Fenestrated discectomy, is it still the gold standard in resource poor setting, an experience of overall outcome in a single orthopaedic unit.

Objective: Lower back pain with radiculopathy poorly responding to non-operative management is common . Microdiscectomy(MD) is currently the gold standard in ideal settings. Our objective was to evaluate the overall outcome of standard open Fenestrated Discectomy(FD) in relation to published data on microdiscectomy. Method: This is a prospective study of 24 consecutive patients, who underwent FD over six months in relation to the operative time, complications, cost and patient satisfaction eight weeks post procedure. Results: Mean age was 42 years (range 21-60yrs) and 75% were males. The most commonly affected disc was L4-5, in 62.5%.  All patients had their activities of daily living affected. Night pain disturbing the sleep in 87.5% and neurogenic claudication in 62.5%.  Nerve root compression was there in 79.2% while 20.8% had cord compression on MRI. Only 4.2% had Cauda Equina syndrome. Mean duration of the surgery was 40 minutes and mean duration of post-op stay was 4.2 days as compared to 70 minutes and 2.5 days in MD. Seventy one percent had uneventful recovery.  Acute retention of urine in 21% and surgical site infections in 8.3% were the commonest complications. Mean cost of the procedure(FD) was 25300LKR as compared to 40000LKR for MD . Night pain resolved in 91.7% in the first post operative day and returned to normal function with overall satisfaction of 95.8% within eight weeks as compared to 85-90% in MD Conclusions: FD is a versatile and cost effective procedure with comparable outcome to MD in resource poor settings

Knee joint reconstruction with modular-megaprosthesis following peri-articular tumour resection and mutilating trauma: Sri Lankan perspective on limb salvage surgery

amount of bone resected, is the most popular & readily available option for limb salvage surgery in the world. MMP can be used for reconstruction of the knee joint where the use of regular prosthesis would be impossible following peri-articular tumour resection and mutilating trauma due to greater degree of bone loss and extensive ligament damage or excision. MMP is yet an emerging concept in Sri lankan setup due to many obstacles in implementing limb salvage surgery. Methods: Six consecutive patients underwent Total Knee Arthroplasty(TKA) with MMP in SJP General Hospital within the period of 31/06/2009--31/08/2012. Primary pathology, operative details, complications following surgery and in subsequent follow-up was analyzed. Knee-Society-Knee-Score-(KSKS) determined the functional outcome of the surgery. Results: Six TKAs were for wide local excision of lower femoral osteosarcomas(n=2), chondrosarcoma(n=1) & a Giant cell tumour(n=1) with a Extensive knee trauma(n=1) and a periprosthetic fracture of previous primary TKA(n=1). Range of follow up duration was(6–24 months). No intra operative or immediate post operative complications were detected. Excellent outcome (Knee-Society-Knee-Score 80 -100) reported in all, except for the patient who underwent TKA following extensive trauma. He subsequently developed a flexion contracture with a peri-prosthetic wound infection. Conclusion: Knee joint reconstruction with MMP is a successful option in periarticular tumor resection or mutilating trauma involving the knee joint which may salvage the limb preserving a good functional outcome despite extensive ligament and bone loss.

Prostate cancer - experience from a specialist urological facility in Sri Lanka

Objective: Prostate  cancer(CaP)  is  one of  the  a  commonest  malignancies  in  the  aging  male. Data on this aspect is sparse in Sri Lanka. Following  a initial report, we present 4½  year  review with regard  to  the mode of presentation, stage  and  histological  characteristics & therapeutic options for CaP. Methods: This is a prospective cohort study of 236 CaP patients presented to a specialist urology unit  from 2007 up to May 2012. Results: Out  of 236 CaP diagnosed, mean age was 70.23.The peak incidence was in the age group 71-75 with 75% of patients being diagnosed at this age interval. LUTS(52.5%), Retention of urine(33.5%) & backpain(31%)  were the  commonest presentations. 51% patients had their initial PSA level above 40ng/ml & only  10% were PSA “non secretors”. Majority of patients (56.4%) had Gleasons 7 or higher histological patterns and 77% had advanced disease at  presentation. Androgen ablation therapy was the commonest treatment modality 63%(n=148) used. Out of them a majority of  90%(n=134) underwent bilateral orchidectomy. Only 15.4%(n=36) were suitable for treatment with a curative intent, 9% were treated with radical radiotherapy while 6.4% underwent radical prostatectomy. 17%(n=41) of the patients required a treatment with  combination of above therapies. Conclusions: This study highlights the need  of  higher  awareness  amongst  men  beyond  50  years  regarding prostate  cancer  and  development  of  a  protocol  based  strategy  to  handle  CaP which is  likely  to  be  significant  health  care  burden  in  an  increasingly  aging  population  in Sri  Lanka