No abstract

Introduction:In 1961 Sir John Charnley demonstrated the use of steel, plastics and cement to conquer the hip joint, ending the dread associated with the ' hip disease'. A new era of orthopedics had begun. There has been continuous evolution of total hip arthroplasty over last four decades throwing up newer forms of prosthesis from cemented to hybrid to cementless. Inspite of few drawbacks, total hip arthroplasty has emerged by far the popular choice among orthopaedic surgeons to tackle common or complicated hip pathologies and today most commonly performed hip reconstruction procedure. The present study aims to evaluate the results of cement less total hip replacement arthoplasties and to compare the results with other standard series. Aim: To evaluate the results of cement less total hip replacement arthoplasties and to compare the results with other standard series. Materials and Methods: The present prospective study was carried out on 30 patients of either sex or varied age groups having various hip disorders who were admitted during the year 2013-2014. The surgical approach for all the patients enrolled in the current study remained the same i.e Modified Gibson (Modified by Marcy and Fletcher) approach. Patients were followed up every month for the first 6 months followed by quarterly visits thereafter. The follow ups included proper clinical evaluation and roentgenographic evaluation. Results and discussion: We obtained 100% excellent overall results in our series which are comparable to a similar larger series done at the department of orthopaedics, university of Innsbruck, Austria which included 71 primary cementless hip arthroplasty using porous coated press fit acetabular cups which were combined with 61 cementless stems and 10 cemented stems with an average follow up of 2.4 years. However Coventry et al had reported 83% overall good to excellent functional results in their series while, Charnley had found it to be 91% in his series. Thus, our results were consistent with the standars series available in literature. Conclusion: We conclude that the operative treatment for various hip disorders in the form of cementless total hip arthroplasty has helped in alleviation of intractable pain, early rsumption of ambulation and return to functional activity.

Background: In proximal tibia fracture, three column concept and fixation is becoming popular as it was proved that fixation of posterior column is a must for proper weight transmission and stability. This study aimed functional outcome of proximal tibia fracture in SCHATZKER TYPE 4, 5, 6 managed with posteromedial approach and their complication rate. Materials and Methods: This prospective case controlled clinical study was carried out in 30 patients, with ASA physical status I and II and scheduled for elective general surgery. All patients had anteriorposterior (AP) and lateral radiographs. The patients were assessed preoperative and postoperatively in form of range of movements, pain, stability, reduction of fracture and early mobilization. All patients were operated with posteromedial plating for proximal tibia via posteromedial approach and were assessed postoperatively for range of movements, stability and graded according to the knee society score. Results: In our series, the majority of the patients are found to be between the age group of 30-40 years (13). 90% of patients were male. Road traffic accident was the most common cause. Screw impingement at far cortex is most common complication. According to knee society score system, 67% patients had excellent results without any deformity and stiffness, 30% had good results. Conclusion: Posteromedial plate by posteromedial approach provide anatomical articular reduction and rigid stable fixation with less soft tissue devastation. Proximal tibia fracture augmented with posteromedial approach is the good, effective and skill-full procedure with minimum risk of superficial and deep infection, knee stiffness, deformity.

The study aims to compare the effectiveness of laminectomy and laminotomy for treating lumbar disc prolapse. Materials and Methods: A prospective study of comparative study between laminectomy and laminotomy. In patient of lumbar disc bulge will be conducted in the department of Orhtopaedics, Sir Takhtsinhji Hospital, Bhavnagar, after getting permission from Institutional Review Board, Government Medical College, Bhavnagar. The Study will compose of 30 patients of lumbar disc bulge admitted in the Department of Orhtopaedics, Sir Takhtsinhji General Hospital, Bhavnagar. Patients will be included after approval of Institutional Review Board, Government Medical College, Bhavnagar. Detailed history regarding personal date, history of mechanism, pre-injury ambulatory status, preexisting local and systemic condition, menopausal status that may affect recovery. Full clinical examination will be done to assess the general condition of the patient, range of movement and any associated complains. MRI whole spine screening will be taken. After deciding the appropriate plan, patient will be prepared for surgery. Every patient will be operated upon as early as possible or within two days of getting fitness for anesthesia. All patients will be assessed with regard to operative time day of getting fitness for anesthesia. All patients will be assessed with regard to operative time, blood loose, hospital stay and post operative complications. Dressing will be checked on the 2 nd , 4 th , 6 th post -operative day. Patients will be discharged and then after will be followed on 2 nd wk, 6 th wk, 12 th wk, and 6 th month. On follow up visits patients' will be evaluated with odoms criteria, general and systemic examination. Results: Laminotomy has definitive advantages over leminectomy in terms of SHORT hospital stay an average of 5 days, less blood loss, Less postoperative pain and Epidural hematomas and Fibrosis, It has the advantage that it's shorter length of hospitalization leads to early return to work thus improving the quality of life earlier. Conclusion:The low complication rate makes laminotomy a choice of surgery in lumbar disc bulge.