Surgical Prophylaxis: Is it Always Needed in Orthopedics Practice

/in /by

Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 114-117 | Swati Lalchandani, Rajesh Yadav, Rakesh Parmar, Rajesh Lalchandani, Shashikant Prakash

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.688

Submitted Date: 15 Jul 2024, Review Date: 10 Aug 2024, Accepted Date: 05 Oct 2024 & Published Date: 10 December 2024

Author: Swati Lalchandani [1], Rajesh Yadav [2], Rakesh Parmar [2], Rajesh Lalchandani [2], Shashikant Prakash [2]

[1] Department of Microbiology, New Delhi Pathology Clinic, New Delhi, India.
[2] Department of Orthopaedics, ESIPGIMSR, New Delhi, India.

Address of Correspondence

Dr. Rakesh Parmar,
Senior Resident, Department of Orthopaedics, ESIPGIMSR, New Delhi, India.
E-mail: rksdoc@gmail.com

Abstract

Objectives: The objectives of this study were to assess the need for antibiotic prophylaxis in soft-tissue surgeries of short duration without usage of implant in the field of orthopedics.
Methods: A prospective and comparative randomized study was performed on 100 cases with clean elective surgical procedure of short duration <⅟2 h. Data were analyzed for development of surgical site infection (SSI) in clean elective soft-tissue procedures of short duration.
Results: In our carefully selected cohort of patients of clean soft-tissue surgeries of less than half hour duration without involving the use of implant, two groups were made based on block randomization technique, one of which got a shot of pre-operative antibiotic prophylaxis and other did not. Mean patient age was 36.1 years (04 month-66 years). In both groups at all age levels, no infection was found. In the group which received antibiotic 80.8% were female and 19.2% were male, and in the antibiotic not given group had 61.5% female and 38.5% male. Therefore, it is evident that antibiotics did not provide clinical or statistical protection against SSI in clean elective soft-tissue procedures of short duration.
Conclusion: We suggest stratification of use of antibiotic prophylaxis, that is, antibiotic prophylaxis is required for surgeries of longer duration involving placement of implants but not required in surgeries of short duration which do not involve placement of implants in the field of orthopedics.
Keywords: Surgical Prophylaxis, Surgical site infection, Orthopaedics Practice

References

1. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309-32.
2. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control 1999;27:97-132; quiz 133-4, discussion 96.
3. Curcio D, Cane A, Fernández F, Correa J. Surgical site infection in elective clean and clean-contaminated surgeries in developing countries. Int J Infect Dis 2019;80:34-45.
4. Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH. Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg 1993;128:79-88.
5. Bratzler DW. The surgical infection prevention and surgical care improvement projects: Promises and pitfalls. Am Surg 2006;72:1010-6; discussion 1021-30, 1133-48.
6. Meehan J, Jamali AA, Nguyen H. Prophylactic antibiotics in hip and knee arthroplasty. J Bone Joint Surg Am 2009;91:2480-90.
7. Knight R, Charbonneau P, Ratzer E, Zeren F, Haun W, Clark J. Prophylactic antibiotics are not indicated in clean general surgery cases. Am J Surg 2001;182:682-6.
8. Li K, Sambare TD, Jiang SY, Shearer EJ, Douglass NP, Kamal RN. Effectiveness of preoperative antibiotics in preventing surgical site infection after common soft tissue procedures of the hand. Clin Orthop Relat Res 2018;476:664-73.
9. Ansari SA, Saddique M, Azim WA. Antibiotic prophylaxis in clean surgery. Biomedica 2005;21:121-4.
10. Olix ML, Klug TJ, Coleman CR, Smith WS. Prophylactic penicillin and streptomycin in elective operations on bones, joints and tendons. Surg Forum 1960;10:818-9.
11. Pavel A, Smith RL, Ballard A, Larsen IJ. Prophylactic antibiotics in clean orthopedics surgery. J Bone Joint Surg Am 1974;56:777-82.
12. Pavel A, Smith RL, Ballard A, Larson IJ. Prophylactic antibiotics in elective orthopedic surgery: A prospective study of 1,591 cases. South Med J 1977;70 (Suppl 1):50-5.
13. Burnakis TG. Surgical antimicrobial prophylaxis: Principles and guidelines. Pharmacotherapy 1984;4:248-71.
14. Dickemore C, Green R, Jolley W, Green D. Prophylactic Antibiotics in Clean Forefoot Surgery: Are They Necessary? Ch. 19.4; 2002. p. 228-30.
15. Tosti R, Fowler J, Dwyer J, Maltenfort M, Thoder JJ, Ilyas AM. Is antibiotic prophylaxis necessary in elective soft tissue hand surgery? Orthopedics 2012;35:e829-33.
16. Ansari SA, Saddique M, Azim WA. Antibiotic prophylaxis in clean surgery. Biomedica 2005;21:121-4.

How to Cite this article: Lalchandani S, Yadav R, Parmar R, Lalchandani R, Prakash S. Surgical Prophylaxis: Is it Always Needed in Orthopaedics Practice. Journal of Clinical Orthopaedics Jul-dec 2024;9(2):114-117.

 (Article Text HTML)       (Download PDF)

Musculoskeletal Tissue Retrieval from Deceased Donors in India: Protocols and Challenges

/in /by

Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 109-113 | Damini Shah, Prasad Bhagunde, Nihar Modi

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.686

Submitted Date: 14 Aug 2024, Review Date: 27 Aug 2024, Accepted Date: 14 Oct 2024 & Published Date: 10 Dec 2024

Author: Damini Shah [1], Prasad Bhagunde [2, 3, 4, 5], Nihar Modi [2, 4, 6]

[1] Novo Tissue Bank and Research Centre, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Sona Medical Centre, Mumbai, Maharashtra, India.
[3] Department of Orthopaedics, Saifee Hospital, Mumbai, Maharashtra, India.
[4] Department of Orthopaedics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India.
[5] Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, Maharashtra, India.
[6] Department of Orthopaedics, Criticare Asia Multispeciality Hospital and Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Damini Shah,
Assistant Director of Operations, Novo Tissue Bank and Research Centre, Mumbai, Maharashtra, India.
E-mail: daminirshah@gmail.com

Abstract

Musculoskeletal tissue donation from deceased donors plays a crucial role in advancing orthopedic and reconstructive surgeries, providing an alternative to autografts and synthetic implants. Despite its clinical significance, the adoption of tissue donation in India remains limited due to challenges such as low public awareness, cultural barriers, and infrastructural constraints. This study analyzes 16 cases of musculoskeletal tissue retrieval conducted in Mumbai between 2022 and 2023, highlighting procedural protocols, ethical considerations, and logistical challenges. The analysis underscores the importance of timely retrieval, adherence to regulatory frameworks like the Transplantation of Human Organs and Tissues Act (THOTA) 1994, and stringent quality assurance measures to ensure the safety and efficacy of allografts. Results demonstrate a high success rate, with over 98% of retrieved tissues meeting bioburden and structural integrity standards. The paper advocates for standardized protocols, improved public awareness, and enhanced training for healthcare professionals to advance tissue donation practices in India. This effort is pivotal for addressing unmet medical needs and fostering a compassionate healthcare system.
Keywords: Allografts, Musculoskeletal tissue donation, Tissue Banking, Orthobiologics, Reconstructive surgeries

References

1. India orthopedic procedures count by segments and forecast to 2030. (2024, June 14). Market Research Reports & Consulting | GlobalData UK Ltd.
2. (2011) The Transplantation of Human Organs and Tissues Act, 1994. Gazette of India, Ext., Pt. II, S. 1.
3. Guidelines for Tissue Banking (2021) rottosottokem.in. Available at: https://rottosottokem.in/downloads/SOTTO%20Tissue%20Guidelines.pdf.
4. Morales Pedraza, J., Lobo Gajiwala, A. and Martinez Pardo, M.E. (2010) ‘A review of the International Atomic Energy Agency (IAEA) international standards for tissue banks’, Cell and Tissue Banking, 13(1), pp. 15–25. doi:10.1007/s10561-010-9215-3.
5. Nather, A. et al. (2018) ‘Tissue banking in Asia Pacific region: Past, present and future’, Cell and Tissue Banking, 19(2), pp. 229–240. doi:10.1007/s10561-018-9697-y.
6. Yusof, N., Shamsudin, A. R., Mohamad, H., Hassan, A., Yong, A. C., & Rahman, M. N. F. A. (2005). BIOBURDEN ESTIMATION IN RELATION TO TISSUE PRODUCT QUALITY AND RADIATION DOSE VALIDATION. In Elsevier eBooks. https://doi.org/10.1533/9781845690779.5.319

How to Cite this article: Shah D, Bhagunde P, Modi N. Musculoskeletal Tissue Retrieval from Deceased Donors in India: Protocols and Challenges. Journal of Clinical Orthopaedics July-December 2024;9(2):109-113.

 (Article Text HTML)       (Download PDF)

Tackling Post-TKR Complications: Achilles Allografts in Extensor Mechanism Reconstruction

/in /by

Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 105-108 | Prasad Bhagunde, Damini Shah, Nihar Modi

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.684

Submitted Date: 10 Sep 2024, Review Date: 02 Oct 2024, Accepted Date: 22 Oct 2024 & Published Date: 10 Dec 2024

Author: Prasad Bhagunde [1, 2, 3, 4], Damini Shah [5], Nihar Modi [1, 3, 6]

[1] Department of Orthopaedics, Sona Medical Centre, Mumbai, Maharashtra, India.
[2] Department of Orthopaedics, Saifee Hospital, Mumbai, Maharashtra, India.
[3] Department of Orthopaedics, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India.
[4] Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, Maharashtra, India.
[5] Novo Tissue Bank and Research Centre, Mumbai, Maharashtra, India.
[6] Department of Orthopaedics, Criticare Asia Multispeciality Hospital and Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Prasad Bhagunde,
Director, Sona Medical Centre, Mumbai, Maharashtra, India.
E-mail: prasadbhagunde27@gmail.com

Abstract

Revolutionizing post-TKR care, novel use of Achilles tendon allografts emerge as a game-changer for displaced extensor mechanism, tackling one of the most challenging complications of total knee replacement. By restoring active knee extension and preventing lateral patellar subluxation, this technique empowers patients with improved mobility and independence.
The study included three patients with persistent patellar instability and malalignment were treated with a lateral retinacular release and Achilles tendon allograft fixation around the quadriceps mechanism. At 12 months, functional outcomes improved significantly: the Kujala score increased from 50 to 85, Knee Society Score (KSS) from 60 to 90, and Tegner Activity Level from 2 to 6. Postoperative imaging confirmed successful graft incorporation and alignment correction.
This technique, combining soft-tissue release with robust Achilles tendon allograft reconstruction, offers a promising solution for complex post-TKR patellar maltracking, highlighting the strength and adaptability of the Achilles tendon in restoring knee dynamics.
Overcoming the limitations of autografts and other traditional methods, this novel approach offers unmatched strength and adaptability while addressing critical surgical complexities. Despite potential challenges like stiffness and availability, the outcomes highlight enhanced function, stability, and patient satisfaction. With its innovative approach and tailored rehabilitation protocols, this procedure sets a new benchmark in orthopedic reconstructive surgery, combining precision and patient-centric care to redefine recovery.
Keywords: Quadriceps displacement, extensor mechanism repair, achilles tendon allograft, post-TKR complications

References

1. Ferri, R., Digennaro, V., Panciera, A., Bulzacki Bogucki, B. D., Cecchin, D., Manzetti, M., Brunello, M., & Faldini, C. (2023). Management of patella maltracking after total knee arthroplasty: a systematic review. In Musculoskeletal Surgery (Vol. 107, Issue 2, pp. 143–157). Springer Nature. https://doi.org/10.1007/s12306-022-00764-9
2. de Franco, C., de Matteo, V., Lenzi, M., Marano, E., Festa, E., Bernasconi, A., Smeraglia, F., & Balato, G. (2022). The active knee extension after extensor mechanism reconstruction using allograft is not influenced by “early mobilization”: a systematic review and meta-analysis. In Journal of Orthopaedic Surgery and Research (Vol. 17, Issue 1). BioMed Central Ltd. https://doi.org/10.1186/s13018-022-03049-w
3. Hoang, V., Anthony, T., Quattrocelli, M., Farina, E., Meter, J., & Lattermann, C. (2023). Quadriceps Tendon Reconstruction With Achilles Tendon Bone Block Allograft. Arthroscopy Techniques, 12(1), e45–e52. https://doi.org/10.1016/j.eats.2022.08.056
4. Kunze, K. N., Burnett, R. A., Shinsako, K. K., Bush-Joseph, C. A., Cole, B. J., & Chahla, J. (2019). Trapezoidal Achilles Tendon Allograft Plug for Revision Quadriceps Tendon Repair With a Large Tendon Defect. Arthroscopy Techniques, 8(9), e1031–e1036. https://doi.org/10.1016/j.eats.2019.05.015

How to Cite this article: Bhagunde P, Shah D, Modi N. Tackling Post-TKR Complications: Achilles Allografts in Extensor Mechanism Reconstruction. Journal of Clinical Orthopaedics July-December 2024;9(2):105-108.

 (Article Text HTML)       (Download PDF)

The Promise of Kinematic Alignment in TKA: Game-changer or Gimmick?

/in /by

Journal 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

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.

 (Article Text HTML)       (Download PDF)

Evaluation of Functional and Radiological Outcome of Total Knee Replacement Surgery in Obese V/S Non-obese Patients

/in /by

Journal 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

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.

 (Article Text HTML)       (Download PDF)

Mucoid Degeneration of Anterior Cruciate Ligament – A Review of Literature

/in /by

Journal 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

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;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.

 (Article Text HTML)       (Download PDF)

Evolution of Femoral Neck Implants: In Search of the Perfect Implant

/in /by

Journal 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

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.

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.

 (Article Text HTML)       (Download PDF)

Robotic-Assisted Total Knee Replacement in a Patient with Severe Varus Deformity and High Cardiac Risk

/in /by

Journal 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

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.

 (Article Text HTML)       (Download PDF)

Spinal Gout: A Comprehensive Review of Clinical Features, Diagnostic Challenges, and Management Strategies in Spinal Gout

/in /by

Journal 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

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.

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.

 (Article Text HTML)       (Download PDF)

Top 10 Things Orthopods Need to Know before Investing in Mutual Funds

/in /by

Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 08-10 | Sachin Kale, Arvind Vatkar, Sanjay Dhar, Pramod Bhor

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.644

Submitted Date: 03 Oct 2024, Review Date: 10 Oct 2024, Accepted Date: 24 Nov 2024 & Published Date: 10 Dec 2024

Author: Sachin Kale [1], Arvind Vatkar [2, 3], Sanjay Dhar [1], Pramod Bhor [2]

[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

Address of Correspondence

Dr Arvind Vatkar,

Department of Orthopaedics, Fortis Hiranandani Hospital, Vashi, Navi Mumbai, Maharashtra, India.
E-mail: vatkararvind@gmail.com.

Abstract

Investing in mutual funds may be intimidating for orthopedic surgeons, who are used to the complexity of surgery but are not usually familiar with financial markets. The Top 10 Things an Orthopaedic Surgeon Should Know Before Investing in Mutual Funds is a practical guide for surgeons to navigate the complex world of mutual funds efficiently. It covers important topics including identifying financial objectives, comprehending several types of funds (equity, debt, and hybrid), and determining risk tolerance at different phases of one’s career. The essay also describes the principle of compounding, defines financial jargon such as CAGR and XIRR, and distinguishes between direct and regular mutual fund programs. It also looks at theme and sectoral funds, emphasizing the need for diversity in risk management.
Keywords: Orthopedic investments, financial planning, mutual funds, power of compounding, thematic mutual funds, tax on mutual funds

 

How to Cite this article: Kale S, Vatkar A, Dhar S, Bhor P. Top 10 Things Orthopods Need to Know before Investing in Mutual Funds. Journal of Clinical Orthopaedics July-December 2024;9(2):08-10.

 (Article Text HTML)       (Download PDF)