Modified posterior approach and its effect on stability and functional outcome in total hip arthroplasty. A retrospective comparative evaluation was done to assess the functional outcome and rate of dislocation in 233 hips (Group A) operated before 2007 by convention posterior approach and 567 hips (Group B) were operated by modified posterior approach.(2007–2011) In this modified posterior approach technique, 2–3 stay sutures (non-absorbale Nylon) are applied in the piriformis tendon, short external rotator and proximal part of Quadratous muscle. Then a conjoint- myocapsular sleeve is raised by starting cutting (with cautery) linearly over the capsule with adherent fibers of gluteus minimus to piriformis tendon, short rotators and part of quadratus to expose and dislocate the head. After inserting the definite prosthesis, upper part of sleeve (capsule, piriformis tendon) is sutured with same nonabsorbable Nylon at the lower part of tip of greater trochanter by passing through the bone with needle or by drilling the bone; lower part of the sleeve is tied with lateral trochanteric bone. Additional stability to repair was given by closing the tendinous part of the gluteus maximus by horizontal cross mattress sutures up its attachment to the proximal femoral shaft.Background:
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Role of intra-articular Tranexamic acid in total knee replacement arthroplasty Prospective evaluation was done to see the effect of intra-articular Tranexamic acid on blood loss in 60 patients (120 knees) undergoing total knee arthroplasty. All the patients were operated by one surgeon with same technique by using same implants. Patients were randomly injected 1500 mg/20 ml of Tranexamic acid on one side of the knee only. Nothing was injected on the contra lateral knee. Evaluation was done for swelling and the amount of blood loss in the drain.Background:
Materials and methods
Is routine use of suction drain after joint replacement is justified. Prospective evaluation was done to compare the effects of postoperative suction drain in 56 patients with no postoperative drain in 56 patients, undergoing total knee arthroplasty at our institute. Patients having severe systemic diseases, disturbed liver function, obesity, unstable diabetes and coagulation disorders were excluded from the study. Comparative evaluation was done for the blood loss, no of units of blood transfusion, wound hematoma, wound healing, duration of hospital stay, pain and range of motions.Background:
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Clear-cell sarcoma is a very rare tumor, and is almost always associated with tendons or aponeuroses or is metastatic from other organs. Sporadic cases only have been reported involving primarily the bone or extending from soft tissues to surrounding bones. To our knowledge, the ilium has not been previously reported as the primary site for clear cell sarcoma. We report a rare case of Primary clear cell sarcoma involving right ilium region in a 18-year-old boy presented with a painful swelling over right ilium and limp on right lower limb of ten month duration. He was initially suspected having tuberculosis based on clinicoradiological evaluation and diagnosis of primry clear cell sarcoma could be established on histopathology. Patient was treated with partial excision of the ilium, the remaining ilium was fused with sacrum. Stabilization was achieved with a cortical autograft harvested from the right fibula and fixation with a titanium plate. The patient had no local recurrences but the plate holding ilium to sacrum broke and was removed in the subsequent surgery after which he developed Trendelenberg’s gait.
Ossyfying periarticular lipoma is a very rare entity. Lipomas undergo involutional changes like chondrification, calcification and very rarely ossification. These changes result in altered clinical, radiological and histopathological features leading to diagnostic challenge in differentiation from the soft tissue tumor like synovial sarcoma, liposarcoma and rhabdomyosarcoma. We present a series of three cases of ossifying lipomas presenting as soft tissue tumor around the knee, shoulder and hip joints. All the tumors revealed calcification and ossification on plain X-rays and on MRI/CT Scans. Clinico-radiological evaluation lead to a similar diagnostic dilemma in our series and a confirmed diagnosis of ossifying lipoma became possible only after histopathology. All the three tumors were excised completely without any recurrence during last 3 1/2 years of follow-up. We recommend the early imaging by MRI/CT scan with closed core biopsy to exclude the malignant pathology and complete excision of the tumor with early mobilization of the adjacent joint.
