The aim of this study was to evaluate the effect of a single immediate postoperative instillation of 10 mL of sodium hyaluronate (Viscoseal) into the knee following arthroscopy. A single-center, prospective, randomized, controlled study was undertaken. Consenting knee arthroscopy patients were randomized into two groups following surgery: the study group received 10 mL of sodium hyaluronate intra-articularly, while the control group received an intra-articular instillation of 10 mL of Bupivacaine. Pre- and postoperative visual analogue scale scores for pain and Western Ontario and McMaster Universities (WOMAC) scores for knee function were obtained. Overall, 48 patients under the care of a single surgeon were randomized into two groups of 24. There were no statistically significant demographic differences at baseline. Three patients were lost to follow-up. There was a statistically significant difference in pain scores favoring the study group compared with the control group at 3 and 6 weeks postoperatively (p < 0.05), and a statistically significant difference in WOMAC scores favoring the study group compared with the control group at 3 and 6 weeks postoperatively (p = 0.01). Synovial fluid replacement with sodium hyaluronate following arthroscopic knee surgery conferred statistically significant improvements in pain and function scores compared with Bupivacaine in the short term (3-6 weeks).
This case illustrates the association between spinal and peripheral vascular malformations, and that this association is not always metameric. It highlights the fact that invasive procedures other than surgery are a valuable part of the therapeutic armamentarium.
A case report of bilateral acute septic arthritis of knees is presented, which was managed with staged total knee replacements for both knees. A literature review on septic arthritis treated with knee arthroplasty is also presented.
Introduction Obesity affects an increasing proportion of orthopaedic patients. Arthroplasties on this sub-population are associated with increased complications(anatomical issues to peri-operative complications/infection). It is postulated patients with increased BMI have longer inpatient stay. Is this the case in our elective orthopaedic department at Fairfield General Hospital? Is there a basis to implement a BMI cut-off for arthroplasties? Method A single centre case-control study in our elective unit including patients who had primary total hip and knee arthroplasties (unicompartmental knee arthroplasties were excluded). Patients were analysed over a 3-month period(January 2019 – March 2019) collating data including their BMI, date of procedure, and discharge date. Results 227 patients included with BMI ranging from 14.4 to 57.6 Inpatient days for the separate BMI classes : Pearson’s correlation coefficient R = 0.134 - a weakly positive correlation between BMI and inpatient stay. Conclusions Interestingly, these results suggest there is no basis to implement a cut-off value for BMI. Further research would be useful, detailing the pre-operative, intra-operative and post-operative issues those with an increased BMI may face. Further research would be useful, detailing the pre-operative, intra-operative and post-operative issues those with an increased BMI may face.
A 24-year-old female was referred to the Manchester Royal Infirmary, where she was diagnosed to have familial adenomatous polyposis. Over the next eight years, she was kept under endoscopic surveillance and underwent colonoscopicpolypectomy on twelve occasions. Restorative polypectomy was performed as a two-stage procedure when she was 32 years old. A total colectomy, mucosal proctectomy and formation of an ileal reservoir was carried out with a proximal defunctioning ileostomy. The surgeon attempted to preserve 2 cm of rectum and to excise the mucosa from this down to the anorectal junction. The apex of the ileal pouch was sutured to the anorectal junction. The temporary ileostomy was closed four months later.Five years after surgery, the patient presented with rectal bleeding and discomfort. Endoscopy showed a normal healthy pouch with two polyps at the ileo-anal anastomosis. One week later, transanalpolypectomy was performed under general anesthesia. Three polyps were excised, and histological examination proved them to be dysplastic tubulovillousadenomata. There was no evidence of malignancy. The patient made an uneventful postoperative recovery but remains under long-term surveillance. DiscussionFamilial adenomatous polyposis is a hereditary disorder usually transmitted as a mendelian dominant. The cardinal feature is the development of numerous adenomatous polyps throughout the lower gastrointestinal tract. Since each of the polyps appears to share the predisposition to malignancy, colorectal carcinoma is almost inevitable, usually appearing about 15 years after the development of adenomatosis.Adenomatosis develops during late childhood, may be symptomless for many years, and it is not unusual for the presenting features to be caused by the development of one or more carcinomas. Presentation is usually in early adulthood with a change in bowel habit and passage ofblood or mucus per rectum. Diagnosis is based on clinical findings, barium contrast examination and endoscopic evaluation. It is the risk of malignant transformation that necessitates the removal of all colonic mucosa.The first recorded operation for polyposis was carried out in 1918. Since then, there have been changes in the management of the disease. The basic principle, however, remains the prevention of colorectal carcinoma, either by removing all diseased tissue or excising the colon and monitoring the rectal remnant. Panproctocolectomy with a permanent ileostomy was one of the first operations performed, and is still in use today. It has the advantage of removing all the diseased tissue as a one-stage procedure, entirely eliminating the risk of cancer. Patients are able to return to normal activity within six to ten weeks of the procedure.1 The big drawback is the loss of perineal fecal continence and the presence of a permanent stoma.Mayo and Wakefield described the now favored subtotal colectomy with ileorectal anastomosis in 1936. 2 This operation in experienced hands has a very low operative morbidity and mortality. Fecal continence, an...
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