Survival of total hip arthroplasty (THA) in sickle cell disease.

BACKGROUND: The objective of this study was to evaluate the outcome of THA done in patients with sickle cell disease at a single center, and compare with rest of the world before we could recommend routine THA in SCD patients. METHODS: In 92 patients, 117 THAs were performed in sickle cell patients. Seventy-six (76) patients had homozygous hemoglobin (Hgb SS) disease, whereas sixteen had sickle cell trait (Hgb AS). Patients with Grade III Ficat and above avascular necrosis of the head of femur (ANFH) with cementless porous-coated proximal femur fixation were included in this analysis. Harris hip score was modified (MHHS) and used for assessment of improvement and visual analog scale score (VAS), for pain assessment. RESULT: VAS improved from average pre-operative mean of 7 (7-9) to 2.5 (1-5). The average pre-operative MHHS was 44 (32-63), and it improved to 79 (71-88) in the final mean follow-up of 12.4 (4-18) years. Nine patients (9.7%) had complications and revision surgery was required in seven (5.9%) for aseptic loosening. CONCLUSION: Our analysis shows that THA in sickle cell disease is safe with average 12 years of follow-up, indicating that surgery in these young patients (≤ 25 years) is safe and should not be delayed.

An assessment of the ocular tear film in patients with thyroid disorders.

Objective: To investigate the ocular tear film in patients with thyroid disorders using various tests. Methods: The study involved the assessment of the ocular tear film in 20 patients with thyroid disorders (6 men and 14 women) aged 18-43 years (mean±standard deviation=34.3±3.2 years). An age-matched control group consisting of 20 subjects (8 males and 12 females) ranging in age from 18 to 43 years (31.3±2.9 years) was also examined under similar conditions. All patients completed the Ocular Surface Disease Index questionnaire, followed by the tear ferning test within the right eye. A phenol red thread test was carried out 10 mins later followed by the fluorescein tear break-up test with a 10-min gap between the tests being implemented. Results: The median score for the Ocular Surface Disease Index (P<0.05) showed the condition of mild dry eyes [median (IQR)=15.5 (21.9)] in patients with thyroid disorders compared to the control group [5.6 (3.6)]. The mean score for the phenol red thread test within both the right and left eyes showed acceptable tear volumes of 11.7±8.1 and 10.5±7.4 mm, respectively, but this was much lower (P<0.05) compared to those recorded within the control group (22.2±6.5 and 20.7±5.2 mm, respectively). In addition, the mean for the tear break-up time (P<0.05) scores in both eyes within the patients with thyroid disorders revealed a certain degree of eye dryness (4.9±1.6 and 4.2±1.9 s), while the control group showed normal eye scores (13.2±2.6 and 12.3±2.2 s). The median score for tear ferning grades showed eye dryness [2.0 (2.2)] within the study group and normal eyes [1.2 (0.9)] within the control group. Conclusions: Patients with thyroid disorders have a significant level of eye dryness compared to normal eye subjects.

Effect of patellar denervation on mid-term results after non-resurfaced total knee arthroplasty. A randomised, controlled trial.

UNLABELLED: Aim of this study is to determine the clinical effect of circumpatellar electrocautery on cases undergoing non-resurfaced total knee arthroplasty. PATIENTS AND METHODS: 184 patients undergoing non-resurfaced total knee arthroplasty were included and randomized into two, patient and outcome assessor-blinded, parallel groups: 92 patient in denervation group & 92 patients in no-denervation group. Pre-operative and final most recent follow up's Western Ontario McMaster score and anterior knee pain rating were used for statistical analysis. RESULTS: There was no statistically significant difference between both groups preoperatively in anterior knee pain, WOMAC score, or range of motion. While on all the three parameters there was a statistically significant difference in improvement in favor of denervation group. DISCUSSION: Our study demonstrated that post-operative functional score and anterior knee pain score were significantly better in electrocauterised group. This shows that patellar denervation significantly improve clinical outcome and decreased anterior knee pain in NR-TKA.

Osteoporosis-related simultaneous four joints fractures and dislocation after a seizure: a case report.

A case of steroid-induced osteoporosis-related multiple fractures and dislocations are described after a seizure is reported. Patient had two years history of steroid use with no supplement or antiresorptive therapy. There was a delay in the diagnosis which affected an otherwise good outcome in such situations. It is recommended that patients on steroid should be given calcium, vitamin D, and an antiresorptive. Furthermore, a meticulous clinical examination is required in patients who are on steroids and suffer epileptic seizures to rule out skeletal injury.

Osteoarthritis of knee: correlation between radiographic and arthroscopic findings.

The objective of this study was to correlate radiologic changes to arthroscopic findings in patients with osteoarthritis of the tibiofemoral joint. The study group consisted of 105 patients, 52 men and 53 women, with a mean age of 51 +/- 9.3 years (range, 39-83 years), with symptomatic tibiofemoral joint osteoarthritis (TFOA). X-rays were graded according to Kellgren and Lawrence grading (KLG) by 2 independent board-certified radiologists. All patients had arthroscopy, and findings were recorded and analyzed per Outerbridge classification (OC). Approval of the Institutional Research and Ethical Committee was obtained. Statistical analysis was done using the Statistical Package for the Social Sciences, version 17 (SPSS Inc., Chicago, IL, USA). In men, the correlation of KLG to OC was more than 75% in grade II and joints appeared as grade IV, but with grades I and III, it was 66% and 57% (P = 0.05). In men in KLG groups I and III, the joints appeared to have milder affliction, but arthroscopy revealed otherwise. In women, the only correlation was of KLG grade IV to OC grade IV. In women, joint affliction was more severe than was predicted by the KLG (P = 0.01). This study shows that radiologic lagging occurs behind arthroscopic findings, especially in women and in apparent early arthritis in roentgenograms (lower radiologic grades). X-rays of the knee per se might give a false impression of a milder disease.

Bilateral non-union of high tibial osteotomies treated by total knee arthroplasty: a case report.

Non-union following high tibial osteotomy (HTO) is very uncommon. We present a case of bilateral non-union of HTOs with end-stage knee arthritis treated with staged, bilateral, posterior stabilized knee replacements. A 77-year-old female presented to our clinic with complaints of debilitating knee pain. She used a frame to get about in her home, she was unable to get up stairs, and she rarely went outside. Simple radiographs revealed bilateral non-unions of her osteotomies, subluxation of the tibial plateauxs and severe knee osteoarthritis. At the time of surgery, the non-unions were found to be fibrous stable. We took a minimal tibial plateaux resection and used long stem tibial stems with offset couplers to bypass the non-unions. At minimum 1 year follow-up, she was walking pain free with full knee range of motion. We found that primary total knee replacement (TKR) using tibial stems and without treating the tibial non-union gave satisfactory results.

Acetabular dysplasia in adult hips of a Saudi population. A possible relation to coxarthrosis.

OBJECTIVE: To evaluate acetabular morphology and the prevalence of dysplasia in a Saudi population, and compare it with others in different geographical areas. METHODS: The study took place at King Fahd University Hospital, Al-Khobar, Kingdom of Saudi Arabia from May 2005 to April 2006. We recruited radiographs of 104 patients of 40-88 years of age. We digitally measured the center edge angle (CEA) of both hips. RESULTS: Of the 208 hips examined, 3 hips (1.44%) had mild-to-moderate acetabular dysplasia but there was no case with severe dysplasia (CEA