A comparative morphometric analysis of operative windows for performing OLIF among normal and deformity group in lower lumbar spine.

PURPOSE: To assess the radiological morphometric parameters of OLIF surgical technique in lower lumbar spine among normal and in patients with adult degenerative spine (levoscoliosis and dextroscoliosis). METHOD: Standing AP radiographs and MRI in supine position were taken. Patients were divided into 3 groups based on Cobbs' angle into normal, levo and dextro scoliosis. Moros classification was used to calculate bare window (BW), vascular window (VW), Psoas window (PW), psoas major height (pmh) and width (pmw) at lower lumbar levels and measurements were done on PACS. RESULTS: Seventy five patients (25 in each group) were assessed. BW has trend from L2-L3 > L3-L4 > L4-L5 in dextro and levoscoliosis. PW has trend from L3-L4 > L2-L3 > L4-L5 in levoscoliosis and normal group. VW has trend from L4-L5 > L3-L4 > L2-L3 in dextro and levoscoliosis; pmw has trend from L4-L5 > L3-L4 > L2-L3 in Levo and dextroscoliosis; pmh has trend from L4-L5 > L3-L4 > L2-L3 in levoscoliosis and normal group. CONCLUSION: BW was noted to be highest at L3-4, lowest at L4-5 in normal group. VW was constant, BW showed a reverse trend with PW across all the levels. Though levoscoliosis group of patients had significantly higher BW, psoas retraction issues are to be kept in mind in view of anatomically taught psoas.

An Early Experience with a Novel Technique of Total Knee Arthroplasty for Osteoarthritic Knee with Coexistent Traumatic Tibia Diaphysis Fracture.

BACKGROUND: Treatment of tibia (upper third and diaphysis) fracture together with severe osteoarthritis (OA) poses challenge to an orthopedic surgeon. Traditionally, it is treated through three-stage surgeries, first fracture fixation followed by implant removal and finally surgery of total knee arthroplasty (TKA). Herein, we describe a novel TKA procedure using long-stemmed tibia component. This one-step technique not only addresses arthritis of the knee joint but also helps in assisting fixation of the fracture. MATERIALS AND METHODS: We reported outcomes of three female non-diabetic patients with OA who developed tibia shaft fracture following trauma. Range of motion and quadriceps strengthening exercise were initiated immediately after the procedure. X-rays anteroposterior and lateral views of the operated limbs were obtained at post-operative week-6 and week-12. We allowed the patients' toe touch weight-bearing immediately after the surgery. The patients were progressed to full weight-bearing after confirming radiological union on the X-rays. RESULTS: At follow-up, all treated patients were able to mobilize with good range of motion of the operated knee and with union of the fracture. The American Knee society scores and WOMAC pain and stiffness scores improved significantly. CONCLUSION: This novel technique offers one-stage solution to the complex situation of osteoarthritis of the knee with associated tibia shaft fracture, thereby reducing future hospital admissions/surgeries and associated costs and complications. Further, it allows faster rehabilitation.

The influence of the internet on the patients' choice of surgeon for their total knee replacement surgery.

BACKGROUND: To study the influence of the internet on the patient's choice about Total Knee Replacement surgery and about their choice of surgeon for their Total Knee Replacement procedure. SIGNIFICANCE: Insight into patient's decision making will help the surgeon to increase his/her visibility and also will help in providing true and reliable information about the patient's ailment. MATERIALS AND METHODS: We studied 200 patients who were operated by a single surgeon. They were given a questionnaire which had various questions regarding their name, age, sex, date of operation. It also had leading questions like did you or your relative searched the net about the operation and the operating surgeon? The information was collected by self filled questionnaire form. RESULTS: There were 166 females and 34 males. 70% of to be operated patients or their relatives searched the net before undergoing the Total knee replacement. Also 36% of patient relatives (mainly son or daughter) searched the surgeon on the net before finalizing the operation. 10% of patients searched the operating surgeon on the internet. 15% of patients or their relatives chose the operating surgeon based on their net search. CONCLUSION: Our study shows that a sizable number of decision makers (patients and their children) search the information about the operation and about their operating surgeon. Hence it is recommended that the surgeon should have an information portal to increase his/her visibility, patient reach and imparting proper information to the prospective patients regarding the operative procedure.

Education, engagement and provision of empathy by trained counselor enhances the patient satisfaction after Total Knee Arthroplasty.

BACKGROUND: One of the major concerns following Total Knee Arthroplasty (TKA) surgery is patient satisfaction. Hence, this study sought to assess the effect of patient education, engagement and provision of empathy delivered by trained counselor on patient satisfaction. METHODS: All the patients included in the study were randomly allocated to two groups: Patients who received counseling from trained personnel during pre-, peri- and post-TKA phase constituted group-A (n = 100) whereas patients who were advised by the surgeon before the procedure constituted group-B (n = 100). All the patients who were counseled by trained personnel continued to receive counseling up to six months following TKA surgery. Patients belonging to group-A were provided counseling pertaining to education related to TKA procedure, the modalities of pain management and post-TKA ambulation regimen. Patient satisfaction was measured with Forgotten Joint Score-12 (FJS-12) and consumer gap (defined as the difference between patient perception and expectation) was recorded by an independent observer after 52-week of the TKA procedure. RESULTS: Patients belong to group-A had higher satisfaction as compared to those in group-B as evident by statistically higher FJS-12 score (64.5 ± 16.4 vs. 59.4 ± 17.9; p = 0.0369). There was statistically significant difference observed in consumer gap between group-A (6%) and group-B (16%) (p = 0.0242). CONCLUSIONS: The results of the study are encouraging to employ counseling by trained personnel during pre-, peri- and post-TKA phases as to improve patient satisfaction and reduce consumer gap.

Comparison of local pain and tissue reaction between conventional pneumatic tourniquet and disposable silicone ring tourniquet during Total Knee Arthroplasty.

BACKGROUND: To study the comparison of conventional pneumatic and disposable silicone ring tourniquet in Total Knee Arthroplasty. MATERIAL AND METHODS: This is a prospective randomized control trial. We used conventional pneumatic tourniquet on one side of leg and disposable silicone ring tourniquet on the other side in consecutive 50 simultaneous bilateral TKR patients. Patients having peripheral vascular disease of the lower limb were excluded from the study. The patient demographics & characteristics are identical being the same patient with two different legs. We started the study with null hypothesis. An independent observer assessed the local tourniquet site pain (VAS score 1-10) and local tourniquet site skin reaction at 24 h and 48 h after the TKA. P value < 0.05 was considered significant. RESULTS: There were no local skin complication with disposable tourniquet (0%). 8 out of 50 patients in whom the conventional tourniquet was applied showed local bruising, and two patients had blister formation making the local skin site complication rate 20% (statistically significant, p value0.0196, chi-squared test). The VAS score at 24 h was 4.3 ± 1.5 for disposable tourniquet group as against 5.6 ± 2.1 for conventional tourniquet group (statistically significant, p value = 0.0152, t statistic test for comparison of means). The VAS score at 48 h was 2.1 ± 1.5 and 3.3 ± 1.2 for disposable tourniquet group and conventional tourniquet group respectively (statistically significant p value = 0.003, student's t-test). CONCLUSION: Use of disposable tourniquet has better outcome than the conventional tourniquet with minimal or no local complications. The advantages of the disposable tourniquet are: 1 less local pain, 2. no local skin problems, 3. accurate tourniquet pressure at the application site, 4.0% local contamination. Hence, we recommend use of the disposable tourniquet during the Total Knee Arthroplasty.

Early experience with the use of trochanteric reattachment plate for the treatment of Vancouver type B 1 periprosthetic hip fractures.

OBJECTIVE: The purpose of our study is to study the usefulness of trochanteric reattachment plate in the management Vancouver type B 1 periprosthetic femur fractures. METHODS: We describe a case series of 15 (12 F: 3 M) Vancouver type B 1 fracture fixed with trochanteric reattachment plate with 3 years follow up. Patients with Vancouver A, B2, B3 and C fractures were excluded in the study. Clinical and radiological assessment of patients was done at 1, 3, 6, 9, 12, 24 and 36 months. The parameters evaluated were fracture union, Harris hip score and post-operative complications if any. RESULTS: Patients mean age was 74 years (range 58-84). Eleven patients were operated with cemented hemiarthroplasty while 4 patients had total hip arthroplasty done before. Operation time mean was 137.2 min and mean surgical blood loss was 522.66 ml. All the patients achieved radiological union of the fracture at mean of 14.13 weeks. Mean Harris hip Score was 82 at 36 months follow up. 13 out of 15 hips (86.67%) showed good clinical results and 2 patients (13.33%) showed fair result. All the patients returned to their pre injury activities of daily living. CONCLUSION: Operative fixation of Vancouver type B 1 periprosthetic fractures is a challenge for an orthopedic surgeon. Open reduction and internal fixation of these fractures using of trochanteric reattachment plate incorporating screws and cerclage wires through the plate provides good outcome in these patients. Use of this plate offers the surgeon stability against shearing as well as rotational forces.

A Rare Case of Type III Dens Invaginatus in a Mandibular Second Premolar and Its Nonsurgical Endodontic Management by Using Cone-beam Computed Tomography: A Case Report.

Invaginated teeth present technical difficulties in clinical management because of their abnormal anatomic configuration. Endodontic clinical management of type III dens invaginatus can be greatly enhanced by newer techniques and materials such as cone-beam computed tomography (CBCT), mineral trioxide aggregate, and platelet-rich fibrin. This case report presents a 13-year-old male patient with type III dens invaginatus (DI) in left mandibular second premolar with history of recurrent swelling. Pulp testing revealed no response with the tooth. Dens invaginatus type III with an immature apex and periapical lesion was seen on radiograph. The case was diagnosed as Oehlers type III DI with pulp necrosis and chronic apical abscess. The treatment was planned and performed by using CBCT imaging. CBCT was performed to see the canal anatomy and to know the size of periapical lesion. Root canal treatment was completed in 2 visits. Calcium hydroxide dressing was placed in the first visit. In the second visit MTA was used for apexification in the main canal, and warm vertical compaction technique with gutta-percha was used in the invaginated canal. At the 2-year reevaluation, the patient was asymptomatic, and his tooth had remained functional since the treatment was completed. Radiographic assessment of the tooth showed significant osseous healing of the preoperative lesion. Three-dimensional imaging is a valuable tool for endodontic management of teeth with complex internal anatomy.