Background

The discussion over the duration, type of therapy and regimen to be used in osteoarticular tuberculosis is losing importance in all orthopaedic gathering. Still little consensus is there over the universality of a treatment regime for osteoarticular tuberculosis.

Aim

We present the medium-term clinical results of a reverse total shoulder arthroplasty with a trabecular metal glenoid base plate.

This study aims to correlate Oxford shoulder score (OSS) to EQ5D score in healthy patients presenting to a shoulder clinic with shoulder pain.

OSS and EQ5D scores were collected prospectively from 101 consecutive patients presenting with shoulder pain in a shoulder clinic at one specialist centre. Patients with ASA > 2 and other significant joint arthritis were excluded from the study. Scores were collected from electronic patient records. Spearman's rho correlation of oxford shoulder scores and EQ5D scores was completed.

Mean age of subjects was 51.8 (range 19.1–81.9) years, 55 of 101 subjects were men (54%). Median OSS was 26 (range 3–48) and median EQ5D score was 0.76 (range 0–0.76). Correlation for all patients was 0.624 (Sig p<0.001).

This study demonstrates a strong correlation between Oxford shoulder scoring and EQ5D in a fit and well shoulder surgery clinic population. It is possible that Oxford shoulder scores may be a useful indicator of quality of life in healthy shoulder clinic patients presenting with shoulder pain.

Summary

There is little consensus regarding the regime for treatment of tuberculosis of spine, although WHO has laid down guidelines couple of years back classifying spinal tuberculosis in Category 1. This study proves the efficacy of WHO regime in spinal tuberculosis by clinico-radiological evaluation.

Introduction

Anterior cruciate ligament (ACL) rupture is a common sporting injury, often managed surgically with patella-tendon or hamstrings autograft. Surgeons are under increasing pressure for open transparent assessment of their performance. Scoring systems can be used to assess outcome. More than 50 different scoring systems have been identified to assess the ACL deficient knee.

Flexion Deformity of knee is the most common deformity in post polio residual deformity. Wilson's release, supracondylar osteotomy etc have been described for its treatment. We present our result of fractional hamstring lengthening followed by gradual distraction using threaded rod in hollow tube to treat flexion deformity of knee. This retrospective study included 150 cases (80 males and 70 females) with the mean of 15 years (8-22yrs). The mean duration of deformity was 6 years (2 – 14yrs) with mean follow up 0f 3 years. The mean preoperative flexion deformity was 45degree (110 – 30 degree) with a mean pre operative further flexion of 110 degree (130 – 90) .20 cases were had a crawling gait and 10 cases were wheel chair bound. Flexion got corrected to 0 degree in 110 cases (P value <0.01). Post operative mean arc of motion was 80degree We had 10 cases who could not tolerate plaster and hence were put on traction . 20 cases had knee stiffness on removal of plaster which could not improve on physiotherapy. 10 cases had superficial infection cured with dressings.

Our findings indicate that this method is very effective in the treatment of flexion deformity of knee with complication of knee stiffness in older cases

Outcomes following TKA often are good, but patients sometimes lack adequate range of motion and strength. Reasons for these deficits may include instability and the loss of cruciate ligament function. One approach to TKA design is to retain the PCL, and configure the TKA surfaces to approximate the function of the ACL. This can be accomplished by having a lateral surface that controls tibiofemoral motion near extension, but allows femoral rollback with flexion. We have been using such a fixed-bearing TKA design since 2001. The purpose of this study was to determine if an ‘ACL-substituting’ arthroplasty design provides clinical and functional results comparable to traditional PCL-retaining arthroplasty designs.

This series consists of 407 consecutive knees in 185 male and 222 female patients (73±9 years, 28±5 BMI) operated from November 2001 to August 2006. All patients underwent TKA by the same surgeon using PCL-retention and implantation of the same cemented ‘ACL-substituting’ TKA design. Clinical outcomes were evaluated using Knee Society Scores and radiographic review for the first 100 TKA with minimum 2 year follow-up. A subset of patients participated in IRB-approved protocols to quantitatively evaluate TKA motion and strength. Functional outcomes were assessed during gait, stair-climbing and curb step-over tasks for 10 unilateral TKA using a motion capture system, force platforms and inverse dynamics to measure the dynamic knee joint flexion moment. Kinematic outcomes were studied during kneeling for 20 TKA using fluoroscopy and shape matching techniques.

Knee Society Scores averaged 96+7 (pain) and 95+12 (function) at an average of 3.2+0.7 (range, 2 to 5) years follow-up. Passive flexion averaged 122°±10°, with 70% of the TKA achieving > 120° flexion. Radiolucent lines (2–4 mm wide) were observed in 7 TKA. Peak flexion moments (dynamic strength) for the TKA averaged 79%, 80% and 85% of the patients’ contralateral normal knees during the gait, stair-climbing and step-over tasks, respectively. In maximum kneeling, knees averaged 131°±13° flexion, 10° ±4° tibial rotation, and 2mm/10mm posterior position of the medial/lateral condyles.

This series’ early clinical follow-up was comparable to any well performing TKA. Knee flexion during passive examination and kneeling were comparable to the best reported results for PCL-retaining and PCL-substituting TKA. Peak knee flexion moments, a measure of functional strength, were comparable to the strongest knees reported in the literature. These early results suggest a fixed-bearing prosthesis with ‘ACL-substitution’ can provide patient performance comparable to the best performing designs.

Purpose: To evaluate the effectiveness of the Ponseti method of the treatment i late presentation of clubfeet.

Method: Prospective study comprising 91 patients(141 feet) between August 2003 and September 2005. Age range was from 7 dats to 20 months. Majority of patients belonged to Dimeglio grade 3 (75%) and Pirani grade 4(43%) at presentation. All were treated by Ponseti method of serial casting with or wothout tendo-achillis lengthening. Tendon lengthening was required in 79% of patients. The average duration of follow up was 1.5 years.

Results: Recurrence of deformity was seen in patients who presented late and had severe deformity at time of presentation. The Ponseti technique failed to achieve correction in 4 patients. Follow up at 2 years showed overall correction rate of 95%. In develpoing countries, delayed presentation could signifucantly affect the final outcomes as the joint deformities progressively become fixed. Our study showed that number of corrective casts, recurrence of deformity and the nned for tendoachillis lengthening was inversly related to the time of presentation. This technique can be relable used to correct clubfeet even in delayed present.

In an eight-year period we treated 51 cases of vascular injury associated with fractures and/or dislocations or soft-tissue injuries of the limbs. We relied on a clinical diagnosis and immediate exploration of blood vessels rather than the time-consuming procedure of arteriography. All patients were operated on by the orthopaedic residents on duty and not by vascular surgeons. Only 17 (33%) were repaired within six hours of injury. Limb viability with good function was obtained in 38. Complications included six deaths, four amputations, two renal failures and delayed occlusion in one case.

External fixation was used in the treatment of 154 intertrochanteric fractures of the femur over a period of eight years. Good fixation and early ambulation was achieved in all cases. Blood loss was slight. There were 12 deaths due to medical causes unrelated to the surgical procedure. Deep pin-track infection occurred in six cases and late displacement of the fracture fragments in nine. The average time for union was 16 weeks. The technique is simple, quick and inexpensive, and causes minimal surgical trauma. All these features are particularly relevant where resources are limited.