Restoration of the joint line of the knee is an important technical goal of a total knee arthroplasty. Failure to restore the joint line of the knee to anatomical position can lead to mid-flexion instability, a reduction in range of motion, impingement of the patellar tendon against the tibial tray, and gap imbalance. The presence and integrity of bone and soft tissue landmarks makes restoration of the joint line Successful. Restoration of the joint line both difficult and unreliable especially in revision TKA, where the necessary landmarks are often missing or obscured. Numerous methods, ranging from relative references, to absolute distances have been described for joint line restoration, yet a lack of consensus remains. The aim this study was to determine a reproducible, quantitative relationship between position of joint line and identifiable anatomical landmarks in Indian population after studying randomly selected Indian population. Results of our study indicate that Femoral diameters are statistically different for Sexes while Tibial diameters are not, IMD is 1.75 times LFJL,CTD is 2.7 times PTFJL, PCO is more important in predicting range of motion in TKA. PCJL:FD and IED:LEJL are also significant.
Acute Compartment Syndrome is a limb-threatening emergency and it occurs most commonly after fractures. The aim of our study is to find out the effectiveness of serial measurement of differential pressure in closed tibial diaphyseal fractures, in diagnosing acute compartment syndrome, using Whiteside’s technique. A total of 52 cases in the age group of 15 to 55 years admitted with closed fractures were studied for serial compartment pressure as well as serial differential pressure. Eight patients had persistent compartment pressure > 40mmHg, out of which only two patients had persistent differential pressure < 30mmHg and these two patients underwent fasciotomy. Thus, by measuring the compartment pressure serially and calculating differential pressure serially, acute compartment syndrome can be diagnosed or ruled out with higher precision, so that unnecessary fasciotomies can be avoided.
Introduction: Osteoarthritis (OA) knee is the most common debilitating degenerative disorder beyond age 60 seeking medical attention for disabling pain and progressive reduction of joint movements and functional limitation. Conservative and rehabilitative measures remain the mainstay for early stages. In the recent years, intra articular injections particularly steroids and viscosupplementation are increasingly used for early stage management and have raised concerns about their efficacy. Various studies have claimed that intra-articular viscosupplementation with Hyaluronic acid (HA), specially hylan G-F 20 appeared to be safe, effective in pain relief and improved functional outcomes. Having this hypothesis, we wanted to analyze in detail by using various outcome scores (VAS, WOMAC, SF-36) and compare it with the steroids (methyl prednisolone acetate). Materials and methods: After the institutional review board clearance, this study was conducted as a randomized, prospective study between July 2012 and April 2015. Patients of both sexes beyond age 40 with symptomatic knee OA demonstrating radiological evidence of arthritis [Kellgren-Lawrence (K-L) grade of less than III were randomized into two groups. Patients in the steroid group (group 1, MPG) were subjected to two sittings of intra-articular 6-Methylprednisolone acetate 40mg each (day 0 and day 7). Patients in viscosupplementation group (group 2, HG) were given a single intra-articular injection of hylan G-F 20. Both groups were given standard physiotherapy regimen post-injection. We used the following parameters to measure outcome, 1) 100 mm visual analog pain scale (VAS), 2) Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), 3) SF-36 health survey and 4) Range of motion (ROM) to document the baseline characteristics and subsequent follow ups at 2 nd , 4 th , 12 th , 24 th and 52 nd week. Results: Among the 68 enrolled patients, no statistically significant differences were found regarding demographic patterns and the baseline outcome scores of patients between two groups. The mean age, grade and duration at presentation among the two groups were 56.57 /59.83 years, grade 2 and 3.4 / 3.8 years respectively. At 54 weeks, HG group had a mean ROM of 126.93 o compared to 120.83 o in the MPG group (p=0.001). Regarding VAS, better pain relief (24.80) was noted in the MPG during early period (<3 weeks) as against the HG (67.10). However, reversal of results was noted in the later period (>3 months) with the VAS scores doing significantly better in the HG group (18.67) as against MPG (61.18). In the HG group, WOMAC scores revealed a delayed (>4 weeks) onset of improvement, with plateau formation at 6 th month (28.43). Early improved WOMAC scores in the MPG showed a decreasing trend reaching pre-injection baseline level (55.93) within 3 months. Post-treatment SF-36 health survey at final follow-up revealed that, patients in hylan group showed greater improvement of mean score from baseline in all 8 functional categories compared to cort...
Introduction:The posterior inclination of the tibial plateau relative to the longitudinal axis of tibia is referred to as the posterior tibial slope (PTS). There is paucity of data regarding PTS in Indian population. Metaphysio-diaphyseal angle (MDA) is the angle between longitudinal axis of tibia and proximal tibial metaphysis, a new entity with a possible clinical significance. This study was performed to determine the mean PTS and mean MDA to study the correlation of PTS and MDA changes with osteoarthritic degeneration in Indian population and to assess the sensitivity and specificity of PTS and MDA in detecting osteoarthritis. A descriptive, cross-sectional study design was followed. Materials and methods: A total of 173 X-rays with true PA and lateral views were examined from 121 individuals using standardized technique. Osteoarthritis was classified based on Ahlback grading system. Posterior tibial slope was defined as the angle formed by two lines in the lateral knee radiograph. Metaphysio-diaphyseal angle is a new entity defined in this study, formed between two lines-first line is the proximal anatomical axis of the tibia and the second is the axis of the proximal tibial metaphysis. All the observations and measurements of PTS and MDA were statistically analyzed using MedCalc software. Results: There were 121 individuals in the study with 91 osteoarthritic knees and 82 normal knees. The mean PTS among normal group is 9.69° [range 5-13° with standard deviation (SD) 1.81] and among arthritic group is 14.05° (range 10-24° with SD 2.38). The mean MDA among normal group is 19.87° (range 15-30° with SD 2.70) and among arthritic group is 25.03° (range 19-34° with SD 3.05). There is a moderate correlation between PTS and MDA (r = 0.64). Sensitivity and specificity in detecting osteoarthritis with PTS is 96.7% and 85.4% and by MDA is 90.1% and 84.7%, respectively. Conclusion:Our study finds that native PTS is similar to that of oriental population but higher than that of Caucasians. There is moderate linear correlation between PTS and MDA. They also serve as a marker in detecting osteoarthritis with good sensitivity and specificity.
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