Patelloplasty with and without circumpatellar denervation in reducing anterior knee pain in primary total knee arthroplasty: a comparative prospective study

Background: Anterior knee pain (AKP) following total knee arthroplasty (TKA) ­­­­­­is one of the complication which cause dissatisfaction in patients. Incidence estimated to be 4-49%. The aim of our study is to know the efficacy of patelloplasty with circumpatellar denervation with diathermy in reducing AKP in primary TKA.Methods: A total of 130 unilateral TKAs’ are divided into 2 groups. Group I (control) includes 65 patients in which only patelloplasty was done. Group II (intervention) includes 65 patients in which both patelloplasty and circumpatellar denervation with diathermy was done and analysed. Mean follow up period was 18 months. Patients were assessed both preoperatively and postoperatively at final follow up.Results: The overall incidence of AKP at follow up (18 months) was 16.9%, with 7.7% in the intervention group and 26.1% in the control group (p<0.05).  Western Ontario and McMaster Universities osteoarthritis index scores were significantly  better in intervention group when compared to control group (28.71±3.948 vs 31.40±3.860). Better results were also found in knee society scores for intervention group compared to control group (166.57±7.941 vs 161.23±11.219); Feller patellar score of  intervention group was significantly better when compared to control group (23.28±2.546 vs 20.69±3.729); the range of knee flexion was similar in both the groups (94.62±12.6 vs 93.54±10.7). In terms of pain referred by the patient at 72 hrs postoperatively, there was statistically significant difference observed according to visual analogue scale.Conclusions: There is statistically significant difference with respect to AKP in patients who have undergone patelloplasty with circumpatellar denervation using diathermy compared with patelloplasty alone.

Factors determining the range of motion in primary total knee arthroplasty

Background: Total knee arthroplasty (TKA) ­­­­­­is one of the most successful surgical procedure with over 90% survival rate at 10 to 15 years. It provides a stable, pain free range of motion (ROM) for day to day activities. The aim of this study is to evaluate various factors determining ROM after TKA.Methods: 348 patients with 390 knees treated with TKA using cruciate retaining (CR) and posterior stabilized (PS) prosthesis were included and analysed. Mean follow up period was 18 months. Patients were analysed for factors like age, sex, diagnosis, body mass index (BMI), pre-operative exercises, ROM, deformity, posterior femoral condylar offset (PFCO), posterior tibial slope (PTS), post-operative rehabilitation and implant design (CR vs PS). Statistical analysis of above factors on knee ROM was done. Patients were assessed pre-operatively, at 6 weeks, 3, 6, 12 and 18 months post-operatively.Results: Age and sex did not affect the final ROM. The mean knee ROM improved from 86.87° to 96.95°. Factors like BMI, deformity had negative correlation and Pre-operative diagnosis, exercises, knee scores, good preoperative ROM, PFCO, PTS had positive correlation on ROM.Conclusions: Pre-operative exercises, diagnosis, ROM, deformity, BMI, PFCO and PTS were important factors which influence ROM in TKA. Patient selection and preoperative counselling are important for good clinical outcome

Influence of posterior tibial slope on knee flexion in posterior stabilized fixed bearing primary total knee arthroplasty

Background: The goal of total knee arthroplasty (TKA) is to relieve pain and maintain stable range of motion (ROM) for day to day activities. Among the various factors, posterior tibial slope slope (PTS) may play an important role in achieving good postoperative knee flexion. Our study aims to know the effectiveness of PTS on the ROM of the knee in a posterior cruciate ligament (PCL)-substituting TKA.Methods: A total of 125 unilateral PCL-substituting TKA’s were included in the study. Based on postoperative PTA which was measured on lateral radiograph, patients were divided into 3 groups, Group A (PTS of ≤2) comprise of 24 patients. Group B consists of 91 patients (PTS of 3 to 7). Group C includes 10 patients (PTS of 8 or more). Functional outcome was measured by using knee society score (KSS) and Western Ontario and McMaster Universities osteoarthritis index (WOMAC) which were evaluated preoperatively and at 18months post operatively.Results: Mean postop ROM was 92.91 ± 10.632; 107.24±10.905; 107.49±13.944 in group A, B, C respectively which was significantly related to mean postop PTS (0.74; 5.62; 9.87 in group A, B, C respectively) (P<0.05). Functional outcome was measured by KSS and WOMAC which showed no significant difference pre and postoperatively.Conclusions: The results of our study validate the hypothesis that a positive correlation exists between the postoperative flexion and PTS in the PCL-substituting TKA, an increase in PTS can lead to a greater degree of the knee flexion for every extra degree of PTS.

Two-Body Abrasive Wear Behaviour of In-Situ Al-TiC Particle Composites: Influence of TiC Reinforcement and Content in the Alloy Matrix and Experimental Parameters

This study pertains to observations made on the abrasive wear response of Al-TiC composites under varying applied load and traversal distance conditions. The influence of TiC particle reinforcement and its content in the matrix on the abrasion characteristics of the samples was investigated. The composites were prepared by generating the reinforcement phase (TiC particles) from within the matrix employing a hybrid in-situ technique consisting of a combination of steps involved in powder and liquid metallurgy routes of synthesizing metal matrix composites. The unreinforced matrix alloy (AA2014) was also tested under identical experimental conditions for comparison purposes. Properties characterized were wear rate, frictional heating and friction coefficient. Microstructural features of the samples and characteristics of wear surfaces, subsurface regions and abrasive medium have also been examined.   The TiC reinforcement led to improved abrasion resistance (inverse of wear rate), the degree of improvement increasing further with the rising concentration of the TiC particles in the alloy matrix. Increasing applied load led to deterioration in the wear behaviour of the samples while a reverse trend was followed as the traversal distance was raised. The severity of frictional heating was noted to increase with load. On the contrary, friction coefficient tended to decrease with increasing load except for the composite containing the highest concentration of TiC wherein a reverse trend was noticed. Both frictional heating and friction coefficient increased sharply with traversal distance initially. This was followed by a reduction in the rate of temperature increase at longer traversal distances whereas friction coefficient was observed to attain steady state condition after showing a decrease in some cases. The presence of TiC reinforcement in the alloy matrix and its increasing content led to a decrease in the friction coefficient and the severity of frictional heating. The observed wear behaviour has been substantiated through the characteristics of abraded surfaces and subsurface regions of the samples and degradation of the abrasive medium. Operating material removal mechanisms have also been examined. &nbsp

Low temperature deformation of the R-phase in a NiTiFe shape memory alloy

Deformation in the P3 phase (R-phase) of NiTiFe was investigated by in situ neutron diffraction during compressive loading at cryogenic temperatures. At 216 K, upon loading the R-phase detwinned and subsequently underwent a reversible stress-induced transformation to the B19\u27 phase (martensite). At 92 K on the other hand, detwinning was suppressed and the stress-induced martensite formed did not transform back upon unloading. The experiments also directly observed a hitherto theoretically predicted B33 phase. Rietveld refinement of the neutron diffraction spectra were used to determine lattice parameters of the B33 and R-phases. Plane-specific elastic moduli were also determined for the R-phase

pH of soil of Majalgaon command area (Jayakwadi project stage-III), India

Present paper deals with the study of pH of soil of Majalgoan command area, India. pH varied from 7.55 to 8.98 in different soil types and showed increased trend with depth in most of the profiles

Impact of lockdown relaxation and implementation of the face-covering policy on mental health: a United Kingdom COVID-19 study

Background: Pandemic mitigation policies, such as lockdown, are known to impact on mental health of individuals. Compulsory face covering under relaxed lockdown restrictions gives assurance of less transmission of airborne infection and has the potential to improve mental health of individuals affected by restrictions. Aim: To examine the association of the lockdown relaxation and the implementation of the face covering policy on the mental health of the general population and sub-groups in the United Kingdom using interrupted time series model. Methods: Using a web-based cross-sectional survey of 28890 United Kingdom adults carried out during May 1, 2020 to July 31, 2020, changes in mental health status using generalised anxiety disorder (GAD-7), and impact of events scale-revised (IES-R) scales are examined, at the dates of the first lockdown relaxation (July 4, 2020) and the subsequent introduction of face covering (July 24, 2020) in United Kingdom. A sharp regression discontinuity design is used to check discontinuities in mental health outcomes at policy-change dates. Results: Average GAD-7 scores of participants were 5.6, 5.6 and 4.3 during the lockdown period, the lockdown relaxation phase and the phase of compulsory face covering, respectively, with lower scores indicating lower anxiety levels. Corresponding scores for IES-R were 17.3, 16.8 and 13.4, with lower scores indicating less distress. Easing lockdown measures and subsequent introduction of face covering, on average, reduced GAD-7 by 0.513 (95%CI: 0.913-0.112) and 1.148 (95%CI: 1.800-0.496), respectively. Corresponding reductions in IES-R were 2.620 (95%CI: 4.279-0.961) and 3.449 (95%CI: 5.725-1.172). These imply that both lockdown relaxation and compulsory face-covering have a positive association with mental health scores (GAD-7 and IES-R). Conclusion: The differential impact of lockdown and relaxation on the mental health of population sub-groups is evident in this study with future implications for policy. Introduction of face covering in public places had a stronger positive association with mental health than lockdown relaxation

Prescription audit of outpatients in tertiary care government hospital

Background: Prescription audit is a tool as well as a technique by its application,all professionals will improve the quality of prescribing drugs. Standards of medical treatment can be assessed by prescription audit. It is based on documented evidences to support diagnosis, treatment and justified utilization of hospital facilities. Prescription audit is a quality improvement process that seeks to improve patient care. In this background the present study was conducted. The objectives of the study were to know the frequently prescribed drugs in OPD, number of the drugs used per prescription and to find out the rationality.Methods: Study was conducted at Sri Chamarajendra Hospital, HIMS, Hassan in OPD of General Medicine.1000 prescriptions were collected and noted down the frequently used medication, number of drugs prescribed and their type of formulations for the particular diagnosis.Results: From the study it is noted that 1910 drugs out of 1000 prescriptions were prescribed which is approximately 1.91 drugs per prescription about 55% of the prescriptions contained single drug. Very few received 4-5 drugs (7%). Almost all the drugs in prescriptions were in Generic names. Around 95% of prescriptions doses were mentioned in mg, ml etc. The most commonly prescribed drugs in order are Antibiotics, antidiabetics antihypertensives, bronchodilators, steroids antiemetics and ORS were prescribed.Conclusions: Polypharmacy was not found in our prescriptions which indicates our prescriptions improved the patient conditions. This type of study will ensure to know the ‘P’ drug development and select the essential medicine list for various levels of health care

Study of prescribing practices of injections in outpatients of a rural tertiary care teaching hospital

Background: Injections are probably the most common of all medical procedures. The combination of injection overuse and unsafe practices creates a major route of transmission of blood borne pathogenic infections. Unnecessary use of injections can also lead to unnecessary burden on the institution in terms of efficiency, infrastructure, staff requirement and poor utilization of resources. Monitoring and analysis of prescribing practices can help to achieve rational use of injections. The present study was carried out to study the injection prescription patterns in outpatients of a rural tertiary care teaching hospital, Ambajogai, Maharashtra, India. Methods: A cross sectional descriptive study was conducted for duration of two months and 744 prescriptions were randomly collected and analyzed.Results: The total number of injections prescribed in 744 prescriptions was 205. Most (71.70%) of the patients receiving them were above 35 years of age. The most common complaint for which the injections were prescribed was musculoskeletal pain (45.36%) followed by fever. About 155 (75.60%) prescriptions contained injection diclofenac which was the most commonly used drug followed by injection paracetamol (11.21%). There was a high tendency of using brand names in prescriptions (89.30%). Conclusion: The study revealed high proportion of use of injectable drugs. There was overuse of analgesic injections like diclofenac, most of which were unnecessary and irrational. This leads to unnecessary burden on the institution in terms of efficiency, infrastructure, staff requirement and poor utilization of resources. There is a need to develop local guidelines for injection usage along with educational sessions for prescribing doctors