Background:Venous thromboembolism (VTE), which consists of deep vein thrombosis (DVT) and pulmonary embolism, is a potentially fatal disease. According to the Western literature, DVT of lower limb veins is one of the most common complications following total hip and knee arthroplasty and surgeries for lower limb fractures. Very few studies have been published from India on the subject and very little is known about the true incidence of the condition. The issue has acquired greater significance in Indian subjects in recent times as there is a manifold increase in the number of joint replacement surgeries and surgeries for lower limb fractures. There are no clear guidelines regarding the prophylaxis for VTE for Indian patients.Materials and Methods:We carried out a prospective study to determine the incidence of DVT. Present study included 125 patients undergoing total knee and hip joint arthroplasty and surgeries for fractures of the lower limb over a three-year period. All the patients underwent duplex ultrasonography between the seventh and 14th postoperative day. No mechanical or chemical form of DVT prophylaxis was used.Results:Only nine patients (7.2%) showed sonographic evidence of DVT and the majority of them resolved without treatment. There was no case of pulmonary embolism.Conclusion:DVT following total joint arthroplasty and surgery for lower limb fractures in Indian patients is not as common as reported in the Western literature. A high level of suspicion and close clinical monitoring is mandatory, routine chemoprophylaxis is perhaps not justified in every patient undergoing lower limb surgery in our opinion. More trials involving a larger number of patients and at multi centers, in future, would be required to confirm the findings of our study.

Background:Total knee arthroplasty (TKA) is a very successful operation for the treatment of end-stage arthritis of the knee joint. In spite of improvement in surgical technique, implant design, postoperative pain management, and rehabilitation, some patients are not satisfied with the outcome of the surgery. It is believed that high-flexion (H-F) activities such as cross-legged sitting and squatting are necessary for satisfaction after TKA in Indian patients due to cultural and social reasons. This has led to the development and marketing of implant designs allowing H-F after TKA without strong evidence in the literature.Materials and Methods:We carried out a retrospective study to determine the level of satisfaction in 74 patients operated for 120 TKA over a 5 year period. This was determined on the basis of a satisfaction questionnaire which included questions to assess satisfaction regarding pain relief and ability to perform routine daily activities and high knee flexion activities such as squatting and cross-legged sitting.Results:Out of a total of 74 patients, 69 patients were overall satisfied with their TKA. Out of these, only 5 patients could squat or sit in a cross-legged position. Majority of the patients were satisfied with the pain relief and improvement in their capacity to work provided by TKA.Conclusions:Ability to perform H-F activities after TKA is not a necessary prerequisite for satisfaction in Indian patients. Implant designs allowing H-F should be used in a selected group of patients with good preoperative knee flexion and specific requirements.

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Introduction: Outcomes of Total Knee Arthroplasty (TKA) performed with modern all polyethylene (AP) tibial components have been reported to be comparable with or better than those TKAs performed using metal-backed modular (MBM) tibial components in several medium and long term studies. As AP components also provide substantial cost savings, there has been increase in their use in primary TKA. In spite of such good results, failure of AP tibial components has been reported. Case Presentation: A sixty three year old lady operated for bilateral cruciate retaining PFC Sigma TKA utilizing AP tibial components without patellar resurfacing in 2011 presented to us in December 2014 with two-year history of severe pain in both knees and inability to walk or stand. She had marked varus deformity of both knees. Radiological examination revealed fracture of the medial tibial plateau with failure of AP tibial component and marked varus deformity. She was treated with bilateral staged revision TKA which resulted in a satisfactory outcome. Conclusion:This case report describes previously unreported complication of AP tibial component following cruciate retaining bilateral AP tibia PFC Sigma TKA in a patient of varus osteoarthritis of knee joint. Early collapse of medial tibial plateau leading to failure of bilateral TKA, which could be attributed to under correction of varus deformity and instability, was managed with bilateral revision TKA using tibial metaphyseal sleeves which led to a very satisfactory outcome and excellent five year follow up.