All polyethylene tibia - results of functional and radiological outcome at 5 years follow-up

Background: Earlier, all-polyethylene tibial (APT) components were the only option available for TKA. APT components improved over years and have shown results similar or superior to MBT components with respect to survivorship and rate of complications. This study aimed to assess the functional and radiological outcome of TKA with APT components with 5 years follow-up.Methods: This longitudinal study was conducted in a tertiary care center in Mumbai in year 2018. All patients who underwent TKA with APT components during the year 2012 were included in the study. Total of 147 knees were operated in 120 patients. Ninty patients (111 knees) followed up at 5 years. Preoperative and postoperative assessment of patients was done for function, pain and radiological outcome. Functional scores used were Knee society score, WOMAC osteoarthritis index, Bristol score and Oxford knee score. Visual analogue scale (VAS) score was used for pain assessment. Pre and postoperative X-rays were done and component alignment angles (α, β, γ and δ) were calculated.Results: Statistically significant difference was found in pre and postoperative values of VAS score, knee society score, WOMAC osteoarthritis index, Bristol score and Oxford knee score (p value <0.001). Component alignment angles were found to be same pre and postoperatively. None of the patients had radiologic evidence of loosening of implants.Conclusions: APT components have good to excellent functional outcome and good radiological outcome at 5 years. They are safe in view of radiologic component migration at 5-year follow-up

Bilateral sequential atypical femur fractures in a patient on zoledronic acid therapy: a case report and review of literature

Bisphosphonates are mainstay of anti-resorptive therapies for osteoporosis. They prevent osteoporotic fractures by 40 to 70 % in women and men with osteoporosis. Use of these medications is not free from complications. A case of 62 year old female who presented with left thigh pain after trivial fall at home. X-ray diagnosed as atypical femur fracture of left femur which was fixed internally with interlock nailing. On 1st postoperative day, she complained of pain in right thigh. X-ray revealed an atypical femur fracture of left femur shaft which was also fixed internally with nailing. Biochemical investigations were suggestive of effectiveness of zoledronic therapy. We report this first case of bilateral sequential atypical femur fractures that was treated with zoledronate for 2 years. To our knowledge there are reports of oral alendronate therapy with atypical femoral fractures but none on zoledronic acid.

Surgical excision of a solitary osteochondroma arising from the lesser trochanter in an adult: a case report

The occurrence of osteochondroma around the proximal femur is rarely reported as most cases are asymptomatic. We report a rare case of symptomatic solitary osteochondroma arising from the lesser trochanter in a skeletally mature patient causing significant impairment of hip function managed by surgical excision. A 32-year-old male labourer presented with pain and swelling over right hip region for nine months. Radiographic examination (X-ray, MRI, CT) revealed the pathognomonic continuity of the cortex and medulla of the lesion with the parent bone. Cartilage cap cover (measuring 15 mm) on MRI helped to clinch the diagnosis. CT guided biopsy was also suggestive of osteochondroma. The tumour was excised en bloc by posterior approach without the need for hip dislocation. The base of the lesser trochanter was osteotomised and the entire mass with the cartilage cap was removed. A two year follow up has shown no evidence of local recurrence. Surgical excision of a symptomatic osteochondroma is a successful form of treatment with low mortality. Adequate pre-operative radiographic examination is helpful to know the location and local spread of the tumour. Measurement of cartilage cap thickness on MRI is an essential tool to diagnose malignant changes. A safe and adequate resection should be carried out in an effective manner with attention to femoral head vascularity and prevention of local recurrences. Patients with solitary osteochondroma around the proximal femur should be kept under observation to help early detection of malignant changes

A case series of percutaneous tension band wiring technique for fixation of fractures of olecranon and patella

There are several advantages in the treatment of fractures by means of closed reduction. Percutaneous fixation is a type of biological fixation. The aim and objectives of this study are to demonstrate the technique of percutaneous tension band wiring in cases of transverse, non- comminuted olecranon and patella fractures and to decrease the soft tissue dissection, blood loss, chances of infection and to ensure speedy mobilization using the innovative percutaneous fixation technique. This retrospective study includes ten patients of olecranon and ten patients of patella operated by the same surgeon. All patients were operated with percutaneous tension band wiring for olecranon and patella. There were six males and four females with olecranon fractures. There were seven males and three females who suffered patella fractures. The average duration of surgery was 55 minutes and average follow up was 24±6 weeks. The suture removal was done at 2 weeks. All patients had full range of movements at six weeks with significantly improved DASH score and Oxford knee score. None of the patients had any complications. Percutaneous fixation decreases the chances of bleeding secondary to unnecessary soft tissue dissection, thereby decreasing the post-operative morbidity. It also, convincingly, decreases the chances of post-operative infection and promotes early mobilization. Closed reduction with percutaneous fixation is believed to be an innovative, safe, reliable and efficient method of managing these difficult fractures