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Kulshrestha Vikas,Sood Munish,Kanade Sarang,Kumar Santhosh,Datta Barun,Mittal Gaurav 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.2
Background: The indications for total knee arthroplasty (TKA) have been expanded to include younger, demanding patients. Some TKA patients expect a return to high-performance activities to restore optimum quality of life. The concept of the medial pivot (MP) TKA is that more natural knee kinematics can be achieved by altering the bearing design. In the present study, we compared the early outcomes of MP TKA with posterior-stabilized (PS) TKA in terms of patient-reported outcomes, function, and performance. Methods: This randomized study was performed in a high volume joint replacement facility of a tertiary care military hospital. We enrolled 40 patients each in the MP group and PS group and assessed knee flexion, patient-reported outcome (new Knee Society Score [new KSS]), patient performance (Delaware Osteoarthritis Profile Score [DOPS]), and function (Forgotten Joint Score [FJS]) at 2 years after surgery. Results: Compared to PS group patients, MP group patients had similar patient-reported outcomes assessed by new KSS (satisfaction, expectation, and activity scales) and FJS. MP knee patients had better performance in the timed up and go test (p < 0.026) and self-paced walk test (p < 0.002) of DOPS. The gain in knee flexion (9.3° ± 14°) compared to baseline was significantly greater in the PS group (p < 0.013). Conclusions: When assessed by DOPS, getting up from chair and walking speed were significantly better in MP knee patients than in PS knee patients. However, considering the predictable rollback ensured by cam and post, the PS knee produced better knee flexion. Despite these results, patients were equally satisfied with the two designs.
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Early Outcomes of Dual-Pivot Total Knee Replacement Compared to an Ultracongruent Design
Vikas Kulshrestha,Munish Sood,Santhosh Kumar,Pardeep Kumar,Abin Stanley,Prashanth P Padhi 대한정형외과학회 2022 Clinics in Orthopedic Surgery Vol.14 No.4
Background: With a quest to optimize outcomes, there have been significant advancements in modern designs of total knee implants, attempting to mimic the natural knee motion and feel. One such new design reproducing the medial and lateral knee pivot is a dual-pivot (DP) knee. In the present study, we endeavored to compare the performance of the DP knee vis-a-vis an ultracongruent (UC) Knee design. Methods: This prospective cohort study was performed in a joint replacement center of a tertiary care military hospital. We enrolled 50 patients each in the DP knee group and the UC knee group and assessed knee flexion, patient-reported outcome (new Knee Society Score [nKSS]), patient performance (Delaware Osteoarthritis Profile Score), and function (Forgotten Joint Score [FJS]) at 2 years of follow-up. Results: The nKSS was similar in the two groups. In the DP group, patients had significantly better improvement in the stair climb test (p = 0.026). In the UC group, timed up and go test was significantly better (p = 0.004). The gain in knee flexion was similar in the two groups: 26.3° ± 23.3° in the DP group and 27.5° ± 27.5° in the UC group (p = 0.930). Return to activity as judged by 2-year FJS was similar in both groups (p = 0.687). Conclusions: Our study showed that the DP knee design had similar knee function to the UC knee. The DP knee design had significantly better stair climbing ability, whereas getting up from chair was better in the UC knee design. With comparable patientreported outcome and possible differences in patient performance in terms of day-to-day activities, any future trial should focus on comparing patient performance.
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Vikas Kulshrestha,Munish Sood,Santhosh Kumar,Pardeep Kumar,Abin Stanley,Prashanth P Padhi,Saurabh Sharma 대한정형외과학회 2023 Clinics in Orthopedic Surgery Vol.15 No.1
Background: One of the symptoms annoying patients after total knee replacement (TKR) is numbness around the operative scar. Some studies have shown that altering the incision in terms of placement or length may decrease the incidence of numbness. It still remains unknown whether numbness affects patient-reported outcomes. Methods: We conducted a randomized study to compare a short-length incision (n = 50) and a lateral exit incision (n = 50) with a standard midline TKR incision (n = 50) in terms of the incidence of numbness and its progress over 1 year of follow-up. Our secondary objective was to look at the involved zone, area of numbness, and secondary symptoms. We also looked at patient-reported outcome in terms of satisfaction in all groups using a visual analog scale and Forgotten Joint Score. Results: At 3 months postoperatively, the incidence of numbness was least in the lateral exit group: 46.2% as compared to midline (62%) and short (58.3%), but the difference was not significant (p = 0.07). At 6 months, the short incision group had a significantly lower incidence (8%) of residual numbness as compared to 30% in the other two groups (p = 0.003). At 1 year, most patients recovered sensation loss and had similar function. Conclusions: Placement or length of an incision did not significantly affect the incidence of numbness; however, the short incision led to early recovery of numbness. At 1 year of follow-up, most patients did not complain of loss of sensation and had similar functional outcome.
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Vikas Kulshrestha,Munish Sood,Santhosh Kumar,Pramila Sharma,Yash Kumar Yadav 대한정형외과학회 2019 Clinics in Orthopedic Surgery Vol.11 No.4
Background: Hip fractures are a significant cause of morbidity and mortality in the elderly. Fast-track multidisciplinary co-management of these patients, rapid preoperative optimization, early surgery, and expeditious rehabilitation may minimize morbidity and mortality. In this study, we evaluated outcomes of fixation of hip fractures in the elderly patients managed by Geriatric Hip Fracture Program at a military hospital in India. Methods: A total of 114 patients above 60 years of age with hip fractures were enrolled. They were comanaged by a team of specialists and fast-tracked to surgery. Independent ambulation with support of a walker was achieved before discharge to home. Patients were followed up for 1 year. Results: The average age of the 114 patients was 77 years; 24 patients were octogenarian. Eighty-four percent of injuries were due to a domestic fall. Hypertension (41%) and diabetes (22%) were the most common comorbidities. All patients were optimized before surgery. The average delay from injury to admission was 1.7 days (range, 0 to 14 days) and that from admission to surgery was 1.8 days (range, 0 to 19 days). Hence, the average time from injury to surgery was 3.5 days. The length of stay in hospital was, as per rehabilitative milestones achieved, 2 to 5 days in 40% of the patients and 6 to 15 days in 60% of the patients. At 1 year after surgery, 95 patients were independently ambulant (56 patients with support and 39 patients without support). Twenty-three percent of the patients had postoperative complications and eight patients died (7.7%) at 1-year follow-up; 11 patients were lost to follow-up. Conclusions: Elderly hip fracture has a high risk of mortality (14%–58%). Thus, expeditious surgery within 24 hours of admission has been advocated in the Western literature to minimize mortality. Mortality rate at 1 year after surgery remains at 10% to 24%. In our study, even with aggressive co-management, the average delay to hip fracture fixation was more than 3 days; however, the 1-year mortality was relatively low (7.7%). This indicates the importance of preoperative optimization and postoperative rehabilitation for independent ambulation and mortality reduction in the elderly population.
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Mechanisms involved in adenosine pharmacological preconditioning-induced cardioprotection
Singh, Lovedeep,Kulshrestha, Ritu,Singh, Nirmal,Jaggi, Amteshwar Singh The Korean Society of Pharmacology 2018 The Korean Journal of Physiology & Pharmacology Vol.22 No.3
Adenosine is a naturally occurring breakdown product of adenosine triphosphate and plays an important role in different physiological and pathological conditions. Adenosine also serves as an important trigger in ischemic and remote preconditioning and its release may impart cardioprotection. Exogenous administration of adenosine in the form of adenosine preconditioning may also protect heart from ischemia-reperfusion injury. Endogenous release of adenosine during ischemic/remote preconditioning or exogenous adenosine during pharmacological preconditioning activates adenosine receptors to activate plethora of mechanisms, which either independently or in association with one another may confer cardioprotection during ischemia-reperfusion injury. These mechanisms include activation of $K_{ATP}$ channels, an increase in the levels of antioxidant enzymes, functional interaction with opioid receptors; increase in nitric oxide production; decrease in inflammation; activation of transient receptor potential vanilloid (TRPV) channels; activation of kinases such as protein kinase B (Akt), protein kinase C, tyrosine kinase, mitogen activated protein (MAP) kinases such as ERK 1/2, p38 MAP kinases and MAP kinase kinase (MEK 1) MMP. The present review discusses the role and mechanisms involved in adenosine preconditioning-induced cardioprotection.
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Munish Sood,Vikas Kulshrestha,Julie Sachdeva,Amresh Ghai,Ajaydeep Sud,Shalendra Singh 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.4
In the article entitled “Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction,”1) the name of one of the authors was incorrectly presented: Shalender Singh should read Shalendra Singh.
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Munish Sood,Vikas Kulshrestha,Julie Sachdeva,Amresh Ghai,Ajaydeep Sud,Shalender Singh 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.3
Background: Anterior cruciate ligament reconstruction (ACLR) remains the gold standard treatment for anterior cruciate ligament (ACL) injury. However, a good functional outcome even after a successful surgery depends on multiple factors. It has been observed that certain patients with a chronic ACL injury demonstrate knee instability voluntarily. The authors observed that these patients might not perform well even after a successful surgery. This study aims to assess the outcome after ACL and other ligament reconstruction in patients with voluntary knee instability. Methods: From a total of 824 patients who underwent ACLR, 13 patients with a history of voluntary knee instability were selected, and data of these patients (demographic and clinical profile) were obtained. Outcomes of surgery in this group of patients were evaluated by using Lysholm score and Tegner activity level. Results: All patients were young men with a chronic ACL injury and manifested instability. Associated injuries were lateral meniscus tear in 3 patients, medial meniscus tear in 2, and posterolateral corner (PLC) injury in 3. ACLR was done using the semitendinosus- gracilis graft in all patients. Further, anterolateral ligament reconstruction was done in 2 patients and PLC reconstruction, in 3 patients. The mean Lysholm score was 54.76 (range, 48–62) preoperatively and 60.92 (range, 54–78) at a mean follow-up of 14.3 months (range, 11–26 months). The median Tegner activity level was 6 (range, 5–7) before injury and 4 (range, 3–5) at the final follow-up. Twelve of the 13 patients were able to demonstrate instability voluntarily at the time of the final follow-up. Conclusions: In patients with ACL and other ligament injuries who demonstrated voluntary knee instability, the functional outcome even after successful ligament reconstruction was poor.
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Venkatesh Sivaprakasam,Vartika Kulshrestha,Godlin Atlas Lawrence Livingston,Senthilnathan Arumugam 한국인터넷정보학회 2023 KSII Transactions on Internet and Information Syst Vol.17 No.7
The development of lightweight, low energy and small-sized sensors incorporated with the wireless networks has brought about a phenomenal growth of Wireless Sensor Networks (WSNs) in its different fields of applications. Moreover, the routing of data is crucial in a wide number of critical applications that includes ecosystem monitoring, military and disaster management. However, the time-delay, energy imbalance and minimized network lifetime are considered as the key problems faced during the process of data transmission. Furthermore, only when the functionality of cluster head selection is available in WSNs, it is possible to improve energy and network lifetime. Besides that, the task of cluster head selection is regarded as an NP-hard optimization problem that can be effectively modelled using hybrid metaheuristic approaches. Due to this reason, an Improved Coyote Optimization Algorithm-based Clustering Technique (ICOACT) is proposed for extending the lifetime for making efficient choices for cluster heads while maintaining a consistent balance between exploitation and exploration. The issue of premature convergence and its tendency of being trapped into the local optima in the Improved Coyote Optimization Algorithm (ICOA) through the selection of center solution is used for replacing the best solution in the search space during the clustering functionality. The simulation results of the proposed ICOACT confirmed its efficiency by increasing the number of alive nodes, the total number of clusters formed with the least amount of end-to-end delay and mean packet loss rate.
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Mechanisms involved in adenosine pharmacological preconditioning-induced cardioprotection
Lovedeep Singh,Ritu Kulshrestha,Nirmal Singh,Amteshwar Singh Jaggi 대한약리학회 2018 The Korean Journal of Physiology & Pharmacology Vol.22 No.3
Adenosine is a naturally occurring breakdown product of adenosine triphosphate and plays an important role in different physiological and pathological conditions. Adenosine also serves as an important trigger in ischemic and remote preconditioning and its release may impart cardioprotection. Exogenous administration of adenosine in the form of adenosine preconditioning may also protect heart from ischemia-reperfusion injury. Endogenous release of adenosine during ischemic/remote preconditioning or exogenous adenosine during pharmacological preconditioning activates adenosine receptors to activate plethora of mechanisms, which either independently or in association with one another may confer cardioprotection during ischemia-reperfusion injury. These mechanisms include activation of KATP channels, an increase in the levels of antioxidant enzymes, functional interaction with opioid receptors; increase in nitric oxide production; decrease in inflammation; activation of transient receptor potential vanilloid (TRPV) channels; activation of kinases such as protein kinase B (Akt), protein kinase C, tyrosine kinase, mitogen activated protein (MAP) kinases such as ERK 1/2, p38 MAP kinases and MAP kinase kinase (MEK 1) MMP. The present review discusses the role and mechanisms involved in adenosine preconditioning-induced cardioprotection.
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