Medial opening wedge high tibial osteotomy (MOWHTO) Femoro tibial angle (FTA) Mechanical axis KOOS Medial compartment OA Knee Varus knee a b s t r a c tObjective: High tibial osteotomy (HTO) is an established procedure to treat medial compartmental osteoarthritis (OA) knee associated with varus deformity. It is well documented that precise correction of deformity and maintenance of correction achieved is important to ensure long term good results. This study was undertaken to record changes in radiological parameters and its effect on the functional outcomes in first two years following HTO done for varus degenerative OA kneeby hemicallotasis technique using HTO fixator. Methods: 31 patients meeting our inclusion-exclusion criteria who underwent HTO by hemicallotasis method using self-adjusting unilateral HTO fixator were included in the study. Their femoro tibial angle (FTA), mechanical axis %, Insall-Salvati ratio, proximal tibial antero-posterior slope and knee injury and osteoarthritis outcome Score (KOOS) were recorded preoperatively, postoperatively at the time of removal of fixator, at 1 year and at 2 years. Results: The FTA and mechanical axis significantly improved from a mean of 183.12⁰ and À3.26% respectively preoperatively to 173.38⁰ and 61.81% at the time of removal of fixator but subsequently showed significant deterioration to 176.06⁰ and 57.96% at 1 year and further insignificant deterioration to 176.16⁰ and 57.74 at 2 years. The KOOS improved from mean 56.61 preoperatively to 70.48 at the time of fixator removal and further improved significantly to 85.68 at 1 year but significantly deteriorated to 84.54 at 2 years. The Insall-Salvati ratio, tibial slope showed no significant change throughout the study. Conclusion: Though desired alignment can be achieved by using the fixator, we found a significant deterioration in achieved radiological parameters after removal of fixator adversely affecting the functional outcome which is a matter of concern.

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<p class="abstract"><strong>Background:</strong> Osteoarthritis of knee is one of the most commonly affecting condition affecting the activities of daily living in the middle age group Indian and Asian population. Total knee arthroplasty (TKA) performed for pain relief and improvement in mobility of individuals is associated with significant post-operative pain. Ischemic preconditioning is one of the non-pharmacologic methods of reduction in postoperative pain using variable periods of tourniquet induced ischaemia which has limited data in literature.</p><p class="abstract"><strong>Methods:</strong> Sample size (n=30) was taken. A standard automatic pneumatic tourniquet was used while performing ischemic preconditioning of the limb prior to TKA and during surgery. Statistical analysis was performed with p values &lt;0.05 considered significant. Standard postoperative analgesia as per hospital protocol was given to patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean 6 hour postoperative and 48-hr postoperative visual analogue scale (VAS) score at rest is significantly higher compared to mean preoperative VAS score at rest (p&lt;0.01 for both). The distribution of mean preoperative and 24 hour postoperative VAS score at rest did not differ significantly (p&gt;0.05). The mean % change in postoperative period compared to preoperative VAS at rest was 47.06%.</p><p class="abstract"><strong>Conclusions:</strong> In this study, the effect of preconditioning over postoperative pain relief was not consistent. Although the patient reported pain scores were low at 6th and 24th postoperative hour, the effect at 48th postoperative hour was not satisfactory. Studies with larger sample size required for better understanding of ischemic preconditioning.</p>

Background: Osteoarthritis (OA) of knee is a degenerative disorder characterized by the softening, ulceration and focal loss of articular cartilage, sclerosis of the subchondral bone, marginal osteophyte formation and a range of morphological and biochemical changes in the synovium & capsule of the knee joint. Total knee arthroplasty (TKA) has been the treatment of choice for advanced osteoarthritis of knee. TKA is associated with significant post-operative pain. The aim of this study is an evaluation of inflammatory markers (ESR, CRP, INR, TLC) following TKA with use of tourniquet in the perioperative period. Methods: Sample size (n=30) was taken A standard automatic pneumatic tourniquet was used during the surgery. Data on demographics, duration of surgery, Erythrocyte sedimentation rate (ESR), C-Reactive Protein (CRP), Total leukocyte count (TLC), Coagulation profile (INR) and limb circumference were analysed. P-values < 0.05 are considered to be statistically significant. The entire data was statistically analysed using Statistical Package for Social Sciences (SPSS version 21.0, IBM Corporation, USA). Results: The distribution of mean 6-hr post-op and 48-hr post-op ESR is significantly higher compared to mean pre-op ESR (P-value<0.001 for both). The mean% change at 48-hr post-op compared to pre-op in CRP is 1404.89% which was statistically significant. The change in preoperative INR versus postoperative 6 th hr INR is not significant (P value>0.05) as well as the preoperative versus 48 th hour. The mean% change at 48-hr post-op compared to pre-op in TLC is 96.24% with p value <0.001. Conclusions: In this study it was found that there is a significant increase in inflammatory markers (ESR, CRP, TLC) in the post-operative period which is consistent with studies in the past. Due to small sample size of the study, the data generated can be utilized as a baseline to study correlation between pain and inflammatory marker levels on a larger scale at multicentric levels.