Background: Despite the large volume of knee replacements carried out the world over, three very pertinent questions regarding the basic act of sitting & its relevance to Knee Arthroplasty have not yet been given adequate thought. Objectives: 1). whether sitting cross legged is healthier than chair sitting, 2). does sitting cross legged impact quality and longevity of life, 3.) Does it affect durability of the Arthoplasty implant whether total or partial knee Arthoplasty. This Pilot Analysis may lead to change in the habitual practice of doing total knee replacements without considering a more functional, less invasive & more cost friendly option. Methods: This study was conducted in accordance with the MOOSE (meta-analysis of observational studies in epidemiology) and PRISMA (preferred reporting items for systematic reviews and Meta analyses) guidelines. Results 1. Sitting cross legged is scientifically proven healthier way to sit compared to chair sitting on all counts…Body &Mind as reported by studies from Yoga, Sports medicine & human physiology. It increases fitness & enhances longevity of life too. 2. Only Unicondylar knee Arthroplasty gives the ability to sit cross legged (most Total knees are not allowed to sit cross legged for fear of exaggerated wear and those that are have a unacceptable percentage of spin offs or dislocation of polyethylene inserts) 3. In almost all lab studies, the mean wear rate of the medial & lateral bearings combined as a Total knee Replacement are significantly lower than a comparable fixed bearing as TKR under the same kinematic conditions. Unicondylar knees last longer too. Conclusions: Sitting cross legged is an important function for health & longevity. It is culturally an unalienable part of Indian/Asian lifestyle. UKA provides these advantages and lasts longer in In vitro studies.

The aim of this study is to compare two methods of internal fixations for isolated fractures of medial malleolus by partially threaded screw fixation and tension band wiring. Patients and Methods: Over the period of 2 years we grouped 20 patients of fractured medial malleolus randomly into two groups of operative treatments, group1 treated by 4mm partially threaded lag screw fixation and group 2 by tension band wiring. Modified ankle scoring system of Olerud and Molander was used to assess outcome of procedures. We use Independent sample t test for analysis and make a comparative study between the two ways of surgical treatment. Clearance from ethical committee is obtained and informed consent from all patient taken for study. Results: The mean time for radiologic bone union was 11 weeks in Group 1 patients and Group 2 patients. No patients had any sign of fixation failure or Kirschner (K) wires migration. According to the modified ankle scoring system of Olerud and Molander excellent and good results were achieved in 80 % in group1 patients and 90 % in group 2 patients (P = 0.049). Conclusions: Tension-band wiring may be better treatment option for internal fixation of medial malleolar fractures than screw fixation in small fragments avulsion fracture.

Determines the prevalence of incidental findings (IF) which need attention or concurrent treatment i.e. meaningful coexisting spine lesion (MCSL) reported in the MRI's with spinogram. Determine role of radiologist in providing axial cut at same time in tandem lesions. Also determine what percentage of treating clinician order a spine MRI without a spinogram. Methodology: It is a retrospective analytic study carried out at Department of spine surgery in our institution. Accumulation of data from two MRI centres (A and B) of city done from 1 st Jan 2018 to 30 th September 2019.We blind the identity of all MRI centres as well as the referring clinicians. Of those clinician ordering only regional MRI were counted. MRI centre 'A' routinely providing us axial cuts of tandem pathologies of MCSL apart from dedicated area along with whole spine screening in same setting. All number of such reports counted and compared with reports of MRI centre 'B' who doing repeat MRI at tandem lesions when we advised only. All the MRIs reports segregate between MRIs with spinogram and only regional or area specific MRI study. Around 2000 MRI films were studied Statistical analysis of data carried out to determine the prevalence of incidental findings of coexisting spine lesion in MRI's spinogram. Data was analysed using chi square test to determine the correlation between the findings, P value <0.05 considered significant. Results: Total 2000 MRI films were studied in which regional MRI were done in 445 (22.3%) and regional along with whole spine screening were done 1555(77.7%) patients .Around 6 out of 36 (15.7%) treating physician ordered only regional MRI investigations. Number of primary spine lesions seen in area specific MRI 708(45.5%) which were radiologically significant. MRIs with IF of meaningful coexisting spine lesions" (MCSL) 274 (17.6%). Area wise distribution of MCSL were, cervical spine 84(5.2%), thoracic spine24 (1.5%), lumbar spine 168(10.8%). There were 274(17.7%) MCSL lesions out of 1545 MRIs of whole spine group, which was significant (p<.05) compared to number of primer lesion i.e. 708, found in same group. Total number of patients who had done repeat MRI at tandem lesion were 154 of which centre 'A' performed 34(20%) and centre 'B' 122(79%) which was statically significant. Conclusion: Whole spine MRI screening is useful for diagnosis of coexisting spinal diseases to avoid, missing of an asymptomatic but significant lesion. Considering the potential advantages in identifying significant IF and the minimal extra time spent to perform whole spine screening as well as taking axial cut at same time which save extra time and cost. Its application can be considered to be incorporated along with regional studies of spine. Role of radiologist cannot be neglected in taking axial cuts at Grade 3 and 4 MCSL at same time.

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Introduction: Shoulder pain is among the most common complaints in the orthopedic outpatient department. It can be due to local pathology or a referred pain from cervical disc degeneration. Frequently, neck and shoulder pathologies may co-exist causing a dilemma regarding treatment approach. Although there are many studies published in literature, we think ours is the first published Indian study to make the observation of concomitant cervical disc degeneration in patients with ipsilateral shoulder pain. Materials & Methods: 39 patients with shoulder pain without any history of trauma, attended the OPD of Walawalkar hospital, Dervan. Of the 3 patients 32 agreed to be part of this pilot study. They underwent x rays & MRI of the shoulder as well as cervical spine. Results: All patients who presented in the orthopaedicopd with complaints of atraumatic shoulder pain, showed varying degrees of cervical disc disease. The commonest affected cervical spine pathological segment was C5-C6 i.e 92 % with two patients having C6-C7 disc disease i.e 8 %. Grading of disc disease was 78.1 % grade 2 8 , 6 patients had grade 3 disc disease, 18.75 %, and only 1 patient had a grade 1 disease with typical signs of chemical radiculopathy with shoulder pain & restriction. X Ray of shoulder showed normal acromiohumeral distance of more than 7 mm in more than 70 % of patients and less than 2 mm in only 1 patient who also incidentally had grade 3 disc disease. MRI of shoulder showed 78 % patients with grade 2 or less of Goutallier grading [9] and all patients of Grade 3 disc disease having grade 3 Goutallier grading and a positive Tangent sign [10] . (18.75 %) This may open another vista in investigation of degenerative rotator cuff disease mimicking grading and severity of cervical disc disease although that is not the primary objective of this paper. We aimed to bring to light the concomitant cervical spine pathology in patients presenting with shoulder pain in this original research. Conclusion: This study found an unusually high rate of coexistent shoulder and cervical spine pathologies. Almost all patients had some form of cervical disc disease and on deeper questioning related signs and symptoms of cervical spondylosis concurrently or a few weeks ago. It undermines the need for investigating this important contributor, the cervical spine, to clinically diagnose the enigma of shoulder pain.