We have assessed the oncological and functional results of limb salvage surgery using a custom-made endoprosthetic replacement in six patients (mean age 17 years) with distal tibial osteosarcoma (stage IIB). A wide margin excision was possible in three, marginal in two and contaminated in one. Skeletal reconstruction was performed using a locally designed and manufactured custom-made distal tibial and ankle replacement prosthesis. Two patients developed local recurrence and one necrosis of the flap and deep infection. In three in whom the prosthesis remained in place the mean functional score according to the rating system of the Musculoskeletal Tumour Society was 24.3/30. In carefully selected patients limb salvage with prosthetic replacement is possible for distal tibial osteosarcomas.

The local treatment of pathological fracture in patients with a primary osteosarcoma remains controversial. In this paper we report the oncological outcome of the treatment of pathological fractures in 18 patients suffering from this disease. There were ten male and eight female patients, and the average age at diagnosis was 17 years. All patients received adjuvant chemotherapy. Wide resections were performed in 17, but in one there was 'contamination' of the margins of the excision. Skeletal reconstruction was performed with a locally designed and manufactured custom 'mega' prosthesis. The average follow-up was 33 months (range: 12-93 months), and 14 patients were alive on completion of the study. Local recurrence appeared in two patients, while three developed pulmonary metastases.Résumé Le traitement local des patients ayant une fracture pathologique due à un ostéosarcome primaire reste sujet à controverse. Nous avons fait une étude sur le résultat oncologique de la chirurgie conservatrice chez 18 patients d'un âge moyen de 17 ans lors du diagnostic ayant des fractures pathologiques d'ostéosarcome. Tous les patients avaient subi d'une chimiothérapie adjuvante. Les marges de résection étaient larges chez 17 patients et contaminées chez un patient. La reconstruction squelettique a été accomplie avec des prothèses faites sur mesures conçues et fabriquées localement. Le suivi moyen a duré 33 mois (entre 12 et 93 mois). Quatorze patients étaient vivants à la fin de cette étude. La récidive locale s'est manifestée chez deux patients alors que trois patients ont été atteints de métastase pulmonaire.

We recruited 89 patients who had hip or knee replacements to assess the performance of below-knee graded compression stockings. The pressure gradients generated by the stockings were measured and all patients had venography of the ipsilateral leg. We found that 98% of stockings failed to produce the 'ideal' pressure gradient (+/- 20%) of 18, 14 and 8 mmHg from the ankle to the knee, while 54% produced a 'reversed gradient' on at least one occasion during the course of the study. The overall rate of deep-venous thrombosis was 16.7%. Stockings which produced reversed gradients were associated with a significantly higher incidence of deep-venous thrombosis (p = 0.026) than those with the correct gradient (25.6% v 6.1%). This suggests that the performance of graded compression stockings can be improved if reversed pressure gradients are detected and prevented.

A 66-year-old woman presented with a 6-week history of an indolent ulcerating lesion on the anterior chest wall. She had a past medical history of pulmonary tuberculosis which had been treated successfully in 1947. Biopsy of the ulcer showed granulomas and acid-fast bacilli. Cultures grew Mycobacterium tuberculosis, sensitive to all antituberculous drugs. After 7 months of treatment with isoniazid and rifampicin, there was little sign of healing. A sinogram showed a fistula leading into the plombage mass in the left upper lobe. Surgery to remove the plombage and excise the fistula was planned but was rejected by the patient as the risks of this operation are considerable. With continued antituberculous medication the discharge has reduced although the ulcer has not healed.

We recruited 89 patients who had hip or knee replacements to assess the performance of below-knee graded compression stockings. The pressure gradients generated by the stockings were measured and all patients had venography of the ipsilateral leg.We found that 98% of stockings failed to produce the 'ideal' pressure gradient (± 20%) of 18, 14 and 8 mmHg from the ankle to the knee, while 54% produced a 'reversed gradient' on at least one occasion during the course of the study. The overall rate of deep-venous thrombosis was 16.7%. Stockings which produced reversed gradients were associated with a significantly higher incidence of deep-venous thrombosis (p = 0.026) than those with the correct gradient (25.6% v 6.1%). This suggests that the performance of graded compression stockings can be improved if reversed pressure gradients are detected and prevented.

A 66-year-old woman presented with a 6-week history of an indolent ulcerating lesion on the anterior chest wall. She had a past medical history of pulmonary tuberculosis which had been treated successfully in 1947. Biopsy of the ulcer showed granulomas and acid-fast bacilli. Cultures grew Mycobacterium tuberculosis, sensitive to all antituberculous drugs. After 7 months of treatment with isoniazid and rifampicin, there was little sign of healing. A sinogram showed a fistula leading into the plombage mass in the left upper lobe. Surgery to remove the plombage and excise the fistula was planned but was rejected by the patient as the risks of this operation are considerable. With continued antituberculous medication the discharge has reduced although the ulcer has not healed.

Study design: A prospective observational study. Objectives: To compare the height and arm span measurements in childhood spinal cord injured (SCI) people and examine the subsequent effect on calculating the predicted lung function using standard formulae and to discuss which of the two measurements is the most appropriate to use in these formulae. Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. Method: A total of 12 children had lung function tests performed and at the same time had height and armspan measured. The predicted lung function was calculated twice; once using height and then using arm span and compared. The actual lung function test results were expressed as percentage of the two predicted values, respectively, and compared. Results: The difference between the mean height (1499 mm) and arm span (1649 mm) measurements was significant (Po0.001). In all cases, the arm span measurement was greater than the height. The two predicted lung function values (one calculated using height and the other armspan) were significantly different (Po0.001). When lung function test results were expressed as percentage of the two predicted values they gave a very different interpretation of the results. The actual performance was much lower than the predicted values if arm span, rather than height, was used in prediction equations. Conclusion: In childhood SCI, the difference in height and arm span is significant. This affects the predicted lung function values significantly and thus changes the interpretation of the lung function test results. The most appropriate measurement to use in prediction equations (height or arm span) in these subjects is yet to be decided.

Background and objective Patient-reported outcome measures continue to play an important role in assessing the performance and determining the comparative effectiveness of total knee arthroplasty. Patient's satisfaction can be influenced by many factors, such as, residual pain, postoperative functionality, and the presence of postoperative complications and hence we evaluated clinical and functional outcomes following total knee arthroplasty. This study was conducted to bust the myth of postoperative pain and disability following a total knee replacement. Materials and methods A prospective observational cohort study was conducted among the patients who underwent primary total knee arthroplasty in the Department of Orthopaedics in the Sundaram Medical Foundation during the study period of March 2017 and January 2018. A total of 30 cases were included. During their follow-up, patient's outcomes were assessed using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and American Knee Society Scores (AKSS). Data were analyzed using SPSS v.17. Results At the end of 6 months, 76.7% of participants were satisfied with their outcome. Significant improvement was noted in both clinical (p = 0.000) and functional outcome (p = 0.000) of AKSS and total WOMAC scores (p = 0.007) during the follow-up at the sixth month. Also, there was a significant difference in AKSS scores noted with respect to age but other parameters like duration of illness and type of arthritis were not significant. Conclusion The majority of study subjects were satisfied with the clinical and functional outcome based on WOMAC and AKSS, which in turn encouraged them to undergo total knee replacement of the other knee. Clinical significance From our study, we could determine the importance of patient- and clinician-reported outcome measures in predicting the satisfaction of the patient following total knee replacement. Assessment of a patient planned for total knee replacement, with the outcome scores both preoperatively and postoperatively will give us a brief idea on how better the patient will fair following surgery and will also help us in the rehabilitation of the patient accordingly. How to cite this article Venkatesan AS, Jayasankar P, Williams S. An Assessment of Clinical and Functional Outcomes in the Patients Undergoing Total Knee Arthroplasty during Postoperative Period. J Orth Joint Surg 2020;2(2):57–61.