Risk Factors and Outcomes Associated with Intraoperative Fractures during Short-Stem Total Hip Arthroplasty for Osteonecrosis of the Femoral Head

Background@#Young age in osteonecrosis of the femoral head (ONFH) demands bone-preserving, short-stem arthroplasty. Several designs including neck-preserving stems and neck-resecting, shortened, standard stems are classified as short stems. There is a paucity of literature investigating risk factors and outcomes of intraoperative complications of neck preserving, short-stem arthroplasty in ONFH. @*Methods@#A total of 107 hips operated with METHA short-stem arthroplasty for ONFH were retrospectively evaluated. The mean age of patients was 43.7 years (range, 27–60 years). Nine patients had an intraoperative fracture. Seven hips received prophylactic cerclage wiring for poor bone quality. Patients were invited for clinical and radiological evaluation at the latest follow-up. @*Results@#The mean follow-up of patients was 47.2 months. Significant association with intraoperative fractures and the need for prophylactic cerclage wiring were found in steroids-, alcohol-, and chronic renal failure-induced ONFH. However, patient sex, body mass index, traumatic/idiopathic ONFH, previous implant in situ, prosthesis size, and single-sitting bilateral total hip replacement (THA) were not the risk factors. All hips showed signs of osteointegration at final follow-up. No revision was done during the study period for any cause. @*Conclusions@#METHA short-stem THA offers excellent functional and radiological outcomes in ONFH. However, precaution must be exercised in patients with steroids-, alcohol-, and renal disorders-induced ONFN due to poor bone quality and higher chances of intraoperative fractures. Also, additional measures such as the use of a high-speed burr and prophylactic cerclage wiring in ONFH may allow predictable and safe use of short stems.

Navigated Unicompartmental Knee Arthroplasty: A Different Perspective

Background@#Anteromedial osteoarthritis is a recognized indication for unicompartmental knee arthroplasty (UKA). Favorable postoperative outcomes largely depend on proper patient selection, correct implant positioning, and limb alignment. Computer navigation has a proven value over conventional systems in reducing mechanical errors in total knee arthroplasty (TKA). However, the lack of strong evidence impedes the universal use of computer navigation technology in UKA. Therefore, this study was proposed to investigate the accuracy of component positioning and limb alignment in computer navigated UKA and to observe the role of navigation in proper patient selection. @*Methods@#A total of 50 knees (38 patients) underwent computer navigated UKA between 2016 and 2018. All operations were performed by the senior surgeon using the same navigation system and implant type. The navigation system was used as a tool to aid patient selection: knees with preoperative residual varus > 5° on valgus stress and hyperextension > 10° were switched to navigated TKA. We measured the accuracy of component placement in sagittal and coronal planes on postoperative radiographs. Functional outcomes were also evaluated at the final follow-up (a minimum of 16 months). @*Results@#Nine patients had tibia vara and 14 patients had preoperative hyperextension deformity. We observed coronal outliers for the tibial component in 12% knees and for the femoral component in 10% knees. We also observed sagittal outliers for the tibial component in 14% knees and for the femoral component in 6% knees. There was a significant improvement in the functional score at the final follow-up. On multiple linear regression, no difference was found in functional scores of knees with or without tibia vara (p = 0.16) and with or without hyperextension (p = 0.25). @*Conclusions@#Our study further validates the role of computer navigation in desirable implant positioning and limb alignment. We encourage use of computer-assisted navigation as a tool for patient selection, as it allows intraoperative dynamic goniometry and provides real-time kinematic behavior of the knee to obviate pitfalls such as significant residual varus angulation and hyperextension that predispose early failure of UKA.

Low pre-diagnosis attrition but high pre-treatment attrition among /Bv patients with MDR-TB: An operational research from Chennai, India

Background: Worldwide, there's concern over high pre-diagnosis and pre-treatment attritions or delays in Multidrug resistant tuberculosis [MDR-TB] diagnosis and treatment pathway [DTP]. We conducted this operational research among patients with presumptive MDR-TB in north and central Chennai, India to determine attrition and turnaround times [TAT] at various steps of DTP and factors associated with attrition

Methods: Study was conducted in Revised National Tuberculosis Control Programme setting. It was a retrospective cohort study involving record review of all patients with presumptive MDR-TB [eligible for DST] in 2014

Results: Of 628 eligible for DST, 557 [88%] underwent DST and 74 [13%] patients were diagnosed as having MDR-TB. Pre-diagnosis and pre-treatment attrition was 11% [71/628] and 38% [28/74] respectively. TAT [median [IQR]] to test from eligibility for DST and initiate DR-TB treatment from diagnosis were 14 [9,27] and 18 [13,36] days respectively. Patients with smear negative TB and detected in first quarter of 2014 were less likely to undergo DST. Patients in first quarter of 2014 had significantly lower risk of pre-treatment attrition

Conclusion: There was high uptake of DST. However, urgent attention is required to reduce pre-treatment attrition, improve TAT to test from eligibility for DST and improve DST among patients with smear-negative TB

Impact of scaling and root planing on C-reactive protein levels in gingival crevicular fluid and serum in chronic periodontitis patients with or without diabetes mellitus

PURPOSE: The present study was conducted to evaluate the impact of scaling and root planing (SRP) on the C-reactive protein (CRP) levels of gingival crevicular fluid (GCF) and serum in chronic periodontitis patients with type 2 diabetes mellitus (T2DM-CP) or without type 2 diabetes mellitus (NDM-CP). METHODS: Forty-eight human participants were divided into two groups: an experimental (T2DM-CP) group (group I, n=24) comprising chronic periodontitis patients with random blood sugar > or =200 mg/dL and type 2 diabetes mellitus, and control (NDM-CP) group (group II, n=24) of those with chronic periodontitis and random blood sugar <200 without T2DM for the study. All subjects underwent nonsurgical periodontal therapy (NSPT) including complete SRP and subgingival debridement. Periodontal health parameters, plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), GCF volume (GCF vol), GCF-CRP, random blood glucose (RBS), glycated hemoglobin, and systemic inflammatory markers, serum CRP, total leukocyte count (TLC), neutrophil count (Neutr) and lymphocyte count (Lymph), were evaluated at baseline, 1 month, and 3 months after SRP. RESULTS: NSPT resulted in statistically significant improvement in periodontal health parameters (PI, GI, PPD, CAL, GCF vol), CRP levels in serum as well as GCF of both groups I and II. The mean improvement in periodontal health parameters (PI, GI, PPD, CAL, GCF vol), CRP levels in serum and GCF was greater in group I than group II after NSPT. There was nonsignificant increase in GCF-CRP, TLC, Lymph, and RBS, and a significant increase in Neutr and Serum CRP in group II at 1 month. The Serum CRP level of 20 out of 24 group II patients had also increased at 1 month. CONCLUSIONS: The CRP levels in both GCF and serum were higher in T2DM-CP patients than in NDM-CP patients. Although there was a significant improvement in both the groups, greater improvement was observed in both GCF and serum samples of T2DM-CP patients.

Inducible clindamycin resistance in Staphylococcus aureus: a study from a tertiary care hospital of north India

Clindamycin is a preferred therapeutic option in erythromycin resistant Staphylococcus aureus skin and soft tissue infections. However, a major concern regarding its use for staphylococcal infections is the possible presence of inducible resistance to clindamycin. The present study was aimed to determine the incidence of constitutive and inducible clindamycin resistance in S.aureus isolates in our hospital. Retrospective study. Pt. BDS University of health Sciences, Rohtak, Haryana, India. A total of 250 consecutive, non-duplicate S. aureus strains were isolated from various clinical specimens, both from inpatients and outpatients. Antibiotic susceptibility tests were performed using Kirby-Bauer disc diffusion method. Methicillin resistance was detected by oxacillin disc on Mueller-Hinton Agar [MHA] plate supplemented with 2% NaCl. D-test was performed on all erythromycin-resistant and clindamycin-sensitive isolates to detect inducible clindamycin resistance. Observed and counted were methicillin resistance in S.aureus, constitutive and inducible resistance of the isolates to clindamycin, origin of the MLSBi isolates that is "community" or "hospital" and resistance of MLSBi isolates to other drugs. Among 250 S.aureus strains, 112 [44.8%] were found to be Methicillin-resistant Staphylococcus aureus [MRSA] and 20% had MLSBi phenotype. MRSA isolates showed higher inducible as well as constitutive resistance [p <0.0001] to clindamycin as compared to methicillin-sensitive S.aureus [MSSA]. All S.aureus isolates having MLSBi phenotype were sensitive to vancomycin and linezolid. The study strongly recommends the routine testing of in vitro inducible clindamycin resistance in S.aureus isolates as it will help in guiding therapy