Effect of early release of tourniquet in total knee arthroplasty

To evaluate whether tourniquet release intraoperatively is better than postoperative release in reducing overall blood loss, duration of surgery, duration of tourniquet, length of hospital stay, wound related complications and transfusion requirement. Comparative study. Department of Surgery, The Aga Khan University Hospital, Karachi, from January 2004 to June 2007. One hundred and thirty patient files were reviewed retrospectively. Patients were divided into two groups. Group-A consisted of 65 patients with early deflation of tourniquet and group-B comprised of 65 patients with the release of tourniquet after applying compressive dressing. Total blood loss [determined by Gross method] and other study variables were noted as per objective and computed. There were 22 males and 108 females with comparable BMI. All had undergone posterior stabilized cemented total knee replacement. Calculated blood loss was 1.208 Land 1.108 Lin group-Aand B respectively [p = 0.27]. Significant increase in duration of surgery was noted in group-A patients. Four patients in group-B showed complication related to wound with 3 being minor and 1 requiring additional operation room visit. Mean length of hospital stay was 9 days. Transfusion frequency was higher in group-B despite comparable postoperative haemoglobin values. Intraoperative tourniquet release does not reduce overall blood loss with no effect in conserving blood after total knee replacement, however, this group had relatively shorter hospital stay

Locking Compression Plate in Musculoskeletal Oncology 'a Friend in Need'

BACKGROUND: We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture. METHODS: A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends. RESULTS: There were 8 males and 17 females in the study. The average age at the time of surgery was 30 years (range, 9 to 66 years). The minimum follow-up was 12 months (range, 12 to 32 months). All patients except three went on to heal successfully. Complications occurred in those three patients: wound infection in one, nonunion in another, and periprosthetic fracture in the other patient. In the remaining patients, union was achieved at an average of 6.5 months after reconstruction in curative resection and 4.75 months after fixation of pathological fractures. CONCLUSIONS: Joint sparing limb salvage surgery was made successfully possible after sekeletal reconstruction with LCP. Its use was also quite effective in pathological fractures with poor bone quality. Use of locking plates for musculoskeletal oncological reconstruction resulted in a good and predictable rate of union.

Complications of total hip replacement

To determine the factors causing complications in unilateral total hip replacement. Analytical study. The Aga Khan University Hospital, Karachi, between 2000 and 2010. During the study period, 199 patients underwent elective unilateral total hip replacement at the Aga Khan University Hospital. Patients were divided into two groups on the basis of postoperative complications within 30 days of surgery. Significant factors at 5% significance level on univariate analysis were further analyzed by multivariate logistic regression. Postoperative complications occurred in 39 patients [19.6%]; dislocation being most common in 13 patients [6.5%], followed by wound infection in four [2%], all of these patients required intervention. Other minor complications which were managed conservatively included wound infection [2.5%], urinary tract infection [2.5%], dislocation [1%], pleural effusion and pneumonia [2%], deep venous thrombosis [0.5%] and myocardial infarction [0.5%]. On univariate analysis, patients with ASA III and IV, peri-operative blood transfusion, pre-operative hip deformity and post-operative bisphosphonate use were significantly associated with complications. On multi-variate analysis, adjusted odd's ratio for perioperative transfusion [3; 95% CI: 1.17-7.7] and hip deformity [3.2, 95% CI: 1.4-3.4] was found statistically significant. Pre-operative hip deformity and perioperative blood transfusion significantly influence the rates of complication after unilateral THR

First Successful autologous chondrocyte implantation in Pakistan

Osteochondritis dissecans entails a hyaline cartilage defect of the articular surface causing pain and functional restriction in young adults, sometimes resulting in early degenerative arthritis. Conventional treatment methods such as abrasion chondroplasty and mosaicplasty have limitations in terms of quality of the resultant cartilage and donor site morbidity. A more recent technique, autologous chondrocyte implantation [ACI] results in hyaline cartilage formation and gives good long-term outcome, but requires a high-level cell culture facility and two surgical procedures. The patient was a young female with knee pain, intermittent locking and feeling of "joint mouse". MRI scan and arthroscopy showed a 2x2 cm full thickness osteochondral defect in the medial femoral condyle. A free fragment of articular cartilage was found, which was extracted arthroscopically, and chondrocytes were cultured from it in the Juma laboratory. Subsequently, patient underwent surgery whereby the chondrocytes were injected under a periosteal patch sewn over the defect. Over six months, patient's symptoms completely resolved and she returned to full function. A repeat arthroscopy after one year revealed complete filling of the previous defect with normal appearing cartilage indicating success of the procedure. This technology can be utilized for treating patients with a variety of conditions affecting hyaline cartilage of joints

Prophylaxis of DVT with enoxaparin in patients undergoing total knee replacement

To evaluate the efficacy and safety of the low molecular weight heparin as prophylaxis against thromboembolism following total knee replacement surgery. Post-operative bilateral lower extremity colour duplex scan was performed on 55 patients subjected to total knew arthroplasty. The scan was performed 7 days after surgery for detection of DVT. All patients were given Enoxaparin 40mg subcutaneous daily for 2 weeks as prophylaxis against DVT. Two patients were diagnosed as DVT by color duplex scanning and both were distal but only one was asymptomatic. Another patient developed pulmonary embolism and died subsequently. The major and minor wound problems were seen in two and six patients respectively; nearly all complications were seen in obese patients. DVT is not a nonexistent entity in our population. Low molecular weight heparins are safe drugs but apparently the bleeding complications are more as compared to Western literature. Larger case control studies are required to determine the true efficacy and safety of LMWH

Berneese periacetabular osteotomy for residual hip dysplasia in adults: a case report and review of literature

Pelvic osteotomy for acetabular dysplasia has been introduced to improve acetabular coverage of the femoral head and reduce the risk of secondary osteoarthrosis. Several surgical methods for acetabular reorientation have been proposed for this purpose by reorientation of the acetabulum single, double, triple, spherical and periacetabular osteotomies. We report our first experience with periacetabulur berneese osteotomy described by Prof. R. Ganz and now the procedure of choice in appropriately selected patients. Fifteen years old boy who presented with complaints of fall and pain in the right gluteal region for 5 days duration that increased with walking. Examination revealed an antalgic gait. Rest of his examination was normal except mild tenderness in the right buttock area. His plain X-rays revealed an incidental finding of dysplastic left hip with deficient lateral coverage, deformed femoral head, coxa magna and mild coxa valga. In addition he had focal arthritic changes over the superolateral acetabulam with sclerosis and cyst formation. His anterior center-edge angle was 24 degrees with an acetabular index of 44 degrees. He had grade II arthritic changes according to the Tonnis classification of osteoarthritis. A periacetabulur ganz osteotomy was performed.Correction was confirmed with intraoperative X-rays. His post operative course was smooth and he was allowed full weight bearing at 8 weeks when X-rays showed satisfactory healing of osteotomy