Journal of Arthroscopy and Joint Surgery最新文献

Wrist arthroscopy is a common procedure done by hand surgeons which have undergone many modifications and improvements since it was first described. The advent of new portals (both dorsal and volar) means that the wrist joint can be viewed from virtually any perspective (“box concept”). Indications for wrist arthroscopy include diagnostic and reparative procedures and, more recently, reconstructive, soft-tissue, and bony procedures.

With an expanding list of indications and procedures that can be performed with this technique, it with an essential diagnostic and therapeutic tool for orthopedic hand surgeons.

Arthroscopic assessment of traumatic conditions such as distal radius fractures, scaphoid fractures, and their associated non-unions, soft tissue, and chondral injuries are thought to be superior to fluoroscopy. Management of non-traumatic conditions such as triangular fibrocartilage complex injury (TFCC), instability, excision of ganglions, kienbocks disease are also possible. Complications of wrist arthroscopy are relatively uncommon.

Introduction

Multiple strategies, used either in isolation or combination, are available to reduce the need for post-operative blood transfusion in joint replacements. Amongst them, the use of tranexamic acid (TXA) has been rising and this study was conducted to compare the efficacy of topical and intravenous TXA in bilateral total knee replacement patients.

Materials and methods

Randomised prospective study with 120 patients (male: female: 25:95) undergoing bilateral TKA. Patients were divided into two groups A and B after computer randomization, who received intravenous or topical (intra-articular) TXA respectively.

Results

The average haemoglobin loss in intravenous group was 90.2379 g/L as compared to 39.137 g/L in topical group (p < 0.005).Moreover, there was reduction in blood loss in topical (330.1602 ml) as compared to intravenous group (764.9622 ml). The blood transfusion rate was more for the intravenous group (average 1.73 units) than for the topical group (average 0.75, unit). WOMAC score at 6 weeks in the intravenous group was 12.50, and in the topical group was 7.23 (p value < 0.001).

Conclusion

Topical TXA is better than intravenous TXA for reduction of blood loss, which also reduces the need for blood transfusion in bilateral TKA patients.

A “floating hip” injury is a very rare presentation with an incidence of around 1 in 10,000 fractures. The combination of floating hip with a centrally dislocated femoral head makes the management even more challenging. Conservative treatment has no role except that in unfit patients and surgical treatment has no standard protocol. Literature suggests both internal fixation and arthroplasty as options depending on the acetabular congruity as well as the future chances of avascular necrosis of femoral head. Treatment has to be tailored according to the situation. We encountered one such difficult case which was managed by a combination of both internal fixation and arthroplasty as staged procedure and would like to show our experience which yielded good result and patient satisfaction.

Background

Total knee arthroplasty is the prevalent surgical intervention being used to treat knee osteoarthritis. Although the medial parapatellar approach is the prominent surgical approach, the parapatellar incision has concerning theoretical risks. The subvastus approach is a less invasive, but less commonly used alternative. The aim of this study is to compare the post-operative outcomes of these two surgical approaches with respect to retropatellar knee pain, knee range of motion, and quadriceps muscle strength at 6 and 12 months post-operation.

Methods

In this randomized controlled trial, 50 patients who suffered from advanced osteoarthritis in both knees underwent simultaneous bilateral total knee arthroplasty, one using the medial parapatellar approach and the other using the subvastus approach. Retropatellar knee pain, quadriceps muscle strength and knee range of motion were assessed pre-operation, as well as at 6 and 12 months post-operation.

Results

This study found no statistically significant differences in retropatellar knee pain, quadriceps muscle strength, or knee range of motion between the medial parapatellar and subvastus approaches at 6 and 12 months post-operation.

Conclusion

The results of this study provide further evidence that the subvastus approach is a comparable alternative to the medial parapatellar approach, but do not indicate any advantages to one over the other. More research is necessary in order to determine if there is an added benefit to the subvastus approach in the short term (<3 months).

Objective

To evaluate clinical outcome of cementless ceramic on ceramic primary total hip arthroplasty in young patients of Avascular necrosis of Femoral head.

Methods

A total of 30 hips undergoing cementless ceramic on ceramic primary total hip arthroplasty using S-ROM femoral stem were prospectively and retrospectively evaluated.

Results

Pre-operatively the mean HHS was 32.73 which increased to a mean of 87.8 post-operatively. The difference was statistically significant (p value < 0.0005) with relatively minor complaints.

Conclusion

Based on our study, we recommend ceramic on ceramic THR for younger patients in the age group of less than 50 years of age.

Knee stiffness is not uncommon following knee surgeries. A stiff knee alters the normal gait of the person and is a recognized cause of social humiliation for the patient. Due to its minimal invasiveness, arthroscopic management is gaining popularity among surgeons and patients. Arthroscopy has the potential to treat the majority of the non-bony causes of knee stiffness without much hassle of open surgeries. However, arthroscopic management is not devoid of its limitations and complications. So, awareness of arthroscopic management of knee stiffness and its clinical outcomes is of paramount importance to a practising knee surgeon.

Osteochondral lesions in children and adolescents can be managed by different techniques. There is a paucity of evidence with regards to the optimal management of these particular lesions. Salvage options are mostly inferred from the adult literature, with Autologous Chondrocyte Implantation the most popular technique. The use of fresh allograft has good documented outcomes in this cohort.

Options for meniscal repair are plenty, but optimal usage of these techniques is imperative to achieve meniscal healing and simultaneously minimize meniscal trauma. In this technical note, a particular suture configuration called the Peacock Crown feather stitch has been described especially for the oblique flap tears.