Evaluation of ketorolac tromethamine as anti-inflammatory drug for topical applications in treatment of knee osteoarthritis

The non-steroidal anti-inflmmatory drugs [NSAIDs] are used as a classic treatment for painful rheumatic disorders of the knee such as osteoarthritis and rheumatoid arthritis. Ketorolac tromethamine [KT] is considered as a member of NSAIDs. It is a non-selective cycloxygenase COX inhibitor that is used in treatment of musculoskeletal and joint disorders. Because KT appears to be associated with a higher incidence of adverse effects mainly irritation to the stomach, change in kidney and liver functions, its use is restricted for the treatment of patients for whom other NSAIDs have been ineffective. The main problems associated with the frequent administration of KT could be overcome by alternative routes of administration. This could be achieved by avoiding the contact between the drug and the stomach through formulating the drug in topical formulations and this was the aim of this work. Seventy osteoarthritis patients were selected and were classified into three groups, KT group [24 patients], piroxicam group [23 patients] and placebo group [23 patients]. Efficacy assessments were done by using the Western Ontario and McMasters Individual Osteoarthritis Index [WOMAC-OA] and the WOMAC Composite Index [WOMAC-CI] for pain, stiffness, and physical functions. Tolerability assessments were done by recording any adverse effects at each visit. All adverse effects or unexpected events were recorded in the case record forms. During the study, 8 patients were lost to follow up 2 from piroxicam group, 3 from KT group and 3 from placebo group. The obtained results indicated that, there was no significant difference in efficacy between KT gel and piroxicam gel [p>0.05] in treatment symptoms of osteoarthritis patients. While there was significant difference between either KT gel or piroxicam gel and placebo gel [p<0.05]. No adverse effects were recorded in all groups within the duration of study except two patients in of KT group and one patient in placebo group showed mild skin irritation [erythema]. The clinical evaluation revealed that, therapy with topical KT in carbopol 934 gel was successful to a great extent and produced high efficacy and safety in improving patients symptoms of osteoarthritis of the knee

Arthroscopically-assisted internal fixation of tibial plateau fractures: adding an anti-settling screw

Intra-articular fractures of the proximal tibia can often be troublesome because of the early and late arthritic complications of damage of the articular surface, and intra-articular lesions. There are some potential benefits of arthroscopy in solving some of the pitfalls of these fractures. The purpose of this work is to study these benefits, and the benefits of adding an antiglide screw. Fifty patients with tibial plateau fractures were treated in Assiut University hospital. Of these patients only [16 patients] were included in this study. Fourteen were men, and two were women. The age ranged between 27-60 years [mean 43 years]. Inclusion in this study was limited to cases of split split depression, or local depression unicondylar fractures using Schatzker classification. Mean follow up was 15 months [6-24 months]. The post operative clinical evaluation depended on Rasmussen scoring system. The radiological evaluation was according to Honkonen and Jarvinen. Complete anatomical reduction of the fracture fragments was achieved in 14 knees [87.5%]. Up to 2 mm displacement or step off was accepted in two knees [12.5%]. Clinical assessment according to Rasmussen classification was: 10 knees [62.5%] excellent, 4 knees [25%] good, 2 knees [12.5%] fair, and none was poor. Radilogical results were: 13 knees [81.25%] grade one, 2 knees [12.5%] grade two, and one knee [6.25%] grade three. None of the cases was grade four at the final follow up radiograph. The use of arthroscopy allowed precise anatomic reduction of the articular surface in the knee. It is particularly helpful in type two and three injuries with central articular depression which often are difficult to assess on preoperative imaging studies. It is also helpful in assessing other intra-articular injuries as meniscal tears and/or ligamentous injuries and their management if possible. The antiglide screw may help in prevention of loss of reduction

Two small anterior incisions for harvesting the patellar tendon autograft in arthroscopic reconstruction of the torn anterior cruciate ligament

The bone patellar tendon bone graft is known as the gold standard for reconstruction of the torn anterior cruciate ligament being strong, rapidly revascularised, and remodeled. The modern trends known are toward minimal invasive surgeries. The aim of this work is to assess the outcome of arthroscopic anterior cruciate ligament reconstruction when two small longitudinal incisions were used to harvest the graft. The use of two small, anterior longitudinal incisions for harvesting the patellar tendon autograft in arthroscopic anterior cruciate ligament was assessed in 234 patients. The patients were 211 males, and 23 females. The mean age was 30 years. The patients were 211 males, and 23 females. The mean age was 30 years. The patients were 211 males, and 23 females. The mean age was 30 years. The patients were examined clinically at 2-3 weeks, 6-12 weeks, 6-9 months, and after 2 years postoperatively for wound healing, numbness or anesthesia in the incidence of anterior knee pain. Sutural pus was found in 1.7% of cases. Numbness or anesthesia occurred in 5.1% of cases after 2-3 weeks postoperatively that decreased to 1.2% after 6-9 months. Anterior Knee pain occurred in 8.9% of cases after 6-9 months postoperatively, and it decreased to 1% of cases after 2 years. We believe that using two separate anterior incisions leaving a skin bridge over the patellar tendon helped to decrease the incidence of injury of the infrapatellar branch of the saphenous nerve, and decreased the incidence of anterior knee pain

Hip arthroscopy a report of the early work of Assiut University Hospital

Hip arthroscopy is relatively a new advancement in the field of arthroscopy in Egypt. The purpose of this work is to report our early work on diagnostic and therapeutic hip arthroscopy. Hip arthroscopy was performed in six patients. Four were males, and two females. The age ranged from 15 - 56 years. Four cases had chronic unexplained hip pain after exhausting the non-invasive investigations, one had chronic pain with a previous history ofpyogenic arthritis, and one case had a loose body. The procedure was performed on traction table under the control of fluoroscopy, using the regular 4 mm. scope, and instruments that are used in Knee arthroscopy. in the case with a loose body it was extracted, and the case with previous history of pyogenie arthritis intra-articular adhesions was found and excised. In the other four cases arthroscopic partial synovectomy was done and the histological examination of the synovial membrane biopsy revealed early tuberculous arthritis in two cases, mono-articular rheumatoid arthritis in one case, and chronic non-specific arthritis in the last case. The adverse events were a pudendal nerve injury in one case, and entrapment of the suction tube in another case. Hip arthroscopy proved to be a useful procedure for diagnosis of hip problems, and for therapeutic procedures as loose body removal, and partial synovectomy

Comparative study between patellar tendon, and hamstring autografts in arthroscopic anterior cruciate ligament reconstruction

The patellar tendon [PT] and the semitendinosus and gracilis [STG] currently are the most common types of grafts used for anterior cruciate [ACL] reconstruction. The aim of this work is to compare the results of reconstruction using the two graft types. Between April 2000,and March 2003, fifty six cases with ACL injury were diagnosed and treated in the arthroscopy and sport injuries unit in Assiut University hospital using Quardrupled semitendinosus and gracilis tendon [STG]. All patients were men with average age 28.4 years: ranged 18-42 years''. Out of these 56 cases, the results of 11 case were deducted because of loss of follow up in 6 cases and due to combined posterolateral corner instability in the other 5 cases. The follow up for this group ranged from 19 months to 35 months [average 23.3 months]. The remaining 45 cases in this group were compared to a group of the same number [45], operated in the same unit between March 1997 and October 2000 but using the patellar tendon autograft arthroscopically with average follow up 24 months [range 9-42 months], and they were all men except one . The rehabilitation program was standard and accelerated in both groups. Both groups were evaluated using the Lysholm Knee score and the International Knee Documentation Committee [IKDC] scores. The Lysholm evaluation showed excellent or good result in 89% of PT group and in 91.2% of the STG group with no statistically significant difference. The IKDC evaluation showed normal or nearly normal results in 89.3% of PT group and in 95.7% of the STG group. No difference was found between the two groups concerning the activity level and return to moderate or strenuous activity. Patello- Femoral crepitus, anterior knee pain and harvest site tenderness were more among the PT group. The extension loss and thigh atrophy were also more frequent in the PT group but the difference was not statistically significant [P-value]. Radiological enlargement of the bone tunnels was more prominent with the STG group although not affecting the final IKDC evaluation and has no clinical impact on the objective or subjective stability. In ACL reconstruction both the autogenous PT and STG grafts provide biomechanically excellent graft material but the STG with recent improvement in the fixation technique has several advantages over the PT graft