BackgroundAn accelerometer-based handheld navigation system (HHNS) for total knee arthroplasty (TKA) does not require a large console needed for computer-assisted navigation systems and has been shown to decrease component malalignment in TKA. The study aimed to use HHNS with conventional instrumentation to compare the radiological evaluation and functional outcomes of TKA. Materials and methodsThis was a multi-surgeon, prospective, assessor-blinded comparative study of 122 patients undergoing unilateral TKA. We used a stratified randomized sampling method to select 35/48 patients undergoing TKA using a handheld navigation system and 35/74 patients undergoing TKA using conventional instrumentation and divided them into two groups: the HHNS group and (conventional) CONV group. Postoperative radiographic evaluation was based on the tibial and femoral alignment angle, posterior tibial slope, and tibiofemoral angle measured from full-length lower-limb anteroposterior and lateral views of the knee. The Oxford Knee Score (OKS) and Knee Society Score (KSS) with a two-year serial follow-up were used to evaluate functional outcomes. ResultsThe mean tibial alignment angle and posterior tibial slope were 0.78° ± 1.27° and 4.38° ± 0.86°, respectively, in the HHNS cohort and 2.63° ± 1.54° and 2.12° ± 1.82°, respectively, in the CONV group (p < 0.001). There was no significant difference in the femoral alignment angles. The overall alignment using the mean tibiofemoral angle was 179.21° ± 1.82° in the HHNS group and 177.31° ± 2.18° in the CONV group (p = 0.002). There were no significant differences in the KSS and OKS at the two-year follow-up between the groups. ConclusionsThe use of HHNS in TKA significantly increased accuracy in limb and implant alignment, but there was no significant difference in the two-years functional outcomes.
Intertrochanteric fractures are one of the most common injuries sustained predominantly in patients over 60 years of age. They are 3 or 4 times more common in elderly women who are osteoporotic, in whom trivial trauma is the most common mode of injury. A total of 98 patients of intertrochanteric fractures of the femur were operated during this period in our institute. Among these patients, 26 patients died after surgery and did not follow up and were not included in this study. The rest of the patients were not traceable via telephone, some even by home visitations by us due to difficulty in tracing certain home addresses. Patients who were followed up for upto 6 months to 1 year were included in this study. All patients were in Sahlstrand's Grade 1 walking ability before trauma. Post-op walking ability in this study shows 60%PFN patients walking without support with 33.3% DHS patients walking without support and 66.7% patients of DHS walking with cane and 13.3% patients of PFN needing 2 canes or walker postoperatively measured at 6 months post-op. It was found that proximal femoral nailing had better functional outcome in patients with especially unstable fractures and DHS had better functional outcome among the stable fractures.
Background: On undisplaced scaphoid fractures treated with prolonged cast immobilisation may result in temporary joint stiffness and muscle weakness in addition to a delay in return to sports or work. Fixation of scaphoid fractures with a percutaneous screw has resulted in a shorter time to union and to return to work or sports. The purpose of this study was to evaluate the results of percutaneous screw fixation scaphoid fractures with respect to time to radiographic union and to return to work. Materials and Methods: In 20 patients with fracture of the scaphoid, fixation with a percutaneous screw was done. Time to fracture union, wrist motion, grip strength and return to work as well as overall patient satisfaction at the time of a two-year follow-up were evaluated. Results: Of the 20 patients in the study, mean radiological fracture union time was 12.2 weeks (range 8-15 weeks). Wrist function was excellent in 10 cases, good in remaining 6 cases and poor in 4 cases. Conclusion:Percutaneous herbert screw fixation is a well-documented surgical procedure. Undisplaced scaphoid fractures fixed by percutaneous headless screw fixation yield better results than patients treated conservatively. Good range of motion is achieved after fixation. It relieves pain and functional disability experienced by patients. Percutaneous screw fixation of scaphoid fractures resulted in faster radiographic union and return to function. The specific indications for and the risks and benefits of percutaneous screw fixation of such fractures must be determined in larger randomised prospective studies.
Introduction Total Knee Arthroplasty (TKA) can be associated with significant peri- and post-operative blood loss necessitating blood transfusion. The blood loss may be relatively less when the accelerometer-based handheld navigation system (HHNS) is used, as there is neither a need for intramedullary breach nor additional pin insertions. The primary hypothesis was that HHNS instrumentation reduced perioperative blood loss when compared with conventional instrumentation, and to prove this, we compared the perioperative parameters like tourniquet time, hemoglobin loss, and estimated blood loss between patients undergoing total knee arthroplasty using conventional instrumentation with handheld navigation instrumentation. Methods This prospective comparative study involves 40 patients in the HHNS group and 40 patients in the conventional group based on the instrumentation used, respectively. Tourniquet was used in all the cases. Patient characteristics like age, sex, body mass index (BMI), American Society of Anaesthesiologists (ASA) grade, and Charlson Comorbidity Index (CCI) were recorded. The perioperative parameters like tourniquet time, the estimated blood loss, hemoglobin loss, blood transfusions, and the number of units transfused were recorded and compared between the groups. Results There was no significant difference in age, BMI, ASA grade, or CCI between the two groups. The tourniquet time was 83.7 ± 9.6 in the navigation and 73.9 ± 10.3 in the conventional group. The estimated Hb loss was lower at 2.5 ± 1.6 in the HHNS group compared to 3.0 ± 1.8 in the conventional group (p<0.001). Similarly, estimated blood loss was also lower at 830 ± 285ml for the HHNS group compared to 1088 ± 228 in the conventional group. Two patients in the navigation group had a total of four units transfused, whereas three patients in the conventional group had five units of blood transfusion. Conclusions The primary hypothesis that HHNS reduced perioperative blood loss was confirmed by the results of our study. We demonstrated that HHNS instrumentation significantly decreased the estimated blood loss, drain volume, and hemoglobin loss compared to conventional instrumentation with similar operating times. Though blood transfusions were seen in fewer patients, there was no significant reduction in blood transfusions by HHNS instrumentation.
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