<p class="abstract"><strong>Background:</strong> The current study had been designed so as to assess whether joint line elevation and change in patellar tendon length influences knee flexion after primary cruciate retaining TKR.</p><p class="abstract"><strong>Methods:</strong> This prospective study involved patients with advanced degenerative joint disease involving one or both knees who presented to the outpatient department of a tertiary care hospital. Exclusion criteria were any prior knee surgery. Surgery was performed under tourniquet with standard medial para-patellar arthrotomy to expose all our knees. In the study radiological assessment was done by true lateral X-ray view of knee in 30 degree of flexion. We choose Caton-Deschamps indices (CI) for diagnosis of post TKR patella infera and joint line elevation. CI&lt;0.6 was defined as patella infera (normal range of CI 0.60-1.45). After all data collection comparison was done between joint line elevation versus without joint line elevation patients (with/without patellar tendon shortening) range of movement.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total of 100 patients (72 females and 28 males) with 176 knees (bilateral=76, unilateral=24) who fulfilled the above said criteria involved in study. The mean age of the patients at the time of surgery was 64.4 years with range of 54 years to 80 years. The average follow up of 24 months, with minimum follow up of 18 months. Average range of motion (ROM) in NO Joint line elevation/patella tendon shortening patient measured 107.2^°, and joint line elevation with patellar tendon shortening (prior patella infera) and joint line elevation without patella tendon shortening(prior patella infera) patient average ROM was measured 86.7 and 87.8 degree respectively.</p><strong>Conclusions:</strong> In our study patellar tendon shortening and joint line elevation reduces ROM knee. Mechanical factors also explain the association between joint line elevation and patellar tendon length with range of motion. Reduction in length of extensor apparatus reduces the range of flexion.

<p class="abstract"><strong>Background:</strong> Femoral component rotation in total knee arthroplasty (TKA) is essential for patella-femoral tracking, flexion gap balance and normal kinematic function of the knee. The two referencing techniques used for sizing and adjudging the femoral rotation are anterior referencing (AR) and posterior referencing (PR).The current study was designed so as to identify which referencing system determines the femoral rotation more accurately<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> This study involved 34 consecutive patients (22 females and 12 males) with 60 osteoarthritic knees (bilateral=26; unilateral =8) who satisfied the inclusion criteria. The trans-epicondylar axis, was taken as gold standard to adjudge the correct femoral rotation and was marked as E. The axis of rotation as per anterior instrumentation (A), and as per posterior instrumentation (P) were marked and compared as to which of the axis (A or P) was parallel to E.<strong></strong></p><p class="abstract"><strong>Results:</strong> A was always parallel to E, however P was parallel to E in 42 knees. In 18 knees (6 with valgoid deformity, 12 with hypertrophic osteoarthritis involving the medial femoral condyle), P and E tend to converge laterally, suggestive of excessive internal rotation<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Anterior referencing determines femoral rotation more accurately than posterior referencing for knees with severe valgoid deformity or those with hypertrophic osteoarthritis involving the overgrowth of medial femoral condyle<span lang="EN-IN">.</span></p>

Introduction: Fractures through the intertrochanteric line of the upper end of the femur, and peritrochanteric fractures, unite readily no matter what treatment is used because the broad fractured surfaces are richly supplied with blood and there is seldom wide displacement. But at the same time, unless suitable precautions are taken, the fracture may unite in a position of coxavara with shortening of the limb and limitation of hip movements. Hence we conducted a study in our set up to know the functional result of short proximal femoral nail (PFN) in treatment of these fractures. Material and Methods: We included all intertrochanteric fracture of femur in skeletally mature patient who are fit for surgery in our study. Fifty patients treated with short PFN were included in the study. Results: Majority of the patient in our study were between 61-80 years with a mean age of 74.46 ± 12.04 years. About 52 percent of the patients were female and 48 percent male. Fall at home was the most common mode of injury. Right hip was involved in 48% of the patient and left hip was 52%. The short PFN required shorter incisions, less blood loss and operative times. Average time for operation was 42.30±10.01. Post operative complications included revision surgery 2 (4.0%) patients, superficial infection in 2 (4.0%), Z effect in 1 (2.0%) patient, inadequate reduction in 1 (2.0%) patient, difficulty in distal locking in 1 (2.0%) patient and varus in 1 (2.0%) patient. The average harris hip score came out to be 87.37 at 24 weeks and 90% of the patients belonged to the 'good' group and 6% of the patients belonged to the 'excellent' group intertrochanteric fractures, treated with short PFN, had significantly better outcomes with all patients having good results in 24 weeks which is very short time. Conclusion: Intra operative technical difficulties associated with short PFN can be reduced by thorough knowledge and understanding of both the anatomy and implant. By using some technical tips difficult closed reduction can be done and internal fixation with PFN can be attempted.

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