Aim

Melioidosis is a significant public health problem in endemic regions such as India. Lack of awareness, predominant empiric antibiotic use reducing culture yields, morphotypic variability of cultures and frequent misidentification by automated blood culture systems, pose myriad challenges in diagnosis and treatment. Through this series, we present our experience of Hematogenous Osteomyelitis with Burkholderia pseudomallei.

Aim

Management of infection after osteosynthesis (IAO) poses a significant challenge in the setting of multidrug resistant organisms (MDRo). We have analysed whether IAO with MDRo has an adverse outcome.

Introduction

We describe five results of a novel single stage arthroscopic technique for the treatment of articular cartilage defects of the knee. This involves micro drilling and application of Atelo-collagen (Coltrix) and fibrin gel scaffold.

Bowel management following joint replacement is often neglected leading lot of patient distress, with the advent of the enhanced orthopedic rehabilitation program, there is a need of a guideline to ensure prompt and quick recovery of bowel habits before discharge. Our aim was to identify the incidence of constipation in joint replacement patients, to evaluate the current practice of bowel management and formulate a protocol for management of constipation to improve the practice. We conducted a prospective study of 50 patients who underwent joint replacement procedures at our institute between September and October 2015. Following initial audit, we formulated a protocol for bowel management, and performed a re-audit by collecting a prospective data of 50 patients. The statistical analysis was done and calculating the mean and standard deviation for continuous variable and Fischer's exact test was used and significance level was set at 0.05. Incidence of constipation was 88% and laxatives were prescribed in 42%. More importantly, there was no correlation between constipation and pre operative fasting (p Value 0.33), post operative fasting (p Value 0.1822), type of surgery (p value 1.00) and type of anaesthesia (p Value 0.27). Following introduction of bowel protocol the laxative prescription increased to 98% (Prophylactic in 81%), consequently the incidence of constipation reduced to 18%. Implementing bowel protocol significantly will improve the patient care and reduce the rate of complications.

Chondral defects of the knee are common and often seen in young and active individuals. A novel single stage arthroscopic technique for the treatment of articular cartilage defects in the knee is described. This involves microfracture and application of concentrated bone marrow aspirate cells (BMAC) with fibrin and Hyaluronic Acid as a gel. After a representative preclinical study, the 5 year results of a prospective clinical study are presented.

The pre-clinical study involved two groups of rabbits with standardised lesions treated with microfracture alone and microfracture combined with fibrin/HA/BMAC application. New cartilage from both groups was subjected to staining with H&E for tissue morphology, toluidine blue (collagen) and safranin O (GAG), immunohistochemistry with antibodies for collagen type I and II, and scanning and transmission electron microscopy to analyse the microstructural morphologies. The fibrin/HA/BMAC group scored better than the microfracture group on all tests.

A subsequent prospective clinical study patients (n=60) with symptomatic ICRS grade III/IV chondral defects (lesion size 2–8cm2). The surgical procedure involved debridement of the lesion, micro-fracture and application of fibrin/HA/BMAC gel under CO2 insufflation. Patients underwent morphological evaluation with MRI (T2*-mapping and d-GEMRIC scans). Clinical assessment employed the Lysholm, IKDC and KOOS scores while radiological assessment was performed with MOCART score.

At 5 years, Lysholm score was 78, compared to 51 pre-operatively (p<0.05). KOOS (symptomatic) improved to 90 from 66 (p<0.05). IKDC (subjective) went to 80 from 39 (p<0.05). The mean T2* relaxation-times for the repair tissue and native cartilage were 26 and 29.9 respectively. Average MOCART score for all lesions was 70.

This technique shows encouraging clinical results at 5 year follow-up. The morphological MRI shows good cartilage defect filling and the biochemical MRI suggests hyaline like repair tissue.

Introduction

We describe a single stage arthroscopic procedure for the treatment of articular cartilage defects in the knee. The novel procedure involves microdrilling and application of atellocollagen and fibrin gel. The aim of the study was to evaluate the clinical outcomes at 4 years.

We describe a novel single stage arthroscopic repair procedure for articular cartilage defect in the knee. The aim of the study was to evaluate the clinical and radiological outcomes at two years.

The pre-clinical study involved two groups of New Zealand rabbits, treated with microfracture alone and microfracture combined with fibrin gel and concentrated bone marrow aspirate cells (BMAC) application. New cartilage from both groups was studied with histological staining, immunohistochemistry and electron microscopy. The fibrin gel-BMAC group scored better than the microfracture group on all counts.

This is a prospective study of 30 patients with symptomatic ICRS grade III/IV chondral defects, ranging from 2–8 cm², which were assessed clinically and radiologically. The surgical procedure involved debridement of the lesion, microfracture and arthroscopic application of concentrated BMAC with fibrin gel under CO₂ insufflation. Patients underwent morphological MRI, quantitative T2*-mapping and d-GEMRIC scan. Clinical assessment was carried out using the Lysholm, IKDC and KOOS scores while radiological assessment used the MOCART score.

At 2 year follow-up, Lysholm score was 80.1, as compared to 50.8 pre-operatively (p < 0.05). KOOS (symptomatic) was 92.1, as compared to 65.7 pre-operatively. IKDC (subjective) was 83, up from 39 preoperatively. The mean T2* relaxation-times for the repair tissue and native cartilage were 29.1 and 29.9 respectively. Average MOCART score for all lesions was 72.

Our technique shows encouraging clinical and radiological results. The morphological MRI shows good cartilage defect filling and the biochemical MRI (T2*-mapping) suggests hyaline like repair tissue.

Introduction

Recent UK national guidelines advocate using a combination of mechanical and pharmacological VTE prophylaxis in patients undergoing lower limb arthroplasty. We compared the results from our two series of patients: one treated with clexane and the other treated with rivaroxaban.

Introduction

Recent UK national guidelines advocate using a combination of mechanical and pharmacological VTE prophylaxis in patients undergoing lower limb arthroplasty but do not recommend one particular pharmacotherapy over another.