Implant positioning in total hip arthroplasty: influence of horizontal and vertical offset on functionality of prosthetic hip joint.

PURPOSE: To analyze the effect of implant position measured in terms of offset on patient reported outcomes (PRO) following hip arthroplasty (THA). METHODS: A total of 243 patients of the total hip replacement who had a one year follow-up were included in the study. Standard both hips radiograph was used to asses post-surgery implant position in terms of horizontal offset and vertical offset, and correlated with functional outcome which was evaluated as change in PRO. i.e., Harris hip score (HHS) post-op. With center of hip rotation as reference, horizontal offset was calculated as sum of distance, of centre, from proximal femoral shaft axis and a vertical line through ipsilateral teardrop, and vertical offset as limb length discrepancy. Post-op patients were classified into three groups depending on the measurement of horizontal offset of the operated hip. The patients having operated hip horizontal offset within 5 mm of the normal hip were grouped as restored offset (RO); those having shorter or higher offset by more than 5 mm compared to normal hip were labeled as decreased (DO) or increased offset (IO) group respectively. The groups were further subdivided into suboptimal and optimal function groups based on HHS, and among these groups, limb length discrepancy was evaluated. RESULTS: Post follow-up mean HHS (78.23 ± 9.96) improved significantly in all three groups (p < 0.0001). The difference in post-operative HHS among DO, RO, and IO groups was significant, with their averages being 72.5 ± 4.7, 82.1 ± 6.5, and 75.2 ± 4.8 respectively (p = .01). Limb length discrepancy was significantly more common in patients with suboptimal functional scores in all three groups. CONCLUSION: This study concluded that both horizontal offset and vertical offset should be reconstructed in patients operated with unilateral THR due to hip pathology, since both factor demonstrated a comparable additive effect on clinical outcome.

A clinicopathological pattern of cutaneous tuberculosis and HIV concurrence in western Rajasthan.

Background: Cutaneous tuberculosis (TB) forms a small subset of extrapulmonary TB and continues to be a significant diagnostic dilemma in routine practice. The present study is an attempt to find the incidence, clinical spectrum, and histopathological features of cutaneous TB in western Rajasthan. The relation of cutaneous TB with the human immunodeficiency virus (HIV) was also assessed. Method: A total of 40 cases of newly diagnosed patients of cutaneous TB attending the dermatology outpatient department over a period of 1 year were included in the study. A detailed clinical examination and investigations including histopathological examination were carried out. Results: The overall incidence of cutaneous TB was 0.025% (40 of 160,000 outpatients). HIV concurrence was 5% (2 cases) of all cutaneous TB cases. The most common variants were scrofuloderma (40%), lupus vulgaris (30%), TB verrucosa cutis (8%), orificial TB (2%), and lichen scrofulosorum (2%). Males suffered more than females (2.07:1) and all patients belonged to lower socioeconomic class. The Mantoux test was positive in 65% of cases. Extracutaneous involvement occurred in 17 (42.50%) cases. Characteristic well-defined tuberculoid granulomas were seen in 60% of cases, whereas 40% of cases showed nonspecific changes. Conclusion: : This study provides the epidemiological data of cutaneous TB in western Rajasthan, identifies the clinicohistopathological pattern, and calls the attention of the health-care professionals that they should improve the propaedeutics of neglected and underdiagnosed cases of cutaneous TB that is prevalent in the lower socioeconomic group. Due to the varied clinical presentations, physician awareness and a high index of suspicion are necessary to diagnose cutaneous forms of TB.