Orthopaedic Journal of M. P. Chapter

Robotics in Total knee Arthroplasty

Vivek Singh — 2024-12-31

The recent introduction of new robotic systems for total knee arthroplasty (TKA) has created somewhat of a craze. Nevertheless, we can ask ourselves whether it is justified to use these new but very costly technologies. The results and limitations of these robotic tools must be analyzed systematically before confirming their benefits. Most of the newest robotic systems are interactive ones.The term “robotic surgery” refers to the use of programmable devices to perform a wide variety of surgical tasks. These are not intended to replace the surgeon but rather to provide assistance. This activity reviews the role of the interprofessional team in evaluation and treatment using robotic assistance to perform knee arthroplasty. (1)

The Current Status of Indian Orthopaedic Research: A Comprehensive Overview

Raju Vaishya — 2024-12-31

This overview illuminates the significant evolution of Indian orthopaedic research from 1996 to 2023, showcasing exponential growth in publications and an increasing global presence. The study reveals a remarkable annual growth rate of 20.8% in literature, with predominant contributions from leading institutions. Despite the surge in quantity, the research underscores the imperative enhancement required in the quality of publications, with only a minor fraction gaining substantial citations. Highlighting the role of international collaborations, particularly with the USA and UK, the overview articulates how these partnerships have been pivotal in elevating the research quality and impact. The narrative also addresses the diverse range of topics covered by Indian researchers in international journals, emphasizing significant scientific contributions in areas like joint replacement, sports medicine, and fracture research. The study acknowledges the regional distribution of contributions across India, signalling a call for increased research emphasis in underrepresented areas. Looking forward, the overview accentuates the potential of Indian orthopaedic research, advocating for enhanced funding, infrastructure, and global collaboration to address prevailing challenges and leverage technological advancements for the betterment of patient care and health equity.

Complications of uncemented total hip replacement in avascular necrosis head of femur, encountered intra and post-operative period

Singh V — 2024-12-31

Introduction: Avascular Necrosis Head of Femur is a progressive disorder in which lack of sufficient blood supply leads to cell death, fracture and collapse of the affected area. In stage 3 and 4 patients of AVN of hip, uncemented total hip replacement is the treatment of Choice. The complications in uncemented THR can be intraoperative, postoperative and anaesthetic and also according to time duration can be immediate, early and late.

Material and Method: Fifty-one patients of Avascular necrosis of femoral head of stage III and IV, are operated in last two years by uncemented total hip arthroplasty and their results were assessed by Harris hip score. There are few complications which we encountered in intraoperative and post operative period. The assessment and corresponding solutions of the complications are provided in this study.

Results: The pre-operative modified harris hip score had a mean of 48.51 with a standard deviation of 3.114. The post-operative modified harris hip score increased significantly to a mean of 90.96 with a standard deviation of 3.268. Intraoperative complication like periprosthetic fracture was seen in 3.9% cases only. The majority (92.2%) did not experience any anesthetic complications. Among those who did, 3.9% encountered hypotension and tachycardia, while 2% experienced postoperative nausea and vomiting. Additionally, one patient (2%) suffered from a spinal headache (PDPH). Post-operative complications were present i.e. 5.9% of the patients experienced sciatic nerve injury, and another 5.9% had superficial infections. Additionally, anterior thigh pain, deep infection, and limb length discrepancy each affected 3.9% of the patients, while 2% experienced dislocation.

Conclusion: Uncemented THR is one of the most successful operative procedure done across the globe. The best possible outcome in uncemented total hip replacement surgery can be achieved by appropriate patient selection, appropriate implant size and design, and above all maintaining sterility intra-operatively and during regular dressings and during suture removal.

Periprosthetic femoral fracture around the stem of Total Hip Arthroplasty

Ajay Khare — 2024-12-31

Introduction: Fractures occurring over a hip femoral implant can be divided into intra-operative and post-operative PFFs, and their treatment depends on factors that may severely affect the outcome: level of fracture, implant stability, quality of bone stock, patient’s functional demand, age and comorbidities, and surgeon expertise. Here, we are discussing the results of management of periprosthetic femoral fractures.

Material and method: Eleven patients of periprosthetic femoral fractures were operated in our hospital in last 3 years. Patients were followed up regularly. Their results were assessed by modified harris hip score. Two fractures were Type A, seven cases were type B and one case was type C fractures. Type A fractures were managed by cables and stainless-steel wires. Type B fractures were managed by long plates, and type C fracture was managed by distal femoral locking plate.

Results: Results were assessed by modified harris hip score. It was found excellent in 3 cases, good in 7 cases and fair in one patient.

Conclusion: In the presence of a well-fixed stem there are various options for retaining the implant and reduction and fixation of the fracture, but loose implants require revision arthroplasty and internal fixation. Future large-scale randomised trials are needed to determine the optimum fixation option with an aim to reduce these complications.

Comparison of open v/s microscopic tubular discectomy at single level lumbar or lumbosacral spine in prolapsed inter vertebral disc patients

Vivek Singh — 2024-12-31

Introduction: Clinical outcomes of using microscopic tubular discectomy for lumbar or lumbosacral disc herniation were evaluated by comparison with open discectomy.

Materials and Methods: As per study criteria 32 patients with low back pain with unilateral radicular pain was included in this study. After admission of patients a detailed, careful history was taken. Patient was assessed clinically to evaluate general condition; vitals were recorded and spine examination was done and radiological assessment was also done.

Result: This study includes total 32 patients undergone microscopic discectomy (16pt) and open discectomy (16 pt). In this study results showed that using tubular microdiscectomyfor lumbar or lumbosacral disc herniation was more effective than open discectomy in improving visual analogue scale score (VAS) (p<0.05) and Oswestry Disability Index (ODI) (p<0.05).

Conclusion: Based on our study it was found that tubular microdiscectomy group has better outcomes than open discectomy group in terms of visual analogue scale score (VAS) and Oswestry Disability Index (ODI). current research suggests that tubular microdiscectomy can achieve clinical results similar to those of open discectomy.

Functional and clinical outcome of fracture clavicle treated by nailing vs plating technique: a comparative study

Vivek Singh — 2024-12-31

Introduction: Clavicle bone fractures are among of the most common bony injuries encountered in orthopaedic opd and emergencies. Clavicle fractures are commonly seen in young adult. The most common site of fracture in the clavicle occurs at the middle third and which accounts for almost 80% of all clavicle fractures. This study is done to compare the functional and clinical outcome of fracture clavicle treated with nailing vs plating.

Material and method: This study includes 44 patients with diagnosed clavicle fractures. After admission thoroughly history was taken and clinical examination done with general condition, vitals and radiological assessment was also done. After getting PAC fitness patients taken randomly by chit system for surgical fixation of fracture either by nailing or plating technique.

Results: Our study shows that nailing technique is better than plating technique on the basis of CMS score.

Conclusion: Based on the data of 44 patients, the TENS method appears to be a favourable option than plating for orthopaedic treatment due to its less invasive nature, faster recovery times, and better early functional outcomes. However, the final decision should also consider the specific fracture pattern,clinical scenario, patient preferences and the potential for long-term complications.

Comparison Of Functional Outcome of Metacarpal Fractures Treated by Anterograde Vs Retrograde Approach of Intramedullary Pinning

Rishabh Kag — 2024-12-12

Purpose: Metacarpal fractures are a common injury, constituting a significant portion of upper extremity fractures. The purpose of this study is to compare the functional and radiological outcomes of anterograde vs. retrograde intramedullary pinning in the treatment of shaft metacarpal fractures. Methodology: This prospective study was conducted from February 2021-September 2022, involving 60 patients aged 18-65 years with closed, displaced metacarpal fractures. 30 patients received anterograde and another 30 received retrograde intramedullary pinning. Follow-up assessments were done at 2, 4, 6, and 12 weeks. Radiological and clinical outcomes were evaluated using TAM score, grip strength measurements, VAS scores, and standard radiographic analyses. Results: Mean age of patients in anterograde group was 34.60±7.35 years, while the retrograde group had a mean age of 32.53±8.80 years. The anterograde group demonstrated significantly higher grip strength at both 6 and 12 weeks postoperatively (p-value<0.0001) and lower VAS scores for pain at 2 and 6 weeks (p-value<0.0001). Radiological union was achieved faster in the anterograde group (mean union time=5.21 weeks) compared to the retrograde group (6.89 weeks). Stiffness was the most common complication, observed in 16.7% of the anterograde group and 23.3% of the retrograde group. The anterograde group also showed a higher percentage of patients achieving excellent results (46.4% vs. 23.4% in the retrograde group). Conclusion: Anterograde intramedullary percutaneous pinning is a superior technique compared to retrograde pinning for the management of metacarpal fractures. It offers faster functional recovery, better grip strength, and reduced pain in the early postoperative period, with fewer complications.