Osteoarthritis of the knee is a complex peripheral joint disorder with multiple risk factors. The molecular basis of osteoarthritis has been generally accepted; however, the exact pathogenesis is still not known. Management of patients with osteoarthritis involves a comprehensive history, thorough physical examination and appropriate radiological investigation. The relative slow progress in the disease allows a stepwise algorithmic approach in treatment. Non-surgical treatment involves patient education, lifestyle modification and the use of orthotic devises. These can be achieved in the community. Surgical options include joint sparing procedures such as arthroscopyando osteotomy or joint-replacing procedures. Joint-replacing procedures can be isolated to a single compartment such as patellofemoral arthroplasty or unicompartmental knee replacement or total knee arthroplasty. The key to a successful long-term outcome is optimal patient selection, preoperative counselling and good surgical technique.

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Objective: To assess the frequency of anatomical variations of the extra-hepatic biliary tract in patients undergoing laparoscopic cholecystectomy in Combined Military Hospital & Pak Emirates Military Hospital Rawalpindi. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital & Pak Emirates Military Hospital, Rawalpindi, from Mar to Aug 2017. Methodology: A total of 136 patients of either gender with cholelithiasis of more than one month were included. Participants were distributed into equal number of groups for both hospitals by lottery method. All the participants had under gone laparoscopic cholecystectomy by consultant general surgeon or senior registrar under direct supervision. Structures mainly assessed for variations were gall bladder, cystic duct, common hepatic duct, supraduodenal part of common bile duct, cystic artery, and hepatic artery which were characteristically encountered during laparoscopy. Results: Overall Extra hepatic biliary variations were 136 (23%), at Combined Military Hospital 68 (16%) and Pak Emirates Military Hospital 68 (29.4%). Gall bladder anomaly was seen in 3% patients, cystic duct anomaly 4.4%, supraduodenal part of common bile duct anomaly 0.7%, cystic artery anomaly 11% and hepatic artery anomaly was seen in 3.6% patients (p>0.05). Conclusion:  Anatomic variations were found to be not uncommon in our set up. Thus, there is a need for doctors to continuously refresh knowledge of normal anatomy and the variants of biliary tract.