Local infilteration of steroid in conjunction with coccygel manipulation as a treatment of coccydynia

To asses the efficacy of local infiltration of steroid in conjunction with coccygel manipulation as a treatment of coccydynia. Interventional study. Department of Orthopaedic Surgery, Ziauddin Hospital Karachi, from December 2000 to December 2008. All selected patients who did not improve three to six month of conservative treatment, were enrolled. The patients were treated with local infiltration of steroid in conjuncation with coccygel manipulation and followed for up to 2 years. A total of 172 patients were diagnosed with coccydynia. The average age of the patients was 38.3 year. There were 138 [80.2%] males and 34 [19.8%] females. Trauma was responsible for pain in 118 [68.6%] cases. Of the total patients, 97 [56.4%] recovered with conservative management and remaining 75 [43.6%] underwent manipulation of coccyx under sedation with local infiltration of steroid. Fifty three [70.7%] patients had excellent results, 14[18.7%] had good response and 8 [10.7%] had fair outcome on first visit. In 2 year follow up 60 [80%] patients showed good response. Second injection was given in 5[6.7%] patients and 3[rd] injection was needed in one [1.3%] patient. Nine [12%] patients were lost to follow up. We recommend manipulation along with local infiltration of steroid in all patients of coccydynia. This approach is less invasive and carried out under sedation as a daycare procedure.

Outcome of total knee replacement in 232 cases

To evaluate, clinically and radiologically, the outcome of total knee replacement [TKR] in our institute. Design and Descriptive, prospective study conducted from Jan. 1999 to Dec. 2003.Ziauddin Medical University Hospital, Karachi.All patients who underwent TKR at our institute.: All patients who underwent TKR were evaluated clinically and radiologically on the basis of modified INSALL knee scoring system prior to surgery and postoperatively between one to three years after surgery. Pre and post operative scores were then compared for each patient to find improvement, both functional and radiological. Amongst the 232 patients that were included in the study, there were 83 males and 149 females, with ages ranging from 58 to 80 years. The preoperative INSALL Knee Scores were between zero to 30 for 87% of patients. Postoperatively 90% of patients had scores greater than 90 and most of them achieved 120 degrees of flexion.Total knee replacement is an excellent modality of treatment for patients suffering from severe arthritis of knee joints with regards to pain, range of motion and stability