Cruciate-retaining Arthroplasty in Patients with Severe Varus Deformity: A Retrospective Comparative Study.

Introduction: There has been debate regarding the advantages of cruciate-retaining over posterior stabilized (PS) knee arthroplasty and vice versa. Many authors consider any coronal plane deformity > 15° as a contraindication for cruciate-retaining total knee arthroplasty. We aimed to compare whether functional outcome, deformity correction, and survivorship of cruciate retaining knee arthroplasty (CR) for severe varus deformity are equivalent to that ofposterior cruciate ligament substituting (PS) for 6 years. Materials and Methods: We conducted a retrospective comparative study among patients who underwent Total Knee Replacement in the Orthopedics Department of a tertiary care hospital between 2016 and 2018 August who had a varus deformity of more than 15°. The first author exclusively performed CR operation (Group A) for all complex knees. In contrast, the second author performed PS surgery (Group B) for any coronal plane deformity over 15°. Clinical evaluation included completing a Knee Society Score (KSS) Evaluation Form. Pre-operative scoring was collected from the hospital database. All clinical examinations and radiographs at the final follow-up were done by the third author, who was unbiased and not involved with the initial patient care. Results: here were 39 patients in Group A (CR) and 28 patients in Group B (PS). In Group A, the mean pre-operative varus was 22.05 ± 2.72° and the pre-operative KSS was 32.94 ± 6.79. Postoperatively, the deformity corrected to a mean valgus of 5.48 ± 1.8° and mean KSS of 89.17 ± 5.79. In Group B, the mean pre-operative varus was 22.14±3.82° and pre-operative KSS was 32.82 ± 5.98. Postoperatively, the deformity corrected to a mean valgus of 4.85 ± 2.1° and mean KSS of 90.17 ± 5.13. The mean insert thickness was 11.76 ± 1.75 mm and 11.42 ± 1.75mm among the CRand PS groups, respectively. Concerning deformity correction (P = 0.19) and functional outcome (P = 0.46), both groups showed equal improvement with a 100% survival rate for 6 years. Conclusion: We concluded that CRknee replacements are possible with excellent functional and radiological outcomes in severe varus arthritic knees with a 100 % survival rate.

Single-Stage Revision With Fluconazole Monotherapy in Fungal Prosthetic Knee Joint Infections.

Fungal prosthetic joint infection is rare, and two-stage revision is usually advocated. We present our experience with 2 cases of fungal prosthetic knee joint infection presenting 25 months and 3 years after index surgery. Both patients were managed with single-stage revision arthroplasty and fluconazole monotherapy. They remain asymptomatic with good knee society score after 2 years of follow-up. Preoperative workup of all aseptic loosening cases should include extended culture for fungal elements. Single-stage revision with antifungal therapy for 3 months gives good results in nonimmunocompromised patients with good soft-tissue envelope.

Bilateral Primary Iliopsoas Abscess with Bilateral Hip Septic Arthritis - A Rare Case Report.

Introduction: Iliopsoas abscess is an uncommon condition, often with insidious and nonspecific symptoms. Patients often present with a limp, fever, weight loss, and flank or abdominal pain. An iliopsoas abscess can be either primary or secondary depending on the presence or absence of an underlying disease. Primary abscess is very common in Asia and other developing countries. If untreated, iliopsoas abscess can spread to lower limbs, compress iliac vein, ureter and can end up in sepsis. There have been only a very small number of cases of psoas abscess with associated hip septic arthritis reported so far. Bilateral iliopsoas abscess is also a rare entity. Case Report: We report here a 58-year-old diabetic lady with fever and both hip pain subsequent to a fall at home one month back around one 1 month before. . She was initially seen elsewhere, and a diagnosis of L4-L5 disc bulge was made following which rest , analgesics and steroids were given. Later, repeat magnetic resonance imageMRI showed bilateral Iliacus abscess and bilateral hip synovitis. She was started on anti anti-tuberculosis medications and referred to us. We investigated for occult sources of infection and did bilateral iliopsoas abscess drainage followed by staged bilateral total hip replacement. She now continues to be symptom free . Conclusion: Our patient had primary bilateral iliopsoas abscess with bilateral hip Streptococcus faeeacalis septic arthritis. It has not been reported in the literature till now . Clinical Message: Early diagnosis through meticulous clinical examination and investigations is important in treatment of the abscess and reducing morbidity and mortality.

Neglected Anterior Dislocation of the Knee with Common Peroneal Palsy.

Knee dislocations usually follow high velocity injuries and are increasingly being treated with immediate reduction and staged repair of the ligaments. Neglected knee dislocations are rare and more difficult to treat with inferior outcomes. We present a rare case of neglected anterior dislocation of the knee treated by surgical arthrodesis.