Introduction: Total knee arthroplasty is one of the most successful orthopedic surgeries performed in recent decades. However, there are controversies regarding the simultaneous or staged bilateral total knee arthroplasty. The aim of this study is to find the prevalence of bilateral total knee arthroplasty in elderly patients among severe osteoarthritis of knee joints in a tertiary care hospital. Methods: This is a descriptive cross-sectional study conducted from hospital records of 2015 to 2019 in elderly patients with severe osteoarthritis in a Tertiary Care Hospital. Ethical clearance (20/2020) was taken from Institutional Review Board. Convenience sampling was used and statistical analyses were performed using the Statistical Package for the Social Sciences software (version 16.0). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Out of 1200 patients with severe osteoarthritis, the prevalence of bilateral total knee arthroplasty was found to be 80 (6.67%) (95% Confidence Interval = 6.60-6.74). The mean Knee Society Score was 36±3.70 preoperatively. There were 21 (26.2%) patients having hypertension, 17 (21.2%) diabetes mellitus, 14 (17.5%) chronic obstructive pulmonary disease and 7 (8.7%) coronary artery disease. Conclusions: Bilateral simultaneous total knee arthroplasty was required in less patients with severe osteoarthritis of knee joints. Bilateral simultaneous total knee arthroplasty is safe, convenient, effective with early functional recovery, higher patient satisfaction and cost effective with acceptable cardiac, pulmonary and neurological complications in properly selected patients.
The management of displaced, intra-articular calcaneal fracture represents a surgical challenge to even an experienced orthopedic surgeon. Plate osteosynthesis using an extended lateral approach is complicated by soft tissue problems, while those treated by closed reduction and percutaneous pinning cannot address all the intra-articular fragments sufficiently. The objective of our study is to evaluate restoration of subtalar joint and long-term functional outcomes in intra-articular displaced calcaneal fractures treated with transverse subcondral screws through a small incision on lateral aspect of calcaneus and percutaneously placed axial screws through the calcaneal tuberosity. Forty-five intra-articular calcaneal fractures were managed with this minimally invasive technique. Calcaneal height, width, length, Bohler's angle, and Gissane angle were measured preoperatively and last follow-up visit. Functional outcomes were assessed on the basis of American Orthopedic Foot and Ankle Society (AOFAS) ankle/hind foot score. Preoperative calcaneal length, height, width, Bohler's angle, and Gissane angle were improved from 68.62 ± 2.64 to 72.44 ± 2.63 mm, 39.28 ± 2.72 to 32.37 ± 2.65 mm, 47.04 ± 2.56 to 49.55 ± 2.45 mm, 12.66° ± 2.86° to 26.93° ± 2.57°, 123.91° ± 3.13° to 96.06° ± 3.92°, respectively, after surgery with P value <0.001. There were 21 (46.7%) excellent, 17 (37.8%) good, 4 (8.8%) fair, and 3 (6.7%) poor outcomes based on AOFAS ankle/hindfoot scores. Time to unite the fracture was 11.06 ± 1.82 weeks (range 8-16 weeks), and all fractures were united without major complications. Minimally invasive technique through a small incision on lateral aspect of calcaneus gives a moderately good exposure for anatomical restoration of Sander's type II and III calcaneal fractures fixed with both transverse and axial screws under fluoroscopic guidance.
Introduction: Total hip arthroplasty (THA) is a well-established procedure for advanced arthritis of the hip joint. It significantly improves the quality of life by relieving pain and improving functional disability. The objective of this study was to evaluate the clinical and functional outcome of primary total hip arthroplasty using the Harris Hip Score. Method: Prospective study was conducted in Civil Service Hospital. Out of 145 THA performed from Jan 2014 to Dec 2018, the first 100 cases that fulfilled the inclusion criteria were analyzed. Patient demographic and site, operative indication, and pre-operative Harris Hip Score was documented. Operative time, total intraoperative blood loss, and complications were noted. Patients were followed in 3 weeks, 6 weeks, 3 months, 6 months, and yearly. In each visit, clinical evaluation using Harris Hip Score and radiological evaluation was done and documented. The duration of follow up ranged from 12 months to 4.5 years. Results: Age varied from 21 to 75 years, 59% were male and 41% female, right side involvement was seen in 55% and left side in 45%. The major indication for surgery was avascular necrosis 46% and primary osteoarthritis in 24%. The average operative time was 65 minutes and the average intraoperative blood loss was 655 ml. Pre-operative Harris Hip Score ranged from 25 to 59 with a mean of 45.5. The mean Harris hip score in last follow up increased to 90.5 with a minimum of 76 and a maximum of 97. Our study found that 85% had excellent, 9% had good and 6% had fair results. Complications include 2% dislocation, 1% infection, 1% greater trochanter avulsion and 1% screw irritation. Conclusion: Primary THA is a safe and effective procedure. It improves pain and function hence improving the activity of daily living and has fewer complications.
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