Indian J Orthop
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Transforaminal lumbar interbody fusion (TLIF) has been preferred to posterior lumbar interbody fusion (PLIF) for different spinal disorders but there had been no study comparing their outcome in lumbar instability. A comparative retrospective analysis of the early results of TLIF and PLIF in symptomatic lumbar instability was conducted between 2005 and 2011. ⋯ Both methods were effective in relieving symptoms, achieving structural restoration, stability, and fusion, but TLIF had been associated with shorter operative time, less blood loss, and lesser complication rates for which it can be preferred for symptomatic lumbar instability.
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Postoperative thromboprophylaxis with low molecular weight heparin (LMWH) for an extended period of 4 weeks is now preferred over short term thromboprophylaxis in patients undergoing total hip/knee arthroplasty (THA/TKA). However, most of the data demonstrating the efficacy and safety of extended thromboprophylaxis and short term thromboprophylaxis is from clinical trials done in the West. In India, the data of the incidence of venous thromboembolism (VTE) following THA/TKA has been conflicting and the duration has not been clearly defined. The aim of the study was to evaluate and compare the efficacy of extended thromboprophylaxis over short term thromboprophylaxis in Indian patients undergoing elective THA/TKA surgeries. ⋯ Extended thromboprophylaxis (for 4 weeks) was found to be more effective than short term thromboprophylaxis in minimizing the risk of postoperative VTE in patients who underwent THA/TKA.
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Main concerns of patients undergoing bilateral surgery is the quantum of pain and the progress of functional recovery. We studied functional recovery in terms of pain, range of motion (ROM), SF12, WOMAC scores and a unique TUG (timed up and go) test for patients undergoing unilateral total knee arthroplasty (U/L-TKA) and sequential bilateral total knee arthroplasty (B/L-TKA). ⋯ The early functional recovery of bilateral TKA patient lags behind that of unilateral TKA patient for the first 5 days, becomes equal by the 14(th) day and remains equal till 1 year after surgery. Bilateral TKA patients regain their preoperative functional status by 6 weeks against 3 months for unilateral TKA. The operative status of the contralateral knee makes no difference to early functional recovery after unilateral TKA. With bilateral TKA, there is no difference in pain and ROM parameters.
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Arthroscopic debridement with continuous irrigation system was used with success in treating infective arthritis. We evaluated the effectiveness of arthroscopic debridement coupled with antibiotic continuous irrigation system in acute presentation of late infected total knee arthroplasty. ⋯ Arthroscopic debridement combined with continuous antibiotic irrigation and suction is an effective treatment for patients with acute presentation of late infected total knee arthroplasty.
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Treatment of complex injuries of interphalangeal joints (IPJs) is difficult. The restoration of joint stability for early joint mobility till fracture union is the key for successful outcome. Although various treatment options like dynamic splinting, external fixator, closed reduction, transarticular Kirschner (K)-wire and ORIF, etc., are available in literature, a universally accepted ideal treatment for complex intraarticular fractures of IPJs is still evolving. Open reduction is difficult because fixation of volar fragment is often impractical and radical procedures like volar plate arthroplasty, arthrodesis or joint replacement, etc., may become mandatory for salvage. We describe percutaneous technique to treat unstable fractures and dorsal fracture-dislocations of the PIP joint and report short-term postoperative results. ⋯ DPK technique may be a cheap and valuable definitive treatment option in the management of unstable or potentially unstable intraarticular fractures of IPJs. The technique gave satisfactory radiological union and functional outcome in our small series. This technique may be worth considering in unstable or potentially unstable intraarticular fractures of IPJs with intact collateral ligaments and when other treatment options are impractical.