Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty.

Purpose: The surgical stress of total knee arthroplasty (TKA) procedure and the application of intra-operative pneumatic thigh tourniquet increases local fibrinolytic activity, which contributes significantly to post-operative blood loss. Tranexamic acid, an antifibrinolytic drug, is commonly used to control post-operative blood loss. The recommended mode of administration of tranexamic acid is either oral or intravenous.

Treatment of Osteoporosis with Antiresoptive agent, Alendronate - warrants careful follow-up.

Introduction: Alendronate is the most popular bisphosphonate used to prevent fragility fracture of postmenopausal osteoporosis. There is common belief among physicians that Alendronates are very safe without many side effects and they continue it for long time. Recent papers have shown that, some patients who are on this drug from a long period suffered a rare type of fracture.

Unusual presentation of altered bone metabolism with long-term antiepileptic therapy: pathological fracture of neck of femur due to brown tumor at calcer.

The antiepileptic drugs are known to alter the bone metabolism and result in various range of pathological conditions (osteoporosis, osteomalacia, vitamin D deficiency, secondary hyperparathyroidism). These clinical conditions developed either due to direct effect of these therapeutic agents on bone or due to alteration in the homeostasis of other regulators of bone metabolism like serum calcium, vitamin D, and parathyroid hormone. Long-term therapy with antiepileptic agents results in higher incidence of pathological fracture, which is a consequence of either osteoporotic or osteomalasic (secondary to vitamin D deficiency) changes in bone produced by these drugs.

Immunohistochemical analysis of ageing and osteoarthritic articular cartilage.

Articular cartilage degeneration seen in osteoarthritis is primarily the consequence of events within the articular cartilage that leads to the production of proteases by chondrocytes. 22 osteoarthritic cartilage specimens were obtained from patients with primary osteoarthritis (46-81 years) undergoing total knee replacement. 12 age-matched (41-86 years) and 16 young (16-40 years) non-osteoarthritic control cartilage specimens were obtained from the cadavers in the department of Anatomy and from patients undergoing lower limb amputation in Trauma center of PGIMER, Chandigarh.

Tramadol added to bupivacaine does not prolong analgesia of continuous psoas compartment block.

The primary aim of our study was to evaluate the quality and duration of analgesia when tramadol was added to 0.25% bupivacaine for continuous psoas compartment block (CPCB) using visual analog pain scores. Thirty patients were prospectively randomized into two equal groups (n = 15).

Combined continuous "3-in-1" and sciatic nerve blocks provide improved postoperative analgesia with no correlation to catheter tip location after unilateral total knee arthroplasty.

This study assessed the efficacy and duration of postoperative analgesia after continuous sciatic nerve block with and without continuous "3-in-1" block with bupivacaine after unilateral total knee arthroplasty and determined catheter tip correlation with analgesia. Thirty patients were randomized into 2 groups. Results suggested significantly reduced pain and rescue analgesic requirement in combined sciatic and 3-in-1 (group TS) compared to 3-in-1 group alone (group T).

High resolution sonography for analysis of meniscal injuries.

High resolution ultrasonography was done prospectively in 51 adult patients with clinically suspected meniscal injuries to evaluate the sensitivity and specificity of ultrasonography as a primary diagnostic tool and to see if it was possible to evaluate the site, extent and size of the tear. All cases were confirmed arthroscopically; ultrasonographic examination revealed inhomogenecity in 45 cases and this was accurate in 40 cases; in 3 cases ultrasonography gave a false positive result and in 2 cases the wrong meniscus was shown to be torn. The six cases with no findings on ultrasonography were proven to have no meniscal tear.

Osteoarthritic femoral articular cartilage of knee joint in man.

Osteoarthritis is the most common of the various articular disorders affecting man. The present study was conducted to observe the microstructure of osteoarthritic human femoral articular cartilage by light microscopy. Fifteen osteoarthritic cartilage specimens obtained from patients with primary osteoarthritis (52-80 years) undergoing total knee replacement were processed for paraffin sections.

The effect of local administration of phenytoin on fracture healing: an experimental study.

The antiepileptic drug phenytoin (Diphenylhydantoin) has been documented to have a beneficial effect on wound healing; its effect on fracture healing, however is still unclear. In an attempt to evaluate any potential benefits phenytoin may have on fracture healing, a prospective study was undertaken combining histology, histomorphometry and radiology, in which the effects of locally administered phenytoin were analysed. Twenty-four Wistar strain rats of 8-9 months age were assigned into two groups of 12 each (matched for age, sex and weight).

Hybrid external fixation in periarticular tibial fractures. Good final outcome in 56 patients.

Out of 65 patients with periarticular fractures of the tibia treated by use of hybrid external fixation (a combination of indigenously manufactured version of ring and AO tubular fixator) from February 1997 to October 2003, 56 cases were taken up for this study with a minimum follow-up of 12 months. The injury was due to a high-velocity motor vehicle accident in 49 and a fall in 7 patients. Thirty five were tibial plateau fractures and 21 were distal tibial plafond fractures.

The uncemented isoelastic/isotitan total hip arthroplasty. A 10-15 years follow-up with bone mineral density evaluation.

The present study analyses the long-term outcome of isoelastic hip prostheses and their influence on the extent of periprosthetic bone remodeling. Ninety-two patients (102 hips) with Isoelastic/Isotitan uncemented total hip arthroplasty were evaluated after an average of 13.4 years.

Bupivacaine/ketamine is superior to intra-articular ketamine analgesia following arthroscopic knee surgery.

Purpose: Centroneuraxial and parenteral administration of ketamine has been shown to produce analgesia. However, this analgesia is limited by adverse effects. The purpose of this study was to determine whether ketamine alone or in combination with bupivacaine provides superior pain relief after surgery in patients undergoing knee arthroscopy.

Extra articular arthroscopic release in post-traumatic stiff knees: a prospective study of endoscopic quadriceps and patellar release.

Knee stiffness due to mismanaged trauma is still common in underdeveloped countries. Many patients with distal femoral fractures, patellar injuries or other local trauma present with intra-articular and extra-articular adhesions between the quadriceps and anterior femur. Nineteen knees with post trauma stiffness due to combined intra- and extra- articular aetiology were taken up for arthroscopic aided release after failing an aggressive physiotherapy protocol.

The long term fate of the fibula when used as an intraosseous graft.

The long term fate of the fibula in an intra-osseous site is still a matter of debate. Since the procedure of free fibular grafting for neglected femoral neck fractures was routinely done at our institute, we were able to observe the serial changes in 37 cases with an average 8.9 years follow-up.

Evaluation of oxidative stress after fractures. A preliminary study.

In a preliminary attempt to see if oxidative stress occurs after major fractures, we evaluated two groups of patients sustaining a single fracture (Group A) and multiple fractures (Group B), and compared them with healthy controls (Group C). Indirect evaluation using plasma was done, as serial samples directly from bone could not be taken in humans. We measured plasma levels of malonyldialdehyde (MDA), which depicts the lipid peroxide content, and the unstable nitric Acid (indirectly through measuring reactive nitrogen intermediates and citrulline), serially over a four-week period.

Does harvesting the medial third of the patellar tendon cause lateral shift of the patella after ACL reconstruction?

Many centers do not use the medial third of the patellar tendon as a graft for ACL reconstruction due to the apprehension that there may be post harvest maltracking of the patella towards the lateral side. We undertook a prospective study to evaluate patellar alignment in 30 patients in whom ACL reconstruction was done using the medial third of the patellar tendon. Q-angle assessment was the rough clinical parameter, and the Merchant view, Laurin views, and CT scans were used for radiological assessment.

Bacterial load in tissues and its predictive value for infection in open fractures.

The role of quantitative bacteriology is considered controversial for the prediction of infection in open fractures. A study was done in 20 patients with open fractures. Post debridement pieces of skin, muscle and periosteal tissue were obtained for quantitative bacterial counts.

Tuberculosis of the foot and ankle.

Tuberculosis of the foot and ankle is an uncommon presentation of skeletal tuberculosis. The uncommon site, lack of awareness, and ability to mimic other disorders clinically and on radiographs, leads to diagnostic and therapeutic delays. In the early stages and when the disease is limited to bone, medical treatment leads to excellent healing and limited residual disabilities.