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Incidence of periprosthetic fractures around knee is going to rise in near future due to dramatic increase in total knee arthroplasty (TKA). Our study is a retrospective case series describing the outcome of osteosynthesis for periprosthetic fractures after TKA. We analyzed the outcome of osteosynthesis for periprosthetic fractures with stable implants in 43 patients having 45 fractures operated between 2010 and 2015. Out of 43 patients, the majority were female (M-15, F-28) with mean age of 65.95 years, majority had left knee involved (L-24, R-19), with fractures involving femur, tibia and patella, respectively, in 29, 11 and 5 patients. Fracture pattern was Rorabeck type 2 in 29, Felix type 2 in 6, type 3 in 5, Goldberg type 2 in 3, type 3a in 2, Unified classification system type A in 2, B1 in 35, C in 4, E in 2 cases. Anterior femoral cortex notching was found in 13 patients with femoral fractures. According to Tayside classification, 12 patients had type 1 and one had type 2 notching. Different implants were used according to the need of the fractures. After TKA, the mean Hospital for Special Surgery score was 84.2, which reduced to mean 76 at 9 months following osteosynthesis. Three patients had nonunion, one had delayed union and one had implant failure. Osteosynthesis for periprosthetic fractures around knee with locked compression plate gives promising results. Fractures involving patella are associated with inferior functional outcome. Understanding the fracture pattern and bone stock available for fixation with correct choice of implant and correct surgical technique gives promising outcome in periprosthetic fractures around knee.

Intraneural ganglion cysts of the peroneal nerve are rare, and there is lack of evidence for the surgical management of this entity. We performed this study to evaluate the imaging, diagnosis, treatment and outcome of seven patients with intraneural ganglion cysts of the peroneal nerve. We retrospectively studied the files of seven patients with intraneural ganglion cysts of the peroneal nerve, diagnosed and treated from 2016 to 2019. Diagnostic approach included clinical examination of the leg and foot, magnetic resonance imaging, nerve conduction studies, surgical excision of the cyst and histological examination. The mean follow-up was 2 years (range 1–3.5 years). We evaluated the time and methods for surgical treatment, and the clinical outcomes of the patients. All patients presented symptoms of peripheral compression neuropathy; three patients presented with foot drop. The intraneural ganglion cysts were excised in all cases in addition to knee articular nerve branch transection to avoid cysts recurrence. Postoperatively, all patients experienced complete neurological recovery without clinical evidence of intraneural ganglion cysts recurrences. The treating physicians should be aware of intraneural ganglion cysts of the peroneal nerve in patients presenting with limb weakness, sensory deficits at the lateral and anterior side of the leg and foot, paresis or paralysis of the foot and ankle. MR imaging is the imaging modality of choice for a clear and accurate preoperative diagnosis to avoid misdiagnosis and wrong treatment. In case of doubt, these patients should be managed in an orthopedic oncology setting with microsurgery facilities available for complete excision of the intraneural ganglion cyst.

The purpose of the current study was to retrospectively evaluate the long-term outcome of our shelf operation for acetabular dysplasia in adults and adolescents. We evaluated the outcome of shelf operation performed in 35 hips of 32 patients with acetabular dysplasia between 1978 and 1996. The mean age at the time of surgery was 30.6 years, and the mean follow-up period was 25.9 years. The pre-operative stage of osteoarthritis was Tönnis grade 0 in 12 hips and grade 1 in 23 hips. Clinical evaluation using the JOA hip score showed more than 85 of 100 points over 25 years. Radiologically, acetabular index was significantly improved after operation. Osteoarthritis deteriorated to grade 3 in 8 of 35 hips (23%) at an average 17.1 years, and accordingly 3 of those 8 hips were converted to THA. The shelf height was significantly higher in those which advanced to grade 3 than in those which did not. There were no significant differences in mean sharp angle, CE angle, AHI, and roundness index. Mean survival was 74% with grade 3 as the endpoint and 72% with THA conversion as the endpoint. Shelf operation provides satisfactory long-term outcome in adults and adolescents with acetabular dysplasia. Higher location of the shelf is a risk factor for advancement of osteoarthritis, whereas sphericity of the femoral head does not affect the long-term results. Further studies are needed to clarify the risk factors about OA progression among the patients with acetabular dysplasia, like as the assessment of three-dimensional morphology of hip joints.

Clinical outcomes of total hip arthroplasty (THA) to treat rapidly destructive coxarthrosis (RDC) have been reported, but to our knowledge, there have been no studies comparing implants. The aim of this study was to examine the effectiveness of acetabular reconstruction for RDC by comparing the clinical results of THA using a Kerboull-type plate with an uncemented cup. Among 921 primary THAs performed between 2006 and 2014, 27 were performed for the treatment for RDC using a Kerboull-type plate or a conventional uncemented cup. A Kerboull-type plate for acetabular reinforcement device was used in 13 hips and an uncemented cup in 14 hips. The mean follow-up period was 61.2 months. The duration of surgery was 156.8 ± 36.4 min in the Kerboull-type plate group and 103.3 ± 14.4 min in the uncemented cup group, being significantly longer in the former (P = 0.0002). In the Kerboull-type plate group and the uncemented cup group, the 5-year survival rates were 100 and 83.9 %, respectively. Recurrent dislocation was observed in two cases in which the posterior approach had been used. In our study, the loosening of the acetabular components was noted in 14.3 % of uncemented cup-applied cases, but no loosening was noted in any Kerboull-type plate-applied case. Therefore, for RDC, in which objective evaluation of fragile bone quality is difficult, the use of the Kerboull-type plate, which disperses weight-bearing of the acetabular, may be an effective means to achieve early functional recovery as well as a long-term favorable outcome.

Treatment for lumbar disc herniation after failed conservative treatment is discectomy. Discectomy can significantly relieve back pain as well as radicular symptoms. However, many patients with lumbar discectomy experience moderate-to-severe back pain and radicular leg pain. The results of application of epidural steroids (ES) for pain management after lumbar discectomy have previously been inconclusive. We have conducted a systematic review and meta-analysis aims to compare outcomes (efficacy and complications) of epidural steroid application and placebo after discectomy in lumbar disc herniation. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies that reported visual analog scale of back and leg pain, morphine consumption, hospital stay and post-operative complications of either group were identified from Medline and Scopus from the date of inception to 28 October 2017. A total of 12 studies were pooled and analysed, with nine studies having undergone conventional discectomy and three studies having undergone minimally invasive surgery (MIS) discectomy. Overall, there were 1006 patients (502 in the ES group and 504 in the placebo group) included. The unstandardized mean difference of VAS of back pain at 1 week and 1 month, leg pain at 1 week and 1 month, morphine consumption and hospital stay was − 0.53 (95% CI − 1.42, 0.36) score, − 0.89 (95% CI − 1.36, − 0.42) score, − 0.63 (95% CI − 0.75, − 0.50) score, − 0.47 (95% CI − 0.78, − 0.15) score, − 8.47 (95% CI − 16.16, − 0.78) mg and − 0.89 (95% CI − 1.49, − 0.30) days lower when compared to placebo after lumbar discectomy in patients with lumbar disc herniation. A total of ten studies compared the ratio of complication between the ES and placebo groups. No significant differences were noted for complications within the two groups (0.92; 95% CI 0.47, 1.83). This meta-analysis analysed lower back and leg pain, morphine consumption and hospital stay, with no significant difference in complications for ES application after lumbar discectomy in lumbar disc herniation. In terms of surgical approaches with MIS compared to conventional approach, this review demonstrates that ES can reduce post-operative morphine consumption when the surgical approach is conventional, but not for MIS. Level of evidence I.

Osteoid osteomas in the spine constitute a challenging group for both surgical and percutaneous approaches. Purpose of the present study is to report a case report of a spinal osteoid osteoma in a challenging spinal location and review literature for safety and efficacy of the technique. We report a case of spinal osteoid osteoma extending in the epidural space and abutting the dura in a pediatric patient treated by percutaneous computed tomography-guided radiofrequency ablation. This is not a systematic review of the literature. A number of separate literature searches were performed. Non-English studies and case reports were excluded from the study. All references of the obtained articles were also evaluated for any additional information. Although all prophylactic measures were taken (hydrodissection, thermocouples and neurophysiologic monitoring) and the procedure was uneventful, patient within three hours, was unable to raise or bend the unilateral lower extremity below the knee. Pain reduction was significant from the first morning post-ablation and during the follow-up period of 18 months. MR scan was within normal limits. Dexamethasone was iv injected for 24 h and prescribed per os for 7 days. At follow-up 1 week later mobility of the lower extremity had returned to normal. As far as spine ablation is concerned, all prophylactic measures should be taken; neurophysiologic monitoring seems to be more sensitive than temperature measurement. Intravenous and per os corticosteroids are extremely useful in case of nerve damage.

To compare the effect of intravenous or intra-articular route of administration of tranexamic acid in reducing the blood loss in simultaneous bilateral total knee replacement surgeries performed without the use of tourniquets. Prospective cohort study of 30 consecutive patients grouped into two groups; Group 1: intravenous group and group 2: intra-articular group. Two outcome measures were studied; mean drop in post-operative haemoglobin and need for blood transfusion in both groups. No significant difference in mean drop of haemoglobin and need for blood transfusion in both groups. Route of administration of tranexamic acid does not influence on the mean drop of haemoglobin and need for blood transfusion in simultaneous bilateral total knee replacement surgeries performed without the use of tourniquet.