Component Alignment in Simultaneous Bilateral versus Unilateral Total Knee Arthroplasty

PURPOSE: The purpose of this study was to investigate differences in component alignment between first and second knees in simultaneous bilateral total knee arthroplasty (SBTKA) and unilateral TKA (UTKA). MATERIALS AND METHODS: 274 SBTKAs and 198 UTKAs were included in study. Patients were divided into three groups as SBTKA on the right knee (group A), SBTKA on the left knee (group B) and UTKA (group C). Femoral and tibial component alignment was checked in both coronal plane (alpha [α] and beta [β] angles) and sagittal plane (gamma [γ] and delta [δ] angles) radiographs. RESULTS: There were no statistically significant differences among groups in the preoperative anatomical varus angle and Kellgren–Lawrence gonarthrosis classification grade (p=0.139 and p=0.329, respectively). In the coronal plane, the alignment of femoral component (α angle) and tibial component (β angle) was similar in all three groups (α angle, 95.01 vs. 95.14 vs. 94.9, p=0.945; β angle, 90.03 vs. 89.67 vs. 89.98, p=0.483). The sagittal plane alignment of femoral component (γ angle) and tibial component (δ angle) did not show significant differences (γ angle, 7.04 vs. 6.98 vs. 7.00, p=0.132; δ angle, 86.56 vs. 87.41 vs. 86.73, p=0.610). CONCLUSIONS: The angular alignment of components was similar between SBTKA and UTKA.

Outcome of bipolar hemi arthoroplasty: analysis of using lateral and posteriolateral approach

Objective: To find the outcome of bipolar hemiarthroplasty using posteriolateral and lateral approaches

Study design: Descriptive case series

Place and Duration of study: Departments of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital Lahore, from January 2015 to December 2016

Methodology: Patients of either sex and of age above 40 year, who presented in Emergency Department with femoral neck fractures, were included in the study. Data included basic demorgraphic profile, Harris hip scoring, duration of surgery, hospital stay and blood loss

Results: A total of 200 patients were included in the study. There were 77 [38.5%] males and 133 [61.5%] females. Male to female ratio was 0.58:1 with mean age of 58.2 +/- 6.02 year. Mean follow up was 14.2 +/- 2.5 months. In 134 [67.0%] patients there was history of fall, 41 [20.5%] presented with fracture after low energy vehicle accident, 20 [10.0%] presented after high energy vehicle accident. Duration of surgery and blood loss were less in posteriolateral approach. The complication rate and Harris hip scoring was similar in both the approaches

Conclusions: Outcome of surgery in terms of infection, mobility and pain as well as dislocations were similar in both the approaches. The posterior approach was superior in terms of short duration of surgery and less blood loss

Outcome of shish kabab osteotomies fixed with SIGN NAILI in osteogenesis imperfecta. our experience at Ghurki Trust Teaching Hospital, Lahore, Pakistan

Objective: To evaluate the results of shish kabab osteotomies fixed with SIGN NAIL in long bone deformities of patients suffering from osteogenesis imperfect

Methods: This study was carried out on 12 patients who presented in OPD or Emergency Department with deformities of long bones. Detailed history, examination and investigations including X-ray AP and Lateral view of involved bone were done. All these cases were treated with Shish Kabab Osteotomies and SIGN NAILunder spinal or general anaesthesia. These cases were followed up for up to average of 20 months [range 06 months -6 years ] and results of the nail were observed in terms of union, rehabilitation and complications

Results: It was found that 8 [66.7%] were male and 4 [33.3%] were females with a mean age of 14.83 +/- 5.24. 5 [41.7%] patients having age 10-15 years and 7 [58.3%] were between 16-20 years. Total 21 surgeries performed. 3[25.0%] had surgery on unilateral femur,2 [16.7%] on unilateral tibia, 3[25.0%] on both unilateral tibia and femur,3 [25.0%] had surgery on bilateral tibia and 1[13.3%] with bilateral tibia and femur. The parents of all patients had a first degree consanguineous marriage. The mean hospital stay were 4.17 +/- 1.75 days. All osteotomies sites heal within 06 months, better bone densities, 1 Having recurrence of deformity and no fracture were found. Only two patients using walkers while remaining need no support for walking

Conclusion: Sign Nail along with shish kabab osteotomies in deformities of osteogenesis imperfecta is the treatment of choice. Patient rehabilitation is early, hospitalization is short, and osteotomies site healing response is good as well as decrease risk of fracture

Autologous percutaneous bone marrow injection in long bone fractures with delayed and nonunion

Objective: to determine the outcome of bone marrow injection in fractures with signs of delayed union and nonunion in terms of clinical and radiological evidence of union

Study design: descriptive case series

Place and Duration of study: department of Orthopedics and Spinal Surgery, Ghurki Trust Teaching Hospital Lahore, from October 2014 to May 2015

Methodology: patients admitted with nonunion or delayed union were included in the study. After evaluation and taking informed consent bone marrow was taken from the iliac crest with the help of bone marrow biopsy needle and injected at the site of fracture with the aid of lumbar puncture [LP] needle under image guidance. Repeat injection was given at three month interval, if needed. Clinical and radiological evidence of bone healing was assessed at six weekly follow ups till six months

Results: a total of 80 patients were included. There were 48 males and 32 females. There were 42 tibial, 18 femoral, 11 radius/ulna and 9 humeral fractures. Sixty-two procedures under local anesthesia and eighteen under short sedation were performed. In 67 patients union occurred following injection. The mean healing time was 16 weeks

Conclusion: percutaneous bone marrow injection is an alternative treatment of choice for delayed union and nonunion for long bone fractures

Geriatric fractures: an experience at a tertiary care hospital

Objective: To find out demographics, mechanism of injury and bones involved so as to suggest preventive measures in geriatric population

Study design Retrospective case series

Place and Duration of study: Department of Orthopaedics and Spine Centre, Ghurki Trust Teaching Hospital Lahore, from January 2015 to December 2015

Methodology: This study included all patients of age greater than 50 year of either sex admitted through emergency or OPD having any type fracture. The data were taken from hospital database and included clinical, epidemiological and radiological records. The results were analyzed using SPSS version 17.0

Results: A total of 1215 patients were included in the study. Of these 880 [72.4%] were males and 335 [27.6%] females. Male to females ratio were 1.38:1 with mean age of 56.21 +/- 12.603 year. Most of them were between 51-60 year [n=629 - 51.77%]. Femoral fractures were the most common and the main mechanism of injury were fall followed by road traffic accidents

Conclusions: Femoral neck fractures were the most common fractures and mostly females were involved. Fall was the main mechanism of injury

Management of lower limb wounds by negative pressure dressings

Objective: To determine the outcome of home-made negative pressure dressings in acute complex wounds of the lower extremity in terms of healing

Study design: Descriptive case study

Place and Duration of study: Department of Orthopaedics and Spine Surgery, Ghurki Trust Teaching Hospital Lahore, from September 2012 to February 2013

Methodology: Patients with soft tissue defects of lower extremity were included. Preoperative size of the wound with Gustilo type IIIA and IIIB was measured and negative pressure dressings were applied. Each dressing was applied for 72 hours. Outcome of the wound was assessed on 9th day after 3 dressings. The quality of granulation tissue and wound healing were noted

Results: A total of 100 patients were enrolled. There were 75 males and 25 females with a ratio of 3:1. Mean age was 32.88 +/- 6.10 year. Seventy percent patients had decrease in size of the wound. Ninety patients developed granulation tissues in the lower limb wounds

Conclusion: Home-made negative pressure dressing was a valuable therapy in the management of acute injuries of lower limb as it resulted in granulation and healing of the wound under challenging conditions

Outcome of intramedullary interlocking SIGN nail in tibial diaphyseal fracture

To determine the outcome of intramedullary interlocking surgical implant generation network [SIGN] nail in diaphyseal tibial fractures in terms of union and failure of implant [breakage of nail or interlocking screws]. Case series. Orthopaedics and Spinal Surgery, Ghurki Trust Teaching Hospital, Lahore Medical and Dental College, Lahore, from September 2008 to August 2009. Fifty patients aged 14 - 60 years, of either gender were included, who had closed and Gustilo type I and II open fractures reported in 2 weeks, whose closed reduction was not possible or was unsatisfactory and fracture was located 7 cm below knee joint to 7 cm above ankle joint. Fractures previously treated with external fixator, infected fractures and unfit patients were excluded. All fractures were fixed with intramedullary interlocking SIGN nail and were followed clinically and radiographically for union and for any implant failure. Forty one [88%] patients had united fracture within 6 months, 5 [10%] patients had delayed union while 4 [8%] patients had non-union. Mean duration for achieving union was 163 + 30.6 days. Interlocking screws were broken in 2 patients while no nail was broken in any patient. Intramedullary interlocking nailing is an effective measure in treating closed and grade I and II open tibial fractures. It provides a high rate of union less complications and early return to function