Significant Incidence of Extra-Articular Tibia Vara Affects Radiological Outcome of Total Knee Arthroplasty

( Balaji Saibaba ),( Mandeep S Dhillon ),( Devendra K Chouhan ),( Rajendra K Kanojia ),( Mahesh Prakash ),( Vikas Bachhal ) 대한슬관절학회 2015 대한슬관절학회지 Vol.27 No.3

Purpose: To identify and quantify the presence of extra-articular tibia vara that might influence the mechanical axis alignment after total knee arthroplasty (TKA). Materials and Methods: A total of 48 TKAs in 30 osteoarthritic Indian patients were prospectively evaluated. The hip-knee-ankle angle (HKA), joint line convergence angle, and varus angulation at the femur and tibia were measured from the preoperative and postoperative standing hip-to-ankle radiographs. Four different methods were used to measure the varus angulation at the tibia: metaphyseo-diaphyseal angle (MDA), the angle between the anatomical axis and mechanical axis of the tibia, the angle between the proximal third and distal third of tibia and the angle between the proximal half and distal half of tibia. Results: Extra-articular tibia vara quantified using MDA had the most positive correlation with HKA. Receiver operating characteristic plotting showed that MDA of >4o predicts abnormal postoperative HKA. Twenty-eight out of 48 knees had MDA of >4o, and 78.6% of these had postoperative HKA under-correction and 21.4% had less than ideal tibial component position. Conclusions: A significant inherent extra-articular varus angulation best measured using MDA exists in the proximal tibia in osteoarthritic Indian patients undergoing TKA. MDA of >4o is associated with abnormal postoperative HKA. Computer navigation may be useful for achieving ideal correction in such cases.

Glomus Tumor of Hoffa’s Fat Pad and Its Management by Arthroscopic Excision

Sharad Prabhakar,Mandeep Singh Dhillon,Rakesh Kumar Vasishtha,Kamal Bali 대한정형외과학회 2013 Clinics in Orthopedic Surgery Vol.5 No.4

We present a rare case of glomus tumor of Hoffa’s fat pad in a 42-year-old woman. Magnetic resonance imaging findings along with the characteristic clinical picture led us to suspect a glomus tumor as the possible etiology. An ischemia test was found to be positive and this further substantiated our diagnosis. An arthroscopic excision was performed and the histology confirmed the diagnosis of glomus tumor of Hoffa’s fat pad. The patient responded well to the excision with immediate complete resolution of pain and she remains asymptomatic at the last follow-up after 15 months. To our knowledge, this is the second reported case of glomus tumor of Hoffa’s fat pad and the first ever to be managed by simple arthroscopic excision. The tumor poses a great challenge to an orthopedic surgeon. However, knowledge of its characteristic clinical presentation and the recognition of such a rare entity can help achieve an early diagnosis and timely management.

Proposed Methods for Real-Time Measurement of Posterior Condylar Angle during TKA

( Prateek Behera ),( Devendra Kumar Chouhan ),( Mahesh Prakash ),( Mandeep Dhillon ) 대한슬관절학회 2014 대한슬관절학회지 Vol.26 No.4

purpose: Conventional instruments are known to result in high numbers of outliers in restoring femoral component rotation primarily due to fixed degree of external rotation resection relative to the posterior condylar line (PCL). Outliers can be reduced by determining the patient specific posterior condylar angle (PCA) preoperatively or intraoperatively. There is a paucity of methods that can be used during surgery for determining the PCA. We propose two simple, real-time methods to determine the PCA and hence to measure the axial anatomical variation during surgery. materials and methods: The study was conducted using axial computed tomography (CT) scans of the knees of 26 patients. The commercial software K-PACS and our proposed two methods (trigonometric and protractor) were used to measure the angle between the transepicondylar axis and PCL, i.e., PCA. Statistical comparison between the mean angles obtained by K-PACS and our methods were done. results: The three methods resulted in similar PCAs. The mean PCA measured by the three methods were similar. The mean PCA value measured by the K-PACS, trigonometric method and protractor method was 6.27o (range, 0o to 12o), 6.23o (range, 0o to 11.11o) and 6.31o (range, 0o to 12o), respectively. There were significant correlations between the K-PACS measured PCA and trigonometrically or protractor measured PCA. conclusions: Our novel, simple, easily reproducible, real-time and radiation-free PCA measurement methods obviate the need for preoperative CT scan for identification of patient specific PCA.

Outcome of ACL Reconstruction for Chronic ACL Injury in Knees without the Posterior Horn of the Medial Meniscus: Comparison with ACL Reconstructed Knees with An Intact Medial Meniscus

( Kevin Syam ),( Devendra K. Chouhan ),( Mandeep Singh Dhillon ) 대한슬관절학회 2017 대한슬관절학회지 Vol.29 No.1

Purpose: Cadaveric studies have shown that deficiency of the posterior horn of the medial meniscus (PHMM) increases strain on the anterior cruciate ligament (ACL) graft. However, its influence on the clinical and radiological outcome after ACL reconstruction is less discussed and hence evaluated in this study. Materials and Methods: This study included 77 cases of ACL reconstruction with a minimum 18-month follow-up. Of the 77 cases, 41 patients with intact menisci were compared clinically and radiologically with 36 patients with an injury to the PHMM that required various grades of meniscectomy. The knees were evaluated using subjective International Knee Documentation Committee (IKDC) score and Orthopadische Arbeitsgruppe Knie (OAK) score. Results: Cases with intact menisci showed better stability (p=0.004) at an average of 44.51 months after surgery. No significant differences were noted in the overall OAK score, subjective IKDC score, and functional OAK score (p=0.082, p=0.526, and p=0.363, respectively). The incidence of radiological osteoarthrosis was significantly higher in the posterior horn deficient knees (p=0.022). Conclusions: The tendency toward relatively higher objective instability and increased incidence of osteoarthrosis in the group with absent posterior horn reinforces its importance as a secondary stabiliser of the knee.

India-Based Knee Osteoarthritis Evaluation (iKare): A Multi-Centre Cross-Sectional Study on the Management of Knee Pain and Early Osteoarthritis in India

Parag Sancheti,Vijay D. Shetty,Mandeep S. Dhillon,Sheila A. Sprague,Mohit Bhandari 대한정형외과학회 2017 Clinics in Orthopedic Surgery Vol.9 No.3

Background: Access to early knee osteoarthritis treatment in low and middle income nations is often believed to be limited. We conducted a cross-sectional study in India to assess prior access to treatment among patients presenting with knee pain to specialist orthopaedic clinics. Methods: The multi-centre, cross-sectional study included patients presenting with knee pain at 3 hospitals in India. Patients who met the inclusion criteria and provided informed consent completed a questionnaire designed to assess patient demographics, socioeconomic status, knee pain, treatment method, and patient’s knowledge on osteoarthritis (OA). Their orthopaedic surgeons also completed a questionnaire on the severity of patient’s OA and their recommended treatments. The impact of demographic characteristics on the prescription of treatment options was analyzed using logistic regression. Results: A total of 714 patients met the eligibility criteria and participated in this study. The majority of patients had been experiencing pain for less than 1 year (64.8%) and had previously been prescribed medications (91.6%), supplements (68.6%), and nonpharmacological (81.9%) treatments to manage their knee OA. Current treatment recommendations included oral medications (83.3%), intra-articular injections (29.8%), and surgical intervention (12.7%). Prescription of oral medications was related to younger age, lack of deformities, and lower Kellgren-Lawrence grades (p < 0.01). Patients treated in private hospital settings were more likely to have been previously treated with medications (range, 84.3% to 92.6%; p < 0.01) and physical treatments (range, 61.8% to 84.8%; p < 0.01) than patients treated at government hospitals. Conclusions: Contrary to the perception, our findings suggest a similar proportion of early knee OA treatment between India and North America.

Safety Profile, Feasibility and Early Clinical Outcome of Cotransplantation of Olfactory Mucosa and Bone Marrow Stem Cells in Chronic Spinal Cord Injury Patients

Vijay G Goni,Rajesh Chhabra,Ashok Gupta,Neelam Marwaha,Mandeep S Dhillon,Sudesh Pebam,Nirmal Raj Gopinathan,Shashidhar Bangalore Kantharajanna 대한척추외과학회 2014 Asian Spine Journal Vol.8 No.4

Study Design: Prospective case series. Purpose: To study the safety and feasibility of cotransplantation of bone marrow stem cells and autologous olfactory mucosa in chronic spinal cord injury. Overview of Literature: Stem cell therapies are a novel method in the attempt to restitute heavily damaged tissues. We discuss our experience with this modality in postspinal cord injury paraplegics. Methods: The study includes 9 dorsal spine injury patients with American Spinal Injury Association (ASIA) Impairment Scale (AIS) A neurological impairment who underwent de-tethering of the spinal cord followed by cotransplantation with bone marrow stem cells and an olfactory mucosal graft. Participants were evaluated at the baseline and at 6 monthly intervals. Safety and tolerability were evaluated through the monitoring for adverse events and magnetic resonance imaging evaluation. Efficacy assessment was done through neurological and functional outcome measures. Results: Surgery was tolerated well by all participants. No significant difference in the ASIA score was observed, although differences in the Functional Independence Measure and Modified Ashworth Scale were statistically significant. No significant complication was observed in any of our patients, except for neurogenic pain in one participant. The follow-up magnetic resonance imaging evaluation revealed an increase in the length of myelomalacia in seven participants. Conclusions: The cotransplantation of bone marrow stem cells and olfactory mucosa is a safe, feasible and viable procedure in AIS A participants with thoracic level injuries, as assessed at the 24-month follow-up. No efficacy could be demonstrated. For application, further large-scale multicenter studies are needed.

Utility of three-dimensional printing in the surgical management of intra-articular distal humerus fractures: a systematic review and meta-analysis of randomized controlled trials

Vishnu Baburaj,Sandeep Patel,Vishal Kumar,Siddhartha Sharma,Mandeep Singh Dhillon 대한견주관절의학회 2024 대한견주관절의학회지 Vol.27 No.1

Background: Clinical outcomes after fixation of distal humerus intraarticular fractures are directly related to the quality of reduction. The use of three-dimensional (3D)-printed fracture models can benefit preoperative planning to ensure good reduction. This review aims to determine if surgery performed with 3D printing assistance are faster and result in fewer complications and improved clinical outcomes than conventional methods. We also outline the benefits and drawbacks of this novel technique in surgical management of distal humerus fractures. Methods: A systematic literature search was carried out in various electronic databases. Search results were screened based on title and abstract. Data from eligible studies were extracted into spreadsheets. Meta-analysis was performed using appropriate computer software. Results: Three randomized controlled trials with 144 cases were included in the final analysis. The 3D-printed group had significantly shorter mean operating time (mean difference, 16.25 minutes; 95% confidence interval [CI], 12.74–19.76 minutes; P<0.001) and mean intraoperative blood loss (30.40 mL; 95% CI, 10.45–60.36 mL; P=0.005) compared with the conventional group. The 3D-printed group also tended to have fewer complications and a better likelihood of good or excellent outcomes as per the Mayo elbow performance score, but this did not reach statistical significance. Conclusions: Three-dimensional-printing-assisted surgery in distal humerus fractures has several benefits in reduced operating time and lower blood loss, indirectly decreasing other complications such as infection and anemia-related issues. Future good-quality studies are required to conclusively demonstrate the benefits of 3D printing in improving clinical outcomes.