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Repurposing Denosumab to Stabilize Acetabular Protrusio: Obviating Surgery

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Open Journal of Orthopedics 2020年第5期10卷 110-115页

作者： sanjay Agarwala Mayank Vijayvargiya Chief of Surgery and Director Professional Services P. D. Hinduja Hospital and Medical Research Centre Mumbai India Department of Orthopedics P. D. Hinduja Hospital and Medical Research Centre Mumbai India

Intrapelvic prosthetic migration prosthesis following hip arthroplasty can occur due to aseptic loosening, infection, injury and malposition of the cup with chronic instability. Revision surgery is the treatment option, but is often complex, is high risk owing to the co-morbidities of the patient, has higher complications and sometimes even patients refuse for the surgery. Osteoclast mediated bone resorption at the prosthetic bone interface is the main pathophysiology process involved in aseptic loosening associated intrapelvic migration. RANK/RANKL (Receptor Activated Nuclear factor κB Ligand) is the primary pathway responsible for the periprosthetic osteolysis, therefore, we have offered Denosumab which binds to RANKL and inhibits osteoclasts mediated bone resorption, to our two patients with intrapelvic prosthetic migration who have refused for the revision surgery. Here, we report the outcome of these two cases of Intrapelvic prosthetic migration following a hip arthroplasty that was treated using subcutaneous injection of 120 mg denosumab monthly for 3 months. Both the cases had good functional outcomes and radiographs showed good consolidation of bone around the prosthesis. These cases suggest denosumab can be repurposed to arrest further intrapelvic prosthetic migration due to its anti-resorptive and bone forming action and can avoid the need for a complex revision surgery.

关键词： Denosumab Re-Purpose Prosthetic Migration Osteolysis

Correlation of Preoperative D-Dimer Levels and Postoperative Venous Thromboembolism in Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty

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Open Journal of Orthopedics 2021年第9期11卷 269-277页

作者： sanjay Agarwala Mayank Vijayvargiya Neeraj Mishra Department of Orthopedics P.D. Hinduja National Hospital Mumbai India

Background: The relationship of preoperative D-dimer and Venous thromboembolism (VTE) after total knee arthroplasty (TKA) and total hip arthroplasty (THA) remains controversial. The purpose of this study was to assess the value of D-dimer in the detection of early VTE after TKA and THA. Materials and Methods: A total of 312 patients were evaluated in this retrospective study from 2016 to 2020 at a tertiary care centre, Mumbai who were operated for THA and TKA. The measurement of plasma D-dimer level was done preoperatively and clinically symptomatic patients were evaluated and confirmed for VTE by Colour Doppler Sonography. The plasma D-dimer levels were correlated statistically with the sonographic VTE. Results: 11 patients developed Deep Vein Thrombosis (DVT) and 1 patient developed Pulmonary embolism (PE). Preoperative plasma D-dimer levels were significantly higher (P (pelvic and femoral veins), and 2 thrombi were seen in distal veins (posterior tibial, peroneal, gastrocnemian veins) of the calf in THA patients, and all 8 thrombi were seen in the distal veins (posterior tibial, peroneal, gastrocnemian veins) of the calf in TKA patients. Conclusion: We infer that if the preoperative D-dimer levels were more than 0.5 mg/l, the chances of developing VTE postoperatively are more, which can be diagnosed clinically and further by other investigations. In this study, we have shown that doing preoperative D-dimer level can almost PREDICT the development of VTE and thus prevent complications.

关键词： Plasma D-Dimer DVT Colour Doppler Clinical DVT Preoperative D-Dimer TKA THA Early DVT

Osteotendinous Suturing for Anchorage of Medial Arthrotomy in Total Knee Arthroplasty

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Open Journal of Orthopedics 2016年第12期6卷 357-362页

作者： sanjay Agarwala Lokesh Sharoff Sameer Chaudhari Department of Orthoapedic Surgery P.D. Hinduja National Hospital & Medical Research Centre Mumbai India

Aim: To develop a method for closure of the arthrotomy wound and approximation of the medial periosteum at the level of tibial tuberosity after total knee arthroplasty in severe varus deformity. Method: We describe a technique of osteotendinous suturing through the tibial tuberosity for suturing of the medially elevated periosteum. Result: This is an easily reproducible technique which results in very early mobilisation and no additional complications and has several advantages over other methods of closure. Conclusion: The osteotendinous technique can be used for medial arthrotomy closure after correction of severe varus deformities and also after partial patellar tendon avulsions in total knee arthroplasty surgeries.

关键词： Total Knee Replacement Anchor Patellar Tendon Avulsion Bone Tunnel Patellar Tendon Suturing Transosseous

Patellaplasty, as an Alternative to Replacing Patella in Total Knee Arthroplasty

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Open Journal of Orthopedics 2015年第9期5卷 277-282页

作者： sanjay Agarwala Anshul Sobti Siddhant Naik Department of Orthoapedic Surgery P.D Hinduja National Hospital & Medical Research Centre Mahim Mumbai India

Aim: In tricompartmental osteoarthritis of the knee, the patellofemoral articulation is severely affected due to degenerative changes. Patellaplasty is done as a part of total knee arthroplasty in these cases to smoothen the articular surface of patella. However, an ideal technique with easy reproducibility has been scarcely reported for the same. Method: We describe a method of using electrocautery and power saw with thin blades for patellaplasty. Results: Using this technique, we have produced results, which are comparable with cases where patellar resurfacing has been done. Conclusion: This described method for patellaplasty is easy with good reproducibility.

关键词： Patellaplasty Electrocautery Power Saw Total Knee Arthroplasty

Restoring Natural Hip Movements with Large Head (Ceramic on Ceramic) Total Hip Replacement: Experience of Our 150 Patients over 6 Years

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Open Journal of Orthopedics 2017年第12期7卷 414-427页

作者： sanjay Agarwala Mayank Vijayvargiya Sameer Chaudhari Department of Orthopedics P.D. Hinduja National Hospital Mumbai India

Background: Asian cultures require floor-seated positions demanding a high range of motion (ROM). Ceramic-On-Ceramic (COC) interface allowed the use of larger head with reduced wear debris generation and adverse tissue reactions. This study was conducted to analyze 6-year clinical-radiological outcome with large head fourth generation DeltaMotion®ceramic-on-ceramic (COC) hip articulation, with special emphasis on postoperative ROM, ability to sit cross-legged, stability, hip noise and revision surgery. Material and Methods: 150 consecutive hips were operated for primary cementless Total Hip Replacement (THR) using DeltaMotion®at a tertiary care center in Mumbai, India, between January 2010 and January 2015. Clinico-radiological outcome was assessed using the Harris Hip Score (HHS) and radiographs at 6 weeks, 6 months, and annually thereafter. Results: 108 (74.5%) patients were males and 37 (25.5%) were females with an average age of 50.87 years. Mean follow-up was 54 months (range: 37 - 86 months). The mean ROM was 120° in flexion, 10° in extension, 30° in adduction, 45° in abduction, 25° in internal rotation and 25° in external rotation. The mean HHS showed a statistically significant improvement of 64.5% (from 54.66 ± 6.42 pre-operatively to 89.95 ± 4.32 post operatively) (p-value: 0.001). 92% of patients were able to sit in squatting position and 92% were able to sit cross-legged on the floor at last follow-up. 0.7% joints (1 hip) had squeaking. Considering no revision surgery as the end point, 6-year prosthesis survivorship was 100%. Complications (superficial infection) occurred in three hips (2%). All patients reported to be satisfied with their outcome after surgery. Conclusion: We infer that DeltaMotion large head COC bearing allows scope for using larger head size in relatively smaller Indian hips due to factory fitted ceramic lining. At 6-year follow-up, high activity level was observed with excellent clinical-radiological outcomes and component lo

关键词： Ceramic-on-Ceramic Total Hip Arthroplasty Squeaking Prosthesis Survivorship Harris Hip Score