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Comparative study of different approaches of Total Hip Arthroplasty based on inclination angle of acetabular cup and Post operative rehabilitation

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Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 32-37 | Mohd Danish, Akhilesh Yadav, Ashutosh Karn

DOI: https://doi.org/10.13107/jcorth.2025.v10i01.710

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 11 Jan 2025, Review Date: 08 Mar 2025, Accepted Date: 10 Apr 2025 & Published Date: 30 Jun 2025

Author: Mohd Danish [1], Akhilesh Yadav [1], Ashutosh Karn [2]

[1] Department of Orthopaedics, Max Superspeciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India,
[2] Department of Orthopaedics, Max Superspeciality Hospital, Saket, Delhi, India

Address of Correspondence

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

Abstract

Introduction: Total hip arthroplasty (THA) is considered to be one of the most successful orthopaedic interventions of its generation. Joint replacement (arthroplasty) as a surgical option for end stage arthritis is well established now and millions of patients across the world have benefited. India is a country of 1.4 billion people with significant knee and hip arthritis population. According to Frost and Sullivan research, 70,000 joint replacement surgeries were performed in India in the year 2011. The most common cause of chronic hip pain and disability is arthritis. Osteoarthritis, rheumatoid arthritis, and traumatic arthritis are the most common forms of this disease.
Aims of Study: To compare post-operative outcome as implant positioning in terms of abduction angle of the cup & rehabilitation based on Harris Hip Score at 2 months and 4 months respectively in different approaches of approach of total hip replacement.
Materials and Methods: This study was conducted in the department of Orthopaedics at Max Super specialty hospital, Vaishali, Ghaziabad, UP after receiving clearance from the Ethical Committee of the institution. It was a randomized case control study. Two different groups of 32 patients each were evaluated and inclination of acetabular cup was calculated on plain radiograph, subsequently the rehabilitation was also evaluated on basis of Harris Hip score in these patients.
Results: In the present study, it was observed that mean postoperative abduction angle in Group A 47.82 ±6.87 and Group B was 51.19 ±7.21 degree respectively. The mean postoperative abduction angle in Group A was less compared to Group B with statistical significance. (P<0.05) In the present study, it was observed that intergroup comparison of mean Harris hip score post-operative at discharge, at 2 months & 4 months in Group A and Group B showed no statistical significance. (P>0.05) The intragroup comparison of mean Harris hip score post-operative at discharge, 2 months and 4 months in Group A and Group B showed statistical significance. (P<0.05)
Conclusion: Present study revealed a significant statistical difference on intragroup comparison of inclination angle and rehabilitation based on Harris Hip Score in both the groups.
Keywords: Arthroplasty, Harris Hip Score, Angle of Inclination

References

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How to Cite this article: Danish M, Yadav A, Karn A. Comparative study of different approaches of Total Hip Arthroplasty based on inclination angle of acetabular cup and Post operative rehabilitation. Journal of Clinical Orthopaedics January-June 2025;10(1):32-37.

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Is Pharmacological Thromboprophylaxis Truly Necessary: Predictive Factors for Venous Thromboembolic Events Post-Total Knee Arthroplasty in an Asian Population

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Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 14-20 | Zavier Yongxuan Lim, Lynn Thwin, Kelvin Guoping Tan

DOI: https://doi.org/10.13107/jcorth.2025.v10i01.704

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 21 Feb 2025, Review Date: 18 Mar 2025, Accepted Date: 26 April 2025 & Published Date: 30 Jun 2025

Author: Zavier Yongxuan Lim [1], Lynn Thwin [1], Kelvin Guoping Tan [1]

[1] Department of Orthopaedic Surgery, Tan Tock Seng Hospital (Singapore), 11 Jln Tan Tock Seng, Singapore 308433

Address of Correspondence

Dr. Zavier Yongxuan Lim,
Department of Orthopaedic Surgery, Tan Tock Seng Hospital (Singapore), 11 Jln Tan Tock Seng, Singapore 308433 6256 6011.
E-mail: yongxuan.lim@mohh.com.sg

Abstract

Introduction: Venous thromboembolic prophylaxis is routinely used in elective total knee arthroplasty (TKA) patients worldwide, and current guidelines vary from aspirin to low molecular weight heparin in combination with mechanical prophylaxis, and direct oral anticoagulants. This study aimed to identify predictive or protective factors for VTEs in an Asian hospital and examine the efficacy of pharmacological VTE prophylaxis.
Materials and Methods: A retrospective cohort study of 2,014 patients who underwent primary TKAs between 2017 and 2022 was performed. All patients received mechanical thromboprophylaxis postoperatively. Patients who were symptomatic were referred for radiological investigations to exclude VTE. We evaluated patient demographics, co-morbidities, and surgical parameters to establish the overall incidence of symptomatic VTEs and risk factors for VTEs.
Results: There were 23 (1.14%) incidences of symptomatic VTEs, of which 1 patient developed pulmonary embolism, and 22 deep vein thrombosis. The incidence of VTE was 0.69% (10/1449) for patients on mechanical prophylaxis only, 2.08% (9/432) for patients on aspirin, 3.67% (4/109) for patients on clexane, 0% (0/19) for patients on clopidogrel, and 0% (0/5) for patients on DOACs. Multivariate analysis revealed length of stay (P < 0.001), the need for blood transfusion (P = 0.007), choice of thromboprophylaxis (P = 0.049), and diagnosis (P = 0.048) were independent risk factors for VTE. The use of tranexamic acid did not significantly affect VTE rates in the model (P = 0.059).
Conclusion: Pharmacological thromboprophylaxis may not be required post-operative in the Asian population. The identification of risk factors in this study allows surgeons to individualise risk counselling for patients listed for elective TKAs and choose appropriate thromboprophylaxis methods.
Keywords: Knee arthroplasty, Arthroplasty, Replacement, Knee, Thromboprophylaxis, Venous thrombosis, Asians

References

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2. Park KH, Cheon SH, Lee JH, Kyung HS. Incidence of venous thromboembolism using 64 channel multidetector row computed tomography-indirect venography and anti-coagulation therapy after total knee arthroplasty in Korea. Knee Surg Relat Res 2012;24:19-24.
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15. Yin H. Enhanced recovery after surgery (ERAS) in postoperative lung cancer patients: A novel perioperative strategy for preventing venous thromboembolism and improving quality of life. Tohoku J Exp Med 2024;262:201-9.
16. Li S, Bercow AS, Falzone M, Kalyanaraman R, Worley MJ, Feltmate CM, et al. Risk of venous thromboembolism for ovarian cancer patients during first-line therapy after implementation of an Enhanced Recovery After Surgery (ERAS) protocol. Gynecol Oncol 2021;162:353-9.
17. Wong SY, Ler FL, Sultana R, Bin Abd Razak HR. What is the best prophylaxis against venous thromboembolism in Asians following total knee arthroplasty? A systematic review and network meta-analysis. Knee Surg Relat Res 2022;34:37.
18. Amarase C, Tanavalee A, Larbpaiboonpong V, Lee MC, Crawford RW, Matsubara M, et al. Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 2. Mechanical venous thromboembolism prophylaxis. Knee Surg Relat Res 2021;33:20.
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How to Cite this article: Lim ZY, Thwin L, Tan KG. Is Pharmacological Thromboprophylaxis Truly Necessary: Predictive Factors for Venous Thromboembolic Events Post-Total Knee Arthroplasty in an Asian Population. Journal of Clinical Orthopaedics. January-June 2025;10(1):14-20.

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

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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

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

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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.
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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.
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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.

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Three dimensional (3D) printing in Orthopaedics: Scope of application and future perspectives

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Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 41-44 | Shubhranshu S Mohanty, Tushar Kadam, Sushant Srivastava

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.592

Authors: Shubhranshu S Mohanty [1], Tushar Kadam [1], Sushant Srivastava [2]

[1] Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Parel, Mumbai-12, Hon Consultant, Jaslok, Nanavati & Shushrusha Hospitals, Mumbai, India.
[2] Department of Orthopaedics, Mata Gujri Memorial Medical College, Kishanganj, Bihar, India.

Address of Correspondence
Dr. Shubhranshu S Mohanty,
Dept of Orthopaedics, #608, 6th Floor, MS Building, Seth GS Medical College & King Edward Memorial Hospital,
Parel, Mumbai-400012, India.

Email: drssmohanty@hotmail.com

Abstract

Three dimensional (3D) printing also known as additive manufacturing has the potential to change the paradigm of Orthopaedic practice. Modern times have witnessed exponential growth in 3D-printing technology as well as its uses. A wide spectrum of printers are now available, ranging from the desktop printer to high end manufacturing units. The ability to use a plethora of materials and create almost limitless geometric shapes with varying surface topography makes this method of production highly appealing. Certain inherent advantages include easy customizability, small production runs, less wastage of material, smaller footprint. Challenges such as lack of data, absence of established government regulations and cost considerations remain, but one can expect these to be overcome as the economy of scale plays out and the medical fraternity becomes more accommodating of the new technology.
Keywords: Three dimensional printing, Recent Advances, Arthroplasty, Spine, Tumor Implants

References

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2. Mumith A, Thomas M, Shah Z, Coathup M, Blunn G. Additive manufacturing: current concepts, future trends. Bone Joint J. 2018 Apr 1;100-B(4):455-460. doi: 10.1302/0301- 620X.100B4.BJJ-2017-0662.R2. PMID: 29629583.
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19. Vaezi M, Black C, Gibbs DM, Oreffo RO, Brady M, Moshrefi- Torbati M, Yang S. Characterization of New PEEK/HA Composites with 3D HA Network Fabricated by Extrusion Freeforming. Molecules. 2016 May 26;21(6):687. doi: 10.3390/molecules21060687. PMID: 27240326; PMCID: PMC6273399.

20. Custom Device Exemption: Guidance for Industry and Food and Drug Administration Staff. White Oak, MD, FDA, 2014
21. Liang H, Ji T, Zhang Y, Wang Y, Guo W. Reconstruction with 3Dprinted pelvic endoprostheses after resection of a pelvic tumour. Bone Joint J. 2017 Feb;99-B(2):267-275. doi: 10.1302/0301-620X.99B2.BJJ-2016-0654.R1. PMID: 28148672.
22. Merceron TK, Burt M, Seol YJ, Kang HW, Lee SJ, Yoo JJ, Atala A. A 3D bioprinted complex structure for engineering the muscle-tendon unit. Biofabrication. 2015 Jun 17;7(3):035003. doi: 10.1088/1758-5090/7/3/035003. PMID: 26081669.
23. Javaid M, Haleem A. Significant advancements of 4D printing in the field of orthopaedics. J Clin Orthop Trauma. 2020 Jul;11(Suppl 4):S485-S490. doi: 10.1016/j.jcot.2020.04.021. Epub 2020 Apr 25. PMID: 32774016; PMCID: PMC7394805.

How to Cite this article: Mohanty SS, Kadam T, Srivastava S. Three dimensional (3D) printing in Orthopaedics: Scope of application and future perspectives. Journal of Clinical Orthopaedics July-December 2023;8(2):41-44.

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“ Shoulder Arthroplasty in Young ”

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Journal of Clinical Orthopaedics | Vol 6 | Issue 1 |  Jan-Jun 2021 | page: 74-80 | Nagraj Shetty

Author: Nagraj Shetty [1]

[1] Consultant Arthroscopy, Shoulder, Knee preservation Surgeon Lilavati hospital Nanavati Superspeciality hospital Hinduja Healthcare Surgical, Mumbai, India.

Address of Correspondence
Dr. Nagraj Shetty,
Orthopaedic Department, Nanavati Superspeciality Hospital, SV Road, Vile Parle west , Mumbai, India.
E-mail: orthodocshetty@gmail.com

Abstract

Background: Prosthetic shoulder replacement provides excellent pain relief and functional improvement for patients with shoulder arthritis. Total shoulder arthroplasty for osteoarthritis and reverse shoulder arthroplasty for cuff tear arthropathy remains the gold standard for the geriatric patient population. Poor long-term survivorship, implant failure (glenoid component loosening, and glenoid arthrosis), and functional deterioration requiring early revision surgery are major concerns of similar management in younger patients. Young patients prove as a major challenge to shoulder surgeons due to expected longer life expectancy, desire to pursue sports, and active lifestyle thereby placing excessive demands on their shoulder arthroplasty components. Alternative strategies for arthroplasty in young have been developed; however, there is presently no clear consensus, recommendations to guide clinicians toward management. This manuscript reviews the current concepts of shoulder arthroplasty in young patients.
Keywords: Shoulder, arthritis, arthroplasty, glenoid, total shoulder arthroplasty

References

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31. Eichinger JK, Miller LR, Hartshorn T, Li X, Warner JJ, Higgins LD. Evaluation of satisfaction and durability after hemiarthroplasty and total shoulder arthroplasty in a cohort of patients aged 50 years or younger: An analysis of discordance of patient satisfaction and implant survival. J Shoulder Elbow Surg 2016;25:72-80.
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38. Clinton J, Franta AK, Lenters TR, Mounce D, Matsen FA 3rd. Nonprosthetic glenoid arthroplasty with humeral hemiarthroplasty and total shoulder arthroplasty yield similar self-assessed outcomes in the management of comparable patients with glenohumeral arthritis. J Shoulder Elbow Surg 2007;16:534-8.

How to Cite this article: Shetty N. “ Shoulder Arthroplasty in Young ”. Journal of Clinical Orthopaedics Jan-Jun 2021;6(1):74-80.

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Peri-proshthetic Joint Infection

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Journal of Clinical Orthopaedics | Vol 4 | Issue 2 |  July-Dec 2019 | page:45-50 | Dr. Shubhranshu S. Mohanty, Dr. Swapnil A. Keny

Author: Dr. Shubhranshu S . Mohanty [1], Dr. Swapnil A. Keny [1]

[1] Dept. of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.

Address of Correspondence
Dr. Shubhranshu S. Mohanty,
Dept. of Orthopaedics, Seth GS Medical College & King Edward Memorial Hospital, Mumbai.
E-mail: drssmohanty@hotmail.com

Abstract

Prosthetic joint infections in one of the most serious complication of Joint Arthroplasty. Over the years the understanding and management of PJI has evolved. The current review presents and overviews of the recent advances in the field
Keywords: Prosthetic joint infection, arthroplasty.

References

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3. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008 Jul;466(7):1710-5.
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9. Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008 Oct;23(7):984-91.
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14. Ghanem E, Parvizi J, Burnett RS, Sharkey PF, Keshavarzi N, Aggarwal A, Barrack RL. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008 Aug;90(8):1637-43.
15. Feldman DS, Lonner JH, Desai p Zuckerman JD. The role of intra operative frozen sections in revision total joint arthroplasty. J Bone Jomt Surg Am. 1995:77:1807-13.
16. Zywiel MG, Stroh DA, Johnson AJ, Marker DR, Mont MA. Gram stains have limited application in the diagnosis of infected total knee arthroplasty. Int J Infect Dis. 2011 Oct;15(10):e702-5.
17. Schoof B, Jakobs O, Schmidl S, et al. Fungal periprosthetic joint infection of the hip: a systematic review. Orthop Rev (Pavia). 2015;7(1):5748. Published 2015 Mar 31.
18. Berbari EF, Marculescu C, Sia I, Lahr BD, Hanssen AD, Steckelberg JM, et al. Culture‑negative prosthetic joint infection. Clin Infect Dis 2007;45:1113‑9.
19. Tsaras G, Maduka-Ezeh A, Inwards CY, Mabry T, Erwin PJ, Murad MH, Montori VM,West CP, Osmon DR, Berbari EF. Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2012 Sep 19;94(18):1700-11.Review.
20. Parvizi J, Jacovides C, Antoci V, Ghanem E. Diagnosis of periprosthetic joint infection: The utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am 2011;93:2242‑8.
21. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, Steckelberg J,Osmon D. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010 Sep1;92(11):2102-9.
22. ungerford DS. Infected total knee arthroplasty treated by arthroscopic irrigation and débridement. J Arthroplasty. 2000 Jun;15(4):430-6.
24. Thakrar RR, Horriat S, Kayani B, Haddad FS. Indications for a single-stage exchange arthroplasty for chronic prosthetic joint infection: a systematic review. Bone Joint J. 2019 Jan;101-B(1_Supple_A):19-24.
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How to Cite this article: Mohanty S S, Keny S A. Peri-proshthetic Joint Infection. Journal of Clinical Orthopaedics July-Dec 2019;4(2):45-50.

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Prosthetic Joint Infection – How to Deal with it Rationally

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Vol 2 | Issue 2 |  July – Dec 2017 | Page 11-15 | Shantanu Patil, Anshu Shekhar, Sachin Tapasvi

Authors: Shantanu Patil [1], Anshu Shekhar [2], Sachin Tapasvi [2].

[1] Department of Translational Medicine and Research, Kattankulathur Campus, SRM University, India.
[2] The Orthopedic Speciality Clinic, Pune, India.

Address of Correspondence
Dr Shantanu Patil
Department of Translational Medicine and Research,
Kattankulathur Campus, SRM University, India
Email: shantanusp@gmail.com

Abstract

Prosthetic Joint Infection is a devastating complication both for the patient and the surgeon. It depends on many factors including patient factors, surgeon factors, surgery set up. The most important factor in management of PJI is to take care of all modifiable factors that can bring down the rate of infection. One of the critical steps is in prevention of surgical site infections and raising awareness among the surgeons and patients about the role of various screening procedures and avoiding indiscriminate antibiotic abuse. Management option includes one stage or two stage exchange arthroplasty, but the success rates are less than 90%. At times salvage surgeries like fusion, excision arthroplasty or amputation may also be needed. The present article overviews the prevention and management of PJI
Keywords: Prosthetic Joint Infection, arthroplasty, revision, salvage

References

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How to Cite this article: Patil S, Shekhar A, Tapasvi S. Prosthetic Joint Infection – How to deal with it Rationally. Journal of Clinical Orthopaedics July-Dec 2017; 2(2):11-15

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