Short term results of total knee arthroplasty in tertiary rural tier three government medical college and hospital

Background: The objective of the study was to assess the clinical and functional outcome of total knee arthroplasty (TKA) using posterior cruciate stabilizing (PS) design in tertiary rural government hospital with limited infrastructure using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and to offer a low cost option and assess post-operative pain relief in rural poor of the society and to compare the WOMAC score pre and post-operatively.Methods: The study was conducted on patients who have undergone primary total knee arthroplasty in Department of Orthopaedics, Government Medical College and Hospital, Aurangabad from December 2018 to December 2019. The patients were assessed using the WOMAC score and X-rays. These evaluations were performed at 3, 6 and 12 months follow up visits.Results: At 1 year follow up of 30 knees, the average pre-op WOMAC score of 79.5 improved to an average post-op score of 42.3. And knee flexion increased from 96.3 degree to 108.5 degrees both of which with a p value <0.0001 are statistically significant. One patient each had wound dehiscence and superficial infection. Patient satisfaction after the procedure was good-both in unilateral and staged bilateral TKA.Conclusions: TKA reduces knee pain significantly and improves the functional ability of the patient. And to be able to do so in a tertiary government rural setup with no laminar airflow and with such great efficacy and minimal complications bodes well for the number of people living in rural areas suffering from knee pain

Comparative study of anterior cervical discectomy and fusion by anterior cervical plate and stand-alone cervical cage

Background: Anterior cervical discectomy (ACD) was used for management of degenerative cervical disc disorders (DCDD) in previous days. Further research and developments in management of DCDD led to evolution of standard and widely used operative technique as anterior cervical discectomy and fusion (ACDF) by either anterior cervical plate (ACDF-ACP) with bone grafting or stand-alone cage (ACDF-SAC). There is less data available in literature regarding when and where to use ACDF-ACP and ACDF-SAC.Methods: The study was conducted on 20 patients operated in Government Medical College and Hospital and Pacific Hospital and Research Centre, Aurangabad from June 2018 to March 2020. These patients divided into group A - 10 patients, operated by ACDF-SAC which are further divided as group Aa - 6 patients - operated for single level ACDF-SAC and group Ab - 4 patients - operated for two level ACDF-SAC, group B - 10 patients, operated by ACDF-ACP which are further divided as group Ba - 5 patients - operated for single level ACDF-ACP and group Bb - 5 patients - operated for two level ACDF-ACP. Patients evaluated preoperatively and postoperatively using X-ray cervical spine anteroposterior (AP) and lateral views, MRI cervical spine, visual analogue scale (VAS) for pain, Robinson’s criteria and Cobb’s angle.Results: In our study we found, ACDF-SAC has small incision size, less intraoperative time, easy to carry out for surgeons, less intraoperative complications and better clinical outcome as compared to ACDF-ACP. Whereas only radiological results were better in ACDF-ACP than ACDF-SAC.Conclusions: ACDF-SAC is superior to ACDF-ACP for appropriately selected patients and in well experienced hands

Functional outcome of instrumented and non-instrumented fusion in lumbar canal stenosis

Background: Lumbar canal stenosis (LSS) is a source of significant morbidity and economic burden in the Indian population. Spinal canal compression is the sine qua non of lumbar canal stenosis but whether instrumentation should be done or not is the major dilemma. In this study, we aim to compare the functional outcome of instrumented versus non-instrumented fusions for the treatment of lumbar stenosis along with the post-operative complications and cost-effectiveness of both procedures.Methods: This study was conducted at a tertiary-care medical college and hospital, Aurangabad specializing in post-graduate training, where all patients who underwent surgical treatment between May 2016 and May 2018 were included. Patients were assessed using the modified Oswestry disability index (MODI) and visual analogue scale (VAS). These evaluations were done at 3, 6, 12 and 24 months.Results: We found similar pain relief and stabilization in both the groups in the initial post-operative period, but after 2 years, there was a significant difference (p=0.0001) between the two groups in terms of VAS (back) and MODI score. Complication rate was higher in instrumented patients. Conclusions: Patient selection is the most important thing in the management of lumbar canal stenosis. We believe that, with the flowchart on the management of lumbar canal stenosis, it would help choosing patients better as to who would require instrumented fusion. Non-instrumented fusions might cost less and have fewer complications, but the overall outcome of the patient in the future should be kept in mind