Purpose The rollout of COVID-19 vaccines began in India in January 2021, with healthcare professionals being the first to receive vaccination. The purpose of this research was to study the incidence and severity of COVID-19 infections among Indian doctors, following vaccination with ChAdOx1 nCoV-19 or BBV152. Methods We conducted an online voluntary survey among Indian doctors who received one or two doses of ChAdOx1 nCoV-19 or BBV152. Questions pertaining to the incidence and severity of COVID-19 infection following vaccination were asked. Data thus obtained were analysed. Results 9146 doctors were included in this study. 8301 of these received ChAdOx1 nCoV-19, while 845 received BBV152. 2842 (31.07%) respondents reported having a COVID-19 infection following vaccination. Presence of pre-existing medical comorbidities was associated with a higher incidence, while prior COVID-19 infection and two doses of either vaccine were associated with a lower incidence of COVID-19 infection post-vaccination. Exposure to COVID-19 patients on a daily basis did not increase the incidence of COVID-19 infection among doctors who were vaccinated. Increasing age, male gender, presence of pre-existing medical comorbidities, and daily exposure to COVID-19 patients were associated with increased severity of COVID-19 infection after vaccination. Two doses of either vaccine resulted in less severity of disease compared to one dose. Conclusion ChAdOx1 nCoV-19 and BBV152 confer immunity against severe forms of COVID-19 infections. COVID-19 infections prior to vaccination result in a lower incidence of breakthrough infection. Presence of pre-existing medical comorbidities is associated with increased incidence and severity of breakthrough infections.

Background Trunnion fracture of the femoral prosthesis is an extremely rare complication following Total Hip Arthroplasty (THA). There are very few reports in literature on trunnion fracture. All previously reported cases are of prostheses with smaller heads, unlike the large metal-on-metal articulation in our case, which is unique. Case presentation A 29-year-old male patient with juvenile idiopathic arthropathy presented to us with a fracture of the trunnion of his left THA, with no history of trauma. He had undergone staged bilateral THA for avascular necrosis of the hips 10 years ago (with AML-A stem and large metal-on-metal articulation bilaterally). We revised the THA and exchanged both femoral and acetabular components. He had a good functional outcome at 3 years’ follow up. Conclusion The primary reason for the trunnion fracture in our case was the faulty stem design of the AML [with a small (9/10) taper, and a large head], causing excessive bending moment at the trunnion, worsening the cantilever effect and leading to subsequent cyclic fatigue failure. Whilst gross trunnion failure (GTF) with dissociation of the head from the taper is commonly reported, trunnion fracture per se is a rare and devastating complication. The AML-A stem has since been recalled by the company and there is a need to constantly monitor these patients for potential trunnion-related complications.

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Tranexamic acid decreases blood loss in patients undergoing TKA independent of all the other blood conserving procedures.

Background: Up to 25% of femoral cortical suspensory fixation devices are reported to be deployed inappropriately during anterior cruciate ligament (ACL) reconstruction. Most techniques for visualizing suspensory button deployment reported in the literature are for adjustable loop buttons and outside-in femoral tunnel technique. Intraoperative radiographs are inconvenient and involve exposure to radiation. No “gold standard” technique for visualization of femoral cortical button deployment has been described yet. Indications: This technique can be employed for all patients requiring ACL reconstruction surgery. Technique Description: The femoral tunnel is prepared from the anteromedial portal. With the knee in flexion, a beath pin loaded with a suture loop is passed via the anteromedial portal through the femoral tunnel; the eyelet of the pin with the suture loop is retained in the femoral tunnel. The knee is extended without fear of bending the beath pin. The arthroscope is shifted into the lateral gutter. An outside-in lateral parapatellar portal is made at the level of the center of the patella, 1 cm lateral to its lateral edge. The joint capsule and soft tissues in the lateral gutter are resected using a shaver. The beath pin is identified without fear of lacerating the suture loop. The exit point of the pin depends on the knee flexion at the time of femoral tunnel preparation, and more flexion results in more anterior pin exit and vice versa. The rest of the surgery is performed as planned. The definitive sutures of the desired femoral cortical suspensory device are passed from the tibial tunnel into the femoral tunnel. The arthroscope is then positioned in the lateral gutter and the cortical button is deployed appropriately under vision, onto the lateral femoral cortex. If required, the cortical button can be manipulated to seat it appropriately, using an instrument from the lateral parapatellar portal. The remainder of the surgery is performed as per the surgeon’s preference. Results: We routinely perform this step during ACL reconstruction. It adds 2 to 4 minutes to the surgical time. We have not encountered any complications of this procedure. Discussion/Conclusion: This maneuver is effective in facilitating appropriate deployment of femoral cortical suspensory devices under vision.