Relation of Femur Neck Shaft Angle with Hip Fractures: An Observational Retrospective Study

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 67-71 | Rajendraprasad Ramesh Butala, Sonali Das

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.670

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 10 Aug 2024, Review Date: 22 Aug 2024, Accepted Date: 17 Sep 2024 & Published Date: 10 Dec 2024

Author: Rajendraprasad Ramesh Butala [1], Sonali Das [1]

[1] Department of Orthopaedics, DY Patil Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Sonali Das,
Department of Orthopaedics, DY Patil Hospital, Navi Mumbai, Maharshtra, India.
Email: drsonalidas@hotmail.com

Abstract

Introduction: Hip fractures are one of the most common fractures in adults encountered in orthopedics, posing a great deal of risk to patients’ life. Hip fractures include subtrochanteric, intertrochanteric, and femoral neck fractures. The proximal femur’s geometry has drawn more attention recently in relation to the etiology of hip fractures. Higher femoral neck-shaft angles (FNSAs) have been implicated in a predisposition to hip fractures.
Materials and Methods: A cross-sectional comparative study conducted at a tertiary care center in western part of India. Two groups of 50 individuals each created, matched for age range and gender, one control and the other with unilateral hip fracture.
Results: On conducting a binary logistic regression with absence or presence of fracture being the dependent variable and FNSA being covariate, an Odd’s ratio of >1 identified, indicating the likelihood of higher FNSA values seen in fracture group than in control group. P value also found to be <0.05 hence significant. No significant difference was noted between the FNSA of males and female patients in fracture group. FNSA was higher in fracture group than in control group, mean FNSA 136.8 and 132.3°, respectively. We have noted an increased risk of hip fractures in patients with higher FNSA matched with their age and gender. This is confirmative of the findings noted in previous studies.
Conclusion: Hip fracture risk appears to be increased in those with higher FNSA. Although the precise cutoff value is yet unknown, this link could serve as the foundation for prevention in individuals whose values are high – that is, >136° – according to this study. Further, evaluation is needed for conclusive understanding of their relationship.
Keywords: Femur neck shaft angle, Hip fractures, Relative risk.

References

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How to Cite this article: Butala RR, Das S. Relation of femur neck shaft angle with hip fractures: An observational retrospective study. Journal of Clinical Orthopaedics 2024:July-December:9(2)67-71.

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Patellar Resurfacing vs. Non-resurfacing in Total Knee Arthroplasty: A Review of Pain and Function

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 72-77 | Aashay Sonkusale, Ashish Phadnis

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.672

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 05 Sep 2024, Review Date: 10 Oct 2024, Accepted Date: 12 OCt 2024 & Published Date: 10 Dec 2024

Author: Aashay Sonkusale [1], Ashish Phadnis [2]

[1] Department of Arthroplasty and Arthroscopy, Apollo Hospital Chennai, Tamil Nadu, India.
[2] Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India.

Address of Correspondence

Dr. Aashay Sonkusale,
Fellow in Arthroplasty and Arthroscopy, Apollo Hospital Chennai, Tamil Nadu, India.
E-mail: sonkusaleaashay614@gmail.com

Abstract

Patella resurfacing in total knee arthroplasty has always been a topic of debate among the orthopedic surgeons around the world since its introduction in 1975 by Insall-Burstein. The results of current technique of PR has the promise lesser re-operations rates and cost-effectiveness in the long run, it is not albeit complications such as fracture, overstuffing of the patellofemoral joint, and maltracking of patella. Recent patella-friendly implants such as single radius anatomic femoral component and medial pivot knee have better patellar kinematic profiles with a deeper trochlear groove, a lateralized trochlear axis in the sagittal plane improving patellar contact force distribution. This has reduced the incidence of anterior knee pain following TKA, although there are other causes which have to be borne in mind when dealing with post-TKA AKP. Non-resurfacing of patella although claim to have similar patient-related outcome measures in the long run, lower patient satisfaction, and anterior knee pain have been deterrents to its absolute acceptance. Other methods such as cautery denervation (CD) and patelloplasty also boast functional outcomes similar to resurfacing with the advantages of being time effectivity, easy, and safe. There is considerable non-uniformity with these non-resurfacing techniques, depending on the surgeon’s preference and training. Selective resurfacing in “at-risk patellae” identified by pre- and intra-operative characteristics is increasing gaining popularity. We undertake a narrative review of the resurfacing of the patella focusing on anterior knee pain and functional outcomes.
Keywords: Patellar resurfacing, non-resurfacing, selective re-surfaces, anterior knee pain, knee society score.

References

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4. Abdel MP, Parratte S, Budhiparama NC. The patella in total knee arthroplasty: To resurface or not is the question. Curr Rev Musculoskelet Med 2014;7:117-24.
5. Parvizi J, Rapuri VR, Saleh KJ, Kuskowski MA, Sharkey PF, Mont MA. Failure to resurface the patella during total knee arthroplasty may result in more knee pain and secondary surgery. Clin Orthop Relat Res 2005;438:191-6.
6. Thomas C, Patel V, Mallick E, Esler C, Ashford RU. The outcome of secondary resurfacing of the patella following total knee arthroplasty: Results from the trent and wales arthroplasty register. Knee 2018;25:146-52.
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12. Van Raaij TM, van der Meij E, de Vries AJ, van Raay JJ. Patellar resurfacing does not improve clinical outcome in patients with symptomatic tricompartmental knee osteoarthritis. An RCT study of 40 Patients receiving primary cruciate retaining total knee arthroplasty. J Knee Surg 2021;34:1503-9.
13. Agarwala S, Shetty V, Karumuri LK, Vijayvargiya M. Patellar resurfacing versus nonresurfacing with patellaplasty in total knee arthroplasty. Indian J Orthop 2018;52:393-8.
14. Aunan E, Næss G, Clarke-Jenssen J, Sandvik L, Kibsgård TJ. Patellar resurfacing in total knee arthroplasty: Functional outcome differs with different outcome scores: A randomized, double-blind study of 129 knees with 3 years of follow-up. Acta Orthop 2015;87:158-64.
15. Ha C, Wang B, Li W, Sun K, Wang D, Li Q. Resurfacing versus not-resurfacing the patella in one-stage bilateral total knee arthroplasty: A prospective randomized clinical trial. Int Orthop 2019;43:2519-27.
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18. Batra S, Malhotra R, Kumar V, Srivastava DN, Backstein D, Pandit H. Superior patient satisfaction in medial pivot as compared to posterior stabilized total knee arthroplasty: A prospective randomized study. Knee Surg Sports Traumatol Arthrosc 2020;29:3633-40.
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How to Cite this article: Sonkusale A, Phadnis A. Patellar Resurfacing vs. Non-resurfacing in Total Knee Arthroplasty: A Review of Pain and Function. Journal of Clinical Orthopaedics July-December 2024;9(2):72-77.

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An Observational Study of Clinical, Radiological, and Functional Outcome in Tibial Plateau Fractures Operated with Open Reduction Internal Fixation in Adults

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 52-57 | Piyush Madhukar Jadhao, Ashish Phadnis

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.664

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 28 Sep 2024, Review Date: 26 Oct 2024, Accepted Date: 02 Nov 2024 & Published Date: 10 Dec 2024

Author: Piyush Madhukar Jadhao [1], Ashish Phadnis [1]

[1] Department of Orthopaedics, Jupiter Hospital – Eastern Express Highway, Thane, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Piyush Madhukar Jadhao,
Senior Registrar, Jupiter Hospital – Eastern Express Highway, Thane, Mumbai, Maharashtra, India.
E-mail: piyushoasis@gmail.com

Abstract

Background: Tibial plateau fractures are among some of the most challenging fractures to treat, associated with a high incidence of posttraumatic osteoarthritis later in life. The most commonly used surgical treatment is open reduction and fixation (ORIF) with plates and screws.
Objectives: This study was conducted to determine the radiological, clinical, and functional outcomes of patients with tibial plateau fractures treated by ORIF.
Materials and Methods: This retroprospective observational study included adult patients operated on for tibial plateau fractures using ORIF. Functional outcome was assessed by patient-reported outcome measures using Short Musculoskeletal Function Assessment, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form-36 Quality of Life questionnaires. Clinical and radiological outcomes were assessed using Modified Rasmussen’s clinical and radiological criteria.
Results: The majority of our patients had type 6 fractures (43.59%). We found a statistically significant negative correlation between the type of fracture and the KOOS total score. Clinical assessment using the Modified Rasmussen Criteria showed excellent results in 33.33% of patients, good results in 51.28% of patients, and fair and poor results in 7.69% of patients each, with an overall satisfactory clinical result in 84.61% of patients. The radiological assessment noted excellent results in 23.08% of patients, good results in 56.41% of patients, fair results in 12.82% of patients, and poor results in 7.69% of patients.
Conclusions: The preferred treatment of choice for tibial plateau fractures is open reduction internal fixation, with most patients demonstrating satisfactory (excellent to good) clinical and radiological outcomes. Operatively treated tibial plateau fractures result in improved functional outcomes, as it offers excellent anatomical reduction and rigid fixation to restore early movement and articular congruity, in addition to preventing stiffness of the knee.
Keywords: Proximal tibia fracture, ORIF, Quality of life, functional outcome, KOOS, SF-36, SMFA.

References

1. Stevens DG, Beharry R, McKee MD, Waddell JP, Schemitsch EH. The long-term functional outcome of operatively treated tibial plateau fractures. J Orthop Trauma 2001;15:312-20.
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8. Timmers TK, van der Ven DJ, de Vries LS, van Olden GD. Functional outcome after tibial plateau fracture osteosynthesis: A mean follow-up of 6 years. Knee 2014;21:1210-5.
9. Raza H, Hashmi P, Abbas K, Hafeez K. Minimally invasive plate osteosynthesis for tibial plateau fractures. J Orthop Surg (Hong Kong) 2012;20:42-7.
10. Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, Benirschke SK. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am 2006;88:1713-21.
11. Ebraheim NA, Sabry FF, Haman SP. Open reduction and internal fixation of 117 tibial plateau fractures. Orthopedics 2004;27:1281-7.
12. Rademakers MV, Kerkhoffs GM, Sierevelt IN, Raaymakers EL, Marti RK. Operative treatment of 109 tibial plateau fractures: Five- to 27-year follow-up results. J Orthop Trauma 2007;21:5-10.
13. Dattani R, Slobogean GP, O’Brien PJ, Broekhuyse HM, Blachut PA, Guy P, et al. Psychometric analysis of measuring functional outcomes in tibial plateau fractures using the Short Form 36 (SF-36), Short Musculoskeletal Function Assessment (SMFA) and the Western Ontario McMaster Osteoarthritis (WOMAC) questionnaires. Injury 2013;44:825-9.
14. Van Dreumel RL, Van Wunnik BP, Janssen L, Simons PC, Janzing HM. Mid-to long term functional outcome after open reduction and internal fixation of tibial plateau fractures. Injury 2015;46:1608-12.
15. Luo CF, Sun H, Zhang B, Zeng BF. Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 2010;24:683-92.

How to Cite this article: Jadhao PM, Phadnis A. An Observational Study of Clinical, Radiological, and Functional Outcome in Tibial Plateau Fractures Operated with Open Reduction Internal Fixation in Adults. Journal of Clinical Orthopaedics July-December 2024;9(2):52-57.

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Habitual Dislocation of the Patella Managed by a Two-in-One Procedure

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 63-66 | Ravi Mittal, M L V Sai Krishna

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.668

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 13 Jul 2024, Review Date: 18 Aug 2024, Accepted Date: 15 Sep 2024 & Published Date: 10 Dec 2024

Author: Ravi Mittal [1], M L V Sai Krishna [2]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,
[2] Department of Orthopaedics, Aayush Hospitals, Eluru, Andhra Pradesh, India

Address of Correspondence

M L V Sai Krishna,
Department of Orthopaedics, Aayush Hospitals, Eluru, Andhra Pradesh, India.
E-mail: krishna.mlv.sai@gmail.com

Abstract

Introduction: Habitual dislocation of the patella is a complex pathological condition of the patella which is characterized by lateral dislocation of the patella with flexion and relocation of the same with extension of the knee. There are numerous surgical procedures with various modifications that have been described in the literature based on the origin of pathology (soft tissue or bone). In this case series of 15 children, we described our technique of two-in-one procedure.
Materials and Methods: We included 15 patients with habitual dislocation of the patella between the ages of 5 and 9 years. In all the patients a detailed evaluation was done preoperatively and all of them were managed by a two-in-one procedure and followed up at 3 months and 1 year.
Results: There was no recurrence of dislocation in any of the patients and all the patients had attained their full range of movement by 1 year.
Conclusion: The two-in-one procedure is a simple and reproducible procedure for the treatment of habitual dislocation of the patella without any bony involvement. The procedure included graded lateral soft-tissue release and the Roux Goldthwait procedure. The amount of lateral soft-tissue release required is titrated intraoperatively.
Keywords: Habitual dislocation, Patella, Two in procedure, Knee.

References

1. Eilert RE. Congenital dislocation of the patella. Clin Orthop Relat Res 2001;389:22-9.
2. Bergmann NR, Williams PF. Habitual dislocation of the patella in flexion. J Bone Joint Surg Br 1988;70B:415-9.
3. Joo SY, Park KB, Kim BR, Park HW, Kim HW. The “four-in-one” procedure for habitual dislocation of the patella in children: Early results in patients with severe generalised ligamentous laxity and aplasis of the trochlear groove. J Bone Joint Sur Br 2007;89:1645-9.
4. Goldthwait JE. Slipping or recurrent dislocation of the patella: With the report of eleven cases. American Journal of Orthopedic Surgery, Vol. 1, pp. 293-308, 1903. J Bone Joint Surg 2003;85-A:2489.
5. Bakshi DP. Pes anserinus transposition for patellar dislocation. Long term follow up results. J Bone Joint Surg Br 1993;75B:305-10.
6. Gao GX, Lee EH, Bose K. Surgical management of congenital and habitual dislocation of the patellar. J Pediatr Orthop 1990;10:255-60.
7. Lai KA, Shen WJ, Lin CJ, Lin YT, Chen CY, Chang KC. Vastus lateralis fibrosis in habitual patella dislocation: An MRI study in 28 patients. Acta Orthop Scand 2000;71:394-8.
8. Niedzielski KR, Malecki K, Flont P, Fabis J. The results of an extensive soft-tissue procedure in the treatment of obligatory patellar dislocation in children with ligamentous laxity: A post-operative isokinetic study. Bone Joint J 2015;97-B:129-33.
9. Mittal R, Sitender, Jain S, Shukla A. Habitual patellar dislocation-management by two in one procedure, short term results. Indian J Orthop 2020;55:392-6.

How to Cite this article: Mittal R, Sai Krishna MLV. Habitual Dislocation of the Patella Managed by a Two-in-One Procedure. Journal of Clinical Orthopaedics 2024:July-December:9(2)63-66.

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Pediatric and Adolescent Ankle Fractures: Current Concepts and Advances in Management

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 44-46 | Swapnil M. Keny

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.660

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 25 Aug 2024, Review Date: 12 Sep 2024, Accepted Date: 16 Sep 2024 & Published Date: 10 Dec 2024

Author: Swapnil M. Keny [1, 2, 3]

[1] Department of Orthopaedics, K. B. Bhabha Hospital, Bandra, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Sir H. N. Reliance Hospital, Mumbai, Maharashtra, India
[3] Department of Orthopaedics, Apollo Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Swapnil M. Keny,
Consultant Pediatric Orthopaedic Surgeon, K. B. Bhabha Hospital, Mumbai, Sir H. N. Reliance Hospital, Mumbai, Apollo Hospital, Navi Mumbai, Maharashtra, India.
E-mail: peadortho@gmail.com

Abstract

Pediatric and adolescent ankle fractures are frequently encountered injuries, often involving the distal tibial growth plate and requiring special management due to the potential for growth disturbances. Recent developments in imaging, surgical techniques, and rehabilitation have significantly improved outcomes. This review highlights contemporary practices in the diagnosis and treatment of ankle fractures in younger patients, with a focus on advances in diagnostic tools, operative management, and individualized care. It also explores the integration of new technologies, such as 3D printing and artificial intelligence, in fracture planning and management, reflecting the current standard of care.
Keywords: Pediatric, ankle fractures, distal tibial physeal injuries, Salter-Harris injuries, internal fixation, decision making.

References

1. Liporace FA, Yoon RS, Kubiak EN, Parisi DM, Koval KJ, Feldman DS, et al. Does adding computed tomography change the diagnosis and treatment of Tillaux and triplane pediatric ankle fractures? Orthopedics 2012;35:e208-12.
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3. Nenopoulos A, Beslikas T, Gigis I, Sayegh F, Christoforidis I, Hatzokos I, et al. The role of CT in diagnosis and treatment of distal tibial fractures with intra-articular involvement in children. Injury 2015;46:2177-80.
4. Seifert J, Matthes G, Hinz P, Paris S, Mutze S, Ekkernkamp A, et al. Role of magnetic resonance imaging in the diagnosis of distal tibia fractures in adolescents. J Pediatr Orthop 2003;23:727.
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6. Cooperman DR, Spiegel PG, Laros GS. Tibial fractures involving the ankle in children. The so-called triplane epiphyseal fracture. J Bone Joint Surg Am 1978;60:1040-6.
7. Spiegel PG, Cooperman DR, Laros GS. Epiphyseal fractures of the distal ends of the tibia and fibula: A retrospective study of two hundred and thirty-seven cases in children. J Bone Joint Surg Am 1978;60:1046-50.
8. Cass JR, Peterson HA. Salter-Harris type-IV injuries of the distal tibial epiphyseal growth plate, with emphasis on those involving the medial malleolus. J Bone Joint Surg Am 1983;65:1059-70.
9. Cummings RJ, Shea KG. Distal tibial and fibular fractures. In: Beaty JH, Kasser JR, editors. Rockwood and Wilkins’ Fractures in Children. 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2010.
10. Asad WA, Younis MH, Ahmed AF, Ibrahim T. Open versus closed treatment of distal tibia physeal fractures: A systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2017;27:503-9.

How to Cite this article: Keny SM. Pediatric and Adolescent Ankle Fractures: Current Concepts and Advances in Management. Journal of Clinical Orthopaedics July-December 2024;9(2):44-46.

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Study of Functional Outcome of Intra-articular Proximal Third Tibia Fractures Treated with Locking Compression Plate

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 88-94 | Adnan Asif, Saurabh Harikant Yadav, P Gokula Kumar, Pawar Bhushan Kumar Bhajandas, Atul Jain, Lalit C Panchal

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.678

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 13 Jul 2024, Review Date: 19 Aug 2024, Accepted Date: 16 Sep 2024 & Published Date: 10 Dec 2024

Author: Adnan Asif [1], Saurabh Harikant Yadav [1], P Gokula Kumar [1], Pawar Bhushan Kumar Bhajandas [2], Atul Jain [3], Lalit C Panchal [1]

[1] Department of Orthopaedics, K B Bhabha Municipal General Hospital, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Chhatrapati Shivaji Maharaj Hospital and Rajiv Gandhi Medical College, Thane, Maharashtra, India,
[3] Department of Orthopaedics, Swami Dayanand Hospital, New Delhi, India

Address of Correspondence

Adnan Asif,
K B Bhabha Municipal General Hospital, Maharashtra, Mumbai, India.
E-mail: adnan.asif1092@gmail.com

Abstract

Background: The study aimed to provide an estimate of the functional outcome following the use of locking compression plate (LCP) in the management of intra-articular proximal third tibia fractures. Materials and Methods: A prospective cohort study was carried out on 30 intra-articular proximal third tibia fractures which were operated with LCP fixation between August 2020 and July 2021. Primary outcome measurement was carried out using Rasmussen’s functional knee grading criteria. Results: Functional outcome assessed by Rasmussen’s functional knee grading criteria showed Excellent results in 16/30 (53.33%) of patients, good result in 9/30 (30%) of patients (overall 83.33% acceptable results), and fair in 4/30 (13.33%) and poor result in 1/30 (3.33%) of patients. Post-operative complications occurred in eight out of 30 of our patients (26.67%). Open reduction and internal fixation was more commonly used (76.67%) as compared to minimally invasive percutaneous plate osteosynthesis (23.33%). We commonly applied a combined principle of fixation (bridging + compression) across 46.67% of our fracture fixations. Primary surgical approach used was almost equal across our study between medial/posteromedial (53.33%) and anterolateral (46.67%).
Conclusion: We conclude that the LCP system with its various type of fixation act as a good biological fixation including difficult fracture situations. However, this also involves the risk that may occur unless properly planned preoperatively and follow guided principles intraoperatively.
Keywords: Proximal tibia, locking compression plate, Rasmussen functional knee grading criteria.

References

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8. Agnew SG, Benirschke SK, Mayo KA, Henley MB, Santoro VM. Open reduction and internal fixation of complex tibial plateau fractures. J Orthop Trauma 1991;5:236.
9. Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop 1994;302:199-2005.
10. Burri C, Bartzke G, Coldewey J, Muggler E. Fractures of the tibial plateau. Clin Orthop Relat Res 1979;138:84-93.
11. Bowes DN, Hohl M. Tibial condylar fractures evaluation of treatment and outcome. Clin Orthop 1982;171:105-8.
12. Segal D, Mallik AR, Wetzler MJ, Franchi AV, Whitelaw GP. Early weight bearing of lateral tibial plateau fractures. Clin Orthop 1993;294:232-7.

How to Cite this article: Asif A, Yadav SH, Kumar PG, Bhajandas PBK, Jain A, Panchal LC. Study of Functional Outcome of Intra-articular Proximal Third Tibia Fractures Treated with Locking Compression Plate. Journal of Clinical Orthopaedics 2024:July-December:9(2)88-94.

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Chronic Low Back Pain: A Spine Surgeon’s Graveyard

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 29-34 | Pranav Shah, Gautam Zaveri

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.648

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 25 Jul 2024, Review Date: 02 Aug 2024, Accepted Date: 12 Sep 2024 & Published Date: 10 Dec 2024

Author: Pranav Shah [1], Gautam Zaveri [2]

[1] Department of orthopedic Spine Surgeon, Namaha Hospital, Mumbai, Maharashtra, India
[2] Department of orthopedic Spine Surgeon, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Gautam Zaveri, Department of orthopedic Spine Surgeon, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India.
E-mail: gautamzaveri1969@gmail.com

Abstract

Background: Chronic low back pain (cLBP) is a prevalent and debilitating condition. The World Health Organisation identified it as a major global health concern with the incidence rising by 50% between 1989 and 2019. It is projected that about 843 million people globally will suffer from cLBP by 2050. Despite its prevalence, the pathogenesis of cLBP remains poorly understood and its treatment fragmented. Almost 70% of cases are categorized as non-specific where the pain could likely be arising from dysfunction in ligament, muscles or joints. Degenerative conditions amount to 27% of cases, while non-spinal and sinister causes contribute to a smaller percentage. Psychosocial factors also play a significant role in both the onset and persistence of cLBP.
Discussion: The management of cLBP is multifaceted, focussing on non-surgical interventions such as pharmacological treatment, physical therapy, lifestyle modifications and complementary therapies. While non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants provide symptomatic relief, physical and behavioural therapies are crucial in addressing the chronic nature of the condition. Surgical options are reserved for cases with specific patho-anatomic aetiologies such as spondylolisthesis or spinal stenosis. The management of psychosocial aspects through cognitive behavioural therapy (CBT) is pertinent in enhancing patient outcomes.
Conclusion: This article provides a comprehensive review of cLBP, encompassing its aetiology, natural history, evaluation and management strategies. The role of multi-disciplinary approach, patient education and lifestyle modification is important in treating this complex condition. By integrating evidence-based practices with individualized care, the clinician can improve quality of life of patients affected by cLBP.
Keywords: Chronic low back pain, Non-specific low back pain, Degenerative lumbar spine, Cognitive behavioural therapy, Ergonomics.

References

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How to Cite this article: Shah P, Zaveri G. Chronic Low Back Pain: A Spine Surgeon’s Graveyard. Journal of Clinical Orthopaedics July-December 2024;9(2):29-34.

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The Efficacy of Platelet-rich Plasma in Arthroscopic Rotator Cuff Repairs: A Narrative Review

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 22-25 | Nihar Modi, Prasad Bhagunde, Damini Shah

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.650

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 15 Jul 2024, Review Date: 09 Aug 2024, Accepted Date: 19 Sep 2024 & Published Date: 10 Dec 2024

Author: Prasad Bhagunde [1, 2, 3, 4], Nihar Modi [1, 3, 5], Daminir shah [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] Department of Orthopaedics, Criticare Asia Multispeciality Hospital and Research Centre, Mumbai, Maharashtra, India.
[6] Novo Tissue Bank and Research Centre, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Nihar Modi,
Consultant Orthopaedic Surgeon, Sona Medical Centre, Jaslok Hospital and Research Centre, Criticare Asia Multispeciality Hospital and Research Centre, Mumbai, Maharashtra, India.
E-mail: modi.nihar95@gmail.com

Abstract

Rotator cuff tears are one of the most prevalent musculoskeletal disorders, with a significant risk of retear following repair. Platelet-rich plasma (PRP) has emerged as a potential adjunct to enhance healing through mechanisms including growth factor release, anti-inflammatory effects, and angiogenesis. This narrative review evaluates the efficacy of PRP augmentation in arthroscopic rotator cuff repairs by examining recent studies and meta-analyses. Findings indicate that PRP, particularly leukocyte-poor PRP, shows promise in improving pain and functional outcomes, and reducing retear rates, though its cost-effectiveness and optimal application protocols remain uncertain. Limitations of current studies and avenues for future research are also discussed.
Keywords: Platelet-rich plasma, Arthroscopic rotator Cuff repairs, orthobiologics, PRP

References

1. Snow M, Hussain F, Pagkalos J, Kowalski T, Green M, Massoud S, James S. The Effect of Delayed Injection of Leukocyte-Rich Platelet-Rich Plasma Following Rotator Cuff Repair on Patient Function: A Randomized Double-Blind Controlled Trial. Arthroscopy. 2020 Mar;36(3):648-657.
2. Ahmad Z, Ang S, Rushton N, Harvey A, Akhtar K, Dawson-Bowling S, Noorani A. Platelet-Rich Plasma Augmentation of Arthroscopic Rotator Cuff Repair Lowers Retear Rates and Improves Short-Term Postoperative Functional Outcome Scores: A Systematic Review of Meta-Analyses. Arthrosc Sports Med Rehabil. 2022 Feb 5;4(2):e823-e833.
3. Samuelson EM, Odum SM, Fleischli JE. The Cost-Effectiveness of Using Platelet-Rich Plasma During Rotator Cuff Repair: A Markov Model Analysis. Arthroscopy. 2016 Jul;32(7):1237-44.
4. Routledge JC, Saber AY, Pennington N, Gupta N. Re-Tear Rates Following Rotator Cuff Repair Surgery. Cureus. 2023 Jan 31;15(1):e34426.
5. Liu B, Jeong HJ, Yeo JH, Oh JH. Efficacy of Intraoperative Platelet-Rich Plasma Augmentation and Postoperative Platelet-Rich Plasma Booster Injection for Rotator Cuff Healing: A Randomized Controlled Clinical Trial. Orthop J Sports Med. 2021 Jun 4;9(6):23259671211006100.
6. Syed, A. N., Landrum, K., & Ganley, T. J. (2024). Platelet-rich plasma and other injectables in the young athlete. Journal of the Pediatric Orthopaedic Society of North America, 6, 100008.
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8. Hurley ET, Danilkowicz RM, Klifto CS. Editorial Commentary: Platelet-Rich Plasma Injections Produced a Significant Improvement in Most Patients With Rotator Cuff Tendinopathy. Arthroscopy. 2023 Sep;39(9):2009-2011.
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12. Malavolta EA, Gracitelli ME, Ferreira Neto AA, Assunção JH, Bordalo-Rodrigues M, de Camargo OP. Platelet-rich plasma in rotator cuff repair: a prospective randomized study. Am J Sports Med. 2014 Oct;42(10):2446-54.
13. Flury M, Rickenbacher D, Schwyzer HK, Jung C, Schneider MM, Stahnke K, Goldhahn J, Audigé L. Does Pure Platelet-Rich Plasma Affect Postoperative Clinical Outcomes After Arthroscopic Rotator Cuff Repair? A Randomized Controlled Trial. Am J Sports Med. 2016 Aug;44(8):2136-46.
14. Trantos IA, Vasiliadis ES, Giannoulis FS, Pappa E, Kakridonis F, Pneumaticos SG. The Effect of PRP Augmentation of Arthroscopic Repairs of Shoulder Rotator Cuff Tears on Postoperative Clinical Scores and Retear Rates: A Systematic Review and Meta-Analysis. J Clin Med. 2023 Jan 11;12(2):581.
15. Ryan J, Imbergamo C, Sudah S, Kirchner G, Greenberg P, Monica J, Gatt C. Platelet-Rich Product Supplementation in Rotator Cuff Repair Reduces Retear Rates and Improves Clinical Outcomes: A Meta-analysis of Randomized Controlled Trials. Arthroscopy. 2021 Aug;37(8):2608-2624.
16. Rossi LA, Gorodischer TD, Camino P, Brandariz RN, Tanoira I, Piuzzi NS, Ranalletta M. Leukocyte-Poor Platelet-Rich Plasma as an Adjuvant to Arthroscopic Rotator Cuff Repair Reduces the Retear Rate But Does Not Improve Functional Outcomes: A Double-Blind Randomized Controlled Trial. Am J Sports Med. 2024 May;52(6):1403-1410.
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18. Vavken P, Sadoghi P, Palmer M, Rosso C, Mueller AM, Szoelloesy G, Valderrabano V. Platelet-Rich Plasma Reduces Retear Rates After Arthroscopic Repair of Small- and Medium-Sized Rotator Cuff Tears but Is Not Cost-Effective. Am J Sports Med. 2015 Dec;43(12):3071-6.
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20. Pandey V, Bandi A, Madi S, Agarwal L, Acharya KK, Maddukuri S, Sambhaji C, Willems WJ. Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elbow Surg. 2016 Aug;25(8):1312-22.

How to Cite this article: Prabhu S, Zaveri G. Surgery for Lumbar Disc Prolapse: The Decision is More Important than the Incision. Journal of Clinical Orthopaedics July-December 2024;9(2):17-21.

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Surgery for Lumbar Disc Prolapse: The Decision is More Important than the Incision

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 17-21 | Shrinivas Prabhu, Gautam Zaveri

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.648

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 13 Sep 2024, Review Date: 22 Sep 2024, Accepted Date: 28 Nov 2024 & Published Date: 10 Dec 2024

Author: Shrinivas Prabhu [1], Gautam Zaveri [2]

[1] Department of Orthopaedics, MGMIHS, Navi Mumbai, Maharashtra, India
[2] Department of Spine Surgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Gautam Zaveri,
Department of Spine Surgery, Jaslok Hospital and Research Centre, Mumbai, Maharashtra, India
E-mail: gautamzaveri1969@gmail.com

Abstract

The common techniques of discectomy for a posterolateral lumbar disc herniation include conventional open discectomy, microlumbar discectomy, tubular microdiscectomy, and endoscopic discectomy. All these techniques involve an interlaminar fenestration for accessing the spinal canal, decompressing the neural elements, and performing the discectomy with the goal of relieving radicular leg pain and improving function. The current review aims to briefly outline the evolution of lumbar discectomy over the last century, examine the pros and cons, and compare the short-term and long-term clinical outcomes of the common techniques of lumbar discectomy. While no single approach may be universally superior to the other, surgical selection tailored to patient-specific factors and surgeons’ experience with a technique helps to optimize clinical outcomes.
Keywords: Lumbar disc prolapse, microlumbar discectomy, tubular discectomy, endoscopic discectomy

References

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5. Teles P, Pereira P, Silva C, Vaz R, Santos Silva P. Minimally invasive treatment for lumbar disc herniation: A matched comparison between tubular microdiscectomy and percutaneous endoscopic lumbar discectomy. Cureus 2024;16:e57589.
6. Liu X, Yuan S, Tian Y, Wang L, Gong L, Zheng Y, et al. Comparison of percutaneous endoscopic transforaminal discectomy, microendoscopic discectomy, and microdiscectomy for symptomatic lumbar disc herniation: Minimum 2-year follow-up results. J Neurosurg Spine 2018;28:317-25.
7. Giardi FP, Cammisa FP Jr., Huang RC, Parvataneni HK, Tsairis P. Improvement of preoperative foot drop after lumbar surgery. J Spinal Disord Tech 2002;15:490-4.
8. Postacchini F, Giannicola G, Cinnoti G. Recovery of motor deficits after microdiscectomy for lumbar disc herniation. J Bone Joint Surg Br 2002;84:1040-5.
9. Aono H, Iwasaki M, Ohwada T, Okuda S, Hosono N, Fuji T, et al. Surgical outcome of drop foot caused by degenerative lumbar diseases. Spine (Phila Pa 1976) 2007;32:E262-6.
10. Liu K, Zhu W, Shi J, Jia L, Shi G, Wang Y, et al. Foot drop caused by lumbar degenerative disease: Clinical features, prognostic factors of surgical outcome and clinical stage. PLoS One 2013;8:e80375.
11. Moranjkic M, Ercegovic Z, Hodzic M, Brkic H. Outcome prediction in lumbar disc herniation surgery. Acta Med Sal 2010;39:75-8.
12. Stromqvist F, Ahmad M, Hildingsson C, Jönsson B, Strömqvist B. Gender differences in lumbar disc herniation surgery. Acta Orthop 2008;79:643-9.

 

How to Cite this article: Prabhu S, Zaveri G. Surgery for Lumbar Disc Prolapse: The Decision is More Important than the Incision. Journal of Clinical Orthopaedics July-December 2024;9(2):17-21.

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Grapefruit Method: Metaphyseal Bone Grafting to Improve Press-fit of Cementless Humeral Stems in Reverse Shoulder Arthroplasty

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 26-28 | Manit Arora

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.652

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 19 July 2024, Review Date: 25 Aug 2024, Accepted Date: 12 Sep 2024 & Published Date: 10 Dec 2024

Author: Manit Arora [1]

[1] Department of Orthopaedics and Sports Medicine, Fortis Hospital, Mohali, Punjab, India.

Address of Correspondence

Manit Arora,
Department of Orthopaedics and Sports Medicine, Fortis Hospital, Mohali, Punjab, India.
E-mail: manit_arora@hotmail.com

Abstract

Reverse shoulder arthroplasty is one of the fastest-growing orthopedic surgeries globally. There exist two options for stemmed humeral components: Cemented and cementless or press-fit designs. In cases of osteoporosis or poor metaphyseal bone stock, generally, the choice is made to opt for the former. We describe a method for metaphyseal bone grafting using the resected humeral head as an autograft to improve metaphyseal bone stock and allow for press-fit humeral component in such cases.
Keywords: Shoulder replacement, Shoulder surgery, Reverse shoulder replacement, Bone grafting

References

1. Levy O, Narvani A, Hous N, Abraham R, Relwani J, Pradhan R, et al. Reverse shoulder arthroplasty with a cementless short metaphyseal humeral implant without a stem: Clinical and radiologic outcomes in prospective 2- to 7-year follow-up study. J Shoulder Elbow Surg 2016;25:1362-70.
2. Plachel F, Scheibel M. Humeral bone grafting in stemless shoulder arthroplasty. Obere Extrem 2017;12:183-5.
3. Micheloni GM, Salmaso G, Berti M, Bortolato S, Zecchinato G, Momoli A, et al. Cementless metaphyseal reverse shoulder arthroplasty: Our preliminary experience. Acta Bio Med Atenei Parm 2019;90 Suppl 1:47-53.

How to Cite this article: Arora M. Grapefruit Method: Metaphyseal Bone Grafting to Improve Press-fit of Cementless Humeral Stems in Reverse Shoulder Arthroplasty. Journal of Clinical Orthopaedics 2024:July-December:9(2)26-28.

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