Background: Medial pivot total knee arthroplasty aims to restore native knee kinematics through highly conforming medial tibiofemoral articulation with survival comparable to contemporary knee designs. The aim of this study was to report preliminary clinical results of medial pivot total knee arthroplasty in an Indian population. Methods: A retrospective analysis of 45 patients (average age, 62 years; 40 women and 5 men) with end-stage arthritis (KellgrenLawrence grade 4) operated with a medial pivot prosthesis was done. All patients were assessed using Knee Society Score (satisfaction, expectation, and functional scores) and Oxford Knee Score, and range of motion was recorded at the end of 5-year postoperative follow-up. In addition, all patients underwent standardized radiological assessment. Results: At the final follow-up, patients reported significant improvement in mean Knee Society Score (satisfaction, expectation, and functional scores) and Oxford Knee Score (p < 0.05). The mean range of motion achieved at the end of 5 years ranged from 0° (extension) to 118.4° (further flexion). There was no evidence of loosening or osteolysis at a minimum follow-up of 5 years. Conclusions These results demonstrated satisfactory clinical and radiological outcomes at 5 years after total knee arthroplasty with a medial pivot design, which may be related to better replication of natural knee kinematics with the medial pivot knee and inherent advantages of this design.

STUDY DESIGN: A retrospective computed tomography (CT)-based morphometric study of 82 occipital condyles in the Indian population, focusing on critical morphometric dimensions with relation to placing condylar screws. PURPOSE: This study focused on determining the feasibility of placing occipital condylar screws in an Indian population using CT anatomical morphometric data. OVERVIEW OF LITERATURE: The occipital condylar screw is a novel technique being explored as one of the options in occipitocervical stabilization. Sex and ethnic variations in anatomical structures may restrict the feasibility of this technique in some populations. To the best of our knowledge, there are no CT-based data on an Indian population that assess the feasibility of occipital condylar screws. METHODS: We measured the dimensions of 82 occipital condyles in 41 adults on coronal, sagittal, and axial reconstructed CT images. The differences were noted between the right and left sides and also between males and females. Statistical analysis was performed using the t-test, with a p-value of < 0.05 considered significant. RESULTS: Mean sagittal length and height were 17.2±1.7 mm and 9.1±1.5 mm, respectively. Mean condylar angle/screw angle was 38.0°±5.5° from midline, with mean condylar length and width of 19.6±2.6 mm and 9.5±1.0 mm, respectively. Average coronal height on the anterior and posterior hypoglossal canal was 10.8±1.4 mm and 9.0±1.4 mm, respectively. The values in females were significantly lower than those in males, except for screw angle and condylar width. Based on Lin et al.'s proposed criteria, eight of 82 condyles were not suitable for condylar screws. CONCLUSIONS: Preliminary CT morphometry data of the occipital condyle shows that condylar screws are anatomically feasible in a large portion of the Indian population. However, because a small number of population may not be suitable for this technique, meticulous study of preoperative anatomy using detailed CT data is advised.
Adult ; Female ; Humans ; Male ; Retrospective Studies

STUDY DESIGN: Retrospective study. PURPOSE: The aim of this study was to analyze various diagnostic tools, including GeneXpert, for the management of tuberculosis of the spine. OVERVIEW OF LITERATURE: Traditional diagnostic methods of microscopy, histology, and culture have low sensitivity and specificity for the management of tuberculosis of the spine. METHODS: Of the 262 treated cases of spinal tuberculosis, data on 1 year follow-up was available for 217 cases. Of these, only 145 cases with a confirmed diagnosis were selected for retrospective analysis. RESULTS: In 145 of the 217 patients (66.80%), diagnosis was confirmed on the basis of a culture. Of the 145 patients with a confirmed diagnosis, 98 (66.20%) patients were diagnosed on the basis of clinical presentation, whereas 123 (84.8%) exhibited a typical magnetic resonance imaging (MRI) picture. In 99 surgically treated patients, the diagnosis was confirmed on the basis of an intraoperative tissue biopsy. Among the 46 patients treated conservatively, 35 underwent a transpedicular biopsy, 4 patients underwent computed tomography-guided biopsy, 6 patients were diagnosed on the basis of material obtained from a cold abscess, and 1 patient underwent an open biopsy. The sensitivity of the culture for the detection of Mycobacterium tuberculosis was 66.80% (145/217) in our patients. Among the cases in which GeneXpert was used, the sensitivity for the detection of Mycobacterium tuberculosis was 93.4% (43/46). Moreover, the sensitivity of GeneXpert to detect rifampicin resistance was 100% (7/7) in our study. CONCLUSIONS: Majority of the patients with tuberculosis of the spine can be diagnosed on the basis of a typical radiological presentation via MRI. In our study, 84.8% cases exhibited typical MRI findings. For patients presenting with atypical MRI features, a rapid and accurate diagnosis is possible by combining GeneXpert with MRI. The combined use of MRI and GeneXpert is a rapid and highly sensitive tool to diagnose tuberculosis and rifampicin resistance in patients with tuberculosis of the spine. Furthermore, we achieved a 97.9% sensitivity for the detection of Mycobacterium tuberculosis and 100% sensitivity for the detection of rifampicin resistance in our study.
Abscess ; Biopsy ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Microscopy ; Mycobacterium tuberculosis ; Retrospective Studies ; Rifampin ; Sensitivity and Specificity ; Spine* ; Tuberculosis* ; Tuberculosis, Spinal

STUDY DESIGN: A retrospective computed tomography (CT)-based morphometric study of 84 C1pedicles in an Indian population focusing on critical morphometric dimensions vis-a-vis C1 pedicle screw placement. PURPOSE: To determine the feasibility of C1 pedicle screw placement in an Indian population and propose a novel classification system for the same. OVERVIEW OF LITERATURE: At present, C1 pedicle screws are rarely used, and very few studies have focused on the feasibility of pedicle screw placement in terms of racial, gender, and ethnic variations in anatomical structures. There are no CT-based data on C1 pedicles that assess the feasibility of pedicle screw placement in the Indian population. METHODS: We measured C1 pedicle diameter on CT coronal scan images of 42 adult patients. Extramedullary height (EMH) and intramedullary height (IMH) were measured. We examined the differences between the right and left atlas pedicles and compared measures between males and females. These data were analyzed using significance tests. Based on the results, we propose a novel classification system, which we believe will help in determining the feasibility of C1 pedicle screw placement. RESULTS: Forty-two adult patients (84 pedicles) were examined. Average EMH and IMH were 4.48±0.91 and 0.86±0.77, respectively. Approximately, 32% of the C1 pedicles had bone thicknesses of <4 mm, 49% had IMH of <1 mm, and 38% had no pedicles. The average thickness in women was 4.21±0.93 mm, which was significantly thinner than that in men (4.73±0.81 mm, p=0.004). Right and left pedicles were not significantly different. CONCLUSIONS: Our data indicate that approximately one-third of the Indian population may not be suitable candidates for C1 pedicle screw placement. Caution should be exercised while placing type 1B and type 2 pedicles based on our proposed classification system.
Adult ; Classification* ; Female ; Humans ; Male ; Pedicle Screws* ; Retrospective Studies

PURPOSESubtrochanteric fractures of the femur are being managed successfully with various intramedullary and extramedulary implants with reasonable success. However, these implants require precise placement under image intensifier guidance, which exposes the surgeon to substantial amount of radiation. It also restricts the management of these fractures at peripheral centers where facility of image intensifiers is not available. Keeping this in mind we designed this study to identify if contralateral reversed distal femoral locking plate can be used successfully without the use of image intensifier.

METHODSTwenty-four consecutive patients (18 men and 6 women) with a mean age of 28 years (range 19-47 years) suffering subtrochanteric fractures of the femur underwent open reduction and internal fixation with reversed contralateral distal femoral locking plate. The outcome was assessed at the mean follow-up period of 3.2 years (range 2-4.6 years) using the Harris hip score.

RESULTSTwenty-one fractures united with the primary procedure, with a mean time of consolidation being 11 weeks (range, 9-16 weeks). One patient developed superficial suture line infection, which resolved with oral antibiotics. Another patient had a fall 3 weeks after surgery and broke the plate. Repeat surgery with reversed distal femoral locking compression plate was performed along with bone grafting and the fracture united. Two cases had nonunion, which went in for union after bone grafting. The mean Harris hip score at the time of final follow-up was 90.63 (range 82-97).

CONCLUSIONThe reversed contralateral distal femoral plate is a biomechanically sound implant, which when used for fixation of the subtrochanteric fractures with minimal soft tissue stripping shows results comparable to those achieved by using other extramedullary implants as well as intramedullary devices. The added advantage of this implant is its usability in the absence of an image intensifier.

Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Hip Fractures ; surgery ; Humans ; Male ; Middle Aged

Purpose: The direct anterior approach (DAA) for conducting total hip arthroplasty (THA) is gaining popularity worldwide. However, careful selection of patients and surgeon experience are important. Although promising outcomes have been reported in international studies, research on DAA in Southern and Southeast Asia has been limited. Materials and Methods: This prospective study included 157 patients who underwent THA using the DAA between January 2019 and June 2022. The patients were divided into three groups for the comparison. Data on preoperative, intraoperative, and postoperative variables were acquired. Improvement of the surgeon’s performance to use of a DAA approach was examined using the CUSUM (cumulative summation method). Results: The mean age of the patients was 43.9 years. Differences in intraoperative variables and complications were observed among the three groups, and improved outcomes were reported in later cases. Functional outcomes showed significant improvement, and no differences were observed between groups. The results of learning curve analysis indicated a shift towards consistent success after the 82nd case, reaching an acceptable rate of failure by the 118th case. Conclusion The findings of this study suggest that DAA can offer benefits but there is a learning curve. Complications were initially high but began decreasing after approximately 80 cases. Careful selection of patients is critical, particularly in the effort to minimize being presented with a challenging case. This study provides insights that may be helpful to surgeons when considering DAA; however, further study is warranted.

Purpose: The direct anterior approach (DAA) for conducting total hip arthroplasty (THA) is gaining popularity worldwide. However, careful selection of patients and surgeon experience are important. Although promising outcomes have been reported in international studies, research on DAA in Southern and Southeast Asia has been limited. Materials and Methods: This prospective study included 157 patients who underwent THA using the DAA between January 2019 and June 2022. The patients were divided into three groups for the comparison. Data on preoperative, intraoperative, and postoperative variables were acquired. Improvement of the surgeon’s performance to use of a DAA approach was examined using the CUSUM (cumulative summation method). Results: The mean age of the patients was 43.9 years. Differences in intraoperative variables and complications were observed among the three groups, and improved outcomes were reported in later cases. Functional outcomes showed significant improvement, and no differences were observed between groups. The results of learning curve analysis indicated a shift towards consistent success after the 82nd case, reaching an acceptable rate of failure by the 118th case. Conclusion The findings of this study suggest that DAA can offer benefits but there is a learning curve. Complications were initially high but began decreasing after approximately 80 cases. Careful selection of patients is critical, particularly in the effort to minimize being presented with a challenging case. This study provides insights that may be helpful to surgeons when considering DAA; however, further study is warranted.

Purpose: The direct anterior approach (DAA) for conducting total hip arthroplasty (THA) is gaining popularity worldwide. However, careful selection of patients and surgeon experience are important. Although promising outcomes have been reported in international studies, research on DAA in Southern and Southeast Asia has been limited. Materials and Methods: This prospective study included 157 patients who underwent THA using the DAA between January 2019 and June 2022. The patients were divided into three groups for the comparison. Data on preoperative, intraoperative, and postoperative variables were acquired. Improvement of the surgeon’s performance to use of a DAA approach was examined using the CUSUM (cumulative summation method). Results: The mean age of the patients was 43.9 years. Differences in intraoperative variables and complications were observed among the three groups, and improved outcomes were reported in later cases. Functional outcomes showed significant improvement, and no differences were observed between groups. The results of learning curve analysis indicated a shift towards consistent success after the 82nd case, reaching an acceptable rate of failure by the 118th case. Conclusion The findings of this study suggest that DAA can offer benefits but there is a learning curve. Complications were initially high but began decreasing after approximately 80 cases. Careful selection of patients is critical, particularly in the effort to minimize being presented with a challenging case. This study provides insights that may be helpful to surgeons when considering DAA; however, further study is warranted.

Purpose: The direct anterior approach (DAA) for conducting total hip arthroplasty (THA) is gaining popularity worldwide. However, careful selection of patients and surgeon experience are important. Although promising outcomes have been reported in international studies, research on DAA in Southern and Southeast Asia has been limited. Materials and Methods: This prospective study included 157 patients who underwent THA using the DAA between January 2019 and June 2022. The patients were divided into three groups for the comparison. Data on preoperative, intraoperative, and postoperative variables were acquired. Improvement of the surgeon’s performance to use of a DAA approach was examined using the CUSUM (cumulative summation method). Results: The mean age of the patients was 43.9 years. Differences in intraoperative variables and complications were observed among the three groups, and improved outcomes were reported in later cases. Functional outcomes showed significant improvement, and no differences were observed between groups. The results of learning curve analysis indicated a shift towards consistent success after the 82nd case, reaching an acceptable rate of failure by the 118th case. Conclusion The findings of this study suggest that DAA can offer benefits but there is a learning curve. Complications were initially high but began decreasing after approximately 80 cases. Careful selection of patients is critical, particularly in the effort to minimize being presented with a challenging case. This study provides insights that may be helpful to surgeons when considering DAA; however, further study is warranted.