Background: Osteonecrosis, also referred to as avascular necrosis (AVN), aseptic necrosis, and ischemic necrosis, is not a specific disease but rather a condition in which a circumscribed area of bone becomes necrotic as a result of a loss of its blood supply. The femoral head is the site most often affected. A number of procedures have been described to accomplish this. Total hip replacement is a reconstructive surgical procedure that provides stability, better quality of life and mobility in patients suffering from hip disorders thus eliminates pain and restore functions of hip. In hip arthroplasty, the acetabulum, femoral head and proximal neck is replaced with metal shell, plastic liner and metal ball. Purpose: To evaluate the clinical, functional, radiological outcome and the complications of uncemented total hip replacement in avascular necrosis of femoral head in adults. Materials and Methods: This prospective study done in the Department of Orthopaedics, Post Graduate Institute of Swasthiyog Prathistan, Miraj, from February 2013 to February 2014. We included the patients of avascular necrosis of femoral head, in the age group of 30 to 60 years. Results: 36 hips of 30 patients with avascular necrosis of femur head who underwent uncemented Total Hip Replacement admitted during above period after evaluating clinically and radiologically Harris Hip Score was used to measure the functional outcome. 36.11 % of the patients were found to be in the 50 and above age group, with age ranging from 30 to 60 years and a mean age of 43.8 years. Majority, 27 (75%) were males and 9 (25%) were females. Excellent or good pain relived and function were obtained in 86.01%. The mean total preoperative score was 34.61, which improved postoperatively to a mean score of 90.83. In the scoring system ie, pain, gait, functional activity and ROM, there was a statistically significant improvement ('p' value of <0.001) in the postoperative score when compared to preoperative score.
Conclusion:The outcome of uncemented total hip replacement done in cases of avascular necrosis of femoral head most of them who are in stage 3 and 4 of Ficat and Arlet classification in adults is determined by multiple factors, including the design of the component, the selection of the patients, and the operative technique.
Background: The line joining the iliac crest superiorly and posteriorly is known as Intercrestal line.Various studies described that it crosses in the midline at L4-L5 intervertebral disc space level. Relationship of spinal level on palpation and imaging the iliac crest intercrestal line is not the same in particular the L4-L5 interspace. Purpose: The purpose of this study is to compare the spinal level identified through palpation and imaging the iliac crest intercrestal line in adults. Materials and Methods: Patients included low back pain undergoing epidural steroid injection at RL Jalappa Hospital and Research Center, between October 2018 to January 2019. Iliac crest posteriosuperiorly was palpated by the authors and the intercrestal line was drawn, then followed by imaging, the level of the spine in the midline identified and were recorded and compared. Results: Our study shows that on palpation the L3-4 spinal level in 27 patients (48.2%) and L4 spinal level in 22 patients (39.2%) whereas on imaging the L4 spinal level in 33 patients (58.9%) and L4-5 spinal levels in 21 patients (37.5%), the intercrestal line formed through palpation tended to identify higher levels. On both methods the same level observed in 10.7% (6 patients) only.
Conclusion:Palpation and imaging method of iliac crest intercrestal line are the two methods to identify the spinal level. Clinically, the palpation of the intercrestal line to identify the L3-4 and L4 spinal levels rather than the L4 or L4-5 levels, particularly in patients with high BMI (body mass indices).
Introduction: Pain in the cervical region is one of the major orthopaedic problem. It causes unhappiness to surgeon and patient both. This study is to analyse the different non-operative treatment modalities for the cervical pain. Purpose of the study: To compare the clinical outcome of cervical spondylosis treated with different non-operative methods. Methods: The study conducted between October 2018 to April 2019 involve patients with cervical pain visiting orthopaedic OPD. Patients were divided into 3 groups involving a) Neck muscle strengthening exercises (NMS) b) Pharmacological regime c) Combined muscle strengthening and drug regime (CMD).Results: On analysis of results with 90 patients each in group a, b, and c, the patient relief was higher in group c planned for CMD regime followed by group b and group a in decreasing order of response rate. Conclusion: Neck pain being one of the very common disease and its nonresponse to treatment is the reason not to trust the doctor by the patient. We concluded that among the different methods, combined muscle strength and drug regime given best results in majority of cases. And also this CMD regime is easy to follow and cheap compared to other nonoperative treatment modalities.
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