, Doherty M, Pascual E, Bardin T, Barskova V, Conaghan P, et al. EULAR evidence based recommendations for gout. Part I: Diagnosis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2006;65:1301-11.
3. Kuo CF, Grainge MJ, See LC, Yu KH, Luo SF, Zhang W, et al. Epidemiology and management of gout in Taiwan: A nationwide population study. Arthritis Res Ther 2015;17:13.
4. Misra DP, Sharma A, Dharmanand BG, Chandrashekara S. The epidemiology of rheumatic diseases in India. Indian J Rheumatol 2024;19:54-61.
5. Singh JA. Racial and gender disparities among patients with gout. Curr Rheumatol Rep 2013;15:307.
6. Singh JA, Reddy SG, Kundukulam J. Risk factors for gout and prevention: A systematic review of the literature. Curr Opin Rheumatol 2011;23:192-202.
7. Choi HK, Stone JH. Epidemiology of gout. In: A Clinician’s Pearls & Myths in Rheumatology. Cham: Springer International Publishing; 2023. p. 513-7.
8. Schlesinger N. Diagnosis of gout. Minerva Med 2007;98:759-67.
9. Khanna I, Pietro R, Ali Y. What has dual energy CT taught us about gout? Curr Rheumatol Rep 2021;23:71.
10. Saag KG, Choi H. Epidemiology, risk factors, and lifestyle modifications for gout. Arthritis Res Ther 2006;8 Suppl 1:S2.
11. van Durme CM, Wechalekar MD, Landewé RB, Pardo Pardo J, Cyril S, van der Heijde D, et al. Non-steroidal anti-inflammatory drugs for acute gout. Cochrane Database Syst Rev 2021;12:CD010120.
12. Nazwar TA, Bal’afif F, Wardhana DW, Panjaitan C. Understanding spinal gout: A comprehensive study of 88 cases and their clinical implications. J Craniovertebr Junction Spine 2024;15:133-40.
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