Abstracts Of Papers At the 61st Research Meeting Of The Medical Research Centre Of Bombay Hospital On Monday 12th October 1998, 2.30 Pm In The Sp Jain Cafeteria (Convenor Hl Dhar)

UNICOMPARTMENTAL KNEE REPLACEMENT OR A TOTAL KNEE REPLACEMENT? THE 5 YEAR RESULTS OF A PROSPECTIVE RANDOMIZED TRIAL

Nilen Shah

Introduction : Surgical treatment of unicompartmental osteoarthritis of the knee in the elderly is variable. An HTO, UKR or a TKR may be offered to these patients. Previous published studies have shown that a UKR produces results better than an HTO at 5 to 10 years’ follow-up. The present study was organised to determine whether UKR or TKR is better in elderly patients with unicompartmental osteoarthritis.

Material and Methods : 100 patients (110 knees) were recruited for the study after ethical committee approval. All patients agreed to take part in the study. However, only 102 knees were actually suitable for a unicompartmental replacement according to our criteria and these were randomised, at arthrotomy, on table, to receive either a UKR or a TKR. Two well-matched groups were obtained with an average age of 69 years. The same surgical team carried out UKR or TKR according to the randomization. 50 knees received the UKR and 52 received the TKR. The knees had an identical post-operative regime and mobilization with the help of physiotherapists. The knees were evaluated in a standard fashion, clinically and radiographically, pre and post-operatively. The patients were followed up for a minimum period of 5 years.

Results : The UKR group had a lesser perioperative morbidity with early region of the range of movement of the knee. At 5 year review, the UKR and the TKR were equally effective in relieving pain. The failure rate between the two groups was also similar but the UKR group had fared better with significantly more excellent results (p < 0.05). The number of knees able to flex more than 120o was significantly higher in the UKR group (p < 0.001).

Discussion : In suitable knees, UKR gives results which are superior to a TKR. This superiority is maintained, at least, until 5 years provided an appropriate prosthesis has been used. The knees with the UKR feel more ‘normal’ due to the preservation of the cruciate ligaments and the normal contralateral compartment.

Conclusion : The use of UKR needs to be re-examined in the Indian setting as knees with UKR are able to flex more and have a ‘normal’ feel. This coupled with low costs and low morbidity make this procedure especially attractive.

SUCKER - A NECESSARY AID OR A NECESSARY EVIL?

Nilen A Shah

A study was organised to see whether the sucker tip that is used in orthopaedic operations (joint replacements) is contaminated by bacteriae at the end of the operation.

At the end of 86 operations the sucker nozzle of the disposable sucker were obtained by taking sterile precautions and were cultured. A similar 65 controls were set up and were also cultured. The types of organism grown and their colony count were recorded. The details of operative procedure, the operative duration and the surgeon’s name were also recorded.

All patients received perioperative antibiotics. The wounds were swabbed if there was oozing. The patients were reviewed at 6 months after the operation to determine if there was any deep infection.

There was no incidence of deep prosthetic infection during the time of follow-up. However, there was a high incidence of contamination of the sucker nozzle by bacteriae. Moreover, in the patients that had a significant wound ooze the organisms cultured from the wound were the same as the ones found on the nozzle at the end of the operation and are the same ones that are implicated most often in the literature for late loosening of the prostheses.

The need to reduce contamination in joint replacement surgery is obvious. Alternative practices to reduce the microbial contamination are suggested.

COMPLICATIONS EXPERIENCED IN AMBULATORY SURGERY

MM Begani

Ambulatory surgery is the demand of the day due to big population, expensive hospital treatment better patient acceptance and quick recovery. During last 20 years with the experience of over 11,000 operations we had noticed various complications which are comparable with hospitalized patients. Patients and relatives motivation, education, involvement of family doctors and social health workers near the patient’s residence place can take care of the minor complications. There was no mortality. A few precautions and warning to the patients about do’s and don’t can avoid or reduce major complications.

LOCAL ANAESTHESIA FOR ANAL SURGERIES : A REVIEW

MM Begani

From the past more than 20 years. We have been operating anal cases under local anaesthesia and sedation, using pudendal block with good results. Since the past 2 years we have started doing anal cases under local ring block in 540 patients with faster recovery and lesser complications.

ACID PEPTIC DISORDER AND H. PYLORI A SURGEON’S EXPERIENCE

MM Begani

Since the discovery of H. Pylori in 1983, there has been various discussions, conference and debates with equally varying treatment modalities, and this has been a physician’s preview, mostly but a large no of surgeons have been variously coming across this phenomenon of recurrent/resistant gastritis in their day to day practise. My own experience regarding this disease entity, I would like to share with you as a surgeon’s view point. Surgery is required for refractory, recurrent and complications of ulcer like haemorrhage, perforation, stenosis.

GASTRO INTESTINAL STROMAL TUMOUR

Jignesh B Jatania, MM Begani

Mr. Baga Vali Mohd aged 70 years male, presented with history of vomiting and black stools, generalised weakness and giddiness with occasional breathlessness since 6 months.

After examination and investigations we found his Hb to be 4-9 gm% and gastroscopy showed a large cricket ball sized mass, in lesser curvature which was vascular; biopsy revealed GIST (gastro intestinal stromal tumour). He was taken for DSA and lt Gastric artery was selectively embolised.

His other reports were within normal limits and after medical fitness patient was taken for surgery on 7-9-98 and under GA exploration showed a mass in the lesser curvature, intraluminal which was resected and histopathology showed GIST. Pt recovered well. He had to be given pre and post op. blood transfusions. Follow up has been satisfactory.

The details of the case would allow me to define the role of multispeciality in our hospital and practise.

MOBILIMB

Asha Andyal

Mobilimb is a machine which gives continuous passive movements i.e. CPM. Mobilimb therapy is started after the removal of the drainage tubes in post operative patients of hip and knee replacement surgery. Machine is attached with grading of degrees from 30 to 120 flexion and complete extension. It has a timer from 10 to 30 minutes. It has a controlling switch in patient’s hand in case of emergency. It is administered for 15 to 20 minutes on 2 to 3 times a day. It mobilizes the operated joints without much pain and effort of the patients.

Indications

1. Post operative total hip and knee i.e. THR and TKR replacement surgery.
2. In stiffness of hip and knee joints, mobilization after manipulation or without manipulation.
3. Post traumatic arthritis with restricted movements.
4. It can be used for diabetic neuropathy patients with inability to move hip and knee.

CPM or mobilimb is seen today in most of the big public hospitals like KEM, JJ and private like Bhatia general and Hinduja wherever the replacement surgery is performed.

Clinical advantages

1. Reduction of post operative swelling and pain.
2. Increase and maintain good range of motion.
3. Prevention of intra-articular adhesions.
4. Reduces the period of hospitalization.

Shoulder Mobilimb

Shoulder mobilimb used for frozen shoulder periarthritis of shoulder and traumatic injuries where shoulder gets stiff and movements are restricted. It is very essential in the post operative shoulder replacement surgery to increase the range of movement of flexion, abduction and external rotation with less pain.

Indications

Acute acrominoplasty, particularly where the operation is repeated and in cases where early -

1. Physiotherapy cannot be started or assumed.
2. In joint contractures after manipulation.
3. Total shoulder replacement.
4. Capsulotomy and arthrolysis for post traumatic arthritis with restriction of movements.
5. Synovectomy for rheumatoid arthritis.
6. Arthrotomy and drainage of acute septic arthritis.
7. Surgical release of extra articular contractures or adhesions.

Contraindications

Extensive rotator cuff repair

Leg and shoulder mobilimb is very important therapy in replacement surgery and other hip, knee and shoulder problems.

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