Cruciate retaining total knee arthroplasty has a better 10 year survival than posterior stabilized total knee arthroplasty: a systematic review and meta-analysis

PURPOSE

There has been a long standing debate regarding superiority of cruciate retaining total knee arthroplasty over posterior stabilized total knee arthroplasty regarding the short-term outcomes as well as long-term survivorship. The proponents of both the techniques have published vast evidence in favor of their respective surgical method and early outcome in meta-analyses does not seem to be significantly different. The decision to select either design should depend on their long-term survivorship but the literature comparing their long-term survival is sparse.This meta-analysis was conducted in order to answer the following questions: (1) Does cruciate retaining total knee arthroplasty has a better long-term survival beyond 10 years.compared to posterior stabilized total knee arthroplasty? (2) Does cruciate retaining knee arthroplasty has higher complication rates compared to posterior stabilized total knee arthroplasty?

METHODS

The present systematic review and meta-analysis study was carried out following PRISMA guidelines. The following databases: Embase, Web of Science, PubMed, Scopus, the Cochrane Library, Google Scholar, and CINAHL were used to search potentially interesting articles published from database inception until January 2022. Inclusion criteria for articles were: (1) retrospective comparative studies; (2) patients who had undergone a total knee arthroplasty; (3) publications evaluating the long-term survival of cruciate-retaining (CR) versus posterior stabilizing (PS) at a minimum 10 years' follow-up; (4) publications evaluating complications of cruciate-retaining (CR) versus posterior stabilizing (PS) at a minimum 10 years' follow-up; and (5) publications reporting sufficient data regarding the outcomes. We used a fixed-effects design in the case of I² < 50% and P > 0.05; if not, we adopted a random-effects design [4]. We also performed subgroups and sensitivity analysis in order to assess the possible source of heterogeneity.

RESULTS

Database searching identified 597 studies to be screened, of which 291 abstracts were revealed as potentially eligible and finally 7 articles were included. The forest plot showed that CR had significantly better survival than PS (OR = 2.17; 95% CI: 1.69-2.80) after 10 years. However, complication rate was not significantly different between CR and PS groups (OR = 0.86; 95% CI: 0.52-1.44; P = 0.57). Subgroup analysis showed that only the period of publication constituted a source of heterogeneity in survivorship outcome. Sensitivity analysis revealed that outcomes did not differ markedly, which indicates that the meta-analysis had strong reliability.

CONCLUSION

The results of this meta-analysis showed that cruciate retaining prosthesis may be preferred over the posterior stabilized design in view of longer survivorship it offers However, further randomized controlled trials are recommended to confirm this finding.

Field induced spin freezing and low temperature heat capacity of disordered pyrochlore oxide Ho2Zr2O7

Spin ice materials are the model systems that have a zero-point entropy as T ! 0 K, owing to the frozen disordered states. Here, we chemically alter the well-known spin ice Ho2Ti2O7 by replacing Ti sites with isovalent but larger Zr ion. Unlike the Ho2Ti2O7 which is a pyrochlore material, Ho2Zr2O7 crystallizes in disordered pyrochlore structure. We have performed detailed structural, ac magnetic susceptibility and heat capacity studies on Ho2Zr2O7 to investigate the interplay of structural disorder and frustrated interactions. The zero-field ground state exhibits large magnetic susceptibility and remains dynamic down to 300 mK without showing Pauling's residual entropy. The dynamic state is suppressed continuously with the magnetic field and freezing transition evolves ( 10 K) at a field of 10 kOe. These results suggest that the alteration of chemical order and local strain in Ho2Ti2O7 prevents the development of spin ice state and provides a new material to study the geometrical frustration based on the structure.

Large magnetodielectric coupling in the vicinity of metamagnetic transition in 6Hperovskite Ba3GdRu2O9

The 6H-perovskites Ba₃RRu₂O₉(R = rare earth element) demonstrate the magnetodielectric (MD) coupling as a manifestation of 4d-4fmagnetic interactions. Here, a detailed study of the structural, magnetic, heat capacity, and MD properties of the 6H-perovskite Ba₃GdRu₂O₉is reported. The signature of long-range antiferromagnetic (AFM) ordering ∼14.8 K (T_N) is evident from the magnetization and heat capacity studies. TheT_Nshifts towards the lower temperature side, apart from splitting in two with the application of the magnetic field. Field-dependent magnetization at 2 K shows three metamagnetic transitions with the opening of small hysteresis in different regions. A new transition atT₁emerges after the onset of the first metamagnetic transition. Complex magnetic behavior is observed in different magnetic field regions whereas these field regions themselves vary with the temperature. Dielectric response recorded at zero and 80 kOe field exhibits the development of MD coupling well aboveT_N. The MD coupling (∼4.5% at 10 K) is enhanced by 25% as compared to the Dy counterpart. Effect of complex magnetic behavior is also conveyed in the MD results where the maximum value of MD coupling is observed in the vicinity of 10 K (onset ofT₁) and near the second metamagnetic transition. Our investigation suggests that both Gd and Ru moments align simultaneously atT_N. Short-range magnetic ordering is possibly responsible for MD coupling aboveT_N.

Manifestation of dissimilar types of magnetism in iron- and chromium-substituted Mn2SnS4

Mn₂SnS₄ belongs to the MII2A^IVQ₄ (M = transition metal; A = Si, Ge and Sn; Q = S, Se and Te) class of compounds that crystallizes in the orthorhombic space group Cmmm and shows complex magnetic properties. Here we report the synthesis and magnetic properties of Fe- and Cr-substituted Mn₂SnS₄ quaternary chalcogenides. All these compounds have been synthesized using a high-temperature solid-state route. Room temperature neutron diffraction studies on the specific compositions of chromium- and iron-substituted compounds were performed to obtain the site occupancy of different elements in the unit cell. The neutron diffraction analysis by employing the Rietveld refinement shows that for the Fe-substituted compound, most of the Fe goes to the Mn site with a small amount at the Sn site, while in the Cr-substituted sample, all the Cr occupy the Mn site. However, the Sn site almost remains intact in the case of the Fe-substituted compound, while it is significantly disordered for the Cr-substituted sample as a fraction of Mn occupies the Sn site and an equivalent amount of Sn occupies the Mn site. XPS study shows that both Cr and Fe exist in the +3 oxidation state, while Mn exists in the +2 state and Sn exists in a mixture of +2 and +4 oxidation states. Magnetic property study of these substituted compounds shows different types of magnetism, which is attributed to the variation of d-electrons of the substituent atom. The chromium-doped compounds show ferrimagnetic character along with two transitions: one transition at ∼37 K and another at ∼152 K. However, in Fe-substituted Mn₂SnS₄ samples, the low-temperature transition disappears and an increase in the high-temperature antiferromagnetic ordering temperature i.e. from 152 K (Mn₂SnS₄) to 174 K (Mn_1.82Fe_0.18SnS₄) is observed. The increase in the antiferromagnetic ordering temperature in Mn_2-xFe_xSnS₄ may be attributed to the increase in the covalence of Mn/Fe-S-Mn/Fe bonds (shorter) with iron substitution.

Evolution of spin freezing transition and structural, magnetic phase diagram of Dy[Formula: see text]La[Formula: see text]Zr[Formula: see text]O[Formula: see text] (0 [Formula: see text] [Formula: see text] [Formula: see text] 2.0)

Dy[Formula: see text]Zr[Formula: see text]O[Formula: see text] a disordered pyrochlore system, exhibits the spin freezing behavior under the application of the magnetic field. We have performed detailed magnetic studies of Dy[Formula: see text]La[Formula: see text]Zr[Formula: see text]O[Formula: see text] to understand the evolution of the magnetic spin freezing in the system. Our studies suggest the stabilization of the pyrochlore phase with the substitution of non-magnetic La along with the biphasic mixture of fluorite and pyrochlore phases for the intermediate compositions. We observed that the spin freezing (T[Formula: see text] [Formula: see text] 17 K) at higher La compositions (1.5 [Formula: see text] [Formula: see text] [Formula: see text] 1.99) is similar to the field-induced spin freezing for low La compositions (0 [Formula: see text] [Formula: see text] [Formula: see text] 0.5) and the well-known spin ice systems Dy[Formula: see text]Ti[Formula: see text]O[Formula: see text] and Ho[Formula: see text]Ti[Formula: see text]O[Formula: see text]. The low-temperature magnetic state for higher La compositions (1.5 [Formula: see text] [Formula: see text] [Formula: see text] 1.99) culminates into a spin-glass like state below 6 K. Cole-Cole plot and Casimir-du Pr[Formula: see text] fit shows the narrow distribution of spin relaxation time in these compounds.

Structure driven magnetic correlations and magnetodielectric coupling in 6H-perovskite Ba3DyRu2O9

The 6H-perovskites Ba₃(R/M)Ru₂O₉(R= rare Earth,M= transition metal) exhibit complex magnetism and have been extensively studied recently for their magnetodielectric (MD) properties. Here, we present a detailed study of structural, magnetic, thermodynamic and MD properties of a 6H-perovskite Ba₃DyRu₂O₉. This compound is found to undergo long range antiferromagnetic ordering below ∼5.8 K (T_N), along with the presence of metamagnetic transition at low temperatures. The heat capacity shows two additional anomalies at ∼28 K (T₁) and ∼33 K (T₂), besides the anomaly atT_N. Signature of these anomalies is also visible in the derivative of magnetization curve. The dielectric response also shows weak anomalies aroundT₁andT₂at zero field whereas anomaly atT₂gets suppressed at 80 kOe. The observed MD coupling of ∼2%-4% at 80 kOe field below ∼30 K temperature range, is among the highest values observed for the compounds of this family. Low temperature crystal structures of the compound show sharp distortion of Ru₂O₉octahedra nearT₂. Our study points toward the emergence of structurally driven spin correlations of Ru moments resulting in the observed MD coupling in this compound.

Electronic and topological properties of group-10 transition metal dichalcogenides

The group 10 transition metal dichalcogenides (TMDs) (MX ₂: M = Ni, Pd, Pt; X = S, Se, Te) have attracted much attention in the last few decades because of observation of exotic phases and phenomena such as superconductivity (SC), topological surface states (TSSs), type II Dirac fermions, helical spin texture, Rashba effect, 3D Dirac plasmons, metal-insulator transitions, charge density waves (CDW) etc. In this review, we cover the experimental and theoretical progress on the physical phenomena influenced by the strong electron-electron correlation of the group-10 TMDs from the past to the present. We have especially emphasized on the SC and topological phases in the bulk as well as in atomically thin materials.

Experimental setup for the Seebeck and Nernst coefficient measurements

A new experimental setup is designed for the measurement of Seebeck and Nernst coefficients on the single crystal flakes and polycrystalline samples. The setup utilizes the multifunctional probe assembly of the physical property measurement system by Quantum Design, Inc. and can measure in the temperature range of 1.8 K-380 K up to 8 T magnetic fields. The experimental measurement was fully automated through a computer using the code written in LabVIEW software. The setup is capable of measurements on samples as small as 2 × 1 mm² in size and thickness as small as a few micrometers, which is quite important for the crystal flakes grown using the vapor transport method. The determination of the coefficients is based on the quasi-static approach, with the thermal gradient of 0.2 K-1.2 K across the sample in the measured temperature range of 1.8 K-300 K. The sensitivity of the instrument is better than 0.1 µV/K, and the accuracy is better than ∼0.5 µV/K, which can be further improved with the better quality of electrical contacts on the sample. The Seebeck and Nernst coefficient measurements performed on some well-studied semimetallic (bismuth), thermoelectric (Bi₂Se₃), and superconducting (FeTe_0.5Se_0.5) systems are also presented.

Emergence of weak pyrochlore phase and signature of field induced spin ice ground state in Dy2- x La x Zr2O7; x = 0, 0.15, 0.3

The pyrochlore oxides Dy2Ti2O7 and Ho2Ti2O7 are well studied spin ice systems and have shown the evidences of magnetic monopole excitations. Unlike these, Dy2Zr2O7 is reported to crystallize in a distorted fluorite structure. We present here the magnetic and heat capacity studies of La substituted Dy2Zr2O7. Our findings suggest the absence of spin ice state in Dy2Zr2O7 but the emergence of the magnetic field induced spin freezing near T ≈ 10 K in ac susceptibility measurements which is similar to Dy2Ti2O7. The magnetic heat capacity of Dy2Zr2O7 shows a shift in the peak position from 1.2 K in zero field to higher temperatures in the magnetic field, with the corresponding decrease in the magnetic entropy. The low temperature magnetic entropy at 5 kOe field is R ln2 - (1/2)R ln(3/2) which is the same as for the spin ice state. Substitution of non-magnetic, isovalent La3+ for Dy3+ gradually induces the structural change from highly disordered fluorite to weakly ordered pyrochlore phase. The La3+ substituted compounds with less distorted pyrochlore phase show the spin freezing at lower field which strengthens further on the application of magnetic field. Our results suggest that the spin ice state can be stabilized in Dy2Zr2O7 either by slowing down of the spin dynamics or by strengthening the pyrochlore phase by suitable substitution in the system.

Enhanced magnetic and room temperature intrinsic magnetodielectric effect in Mn modified Ba2Mg2Fe12O22 Y-type hexaferrite

We have reported a systematic investigation on structural, magnetic, magnetodielectric and magnetoimpedance characteristics of Y-type Ba₂Mg₂(Fe_1-x Mn _x )₁₂O₂₂ (0  ⩽  x  ⩽  0.12) hexaferrite synthesized by solid-state reaction route. Rietveld refinement of x-ray diffraction pattern confirms the phase purity of all the samples with rhombohedral crystal structure. The Mn dopant modulates not only superexchange angle near to the boundary of magnetic blocks but also magnetic transition temperature. Temperature-dependent magnetization data suggests that due to Mn doping at Fe sites, ferrimagnetic to proper screw transition temperature (T _II) increases from 190 K to 208 K, while there is a decrease in proper screw to longitudinal conical spin transition temperature (T _I) from 35 K to 25 K. We observe remarkable decrease in the magnetic field from 20 kOe to 12 kOe to produce intermediate spin ordering from ferrimagnetic ordering which can be understood because of modification of superexchange angle due to Mn doping. The value of loss tangent decreases with increasing doping concentration at 300K, i.e. ~60% and 180% in BMFM4 (x  =  0.04) and BMFM8 (x  =  0.08) respectively as compared to BMF, suggesting the evolution of intrinsic feature in the doped samples. Magnetodielectric (MD) effect shows that in the low-frequency regime, the robust MD effect is because of Maxwell-Wagner interfacial polarization, whereas in the high-frequency regime intrinsic effect dominates. Further, magnetoimpedance measurement confirms the presence of substantial intrinsic MD% (~6%) at 1.3 T applied field at 300 K for 4% Mn-doped sample. Finally, the nature and strength of magnetoelectric coupling in BMFM4 and BMFM8 samples at 300 K is found to be biquadratic (P ² M ²) and maximum strength of coupling is 3.09  ×  10^-4 emu² g^-2 and 2.34  ×  10^-4 emu² g^-2, respectively.

Enhanced, homogeneously type-II superconductivity in Cu-intercalated PdTe2

Though the superconducting phase of the type-II Dirac semimetal PdTe₂ was shown to be conventional in nature, the phase continued to be interesting in terms of its magnetic properties. While certain experiments indicated an unexpected type-I superconducting phase, other experiments revealed formation of vortices under the application of magnetic fields. Recently, scanning tunneling spectroscopy (STS) experiments revealed the existence of a mixed phase where type-I and type-II behaviours coexist. Here, based on our temperature and magnetic field dependent STS experiments on Cu-intercalated PdTe₂, we show that as the critical temperature of the superconducting phase goes up from 1.7 K to 2.4 K on Cu-intercalation, the mixed phase disappears and the system becomes homogeneously type-II. This may be attributed to an averaging effect caused by quasiparticle exchange between type-I and type-II domains mediated by the Cu atoms and to decreased coherence length due to increased disorder.

Mixed-valent antimony-induced disorder in substituted antiferromagnetic Mn2SnS4

Among MII2AIVQ4 (M = transition metal; A = Si, Ge, and Sn; Q = S, Se, and Te)-type compounds, most of which crystallize in an olivine or spinel structure, Mn2SnS4 is a unique compound that crystallizes in the orthorhombic space group Cmmm and exhibits complex magnetic properties. In this article, we report synthesis and study of the effect of Sb substitution (up to 20%) on the magnetic properties of Mn2SnS4. All the compounds were found to be in a single phase and indexed with the orthorhombic parent structure. Rietveld refinement of the room-temperature neutron diffraction data of Mn2Sn0.85Sb0.15S4 sample shows that Sb occupies the Mn site by replacing an equivalent amount of Mn. Subsequently, the replaced Mn occupies the Sn site causing disorder at both the Mn and the Sn sites, and the refined composition (Mn1.85(1)Sb0.15(1))(Sn0.85(1)Mn0.15(1))S4 is obtained. Although the purpose of incorporation of Sb(iii) was to create a mixed valence state at the Mn site, XPS study shows contrasting results. Sb exists in a mixed valence state, Sb(iii) and Sb(v), which balances the charge at the Sn(iv) site. Magnetic study of the compounds shows a very interesting trend. Pure Mn2SnS4 shows two magnetic transitions: one at 152 K that corresponds to antiferromagnetic ordering and other at 53 K corresponding to weak ferromagnetic ordering possibly due to spin canting. With antimony substitution, the temperature (152 K) of antiferromagnetic ordering remains unchanged, whereas the temperature of weak ferromagnetic ordering gradually increases with an increase in the Sb content from 53 K for the undoped compound to 88 K for 20% Sb-doped Mn2SnS4. The increase in the temperature of weak ferromagnetic ordering could be attributed to the incorporation of Sb, which induces more disorder at the Mn site, thereby making the magnetic lattice dilute with reduced frustration.

Arthroscopic and 3D CT Scan Evaluation of Femoral Footprint of the Anterior Cruciate Ligament in Chronic ACL Deficient Knees

The outcome of single-bundle anterior cruciate ligament (ACL) reconstruction depends largely on the anatomic placement of bone tunnel. The lateral intercondylar ridge (LIR) and bifurcate ridge (BR) are useful bony landmarks for femoral tunnel placement. The purpose of our study was to compare the bony landmarks of ACL footprint on femur by three-dimensional computed tomography (3D CT) scan and arthroscopy in chronic ACL-deficient knees. Fifty patients above 18 years of age who were diagnosed of having ACL tear were selected for the study. All the cases were more than 6 months old since the injury. Preoperative 3D CT scan of the affected knee was obtained for each of them. They underwent single-bundle anatomic ACL reconstruction. Measurements were done on the preoperative 3D CT and arthroscopy to quantify the position of the LIR and BR. The proximodistal distance of lateral femoral condyle was 21.41+/-2.5 mm on CT scan and 22.02+/-2.02 mm on arthroscopy. On preoperative 3D CT scan, the midpoint of the LIR was found to be located at a mean distance of 11.17±2.11 mm from the proximal margin of the lateral femoral condyle. On arthroscopy, it was at 10.18+/-1.52 mm from the proximal margin the lateral femoral condyle. The "bifurcate ridge"(BR) was not visible in any of the cases during arthroscopy or CT scan. We concluded that LIR is an easily identifiable bony landmark on arthroscopy in all cases. It can also be identified on CT scans. BR is not identified both on arthroscopy and CT scans in chronic ACL tears. The arthroscopic measurements of bony landmarks are quite close to those of CT scan. Midpoint of LIR is at 52.185% of the proximodistal distance on CT scan evaluation and it is at 46.21% on arthroscopic evaluation.

Nature of spiral state and absence of electric polarisation in Sr-doped YBaCuFeO5 revealed by first-principle study

Experimental results on YBaCuFeO5, in its incommensurate magnetic phase, appear to disagree on its ferroelectric response. Ambiguity exists on the nature of the spiral magnetic state too. Using first-principles density functional theory (DFT) calculations for the parent compound within LSDA + U + SO approximation, we reveal the nature of spiral state. The helical spiral is found to be more stable below the transition temperature as spins prefer to lie in ab plane. Dzyaloshinskii-Moriya (DM) interaction turns out to be negligibly small and the spin current mechanism is not valid in the helical spiral state, ruling out an electric polarisation from either. These results are in very good agreement with the recent, high quality, single-crystal data. We also investigate the magnetic transition in YBa1-xSrxCuFeO5 for the entire range (0 ≤ x ≤ 1) of doping. The exchange interactions are estimated as a function of doping and a quantum Monte Carlo (QMC) calculation on an effective spin Hamiltonian shows that the paramagnetic to commensurate phase transition temperature increases with doping till x = 0.5 and decreases beyond. These observations are consistent with experimental findings.

Effect of dexmedetomidine as an adjuvant to bupivacaine in femoral nerve block for perioperative analgesia in patients undergoing total knee replacement arthroplasty: A dose-response study

Context:

Dexmedetomidine is being increasingly used in nerve blocks. However, there are only a few dose determination studies.

Aims:

To compare two doses of dexmedetomidine, in femoral nerve block, for postoperative analgesia after total knee arthroplasty (TKA).

Settings and Design:

A prospective, randomized, controlled trial was conducted in the Department of Anesthesia at AIIMS, a Tertiary Care Hospital.

Materials and Methods:

Sixty American Society of Anesthesiologists I–II patients undergoing TKA under subarachnoid block were randomized to three Groups A, B, and C. Control Group A received 20 ml (0.25%) of bupivacaine in femoral nerve block. Groups B and C received 1 and 2 μg/kg dexmedetomidine along with bupivacaine for the block, respectively. Outcomes measured were analgesic efficacy measured in terms of visual analog scale (VAS) score at rest and passive motion, duration of postoperative analgesia, and postoperative morphine consumption. Adverse effects of dexmedetomidine were also studied.

Statistical Analysis Used:

All qualitative data were analyzed using Chi-square test and VAS scores using Kruskal–Wallis test. Comparison of patient-controlled analgesia (PCA) morphine consumption and time to first use of PCA were done using ANOVA followed by Least Significant Difference test. A P < 0.05 was considered statistically significant.

Results:

The VAS score at rest was significantly lower in Group C compared to Groups A and B (P < 0.05). There was no difference in VAS score at motion between Groups B and C. The mean duration of analgesia was significantly longer in Group C (6.66 h) compared to Groups A (4.55 h) and B (5.70 h). Postoperative mean morphine consumption was significantly lower in Group C (22.85 mg) compared to Group A (32.15 mg) but was comparable to Group B (27.05 mg). There was no significant difference in adverse effects between the groups.

Conclusion:

The use of dexmedetomidine at 2 μg/kg dose in femoral nerve block is superior to 1 μg/kg for providing analgesia after TKA, although its role in facilitating early ambulation needs further evaluation.

Unequivocal evidence of enhanced magnetodielectric coupling in Gd3+substituted multiferroic Bi2Fe4O9

We report an enhanced magnetodielectric (MD) coupling in antiferromagnetic Bi₂Fe₄O₉(BFO) lightly substituted by gadolinium (Gd³⁺).

Superconductivity at 5.2 K in ZrTe3 polycrystals and the effect of Cu and Ag intercalation

We report the occurrence of superconductivity in polycrystalline samples of ZrTe(3) at temperature 5.2 K at ambient pressure. The superconducting state coexists with the charge density wave (CDW) phase, which sets in at 63 K. The intercalation of Cu or Ag does not have any bearing on the superconducting transition temperature but suppresses the CDW state. The feature of a CDW anomaly in these compounds is clearly seen in the DC magnetization data. Resistivity data are analyzed in order to estimate the relative loss of carriers and reduction in the nested Fermi surface area upon CDW formation in ZrTe(3) and the intercalated compounds.

A comparative analysis between fixed bearing total knee arthroplasty (PFC Sigma) and rotating platform total knee arthroplasty (PFC-RP) with minimum 3-year follow-up

BACKGROUND

Since the introduction of mobile bearing total knee designs nearly 30 years back, many studies have been done to evaluate its long-term result. Comparison with fixed bearing designs has been done in the past, but the studies were confounded by variables such as disease, surgeon, bone quality, pain tolerance, etc. We attempt to eliminate these variables in this study.

METHODS

A total of 50 patients who had bilateral arthritis of the knee with similar deformity and pre-operative range of motion on both sides agreed to have one knee replaced with mobile bearing total knee design (PFC-RP) and the other with a fixed bearing design (PFC Sigma) were prospectively evaluated. Comparative analysis of both the designs was done at a mean follow-up of 40 months, minimizing patient, surgeon and observer related bias. Clinical and radiographic outcome, survival and complication rates were compared.

RESULTS

At a mean follow-up of 40 months (range 36-47 months), no benefit of mobile bearing (PFC-RP) over fixed bearing design (PFC Sigma) could be demonstrated with respect to Knee Society scores, pain scores, range of flexion, subject preference or patello-femoral complication rates. Radiographs showed no difference in prosthetic alignment. No patient required a revision surgery till last follow-up.

CONCLUSIONS

Our study demonstrated no advantage of the mobile-bearing arthroplasty over fixed bearing arthroplasty with regard to clinical results at short-term follow-up. However, longer follow-up is necessary to confirm whether these results are sustained.

Displaced femoral neck fractures in the young: significance of posterior comminution and raised intracapsular pressure

BACKGROUND

Osteosynthesis in fracture neck of femur (NOF) in young is a universally acceptable procedure. Various factors affect the outcome; with AVN (avascular necrosis) and non-union primarily contributing to adverse results in such patients. To identify factors affecting outcome of displaced fracture NOF, a prospective cohort study was carried out in the setting of a tertiary care centre in developing country.

METHODS

27 consecutive patients with displaced fracture NOF suitable for osteosynthesis underwent closed reduction and fixation with three 6.5 mm cancellous cannulated screws. A record of posterior comminution and its extent (as seen on CT scan) and the intracapsular pressure difference between the fractured and the opposite side was kept in all the patients. The patients were followed-up for 1 year. The main outcomes measured at 1 year were non-union (as identified by CT scan) and AVN (as identified by bone scan).

RESULTS

Cases with pressure difference >30 mm were found to have a higher rate of AVN and this result was found to be statistically significant (p value 0.034). The patients with significant posterior comminution were found to have higher non-union rates and this result was also found to be statistically significant (p value 0.04).

CONCLUSIONS

Prognosis of displaced fracture NOF is significantly associated significant with posterior comminution and intracapsular pressure difference between fractured and normal side.

Hemophilic pseudotumor--is there a role of radiotherapy? Literature review and a case report

We share the literature and management of an adult with moderate hemophilia a presented with a calcaneal pseudotumor and non healing ulcer by radiation therapy, factor VIII and cryoprecipitate supplement. Numerous literatures so far have quoted the satisfactory role of radiotherapy in hemophilic pseudotumor. We found it to be of great help as our case responded with radiotherapy, factor VIII and cryoprecipitate supplement and has a satisfactory 2 years follow up.

Propoxur-induced acetylcholine esterase inhibition and impairment of cognitive function: attenuation by Withania somnifera

Propoxur (2-isopropoxyphenyl N-methylcarbamate) is widely used as an acaricide in agriculture and public health programs. Studies have shown that sub-chronic exposure to propoxur can cause oxidative stress and immuno-suppression in rats. Carbamates are also known to exhibit inhibitory effect on cholinesterase activity, which is directly related to their cholinergic effects. In the present study, the effect of Withania somnifera (Ashwagandha), a widely used herbal drug possessing anti-stress and immunomodulatory properties was studied on propoxur-induced acetylcholine esterase inhibition and impairment of cognitive function in rats. Male Wistar rats were divided into four groups. Group I was treated with olive oil and served as control. Group II was administered orally with propoxur (10 mg/kg b.wt.) in olive oil, group III received a combination of propoxur (10 mg/kg b.wt.) and W. somnifera (100 mg/kg b.wt.) suspension and group IV W. somnifera (100 mg/kg b.wt.) only. All animals were treated for 30 days. Cognitive behaviour was assessed by transfer latency using elevated plus maze. Blood and brain acetylcholine esterase (AChE) activity was also assessed. Oral administration of propoxur (10 mg/kg b.wt.) resulted in a significant reduction of brain and blood AChE activity. A significant prolongation of the acquisition as well as retention transfer latency was observed in propoxur-treated rats. Oral treatment of W. somnifera exerts protective effect and attenuates AChE inhibition and cognitive impairment caused by sub-chronic exposure to propoxur.

Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures

OBJECTIVES

To assess the efficacy and safety of digastric trochanteric flip osteotomy technique in the management of acetabular fractures and to evaluate surgical outcome in terms of fracture reduction, femoral head viability of selected acetabular fractures treated operatively using a digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with surgical dislocation of the femoral head.

DESIGN

Prospective.

PATIENTS

Eighteen patients predominantly with combined transverse and posterior wall fractures or multifragmentary posterior wall fractures. OUTCOME EVALUATION: Clinical and radiographic analysis after a minimum 18 months follow-up. Methods A single modified approach involving digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with anterior (n = 14) or posterior (n = 4) surgical dislocation of the femoral head, was done for one or more of following reasons: intra-articular assessment of reduction in fractures with comminution, marginal impaction and involvement of the anterior column, removal of intra-articular fragments, and confirmation of extra-articular screw placement.

RESULTS

At a mean follow-up of 26 months (18–40 months), the 17 patients presented with a good to excellent clinical result according to the d’Aubigné score. In all subjects, anatomical reduction was achieved during surgery. The osteotomy site healed at an average of 7 weeks and all the patients recovered abductor strength at 12 weeks. One avascular necrosis occurred in a case of posterior column plus wall fracture (who presented to us after 3 weeks). No heterotopic ossification interfering with hip function was found.

CONCLUSION

This technique gives good exposure (especially in posterior wall, dome area, posterior fracture-dislocation with intra-articular fragments/femoral head fractures and T-fractures), preservation of abductor strength (which may be lost with excessive retraction of abductors to see dome area in classical posterior approach), reliable healing of osteotomy (in contrast to conventional trochanteric osteotomy) without risking the vascularity of femoral head.

Transport and magnetic properties of Fe(x)VSe(2) (x = 0-0.33)

We present the results of the effect of Fe intercalation on the structural, transport and magnetic properties of 1T-VSe(2). Intercalation of iron suppresses the charge density wave transition at 110 K in 1T-VSe(2). And for more than 10% Fe concentration a new kind of first-order transition appears below 160 K in our resistivity results. The transition becomes stronger with a broad hysteresis (80-160 K) for 33% Fe intercalation. The anomalies are absent in the thermopower measurements of polycrystalline Fe(x)VSe(2) compounds (x = 0-0.33). The susceptibility measurements between 2 and 300 K and the magnetization in a high magnetic field up to 14 T at 2 K are reported. The Fe atoms are in the low-spin ( S = 1/2) state of Fe(3+) and the compounds show the absence of any magnetic order at low temperatures.

Computed tomography-guided radiofrequency ablation of osteoid osteomas

PURPOSE

To report on 14 patients with osteoid osteomas treated by computed tomography-guided radiofrequency ablation.

METHODS

Nine males and 5 females aged 13 to 45 (mean, 25) years with osteoid osteomas were included. The proximal tibia was the commonest site involved. A bipolar 18-gauge radiofrequency probe with a 9- mm active tip was used. A 4.5-mm hollow drill was introduced into the nidus. Energy application was started at 2 W and increased to a maximum of 5 W. Heat was applied for 4 to 6 minutes at 90 degrees Celsius.

RESULTS

12 (86%) of the 14 patients had prompt pain relief; the remaining 2 underwent a repeat ablation. After a mean follow-up period of 19 (range, 9-25) months, no patient had pain recurrence.

CONCLUSION

Radiofrequency ablation is a minimally invasive and cost-effective treatment for osteoid osteomas.

Dextrose prolotherapy for recalcitrant coccygodynia

PURPOSE

To present the results of dextrose prolotherapy undertaken for chronic non-responding coccygodynia in 37 patients.

METHODS

14 men and 23 women (mean age, 36 years) with chronic coccygodynia not responding to conservative treatment for more than 6 months were included. 27 of them had received local steroid injections. A visual analogue score (VAS) was recorded for all patients before and after injection of 8 ml of 25% dextrose and 2 ml of 2% lignocaine into the coccyx. In 8 patients with a VAS of more than 4 after the second injection, a third injection was given 4 weeks later.

RESULTS

The mean VAS before prolotherapy was 8.5. It was 3.4 after the first injection and 2.5 after the second injection. Minimal or no improvement was noted in 7 patients; the remaining 30 patients had good pain relief.

CONCLUSION

Dextrose prolotherapy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. Randomised studies are needed to compare prolotherapy with local steroid injections or coccygectomies.

A rare actinomycosis of humerus: an unusual location and a diagnostic dilemma. A case report

BACKGROUND

Isolated actinomycosis of the humerus is a very rare entity.

METHOD

A 30-year-old male had an erythematous plaque with a pus-(minimal) discharging sinus over left lower arm. The patient had no discharge of sulphur granules from the sinus. The patient had raised ESR with a single lytic lesion with minimal sclerosis and inconspicuous periosteal reaction on radiographs. Such atypical clinical and radiological features lead to initial wrong diagnosis of tuberculosis. A diagnosis of Actinomycosis of humerus became possible after demonstration of filamentous bacilli in culture and on histopathology from the sulphur grains obtained by open biopsy.

RESULT

The patient recovered completely after administering PenicillinG 24 million units intravenous for 7 days followed by 1.2 g of oral amoxicillin in three divided doses for 3 months and did not show any recurrence during last 2 years of follow up.

CONCLUSION

Surgeons should be aware of this rare entity and difficulty in its diagnosis due to its variable manifestations, including confusion with highly endemic tuberculous infection. Awareness of full spectrum of the diseases and careful evaluation in individual cases will expedite diagnosis and avoid unnecessary surgical interventions.

The 'Delhi active test' for detection of anterior cruciate ligament tears

All the described tests for the detection of anterior cruciate ligament (ACL) tear are passive tests. For obese or muscular built patients these tests are cumbersome and often unsuitable. We describe for the first time a new method, the 'Delhi active test', by which a torn ACL can be detected irrespective of the size or build of the patient. The results of this test are reproducible and the diagnostic accuracy is comparable with other tests. We suggest that the 'Delhi active test' be used as one of the routine clinical methods to detect the torn ACL.

Unusual presentation of shoulder joint tuberculosis: A case report

Tuberculosis of the shoulder joint is uncommon. In adults the classical dry type of shoulder tuberculosis (caries sicca) has been described, while the fulminating variety has not been reported. We treated a case of fulminating variety of tuberculosis of the shoulder joint with anti-tubercular therapy and a shoulder immobilizer sling. At 18 months of follow up, the patient was disease free and had a good functional range of motion.

Preliminary clinical study of kalanchoe spathulata dc. On inflammatory wound

Here, an attempt is made to study the clinical aspect of Kalanchoe spathulata Dc. It has been observed that would heals rapidly leaving no scar. The study clearly validates the ancient concept of Ayurveda, that without taking the help of surgery, there are several medicinal plants which may cure diseases very well.