BACKGROUND Among the various surgical approaches for total knee arthroplasty, medial parapatellar and subvastus approach are two commonly used surgical approaches in total knee arthroplasty. The aim of this study is to compare the functional outcome between subvastus approach and medial parapatellar approach. METHODS This is a prospective study which compared medial parapatellar approach (Group-1, 30 patients) and subvastus approach (Group-2, 30 patients) from November 2017 to March 2019, in Rajarajeswari Medical College and Hospital, Bangalore. Patients were followed up for 16 months. Revision knee arthroplasty cases and total knee arthroplasty cases operated by other surgeons were excluded. RESULTS There was no significant difference between subvastus approach and medial parapatellar approach. Except that in subvastus approach, quadriceps tendon was not disrupted. Pain was better controlled in subvastus approach on post-operative day but operative time was more in subvastus group. There were no difference between two groups with regard to duration of stay, blood loss and post-operative complications. CONCLUSIONS Subvastus approach provided better pain relief postoperatively, but operative time was more in subvastus group. There was no significant difference between the two groups in duration of stay and post-operative complications. Subvastus can also be considered as an alternative surgical approach along with standard medial parapatellar approach for primary total knee arthroplasty.

Background: Management of intertrochanteric fractures have been evolved from extra medullary implants to intramedullary implants. Intramedullary implants have proven advantage over their counterpart in terms of stable anatomical fixation and better functional outcome. Among the intramedullary implants, Proximal Femur Nail (PFN) & Proximal Femur Nail Anti Rotation for Asia (PFNA2) have been traditionally used. This study is based on the comparison between these two intramedullary implants in terms of clinical and functional outcome. Materials and Methods: A total of 40 patients fulfilling inclusion and exclusion criteria were randomized into two groups PFN (n= 20), PFNA2 (n=20) between August 2018 to July 2019. They were compared in terms of demography, per operative variables, postoperative functional outcome and were followed up for a period of 6 months postoperatively. Results: Average age of PFN group was 61.35 years & PFNA2 was 66.90 years. In PFN group 9 patients (45%) had grade 2 of Singh's osteoporosis index and in PFNA2 12 patients (60%) had grade 2. Mean Harris hip score at 6 months in PFN was 83.15 and in PFNA2 it was 86.80. Complications like infection were seen in 2 patients (10%) in PFN and 1 patient (5%) in PFNA2. Valgus deformity was seen in 1 patient (5%) in PFNA2. Z effect was seen in 4 (20%) in PFN Conclusion: There was no significant difference between the two groups in terms of clinical and functional outcome. However implant related complication's like screw back out, Z effect were not present in PFNA2 and the duration of surgery was less in PFNA2. We conclude that PFNA2 is a better option for treatment of intertrochanteric fractures of hip especially in osteoporotic patients.

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A BS T R A C T BACKGROUNDPain, functional limitations, and impaired health related quality of life, are key concerns for individuals with advanced osteoarthritis of the knee. Total Knee Arthroplasty (TKA) is the primary treatment for patients with end stage arthritis. Despite being a common intervention associated with generally favourable outcomes, 1 a large proportion of individuals do not have expected outcomes following TKA. 2 So, the present study was conducted to evaluate functional outcome following primary TKA in an institute which caters to rural and semi urban population with limited financial provisions. RESULTSIn our study, pre-operatively all of our patients had moderate to severe pain, postoperatively 24 knees had no pain and 36 knees had mild pain. Pre-operative average flexion of 76˚ was increased to 95.8˚ post-operatively. All the 60 knees had poor knee score of < 60 pre-operatively, post-operatively 42 knees had excellent score (80-100) and 17 knees with good score (70-79). 38 patients had poor functional score (< 60) and 3 patients had fair functional score (60-69) pre-operatively. Post-operatively 21 patients had excellent score (80-100), 11 patients had good score (70-79), 6 patients had fair score (60-69) and 3 patients had poor score (< 60). CONCLUSIONSTKA is now a common and established surgical procedure. Functional outcome of the procedure is dramatic, durable, and satisfactory with high patient acceptance.