Indian Journal of Orthopaedics最新文献

Background: Periprosthetic fractures (PPFs) remain a serious complication following total hip arthroplasty (THA), contributing to increased morbidity and healthcare costs. Femoral stem design, particularly the presence of a collar, has been hypothesized to enhance axial stability and reduce micromotion, potentially lowering the risk of PPFs. This retrospective cohort study aimed to compare outcomes between collared and non-collared femoral stems in cementless THA.

Methods: We retrospectively analyzed 618 patients who underwent cementless THA between January 2014 and December 2024. Patients were stratified into two groups based on femoral stem design: collared (n = 308) and non-collared (n = 310). Baseline demographics, comorbidities (Charlson Comorbidity Index), fixation method, stem alignment, and complications were recorded. Periprosthetic fractures were classified using the Vancouver system, and radiological findings were evaluated across Gruen zones. Follow-up outcomes included stem subsidence, alignment, and radiographic changes.

Results: The collared stem group showed a significantly lower incidence of PPFs (0.97% vs. 3.87%, p = 0.033) and reduced stem subsidence (0.54 mm vs. 0.83 mm, p < 0.001). Radiographic analysis demonstrated improved neutral alignment (p < 0.001), fewer varus (p = 0.009) and valgus alignments (p = 0.021), and less cortical hypertrophy (p = 0.021) in collared stems. Reactive lines were more frequent in the collared group (p = 0.003). Hospital stay was marginally longer in this group (p = 0.012), with no significant difference in early complications.

Conclusion: Collared cementless femoral stems are associated with improved alignment, less subsidence, and a significantly lower risk of PPFs, supporting their biomechanical advantage in primary THA.

Introduction: These guidelines provide a comprehensive and practical framework for preventing osteoporosis. They are designed for use by healthcare professionals, including orthopaedic surgeons, primary care physicians, specialists, nurses, and allied health providers, as they work with patients at risk of or already diagnosed with osteoporosis.

Methodology: This iterative process involved multiple questionnaires sent to a panel of 62 osteoporosis and bone health experts. Experts, including clinicians, researchers, and academicians, were selected based on their recognised expertise and contributions to the field of osteoporosis.

Observations: There were 62 medical personnel with experience. The protocol was to get consensus from experts for each round. The set of questions was divided into six rounds. This structured Delphi methodology ensured that the resulting osteoporosis guidelines were evidence based and reflective of expert consensus, providing a robust clinical practice framework.

Results: The guidelines were put up in sections with titles as: prevention of osteoporosis, Screening for osteoporosis, diagnosing osteoporosis, calcium and vitamin D in osteoporosis, microbiome, obesity in osteoporosis, postmenopausal osteoporosis, male osteoporosis. Chronic kidney disease and osteoporosis, glucocorticoid-induced osteoporosis (GIOP), therapeutics in osteoporosis, monitoring osteoporosis therapy and osteosarcopenia. Ultimately, all the details obtained in various meetings were analysed, and responses were sought from all the participant members. All such reactions were again grouped back sequentially.

Conclusions: osteoporosis is a significant problem, and many protocols exist in the literature. These guidelines were created by consensus among experts using the Delphi method. They have been developed until current knowledge is available and may be changed in the next 5-6 years, depending on the new research accumulated by that time.

The optimal surgical treatment for lateral epicondylitis remains debated, while arthroscopic lateral release offers theoretical benefits over the traditional open approach. This study aimed to compare arthroscopic versus open technique in early and long-term outcomes. In this study, 45 patients with chronic lateral epicondylitis underwent arthroscopic (n = 23) and open lateral release (n = 22). The primary outcome was the Patient-Rated Tennis Elbow Evaluation (PRTEE) score. Secondary outcomes included the visual analog scale (VAS) for pain, Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score, time to return to work, operative time, scar satisfaction, and complications from postoperative day 1 through 12 months. Both surgical techniques significantly improved pain and function without complications at 12 months. However, the arthroscopic group demonstrated superior early outcomes. At 1 month, PRTEE scores were significantly lower in the arthroscopic group (mean 0.47 ± 0.10 vs. 0.75 ± 0.10; P < 0.05). VAS score was markedly reduced from day 1 through 1 month (P < 0.05), with a mean day 1 difference of -2.7 (95% CI -2.90 to -2.03). qDASH scores also favored arthroscopy at week 1 (mean 13.2 vs. 21.3; P < 0.05), returned to full-duty work significantly earlier (mean 2.3 vs. 12.9 weeks; P < 0.05), and reported higher scar satisfaction (mean 5.0 vs. 4.63; P < 0.05). The open technique had significantly shorter operative time (30.5 vs. 40.6 min.; P < 0.05). Both surgical techniques are effective and safe. The arthroscopic approach had significant early advantages, including reduced pain, quicker return to work, and superior cosmetic satisfaction. These findings support arthroscopic release as a preferred option for patients prioritizing early recovery and minimal invasiveness. Level of Evidence Level I.

Traumatic amputations and non-reconstructable sub-amputations with soft-tissue loss of the lower limb are highly disabling events. The calcaneus osteocutaneous fillet flap should be considered in lower leg amputations and non-reconstructable sub-amputations to preserve length and convert an above-knee amputation to a below-knee amputation without further donor site morbidity. Preserving the knee joint in an amputated limb is associated with faster rehabilitation and a quicker, more natural gait. Some complications can occur and must be appropriately managed during the postoperative days and the following months. This report presents a case of a fillet flap successfully performed in a young woman, with an extended 6-year follow-up. Three consecutive complications, i.e., osteosynthesis revision, painful saphenous nerve amputation neuroma, and surgical scar dehiscence, were successfully managed in the postoperative weeks. At 6 years from injury, the patient had a physiological gait and walked a distance of 200 m in 2 min without shortness of breath. She scored optimally (82 out of 100 points) in all the items of the Short-Form Health Survey SF-36 test (compared with the standard scores for below-knee amputated patients). She scored 63 out of 80 on the Orthotics and Prosthetics User's Survey (OPUS) test. No further revision surgery was necessary. No sensory disturbances persisted after the first year from the trauma. The patient reported occasional mood swings coinciding with episodes of phantom limb pain that continued throughout the years and needed painkillers.

Introduction: Trochanteric entry nails are the standard of care for adolescents with femoral shaft fractures. This implant was introduced in the last decade and is not widely available across all the centers. We have been using the conventional adult intramedullary interlocking nails to stabilize these fractures for more than 15 years and this study was done to analyze their outcomes.

Materials and methods: We retrospectively collected the data of all femoral shaft fractures in children less than 18 years treated with intramedullary interlocking nail between 2006 and 2020, in our institution. The time to union, union rates, and complications including avascular necrosis (AVN) were analyzed based on the serial radiographs. The final functional and radiological outcomes were also analyzed for difference between trochanteric entry and piriformis fossa entry.

Results: We had 103 children with 105 femoral fractures with an average age of 16.5 years (range 13-18 years). Piriformis entry was used in 47 and greater trochanteric (GT) entry was done in 58. The average follow-up was 18.2 months. No osteonecrosis was seen in either group. There was no significant difference in the rate of union in both groups. The incidence of heterotopic ossification was slightly higher in the trochanteric entry nailing, but not statistically significant. There was no difference in the final functional and radiological outcomes.

Conclusion: This is the first study to report the safety of usage of conventional femoral interlocking nails to treat femoral fractures in adolescents. We found that conventional interlocking nail can be safely used in adolescents.

Background: This study aimed to compare the clinical outcomes and complications of operative versus non-operative approaches in treating patients with high-grade acromioclavicular (AC) joint injuries.

Methods: A search was conducted in PubMed, Scopus, and Cochrane databases for studies published between 2007 and 2024. The search focused on studies directly comparing postoperative patient-reported outcomes, radiographic findings, and complications associated with surgical and non-surgical techniques for high-grade AC joint injuries. For dichotomous outcomes, odds ratios (ORs) were calculated, while mean differences (MDs) were computed for continuous outcomes.

Results: A total of eight studies, encompassing 473 AC joints, were analyzed. The results indicated no statistically significant differences in postoperative clinical outcomes at final follow-up between the operative and non-operative approaches. Specifically, among the seven studies reporting the Constant Score, MD was - 1.38 (95% confidence interval [CI] - 3.14 to 0.38, p = 0.12). For the Disabilities of the Arm, Shoulder, and Hand score, the MD was 1.92 (95% CI - 0.34 to 4.17, p = 0.10), indicating no statistically significant differences. Additional radiographic findings also suggested similar outcomes between the two treatment modalities.

Conclusion: The analysis revealed comparable clinical outcomes between the two approaches, demonstrating that both strategies can be considered viable options for patient management.

Introduction: CCS fixation is considered a gold standard for stabilization of displaced intracapsular fracture neck of the femur (DICNF). Recently, a minimally invasive implant has been developed for these fractures called the Femoral Neck System (FNS). Currently, there is no comparative prospective study to assess the superiority of one over the other. Thus, this study was conducted to compare the functional and radiological outcomes of DICNF managed with FNS and CCS in adults.

Materials and methods: A prospective comparative study was performed in patients between 18 and 60 years of age with DICNF managed with FNS or CCS. Thirty-four patients (n = 17 in each group) were enrolled in this study and randomized into two groups with the same inclusion and exclusion criteria. Radiological outcomes of these patients were compared in terms of union, and functional outcome was measured using Harris Hip Score at a minimum of 12 months.

Results: The mean Harris hip score in the CCS subgroup was 72.82 ± 29.34 compared to 88.82 ± 23.58 in the FNS subgroup, which was statistically significant. Intraoperative duration in the CCS group was 53.41 ± 18.94 min and in the FNS group was 38.12 ± 6.81 min, p = 0.005, there was no difference concerning union at the fracture site.

Conclusion: At 12 months of follow-up, the mean HHS was 88.82 in the FNS subgroup and 72.82 in the CCS subgroup where the difference was statistically significant. The mean operating time in the FNS subgroup was 38.12 min, and in the CCS subgroup, it was 53.41 min where the difference was statistically significant. 94.1% of cases in FNS and 88.2% of cases in the CCS group attained union at 12 month follow-up. However, the difference between 2 subgroups was not statistically significant.

Purpose: To maintain a plantigrade foot, knee deformity prompts compensatory hindfoot deformity. TKA realigns the knee correcting hip-knee angle (HKA) However, the consequential impact of severe varus on ankle and foot has been inadequately investigated in contemporary literature.

Materials and methods: The study consisted of 66 patients (87 knees) who underwent TKA. The radiological parameters assessed were hip-knee angle (HKA), tibial plafond inclination angle (TPIA), tibio-talar tilt angle (TTTA) and talar inclination angle (TIA). Functional assessment was done with AOFAS score pre-operatively and at 2-year follow-up. The paired t test and Pearson's correlation tests were used for statistical analysis.

Results: HFA, TPI, TTT, and TIA post-TKA showed statistically significant correction (p < 0.001 for all parameters). On correlating HKA with hindfoot alignment, for physiological HFA ≤ 6 degrees, the mean correction in HFA was 2.55 degrees (r = 0.668, p < 0.001) and for abnormal HFA > 6, the mean correction in HFA was 6.47 degrees (r = 0.355, p = 0.029). On correlating correction of ankle alignment with correction in HKA, correction in TPI (r = 0.04, p = 0.713), TTT (r = -0.017, p = 0.874), TIA (r = 0.158, p = 0.144) was not statistically significant. Significant improvement in AOFAS was seen post-TKA with a mean increase from 72.0 to 88.9 (p < 0.001).

Conclusion: TKA improves ankle and hindfoot alignment both radiologically and functionally. However, any persistent malalignment in the ankle and hindfoot can lead to patient dissatisfaction.

Background: Orthopedic surgery remains one of the least diverse medical specialties, historically framed as physically demanding and exclusionary. In India, despite near-parity in medical school enrolments, representation in orthopedics is disproportionately low compared to global averages. Structural barriers-including stereotypes, inequitable training pathways, and limited mentorship-have influenced workforce composition. However, evolving definitions of surgical competence, advances in technology, and advocacy initiatives have begun reshaping the specialty.

Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar, supplemented by official resources (IOA, IODA), institutional archives, and Royal College records. Eligible material included workforce audits, descriptive studies, and official reports. Purposeful sampling identified key pioneers and leaders in Indian orthopedics, with contributions verified through publications, biographies, and archival sources.

Results: Historical barriers limited entry and progression within orthopedics, reinforcing perceptions of physicality over precision. Notable pioneers established new benchmarks in pediatric orthopedics, hand surgery, scoliosis care, limb reconstruction, and arthroplasty. The establishment of WOICE in 2016 provided a platform for mentorship, advocacy, and leadership development. Despite progress, underrepresentation persists in subspecialties such as spine and arthroplasty, alongside systemic challenges including limited institutional support and inconsistent mentorship.

Conclusion: The evolution of orthopedics in India highlights gradual but meaningful change. Continued progress requires structural reforms in training, equitable leadership opportunities, and inclusive professional policies. Advancing diversity is not only a matter of equity but also central to clinical excellence and improved patient outcomes.