https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60353-5.pdf

Failure rates of stemmed metal-on-metal hip replacements: analysis of data from the National Joint Registry of England and Wales

The dismal outcome of tuberculosis of the spine in the pre-antibiotic era has improved significantly because of the use of potent antitubercular drugs, modern diagnostic aids and advances in surgical management. MRI allows the diagnosis of a tuberculous lesion, with a sensitivity of 100% and specificity of 88%, well before deformity develops. Neurological deficit and deformity are the worst complications of spinal tuberculosis. Patients treated conservatively show an increase in deformity of about 15°. In children, a kyphosis continues to increase with growth even after the lesion has healed. Tuberculosis of the spine is a medical disease which is not primarily treated surgically, but operation is required to prevent and treat the complications. Panvertebral lesions, therapeutically refractory disease, severe kyphosis, a developing neurological deficit, lack of improvement or deterioration are indications for surgery. Patients who present with a kyphosis of 60° or more, or one which is likely to progress, require anterior decompression, posterior shortening, posterior instrumented stabilisation and anterior and posterior bone grafting in the active stage of the disease. Late-onset paraplegia is best prevented rather than treated. The awareness and suspicion of an atypical presentation of spinal tuberculosis should be high in order to obtain a good outcome. Therapeutically refractory cases of tuberculosis of the spine are increasing in association with the presence of HIV and multidrug-resistant tuberculosis.

/pdf/tuberculosis-of-the-spine-a-fresh-look-at-an-old-disease-yfo66tak14.pdf

Tuberculosis of the spine: a fresh look at an old disease.

Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired. This alters knee biomechanics and kinematics and significantly increases tibiofemoral contact pressure. In recent years, meniscal root tears, which by definition include direct avulsions off the tibial plateau or radial tears adjacent to the root itself, have attracted attention because of concerns that significant meniscal extrusion dramatically inhibits normal meniscal function, leading to a condition biomechanically similar to a total meniscectomy. Recent literature has highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in magnetic resonance imaging and arthroscopy. This article presents a review of the clinically relevant anatomic, biomechanical, and functional descriptions of the meniscus root attachments, as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus root attachments.

Meniscal Root Tears: Significance, Diagnosis, and Treatment

THE LUMBAR SPINE: Mechanical Diagnosis and Therapy, R.A.

To determine changes in bone density during growth, trabecular vertebral density and an index of spinal cortical bone were measured with quantitative computed tomography in 101 children. The children were divided by age into three groups: prepubertal, indeterminate, and pubertal. Compared with prepubertal children, pubertal adolescents had significantly higher trabecular bone density and more compact bone in the spine (P less than .001). After controlling for puberty, vertebral bone density failed to correlate significantly with age, sex, weight, height, surface area, and body mass index. The results indicate that bone density increases markedly during puberty.

Vertebral Bone Density in Children: Effect of Puberty

Groin pain remains one of the most poorly understood conditions in clinical sports medicine. It may be caused by either extra-articular or intra-articular conditions. While extra-articular causes have been extensively studied and reasonably understood, a number of elusive intra-articular causes are emerging, many of which were previously unknown and therefore undiagnosed, leading to premature ending of many competitive careers. This article makes an attempt to look at various, elusive intra-articular causes of groin pain in athletes. This article also analyses the currently available evidence on trends in diagnosis and treatment for these conditions.

Emerging intra-articular causes of groin pain in athletes.

This survey of spine surgeons aimed to determine the prevalence of neck pain and identify the associated risk factors. The prevalence of neck pain has been reported in various medical sub-specialities including laparoscopy surgeons, dentists, plastic surgeons, ophthalmologist, urologist and orthopaedic surgeons. However, the literature is lacking on prevalence and risk factors for neck pain in spine surgeons.A survey questionnaire containing demographic, Neck pain and work practice details was administered to 300 spine surgeons (members of an online group) via text message and e-mail.One hundred and eighty surgeons responded to the survey (response rate, 60%). Three spine surgeons had previous cervical spine surgeries. The 1-month prevalence rate of neck pain was 74.4% (134/180 surgeons). One hundred and eighteen surgeons (88%) reported only neck pain, 16 surgeons (11.9%) had neck pain with radicular arm pain. Only 20.5% of surgeons used a loupe, 18% of surgeons used a microscope, and 24% of surgeons used operating table height at umbilicus during surgery. There was no significant difference between the mean age (p = 0.65), work experience (p = 0.8), time spent in surgery (p = 0.7), and operating table height preference (p = 0.4) when symptomatic and asymptomatic groups were compared. However, a significantly greater percentage of surgeons had a sedentary lifestyle (p = 0.002) & used loupes as compared to microscopes (p = 0.04) in the symptomatic group. There was significant correlation between the surgeon's lifestyle & use of loupe and the incidence of neck pain.Spine surgeons have a higher prevalence of neck pain than general populations and surgeons from other specialties. Considering the high prevalence of neck pain, general health, work, and ergonomic guidelines and recommendations must be formulated to help prevent and decrease the burden of neck pain among spine surgeons. 

Prevalence and risk factors of neck pain in spine surgeons - Are we our own patients?

Bone cuts and soft-tissue releases are the principal steps in TKA. However, some knees undergoing TKA may require an additional procedure in the form of an osteotomy. An osteotomy in primary TKA is usually indicated in rigid or severe deformities to facilitate soft-tissue balance and deformity correction, to concomitantly correct an extra-articular deformity or rarely to facilitate exposure of the joint. Frequently, in varus arthritic knees undergoing TKA, the medial and posteromedial side of the tibial plateau shows adaptive changes resulting in the formation of a prominent bony flare in this area. This causes local tenting of the medial soft-tissue structures and contributes to knee deformity and medio-lateral soft-tissue imbalance. A reduction osteotomy involves excision of this medial bony flare to decompress the medial soft-tissue structures. Rarely, despite extensive soft-tissue release and a reduction osteotomy, a knee deformity may be too rigid and/or the medio-lateral soft-tissue imbalance too severe to correct. In such cases a sliding medial condylar osteotomy (SMCO) in a varus knee or a lateral epicondylar osteotomy (LEO) in a valgus knee may be required to achieve optimum limb alignment and soft-tissue balance.

Osteotomies in Total Knee Arthroplasty

Management of Pyogenic Spondylodiscitis Following Nonspinal Surgeries: A Tertiary Care Center Experience.

Excessive soft-tissue laxity is frequently encountered in severely deformed arthritic knees undergoing TKA. It is usually uni- or biplanar where the lateral side (in varus deformity) or medial side (in valgus deformity) shows excessive laxity with or without an associated posterior laxity (in hyperextension deformity). However, rarely, an arthritic knee undergoing TKA may also show multiplanar or global laxity where there is significant medial, lateral and posterior ligamentous insufficiency along with significant bone loss. Although extremely rare in osteoarthritis or rheumatoid arthritis, severe or global knee instability may be secondary to a neuromuscular disorder (such as post-poliomyelitis, spinal neuropathy) or due to post-traumatic global ligamentous insufficiency.

Gautam M. Shetty

Papers

Emerging intra-articular causes of groin pain in athletes.

Prevalence and risk factors of neck pain in spine surgeons - Are we our own patients?

Osteotomies in Total Knee Arthroplasty

Management of Pyogenic Spondylodiscitis Following Nonspinal Surgeries: A Tertiary Care Center Experience.

The Unstable Knee