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Introduction: Patello-femoral complications are the most common complications in postoperative Total Knee Arthroplasty (TKA) patients especially overstuffing of Patello - Femoral Joint (PFJ). So, to study the effects of overstuffing of PFJ in postoperative TKA patients we put forth a new dimension - "PATELLO - FEMORAL COMPOSITE (PFC)". This is the maximum distance between anterior cortical line of femur shaft and the anterior cortex of patella with knee in full extension. Aim: To calculate chances of overstuffing of PFJ in postoperative TKA patients and document the effect of overstuffing of PFJ on the passive knee Range of Motion (ROM) in post- op TKA patients. Materials and Methods: This was a prospective observational study which included 51 consecutive primary TKAs. Preoperative and postoperative (24 weeks) passive knee ROM was measured. Preoperative and postoperative radiological parameters {PFC, Anterior Femur Offset (AFO), Patellar thickness (PT)} was recorded using Computed Tomography (CT) Scanogram image of patient in lateral view with knee in full extension and perfect overlap of both femur condyles, using DICOM format of the CT Scanogram image on the DICOM viewer. Results: The postoperative PFC was more than its Preoperativevalue in 80.39% TKAs. Patients who had increased postoperative PFC had significantly less Preoperative AFO. Female patients in our study had significantly less Preoperative AFO compared to males. Thus, we deduced that female patients with lesser Preoperative AFO undergoing TKA had increased postoperative PFC than male patients. PFC not only accounted for the overstuffing of the PFJ because of the patellar component, but also because of the femoral component; thus was a better measure of PFJ overstuffing compared to isolated PT. Passive knee ROM in the postoperative TKA patients approximately decreased by 2 degrees for every 1 mm increase in PFC compared to its Preoperative-value in the patients with PFJ overstuffing. Conclusion: We conclude that overstuffing of the PFJ in postoperative TKA is present in 80.39% patients. Higher chances of postoperative PFJ over stuffing are present in female patients and those with thinner anterior cortex of distal femur. Postoperative passive knee ROM decreases significantly in patients with postoperative PFJ overstuffing (Every 1 mm increase in the postoperative PFC, passive knee ROM decreased by approximately 2 degrees). [ABSTRACT FROM AUTHOR]

Orthopaedic Surgeons rarely encounter mycobacterial infections in Post Total Knee Arthroplasty (TKA) patients. We present series of two cases to create awareness among clinicians to expect the unexpected. Tuberculosis typical/atypical is a hidden culprit in catch clinical situations when chronic infection is Suspected, but the lab investigations are negative in persistently symptomatic patients. In such situations clinicians should suspect atypical or complex mycobacterial infections and evaluate the patients accordingly. Clinical suspicion, evaluation, isolation and treatment of atypical or complex mycobacterial infections with sensitive chemotherapy, leads to complete resolution of infection and full functional rehabilitation. [ABSTRACT FROM AUTHOR]

The technique of high tibial osteotomy (HTO) was traditionally documented for symptomatic medial tibiofemoral arthrosis associated with coronal plane malalignment in a stable knee., recently, more attention has been given to the treatment of coronal malalignment in lax knees with HTO with or without ligament reconstruction. Patients with overwhelming pain, chronic ligament deficiency and coronal or sagittal deformity are generally easier to treat with HTO as compared to those who have mild pain and a proximal tibial deformity. The instability at the knee joint can be either in the coronal or sagittal plane or in both planes. Younger patients with chronic ACL deficiency, varus malalignment and advanced medial compartment arthritis, who present with pain and slight instability show satisfactory results with HTO. Double-limb weight bearing anteroposterior view radiographs are used to plot mechanical leg axis (from the centre of the femoral head to the centre of the knee), anatomical axis (a line from the centre of the piriformis fossa to the centre of the knee joint and a line through the long axis of tibia) and weight bearing axis (line drawn from the centre of the femoral head to the centre of the ankle joint) and are used to plan HTO. A 3-dimensional pre-operative plan using CT and MRI is recently studied. The decision to perform HTO alone or in combination with ligament reconstruction involves consideration of patient demographics, symptoms and ligaments involved. The most commonly used surgical techniques for high tibial osteotomy include lateral close wedge osteotomy, medial open wedge osteotomy and dome osteotomy. The post-operative rehabilitation depends on the rigidity of fixation., Competing Interests: None of the authors have any financial or other conflicts of interest that may bias the current manuscript., (© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Background: End stage arthritis in young patients requires surgical intervention. THA remains the treatment of choice for restoring function and activity in end stage hip arthritis. The medium term outcome of uncemented THA in Indian population is less studied. Hence this study was taken up with aim to study clinical and radiological outcome of uncemented THA in patients with age less than 40 years., Methods: This study was conducted during January 2013 to December 2013. Overall 66 patients with 74 arthritic hips were operated by single surgeon (1st Author) with Uncemented THA. All patients were either unilateral or bilateral arthritis of hip less than 40 years of age. Patients were evaluated preoperatively and postoperatively. After discharge patients were followed up at regular intervals. Activity level and Harris Hip score was calculated. Radiological evaluation was done with anteroposterior and lateral X-rays., Results: Total 50 patients (56 hips) followed up at five year follow-up. Clinical and radiological evaluation was done during follow-up. Most common etiology was avascular necrosis of hip (56.6%). None of the patients had any major complications. Mean Harris Hip score improved from 36 to 92. The activity level was assessed at five year follow-up with maximum patients in moderate manual labor category. Bony ingrowth with no evidence of loosening was seen consistently both on femoral and acetabular side in all patients on X-ray. No statistically significant association was found between initial alignment of the femoral component and clinical outcome., Conclusion: Uncemented THA can be used in young patients with excellent to good functional and radiological outcome at midterm follow-up, high satisfaction rate and lower rate of complications., Competing Interests: None declared., (© 2019 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)