Introduction: India is a country where many religions coexist together. Prayer & meditation form an integral part of Indian lifestyle. Also 90% of India's population lives in the rural areas. Medial compartment osteoarthritis is the most common type of arthritis in India. Total knee replacement has longer rehabilitation time, morbidity and cost. In addition, it doesn't allow squatting and sitting cross legged. With rise in unicondylar knee replacements for medial compartment osteoarthritis, patient's satisfaction is much higher. Hypothesis of this paper was to investigate whether sitting cross-legged easily on floor for prayer and meditation, contributed to higher levels of patients satisfaction in unicondylar knee replacement significantly. Material & Methods: this retrospective study was done with study population of 36 patients of which, 33 knees of unicondylar knee replacement (mean age 61.7) and 25 knees of total knee replacement (mean age 63.5). We used modified Oxford knee score to compare the functional outcome and Likert scale for grading the patient's satisfaction level. Results: study outcome after unicondylar knee replacement was extremely satisfactory for all patients measured with modified Oxford knee score and is better than total knee replacement. The mean Oxford score for 33 knees with unicondylar knee replacement is 47.18 and for 25 knees with total knee replacements is 46.35. But viewing by satisfaction index point of view, patients are highly satisfied with unicondylar knee replacement because of ability to squat and sit cross-legged used for praying and meditation and other social habits.

Introduction: OA knee is most common form of arthritis in Asian population. The medial compartment of knee is most commonly involved. Most X-ray studies have been from the Western Caucasian patients with different genetic pool, habitus and lifestyle. The accepted norm for surgical intervention like unicondylar knee replacement or High Tibial Osteotomy is bone on bone Arthritis which has simultaneous affection of both medial Tibial & Femoral compartments. We however noted a different radiological pattern also causing severe pain on medial side of knee, without bone on bone arthritis. This was labeled DERVAN RIM SIGN. Materials and Method: This pilot Study describes a new radiological sign based on standard Anteroposterior Xray of knee joint, taken in standing weight bearing position with toes and patella pointing forwards in 15 degrees of flexion. The findings of this sign and correlation to selective medial condylar femoral cartilage loss in 25 patients are confirmed with 1 MRI of knee joint 17 patients 2 Arthroscopy of knee joint 3 patients 3 Open Arthrotomy during Unicondylar knee Arthroplasty 5 patients Results: 100 percent correlation is seen in all 25 cases between the Dervan RIM sign & Eburnation and loss of Medial femoral cartilage in the three modalities of visual confirmation viz MRI, Arthroscopy or Visual examination in open surgery. Mild involvement of the Tibial condyle was noted in all cases and this was the cause of absence of bone on bone Arthritis.

Introduction: Knee pain is among the commonest complaints in the outpatient orthopedic department. However the cause does not always originate from knee itself. and knee pain is used by the patient more as an umbrella term. In fact very few patients give the complete list of accompanying symptoms. They have more often than not to be coaxed out of the patient. To make matters more complex, Referred pain from the Spinal nerves, Hip and Ankle joints join the many structures around the knee to make knee pain an umbrella term for this Pandora's Box. Misdiagnosis or partial diagnosis leads to inadequate or wrong treatment and continued suffering for patient and treating doctors Materials & Methods: 78 patients with knee pain attended the OPD of Walawalkar hospital, Dervan. On x-ray, 28 were found to have different grades of osteoarthritis. Of these 25 agreed to be part of this pilot study. They underwent standing x rays & MRI of the lumbosacral spine. Results: This study found an unusually high rate of coexistent knee and spine pathologies. All patients had some degree of disc disease accompanying medial or tricompartmental osteoarthritis. It undermines the need for investigating this important contributor to the umbrella term of knee pain. The commonest affected disc segment was L4-5 i.e 92% with two patients having L5-S1 prolapse 8%. The purpose of this pilot study is only to alert the surgical and rehabilitation colleagues of the frequent coexistence of the spine and knee conditions for Counseling, consent, surgery & rehabilitation and thus improve patient satisfaction.

Introduction: Osteoarthritis is a progressive disorder of joints caused by gradual loss of cartilage most commonly occurring at knee joint in Indian population. Post-operative physiotherapy is one of the most important pre requisite for further recovery. Traditionally only forward walking is studied, practiced in all rehabilitation protocols. Drawing clues from Yoga and martial arts we have studied the effect of backward walking in post operative rehabilitation of knee replacement patients. Changing basic approach of Rehabilitation has been done for the first time in our knowledge. Materials & Methods: This study was done in Walawalkar Rural Hospital and research centre, Dervan, Ratnagiri, Maharashtra. This was a randomized control study. 34 postoperative Patients were randomized into 2 groups. Pre-Operative and Post-Operative assessment was done with VAS score and Modified Oxford Knee Score at the end of 2 weeks. Results: Backward walking group shows 64.4% additional improvement in post-operative Modified Oxford knee score over forward walking group. There is significant improvement in pain score (VAS) in backward walking group at the end of 2 weeks. Discussion: The above results conclude that backward walking reduces significantly the impact force upon contact, foot contact pattern and lower extremity kinematic pattern. Range of Motion at the knee joint is reduced during backward walking incorporating a nearly isometric pattern following contact compared to a more stressful eccentric loading in the traditional forward walk rehab protocol. This can be especially advantageous for rehabilitation of knee joint surgeries along with better proprioception highlighting beneficial effects of backward walking like strengthening of Anti-gravity muscles, Quadriceps loading, Stretching of Post Capsule.

Introduction: Surgery has made tremendous advances in the fields of joint Arthroplasty & Spine. Major advances in both these fields have made patient care more nature friendly & less morbid, thus allowing smaller incisions, day care procedures like endoscopic spine surgeries, minimally invasive joint replacement and so on. However, both these specialties have remained diverse and separate. Thus, in the typical modern-day specialty-based practice era, a patient consulting an Arthroplasty surgeon will seldom have a detailed spine examination or vice versa. This may lead to scenarios where the pain generator is from for example radiculopathy to the knee and below & the recommended procedure is a joint replacement due to incidental wear of the joints seen on the X ray. (1) The international data shows that there are 20% dissatisfied arthroplasty patients worldwide. (2) We have found concomitant knee & spine pathologies in more than 90% of our patients& published our research on the same topic. (1, 3, 4, 5) Thus the need arises for taking care of both pain generators i.e. from the spinal stenosis (central & or lateral) & knee arthritis for complete pain relief to the lower limbs. The developed protocol is the first of its kind for a more Holistic diagnosis & treatment of lower limb pain. It also saves interval dissatisfaction of the patient, healthcare costs & is a step towards a more team based surgical care between specialized spine & arthroplasty surgeons. Specialization should no more be a cause of separation between treating surgical teams & continued pain for the patient. A more Holistic clinical & surgical approach is hereby proposed. Methods: In this pilot study, twenty two patients were selected who underwent simultaneous & single sitting surgical treatment for leg pain, unilateral or bilateral. After detailed clinical examination & imaging studies, Simultaneous, Single stage Surgery was carried out in needy patients. Step one was Transforaminal Endoscopic Lumbar discectomy of the L4-5 disc in 17 patients, 2 level L3-4 & L4-5 in 3 patients & L5-S1 in 2 patients under local anesthesia in an awake & aware patient. After completion of the Percutaneous Endoscopic Lumbar Discectomy, an epidural catheter was inserted through the endoscope under vision in the epidural space by the spine surgeon (Dr. Sunil Nadkarni) & patient turned supine after checking the position of the catheter with radiolucent dye & securing the catheter. The anesthetist pushed the drug, patient was turned supine and painting & draping was done to begin the second part of the procedure i.e. single side or bilateral unicondylar joint replacement. Results: Results were classified by VAS, ODI, Oxford knee score, SF 12 before & after the procedure. Conclusion:The proposed "Dervan Simultaneous Surgical protocol "for Lower Limb pain, is a satisfying procedure with good to excellent outcomes in more than 90% patients. It provides the way for a holistic patient centered approach to treating all the main pain generators of the lower limb in one sitting....