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   Table of Contents - Current issue
July-September 2019
Volume 4 | Issue 3
Page Nos. 43-56

Online since Monday, September 9, 2019

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Incidence and risk factors for development of postoperative heterotopic ossification in a high-volume hip arthroscopy practice: A case series p. 43
Thomas Duncan Smith, Anjaneyulu Purnachandra Tejaswi Ravipati, Ivan H Wong
Background and objective: Heterotopic ossification (HO) is a known complication of hip arthroscopy and may significantly affect the outcomes of patients undergoing hip arthroscopy. Its incidence in the literature varies from 0–44% following hip arthroscopy without prophylaxis. Our primary goal was to find the local rate of HO after hip arthroscopy as determined by the Brooker Classification. Secondary outcomes included determining risk factors for development of HO by sex, age, body mass index, hip pathology and effects on outcome scores. Subjects and methods: Patients who underwent hip arthroscopy by a local high-volume surgeon from July 2012 to June 2015 were reviewed for the presence of pre- and postoperative HO retrospectively. Patients required at least 12 months of postoperative radiographic follow-up with anteroposterior pelvis radiographs. Patients were excluded if they had any other procedure performed at the time of hip arthroscopy or if medical records were not accessible. Radiographs were reviewed for HO according to the Brooker Classification. Demographic data including sex, age, body mass index, presence of labral tear and repair and outcome score were obtained. The incidence of HO and demographic averages were calculated and compared. This study received approval from the Nova Scotia Health Authority (NSHA) Research Ethics Board (REB) (approval No. 1021503) on August 8, 2016. Results: A total of 307 hips met inclusion criteria, 152 females and 155 males. The overall incidence of HO was 23.45% (72 hips). Fifty-six hips (78%) had Brooker class I HO, 13 (18%) hips had Brooker class II HO, and 3 (4%) hips had Brooker class III HO. No specific demographic variables or the pathology were seen to be associated significantly with development of HO. Outcome score differences were not significantly different between the HO and non-HO groups (P = 0.94). Conclusion: The incidence of HO in our series matched the range found in other studies of HO incidence in the literature. The incidence of HO dose not appear to be influenced by demographic variables including sex, age, and body mass index in our study. This data will add to the developing base of literature on HO incidence in hip arthroscopy and will serve as a comparison and benchmark for future study on HO prophylaxis.
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Influence of different inclination angles on middle deltoid muscle activity in stroke patients with shoulder subluxation: protocol for a cross-sectional study p. 47
Navjyoti Gupta, Subhasish Chatterjee
Background and objective: Glenohumeral subluxation is a common complication that is a palpable gap between the acromion and humeral head and causes mechanical integrity change in the joint. Electromyography is a method used to assess and capture skeletal muscle electrical activity and assess the strength of muscle that controls motor neurons. The objective of this study is to investigate whether different inclination angles influence middle deltoid muscle activity in patients with glenohumeral subluxation. Subjects and methods: It is a cross-sectional study in which 30 stroke patients with shoulder subluxation were included. Recruitment started from September, 2018. The study was completed in July 2019. Uncooperative patients or those who develop reflex sympathetic dystrophy or have psychological problems were excluded from this study. Purposeful sampling was used to collect samples. Glenohumeral subluxation will be assessed. Electromyography surface electrodes will be used to capture the middle deltoid muscle activity. The study is conducted in the Neurophysiology Unit of Neurophysiotherapy Research Lab of the Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation (India). Ethical approval was obtained from Institutional Ethical Committee (IEC) of Maharishi Markandeshwar University (IEC/MMU 2018/1114) on March 24, 2018. Outcome measures: Primary outcome measure is electromyography motor unit action potential parameter. Secondary outcome measures are amplitude, duration, and rise time. Discussion: Results from this study will provide evidence whether patient exercise performance without changing patient position but only adjusting bed/couch angles can improve the motor function of stroke patients. The study findings may help therapists and patients to prescribe exercise in what particular degree to get good results from the therapy. Trial registration: The study was registered with Clinical Trials Registry-India on September 17, 2018 (registration No. CTRI/2018/09/015732).
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Atypical subtrochanteric femur fracture following bisphosphonates: A grey area of diagnosis and management p. 50
Prakash Mahadevappa, Supreeth Nekkanti, Punith Nanjesh, Alok Moogali, Sachin Patel
Background and objective: Osteoporosis is a common orthopaedic problem of the geriatric population. Bisphosphonates have been effectively used to control osteoporosis and improve the bone strength. Bisphosphonates has particularly been used in glucocorticoid induced osteoporosis. However, there are emerging concerns over the risk of atypical femoral pathological fractures consequent to prolonged use of BPN therapy. This study was designed to report the diagnosis and treatment of atypical subtrochanteric femur fractures after bisphosphonate treatment. Subject and methods: We report a rare case of atypical femur fracture in a 70-year-old female patient who has been taking bisphosphonates for glucocorticoid-induced osteoporosis for 5 years. She suffered a subtrochanteric fracture after tripping on the doorstep. The fracture was fixed using a titanium proximal femur nail. The patient was followed up by X-ray examination 1 year after operation. This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Jagadguru Sri Shivarathreeshwara Hospital, India. Written informed consent was obtained from the patient. Results: The postoperative period was uneventful, and the patient recovered well. The patient was independently ambulatory with good function of her left hip. Conclusion: Atypical femoral fractures are defined clearly by the American Society of Bone and Mineral Research (ASBMR) criteria. Many reports in the literature have reported atypical femoral fractures after bisphosphonates therapy but do not meet the ASBMR criteria. The risk ratio of atypical femoral fractures after bisphosphonates use is high. Regular monitoring and screening of patients on bisphosphonates therapy by radiographs allow us to diagnose these fractures early and treat them successfully.
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Is arthroscopic surgery adequate to treat pigmented villonodular synovitis of the knee joint? p. 53
Vijay Chandru, Supreeth Nekkanti, R Madhukesh, Sumit Sudan, M Rishikesh
Background and objective: Pigmented villonodular synovitis (PVNS) is characterized by inflammation and deposition of hemosiderin in the synovium. There is no clear consensus on the exact treatment protocol of PVNS. This study aimed to understand the effectiveness of arthroscopic surgery for PVNS of the knee joint. Subject and methods: We reported a case of 21-year-old male who presented with a progressive painful diffuse swelling of the knee joint. Radiographic imaging revealed PVNS of the knee which was confirmed by arthroscopy. The patient underwent radiotherapy after arthroscopic surgery for 8 weeks. This study has been submitted after due approval from the institutional review board of Jagadguru Sri Shivarathreeshwara Hospital, India. Results: Patient was followed up for 1 year with no evidence of recurrence. Conclusion: Arthroscopy coupled with postoperative radiotherapy is useful in inhibiting PVNS and preventing its recurrence.
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