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Background Avascular necrosis (AVN) is characterized by bone death due to impaired blood supply leading to its collapse causing pain and suboptimal joint function. The blood supply of the femoral head is so tenuous that even a slight vascular injury can predispose to AVN. Hence, AVN is commonly seen in the femoral head. Core decompression can arrest or even reverse the process of AVN and can avoid femoral head collapse and its sequelae. A lateral trochanteric approach is used for core decompression. The necrotic bone is removed from the femoral head. The use of a non-vascularized bone graft is more attractive than a vascularized graft because it is significantly less technically challenging. The regenerative properties due to the presence of osteoblasts in the trabecular bone and the ability to procure a large amount of graft make the iliac crest the gold standard site of cancellous bone graft harvesting. Core decompression can be considered an effective treatment modality in early-stage AVN (up to stage 2B) of the femoral head. Methodology A prospective, interventional study was conducted in a tertiary care teaching hospital in southern Rajasthan, India. 20 Patients with AVN of the femoral head (up to grade 2B of Ficat and Arlet classification) who met the inclusion and exclusion criteria and presented to the orthopedic outpatient department of our institute were included in this study. Patients were treated with core decompression and cancellous bone grafting with a graft taken from the iliac crest. The Harris Hip Score (HHS) and Visual Analog Scale (VAS) score were used to assess the outcomes. Results In our study, the majority (50%) of the patients were in the 20-30-year age group, making it the most common age group with a male predominance (85%). In this study, the final result was calculated according to the HHS and VAS scores. The mean HHS was 69.45 preoperatively and 83.55 at six months postoperatively. Similarly, the mean VAS score was 6.3 preoperatively and 3.8 at six months postoperatively. Conclusions Core decompression with cancellous bone grafting is a promising procedure in stages 1 and 2 as it reduces the symptoms in the majority of cases and improves functional outcomes.
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INTRODUCTION: The present study was done to analyze the functional outcome, donor site morbidities, and associated parameters when using the anterior half of the peroneus longus for augmentation of an inadequate hamstring graft when performing arthroscopic anterior cruciate ligament (ACL) reconstruction. METHODS: Thirty patients with complete ACL tears were operated on. In all these patients, the thickness or length of the hamstring graft taken was found to be inadequate (less than 8 mm and 7.5 cm, respectively). So, additionally, the anterior half of the peroneus longus tendon (AHPLT) graft was harvested to reach an optimum size of the final graft. Functional outcome was assessed using the International Knee Documentation Committee (IKDC) score at six weeks, three months, and six months. The Foot and Ankle Disability Index (FADI) score at six months was used to assess ankle stability. RESULTS: The mean age in our study was 28.8 years with male predominance (73.33%). The mean operative time was 86.4 minutes. The mean hamstring graft thickness in our study was 6.5 mm, which improved to 9.12 mm after augmentation. The mean graft length after AHPLT augmentation was 9.38 cm. The mean IKDC score at six months was 87.35. At the end of six months, FADI scores were found within normal limits (range: 135-136) in all the patients. No complications were noted in any of the patients. CONCLUSION: The AHPLT graft was always found to be sufficient enough for augmenting the hamstring graft to reach an acceptable thickness and length. There was no graft site morbidity and the ankle functional levels remained the same as preoperative levels, making it an excellent choice for augmentation of inadequate hamstring grafts.
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Background Total knee arthroplasty (TKA) is a procedure that has improved the quality of life of patients with knee arthritis. Postoperative pain and blood loss are the two major drawbacks of TKA which affect patient satisfaction and delay recovery and rehabilitation. Local infiltration analgesia has shown better results in controlling immediate postoperative pain, thus enabling early rehabilitation and mobilization, while local infiltration of antifibrinolytic agents has shown impressive results in controlling blood loss. In this study, we evaluate the effect of a combination of intra-articular infiltration of ropivacaine cocktail along with intra-articular instillation of tranexamic acid in reducing patient-reported postoperative pain and the level of blood loss control after TKA. Methodology Patients presenting with high-grade osteoarthritis and undergoing TKA were included and randomly allocated to two groups: one receiving the intra-articular infiltration (group A), and the other not receiving any infiltration (group B). Postoperative pain was measured through the Visual Analog Scale (VAS) every three hours for the first 24 hours, and then at 48 hours and 72 hours postoperatively. The need for additional analgesia, in the form of a slow epidural infusion, in patients experiencing severe postoperative pain was evaluated in both groups. Postoperative blood loss was assessed by measuring total drain output (in mL) and by comparing preoperative and postoperative (at 24 hours) hemoglobin, hematocrit drift, and blood transfusion rates. The duration of the postoperative hospital stay and the time taken to start postoperative knee mobilization exercises and weight-bearing were noted to assess the recovery and rehabilitation of the patients in the two groups. Results The study included 42 patients (group A, 22 patients; group B, 20 patients) with 28 knees in each group. Patients with intra-articular infiltration using ropivacaine cocktail with tranexamic acid showed excellent pain control compared to the non-infiltrated patients in the early 48 hours postoperatively. There was a significant drop in postoperative hemoglobin and hematocrit values in the non-infiltrated patients compared to the other group. Further, the intra-articular infiltration-instillation significantly reduced blood loss through the drain, the requirement of postoperative blood transfusions, and the duration of hospital stay. Conclusions It can be safely concluded that ropivacaine cocktail and tranexamic acid instillation postoperatively in knee arthroplasty patients is a very useful and effective technique to reduce postoperative pain and blood loss.
