ABSTRACT
Introduction The proximal femur is a common site for primary bone sarcomas, including Ewing's sarcoma, chondrosarcoma, osteosarcoma, and giant cell tumors (GCT). Extensive resections are challenging to reconstruct because the size of the tumor may necessitate an extensive resection of the femur to achieve adequate oncologic clearance. The resection of the proximal femur can result in hip joint instability due to the loss of the strong native hip capsule or hip abductor strength. With a wide range of reconstruction options, such as resection arthrodesis, allograft-prosthetic composite (APC), and endoprosthesis, we can achieve limb salvage with good functional outcomes. Objective The objective of this case series is to evaluate the clinical outcomes and complications associated with endoprosthesis replacement in patients with proximal femur tumors. Methods A prospective analysis was conducted with 32 patients who underwent modular endoprosthesis replacement for proximal femoral tumors at our institution. Patient data, tumor characteristics, surgical details, and postoperative outcomes were collected and analyzed. Results The study involved 32 patients who met the inclusion criteria. They were assessed using the Musculoskeletal Tumor Society Score (MSTS), which showed good functional outcomes in 72.84% of the patients. The study highlights the functional outcomes and potential complications associated with the use of modular prostheses. Conclusion Endoprosthesis replacement in proximal femur tumors is a viable treatment option, providing good functional outcomes and an acceptable method for limb salvage, which enhances the quality of life.
ABSTRACT
Introduction Total Knee Arthroplasty (TKA) can be associated with significant peri- and post-operative blood loss necessitating blood transfusion. The blood loss may be relatively less when the accelerometer-based handheld navigation system (HHNS) is used, as there is neither a need for intramedullary breach nor additional pin insertions. The primary hypothesis was that HHNS instrumentation reduced perioperative blood loss when compared with conventional instrumentation, and to prove this, we compared the perioperative parameters like tourniquet time, hemoglobin loss, and estimated blood loss between patients undergoing total knee arthroplasty using conventional instrumentation with handheld navigation instrumentation. Methods This prospective comparative study involves 40 patients in the HHNS group and 40 patients in the conventional group based on the instrumentation used, respectively. Tourniquet was used in all the cases. Patient characteristics like age, sex, body mass index (BMI), American Society of Anaesthesiologists (ASA) grade, and Charlson Comorbidity Index (CCI) were recorded. The perioperative parameters like tourniquet time, the estimated blood loss, hemoglobin loss, blood transfusions, and the number of units transfused were recorded and compared between the groups. Results There was no significant difference in age, BMI, ASA grade, or CCI between the two groups. The tourniquet time was 83.7 ± 9.6 in the navigation and 73.9 ± 10.3 in the conventional group. The estimated Hb loss was lower at 2.5 ± 1.6 in the HHNS group compared to 3.0 ± 1.8 in the conventional group (p<0.001). Similarly, estimated blood loss was also lower at 830 ± 285ml for the HHNS group compared to 1088 ± 228 in the conventional group. Two patients in the navigation group had a total of four units transfused, whereas three patients in the conventional group had five units of blood transfusion. Conclusions The primary hypothesis that HHNS reduced perioperative blood loss was confirmed by the results of our study. We demonstrated that HHNS instrumentation significantly decreased the estimated blood loss, drain volume, and hemoglobin loss compared to conventional instrumentation with similar operating times. Though blood transfusions were seen in fewer patients, there was no significant reduction in blood transfusions by HHNS instrumentation.
ABSTRACT
The primary objective of this study was to compare the efficacy of use of Vancomycin impregnated bioabsorbable calcium sulphate (VCS) pellets along with surgical debridement to control group without the use of calcium sulphate for chronic osteomyelitis. The secondary objective was comparing the results in different subtypes of chronic osteomyelitis. Methods: 50 consecutive patients were enrolled in VCS group and control group based on used whether VCS was used in treatment in addition to surgical debridement or not. Patients were classified using Cerny Mader Classification and were serially followed up to compare efficacy of eradication of infection and complications between the groups. Results: Patients were followed for a minimum of 24 months postoperatively (range, 24-63 months; mean 32.2 ± 4.2months). 88% (44/50) of patients in VCS group achieved eradication of infection when compared to 64% (32/50) in control group at 2-year follow-up period (p < 0.001). Three out of six patient with recurrence in VCS group and 11 out 18 patients in control group achieved eradication after second stage surgery using same protocol using VCS. Among 10 with persistent infection, 5 among these were those with diffuse osteomyelitis and 5 were those with medullary osteomyelitis. In VCS group, 18/50 patients had persistent serous drainage from the wound for up to 4 weeks which was self-limiting. Conclusion: Local debridement combined with antibiotic impregnated calcium sulphate as a single-stage treatment is effective in treating chronic localized osteomyelitis when compared to debridement alone. However, its use alone in diffuse osteomyelitis may be less effective.
ABSTRACT
Background An accelerometer-based handheld navigation system (HHNS) for total knee arthroplasty (TKA) does not require a large console needed for computer-assisted navigation systems and has been shown to decrease component malalignment in TKA. The study aimed to use HHNS with conventional instrumentation to compare the radiological evaluation and functional outcomes of TKA. Materials and methods This was a multi-surgeon, prospective, assessor-blinded comparative study of 122 patients undergoing unilateral TKA. We used a stratified randomized sampling method to select 35/48 patients undergoing TKA using a handheld navigation system and 35/74 patients undergoing TKA using conventional instrumentation and divided them into two groups: the HHNS group and (conventional) CONV group. Postoperative radiographic evaluation was based on the tibial and femoral alignment angle, posterior tibial slope, and tibiofemoral angle measured from full-length lower-limb anteroposterior and lateral views of the knee. The Oxford Knee Score (OKS) and Knee Society Score (KSS) with a two-year serial follow-up were used to evaluate functional outcomes. Results The mean tibial alignment angle and posterior tibial slope were 0.78° ± 1.27° and 4.38° ± 0.86°, respectively, in the HHNS cohort and 2.63° ± 1.54° and 2.12° ± 1.82°, respectively, in the CONV group (p < 0.001). There was no significant difference in the femoral alignment angles. The overall alignment using the mean tibiofemoral angle was 179.21° ± 1.82° in the HHNS group and 177.31° ± 2.18° in the CONV group (p = 0.002). There were no significant differences in the KSS and OKS at the two-year follow-up between the groups. Conclusions The use of HHNS in TKA significantly increased accuracy in limb and implant alignment, but there was no significant difference in the two-years functional outcomes.
