Ancient Schwannoma Along the Patellar Tendon: Unveiling a Rare Clinical Phenomenon With Literature Review.

Ancient schwannoma, a rare subtype of schwannoma, a benign tumor originating from nerve sheaths, can arise from various nerves, except for the optic, olfactory, spinal, and autonomic nervous systems. Schwannomas are typically characterized by the presence of neoplastic Schwann cells and tend to develop eccentrically. Malignant transformations of schwannomas are exceptionally uncommon. In this case report, a 42-year-old male presented with a painful lump on the front of his left knee. The lump was described as an extra-articular swelling below the kneecap, situated over the patellar tendon. Initially, ultrasonography (USG) indicated the presence of a slow-flow vascular malformation in the infrapatellar region of the left knee. However, subsequent magnetic resonance imaging (MRI) revealed a well-defined mass in the subcutaneous plane below the knee, with minimal septations, leading to an initial suspicion of a large sebaceous cyst. Further investigation through histopathological analysis confirmed the diagnosis of an extra-articular schwannoma. This finding highlights the importance of thorough examination and diagnostic techniques in differentiating between various types of soft tissue masses. Schwannomas, although uncommon in certain locations, should be considered in the differential diagnosis of painful lumps, even in atypical anatomical sites such as the knee.

Functional and Cost Audit of Primary Total Knee Arthroplasty in Public vs Private Hospitals: A Retrospective Cohort Study.

BACKGROUND: Government funded hospitals are believed to be stigmatised with 'substandard care' and constant fear of infection. The aim of this study is to compare the results and direct expenditure incurred for total knee arthroplasty (TKA) done at a government funded public teaching hospital with an economy packaged private hospital in India. MATERIALS AND METHODS: A review of electronic and physical records of the patients operated by the senior author for primary TKA at a government funded hospital and a private hospital spanning 2007 to 2019 was done. A retrospective cohort study was designed matching the implant design and the ASA grade of the patients. Knee injury and Osteoarthritis Outcome Score (KOOS), Hospital for Special Surgery score (HSS), Knee Society Score (KSS) at 2 years follow-up were the primary outcome parameters. The retrieved data describing the cost of surgery and perioperative complications were analyzed. The confounders were minimized by including only the surgeries performed by the author, using the same instruments and implants in similar operating theatre environments. RESULTS: This study involved two cohorts comprising 280 patients each, with no differences in gender, ASA grade and primary diagnosis. There was no significant difference in the 2-year HSS, KSS and KOOS score between the two groups. The 2-year cumulative incidence of major and minor complications in both the study cohorts showed no significant difference. The mean cost of an uncomplicated primary TKA (2019) in government hospital was INR. 85,927; 39.476% of that required in a private setup (INR. 2,17,667). CONCLUSION: Affordable TKA package in a government funded hospital can produce results comparable to that in a private hospital setup at a reasonably lower cost without increasing the complication rates.

India Joining the World of Hip and Knee Registries: Present Status-A Leap Forward.

BACKGROUND: The number of joint replacements in India is set to grow at the highest rate in the world from 2020 to 2026. It is high time for India to have an efficient and credible registry to help curtail the clinical impact of implant failure at a very early stage by prompt reporting. METHODS: Indian Joint Registry has been established by ISHKS with new data forms for reporting. These new detailed forms record, in addition to previous form, component-wise details of implants. Additional useful features include Linking with unique ID like PAN or Aadhaar, thromboprophylaxis, untoward intra-operative event, IJR consent and type of anaesthesia. RESULTS: There were 712 registered surgeons in IJR database till June 2020. Total TKRs being reported to registry increased from 1019 in 2006 to 27,000 in 2019. Majority of the patients (98.5%) were diagnosed with osteoarthritis knee. Company-wise distribution unveils that Johnson & Johnson DePuy represents the highest implant usage at over 37%. There has been increased utilisation of uncemented THR over cemented THR from 2006 to 2019. Dual-mobility THRs have gained ground as surgeon preference for the choice of implant. CONCLUSION: Effective use of quality registries can lead to better health outcomes at a lower cost for the society. An effective, responsive and sustainable registry in India offers many benefits and should be considered as a key objective. Making the registry function in India successfully will undoubtedly require multi-pronged efforts, but can deliver many benefits both to the patient and to the nation as a whole.

Does total contact of the patella with the femoral trochlea during no thumb test significantly reduce anterior knee pain?

BACKGROUND: Complications such as anterior knee pain (AKP) and crepitus continue to be causes of dissatisfaction after total knee arthroplasty (TKA). This prospective study aimed to study the significance of total patellar contact with the femoral trochlea of the implant, with the no thumb test during trial reduction, and its effect on reducing AKP. METHODS: Between 2014 and 2016, 445 patellofemoral joints (M:F 126:319, age 45-80 years) and their contact with the trochlea of the femoral component were graded at trial reduction without lateral retinaculum release (Grades I, Ia, II, III based on existing publications). The aim was to restore all patellae to pre-operative thickness. Posterior stabilized implants with a domed patella were used in all cases. The Knee Society Score (KSS) and Visual Analogue Scale (VAS) score were noted at follow up between 12 and 24 months after surgery. RESULTS: AKP was significantly lower with 100% patellofemoral contact. The KSS and VAS had statistically significant P-values of 0.021 and 0.025 in Grade I and Ia contact, respectively. Better results were achieved where patellar thickness was restored in Grades I and Ia with P-values of 0.041 and 0.046 for VAS change and 0.038 and 0.044 for KSS change, respectively. CONCLUSION: At follow up, superior results were obtained where there was a complete patellofemoral contact at trial reduction in Grade I and Grade Ia, and when other confounding factors such as patellar thickness and normal rotation of the femoral and tibial components were standardized. To minimize AKP it is imperative to have total patellar contact with the femoral trochlea.