Posterior-stabilized total knee arthroplasty: short term clinical and radiological outcome

To prevent posterior subluxation of the tibia and to improve range of motion and stair climbing ability, total knee prosthesis was modified to the posterior stabilized [PS] one in 1978 and further modifications followed. The Knee Society in 1989 introduced a rating score for TKA named the Knee Society Score [KSS], it's widely used and revised in 2012. To study the clinical and radiological results of PS/ TKA. We prospectively studied 30 patients with PS/TKA. The mean age was 63 years and mean follow-up was 12 months, 24 knees had osteoarthritis [OA] and 6 knees were rheumatoid [RA]. All were unstable and malaligned. The results assessed using the scoring system of Insall et al. and the KSS. Postoperative radiological assessment performed using weight-bearing AP and supine lateral radiographs. At last visit, 9 knees [30%] had excellent result, 18 [60%] had good result and 3 [10%] had fair result. The mean KSS improvement was from 31 points preoperatively to 89 points postoperatively. The mean ROM [flexion] preoperatively was 68.5[degree] improved postoperatively to 106[degree]. Postoperatively all knees were stable in AP direction only 4 [13.3%] had mild lateral instability. The ideal position for femoral component within [6-10[degree]] valgus was obtained in 24 knees [80%], it was within [0-5[degree]] valgus in 6 knees [20%]. In 93% [28 knees] the tibial component were within 2[degree] of varus or valgus, 6.6% [2 knees] was in greater than 2[degree] varus. Knee function score improved from a mean 27.5 points preoperatively to 58 points postoperatively and patients were able to walk more than 500 meters. PS/TKA increases range of motion, increases joint stability and improved gait. Both OA and RA patients responded well to its use with nearly same end results. We strongly recommend the use of PS/TKA for primary total knee replacement

Antibiotic treatment in patients with chronic low back pain and vertebral bone edema [modic type I changes]: a randomized clinical controlled trial of efficacy

Modic type I changes/bone edema in the vertebrae are present in 6% of the general population and 35-40% of the low back pain population. It is strongly associated with low back pain. Chronic Low back pain [CLBP] is a leading cause of disability. It occurs in similar proportions in all cultures, interferes with quality of life and work performance, and is the most common reason for medical consultations. A new method of treatment included the use of antibiotic in management of CLBP with Modic type I changes has proved to be effective in some cases. The aim was to test the efficacy of antibiotic treatment in patients with chronic low back pain [>6 months] and Modic type I changes [bone edema]. The study was a randomized clinical trial [RCT] with 71 patients whose only known illness was chronic LBP of greater than 6 months duration occurring after a previous disc herniation and who also had bone edema demonstrated as Modic type I changes in the vertebrae adjacent to the previous herniation. Patients were randomized to either 100 days of antibiotic treatment or placebo and were evaluated at baseline, and end of treatment. Outcome measures: are the disease-specific disability Questionnaire, which is Roland Morris Disability Questionnaire [RMDQ] and lumbar pain. 43 of the 71 original patients were evaluated at baseline and at end of treatment follow-up. The two groups were similar at baseline. The antibiotic group had better improvement on the outcome measures and improvement continued after end of treatment. At baseline, 100 days follow-up the means of the disease specific disability-RMDQ changed: antibiotic 15.5, 12; placebo: 15, 14.8. For Lumbar pain: antibiotics 6.4, 4.8; placebo 6.1, 6.0. The antibiotic protocol in this study was more effective for this group of patients [CLBP associated with Modic changes type I] than placebo in the outcomes

Ponseti method in treatment of idiopathic club foot

Clubfoot is a well known deformity that had a lot of attention; Dr. ponseti had proposed his own method of management with serial casting and minimal invasive surgeries that can be applied to a wider range of child age with less incidence of foot pain and stiffness compared to other methods of treatment, his technique is widely used after he published his paper in 1995. This study designed to prove that most of the children with congenital idiopathic club foot can be managed excellently by Ponseti method without the need for extensive corrective surgery. 53 children with 77 clubfeet were managed by serial manipulation and casting as described by Ponseti from May 2007 to July 2008 in Al-Wasity and Surgical specialty hospitals including initial correction of the deformity and minimal corrective surgery with follow up till October 2008. Total full correction was obtained in 91% of feet inrolled in this study, 71.6% of our patients were males, 28.3% were females, 45.2% with bilateral club feet, 54.7% with unilateral club foot, the number of casts required to full correction was 3-7 casts, 67.5% of our feet required percutaneous Achilles tenotomy to correct the equinus, 9% had incomplete correction [mainly equinus] which was corrected by open surgery, our complications was 5.1% with ulcer on the medial surface of head of 1[st] metatarsal, 7.7% with cast falling and 15.5% of feet developed relapse. The Ponseti method is a safe and effective treatment for congenital idiopathic clubfoot and radically decreases the need for extensive corrective surgery. This technique mostly useful in children up to 2 years of age, after that it can decrease the magnitude of any required procedure

Single slip sublimins transfer for the management of post-traumatic swan-neck deformity of the fingers; preliminary study of a newly proposed technique

Swan-neck deformity of the fingers is a cause of functional and cosmetic deficit for most of the patients, the main pathology lies on the PIP joint and most of the surgical treatments depends on the integrity of the soft tissues around it including sublimins tendon that plays an important role in the success of most of the surgical procedures to describe anew surgical technique for the treatment of post - traumatic swan-neck deformity in the fingers. nine patients with post-traumatic swan-neck deformity with intact [FDS] were included in this study. The operation included transferring the insertion of one slip of the sublimins to the A4 transverse pulley this allowed a more dynamic PIP and a better hand function in comparison with other known operations further studies with larger sample and longer period of follow up may give better and more accurate results about this new procedure that can be regarded as a modified Tonkin technique