Purpose: The age-old practice of closed suction drain following orthopedic procedures has been challenged since past few decades. Our aim was to assess the effectiveness of closed suction drain after total knee arthroplasty. Materials and methods: One hundred twenty patients (135 knees) with primary Total Knee Arthroplasty were divided into a study group (no drain) and a control group (drain used). Inclusion criteria were grade 3 and grade 4 osteoarthritis of the knee. Revision cases and rheumatoid arthritis were excluded. Parameters assessed were pain, pre and post-op Hb, dressing change, early infection, ecchymosis and duration of stay. Results were calculated using Western Ontario and McMaster Universities Osteoarthritis Index and Oxford Knee scoring systems at two weeks, six months and one year. Results: Mean age was 72.03 ± 6.68 in study group and 71.38 ± 7.02 in control group. Pre and post op Hb was 12.1678 ± 1.3220 (study group), 12.1803 ± 1.2717 (control group) and 9.8373 ± 1.5703 (study group), 9.7918 ± 1.4163 (control group). There was one case of early infection in both groups which was controlled by oral antibiotics. Change of dressing and ecchymosis were more in the study group. Duration of hospital stay was more in the control group p < 0.0006 (statistically significant). Conclusion: There is no added advantage of closed suction drain over no drain usage and this practice can safely be brought to a halt.

Purpose Osteonecrosis of the femoral head is a progressive and debilitating disease that causes pain, osteoarthritis and hip joint collapse, eventually necessitating hip replacement. This study evaluated the long-term outcomes of autologous adult live-cultured osteoblasts (AALCO) implantation in patients with osteonecrosis of femoral head. Patients and Methods In this retrospective multicenter study, we collated and analyzed data of patients ≥12 years of age who underwent AALCO (OSSGROW ® ) between 2010 and 2015 for the treatment of osteonecrosis of the femoral head. Results Data from 64 patients (101 hip joints) were assessed in this study. The mean ±SD duration of disease since diagnosis of osteonecrosis was 7.4±1.6 years. The mean follow-up duration was 6.3±1.4 years. The mean VAS score (n=98 hips) reduced significantly from 58.8 ± 13.8 to 32.2 ± 32.1 post-operatively (mean difference: −26.5±35.2, p=0.001) and Harris hip score (n=97 hips) also significantly improved from 47.1±12.3 to 63.7±27.7 post-operatively (mean difference:16.7±28.7, p=0.0001). Following the AALCO treatment, 29 hips in 13 patients (28.7%) underwent total hip replacement (THA), indicating that AALCO treatment could delay THA for 71.3% of hips. A total of 39.1% of hips diagnosed in early stage versus 60.8% in the late stage of osteonecrosis required THA. Overall, 60.4% of hips improved, 2% remained stable, and 37.6% progressed following the AALCO implantation. The condition of disease was found to have improved in 71.1% of patients in early stage (Grades I and II) versus 58% in the late stage (Grades III and IV) of osteonecrosis. Conclusion Patients with osteonecrosis who received implantation of autologous-cultured osteoblasts using AALCO showed improvement in joint function and decrease in pain. Treatment with AALCO halted progression of osteonecrosis, preserved the natural hip, and eliminated the need for hip replacement surgeries in 7 out of 10 patients.

Osteonecrosis of the femoral head is a progressive disease that leads to femoral head collapse and secondary osteoarthritis if left untreated. Head preservation surgeries are notable for their inefficiency in providing a pain-free hip joint in cases with extensive involvement of the femoral head. This single-center study evaluated the effectiveness of autologous cultured osteoblast cells implanted after core decompression and debridement in 15 patients diagnosed with early osteonecrosis of the femoral head from 2010 to 2012. Overall mean follow-up was 51 months; the longest follow-up was 7 years in 3 patients. At 9 months after implant, all of the patients had resumed their normal routine activities. Reduction in pain and dependency on walking support was remarkable, and none of the patients required revision. The femoral joints were preserved structurally, and the joint biomechanics, strength, and function were regained. The use of autologous osteoblast cell implant is recommended for patients with early osteonecrosis. [ Orthopedics . 2021;44(2):e183–e189.]

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