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Local infiltrative analgesia reduces post-operative pain and hospital stay in total knee replacement
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j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 6 ( 2 0 1 5 ) 6 1 e6 7
Ploidy by Feulgen IOD showed that 10 of 20 (50%) were diploid, 9(45%) were hyperploids and 1(5%) was aneuploid. All 5 Campanacci grade I and grade II were diploid (100%). 5 out of remaining 14(35.71%) grade III tumours were diploid, while 9(64.29%) were non diploid which was significant (p¼0.013). Estrogen and progesterone receptor was negative in all the 11 female patients. P53 status Out of 21 patients in whom p53 was analysed, 4 were positive(19.05) and 17(80.95%) were negative. Out of 4 positive patients 3 were recurrent at presentation while 1 was primary. Out of 17 negative cases, 9 (52.94%) were primary and 8(47.06%) were recurrent which was not significant (p¼0.314) Conclusions e Aneuploidy is a risk factor for aggressiveness of GCT. Hyperploidy of GCT correlates with clinical and radiological aggressiveness but it has no correlation to recurrence of GCT. Estrogen and progesterone have no role to play in aggressiveness of GCT. P53 has no correlation with aggressiveness of GCT.
AU10. Local infiltrative analgesia reduces post-operative pain and hospital stay in total knee replacement V. Vijay, R. Vaishya, A. Majeed Wani Indraprastha Apollo Hospital, New Delhi Background: Postoperative analgesia following Total Knee Arthroplasty (TKA) with the use of parenteral opioids or epidural analgesia can be associated with troublesome side effects which
may lead to prolonged hospital stay which in turn may cause unwanted medical problems like nosocomial infection, DVT and poor surgical outcome. Methods: Eighty patients undergoing TKA were randomized to receive a periarticular mixture of drugs containing bupivacaine, ketorolac, morphine, and adrenaline or to receive normal saline. All patients received patient controlled analgesia (PCA) for 72 hours post operatively, followed by standard analgesia. Visual analog scores (VAS) (at rest and during activity) and for patient satisfaction and range of motion were recorded postoperatively. The consumption of PCA postoperatively and the overall analgesic requirement was measured. Results: The patients who had received the periarticular injection used significantly less PCA after the surgery as compared to control group. They had lower VAS for pain during rest and activity and higher patient satisfaction 72 hours after the operation (p<0.001). The length of hospital stay was also lower in the LIA group as compared the control group (statistically significant e p<0.001). The post operative range of motion gained in the LIA group was also greater than the control group. Conclusions: Intraoperative periarticular injection with multimodal drugs following TKA can significantly reduce the postoperative pain and hence the requirements for PCA and improve patient satisfaction, with no apparent risks. The added advantage of using local infiltrative analgesia is the reduced cost and the ease of administration of the drugs.
Above 40 AF1. A modified Stoppas approach: The new way of managing acetabular fractures V. Trikha Background: Anterior fixation of acetabular fractures usually involves lot of intricacies and also morbidity to the patient with ilioinguinal and iliofemoral approaches being commonly used. In the last decade, modified Stoppas approach has evolved as a better way of approaching these fractures. The prospective early results of a single surgeon managed acetabular cases with modified Stoppas approach have been evaluated in this study. Materials and methods: All cases of acetabular fractures managed with modified Stoppas approach were prospectively studied from January 2013 till April 2014. Patients with a minimum followup of six months were only included. Various intraoperative parameters with the early followup of these patients were evaluated and compared with a previous subset of patients operated with ilioinguinal approach. Results: 18 patients with acetabular fractures were operated with modified Stoppas approach during this period. Majority of them were males with only 2 females. Most of them were T type, associated both column fracture, or anterior column with posterior hemitransverse fractures. 12 patients required additional lateral window of the iliac crest for the plate application or posterior column screw fixation. The reduction achieved with this approach was within 2 mm for both anterior column and posterior column fractures. Blood loss (avg 470ml) was less as compared to the ilioinguinal approach patients previously operated by the same surgeon. The average total duration of surgery was 164 minutes with a total duration of stay of average 7.4 days.
Conclusion: Modified Stoppas approach is a good surgical approach for patients with complex acetabular fractures. It causes less morbidity to the patient with lesser hospital stay and better immediate postoperative reduction of the complex fractures. This is the first study from our country presenting the early results of modified Stoppas approach in acetabular fractures.
AF2. Rationale and utility of single approach for management of complex acetabular fractures: Our experience P. Mishra1,2, Ish.K. Dhammi1,2, R.Ul. Haq1,2 1 University College of Medical Sciences, Delhi, India; 2Guru Teg Bahadur Hospital, Delhi, India Introduction: Complex acetabular fractures are the ones that involve both the columns and frequently may necessitate utilization of more than a single approach for stabilization of both the columns. Dual approach, in addition to increasing the morbidity, may also be difficult at times as occasionally fixation of one column may preclude the mobility of the fracture fragment via the second approach. We present our experience in treating 30 cases of complex acetabular fractures from April 2007 to October 2013by utilizing only a single (extensile or a nonextensile) approach and indirect reduction and stabilization of the opposite column. Materials and methods: As per Letournel and Judet classification, there were 12 anterior column with posterior hemitransverse fractures, 7 both column, 1 both column with posterior wall, 2 T fractures, 7 transverse fractures with posterior wall fractures, 1 four month neglected transverse with malunited posterior wall fracture with AVN of femoral head. The single approaches used in the cases were Ilioinguinal approach (19 cases), Kocher Langenbeck approach (4 cases), Trochanteric flip osteotomy via Kocher
j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 6 ( 2 0 1 5 ) 6 1 e6 7
Ploidy by Feulgen IOD showed that 10 of 20 (50%) were diploid, 9(45%) were hyperploids and 1(5%) was aneuploid. All 5 Campanacci grade I and grade II were diploid (100%). 5 out of remaining 14(35.71%) grade III tumours were diploid, while 9(64.29%) were non diploid which was significant (p¼0.013). Estrogen and progesterone receptor was negative in all the 11 female patients. P53 status Out of 21 patients in whom p53 was analysed, 4 were positive(19.05) and 17(80.95%) were negative. Out of 4 positive patients 3 were recurrent at presentation while 1 was primary. Out of 17 negative cases, 9 (52.94%) were primary and 8(47.06%) were recurrent which was not significant (p¼0.314) Conclusions e Aneuploidy is a risk factor for aggressiveness of GCT. Hyperploidy of GCT correlates with clinical and radiological aggressiveness but it has no correlation to recurrence of GCT. Estrogen and progesterone have no role to play in aggressiveness of GCT. P53 has no correlation with aggressiveness of GCT.
AU10. Local infiltrative analgesia reduces post-operative pain and hospital stay in total knee replacement V. Vijay, R. Vaishya, A. Majeed Wani Indraprastha Apollo Hospital, New Delhi Background: Postoperative analgesia following Total Knee Arthroplasty (TKA) with the use of parenteral opioids or epidural analgesia can be associated with troublesome side effects which
may lead to prolonged hospital stay which in turn may cause unwanted medical problems like nosocomial infection, DVT and poor surgical outcome. Methods: Eighty patients undergoing TKA were randomized to receive a periarticular mixture of drugs containing bupivacaine, ketorolac, morphine, and adrenaline or to receive normal saline. All patients received patient controlled analgesia (PCA) for 72 hours post operatively, followed by standard analgesia. Visual analog scores (VAS) (at rest and during activity) and for patient satisfaction and range of motion were recorded postoperatively. The consumption of PCA postoperatively and the overall analgesic requirement was measured. Results: The patients who had received the periarticular injection used significantly less PCA after the surgery as compared to control group. They had lower VAS for pain during rest and activity and higher patient satisfaction 72 hours after the operation (p<0.001). The length of hospital stay was also lower in the LIA group as compared the control group (statistically significant e p<0.001). The post operative range of motion gained in the LIA group was also greater than the control group. Conclusions: Intraoperative periarticular injection with multimodal drugs following TKA can significantly reduce the postoperative pain and hence the requirements for PCA and improve patient satisfaction, with no apparent risks. The added advantage of using local infiltrative analgesia is the reduced cost and the ease of administration of the drugs.
Above 40 AF1. A modified Stoppas approach: The new way of managing acetabular fractures V. Trikha Background: Anterior fixation of acetabular fractures usually involves lot of intricacies and also morbidity to the patient with ilioinguinal and iliofemoral approaches being commonly used. In the last decade, modified Stoppas approach has evolved as a better way of approaching these fractures. The prospective early results of a single surgeon managed acetabular cases with modified Stoppas approach have been evaluated in this study. Materials and methods: All cases of acetabular fractures managed with modified Stoppas approach were prospectively studied from January 2013 till April 2014. Patients with a minimum followup of six months were only included. Various intraoperative parameters with the early followup of these patients were evaluated and compared with a previous subset of patients operated with ilioinguinal approach. Results: 18 patients with acetabular fractures were operated with modified Stoppas approach during this period. Majority of them were males with only 2 females. Most of them were T type, associated both column fracture, or anterior column with posterior hemitransverse fractures. 12 patients required additional lateral window of the iliac crest for the plate application or posterior column screw fixation. The reduction achieved with this approach was within 2 mm for both anterior column and posterior column fractures. Blood loss (avg 470ml) was less as compared to the ilioinguinal approach patients previously operated by the same surgeon. The average total duration of surgery was 164 minutes with a total duration of stay of average 7.4 days.
Conclusion: Modified Stoppas approach is a good surgical approach for patients with complex acetabular fractures. It causes less morbidity to the patient with lesser hospital stay and better immediate postoperative reduction of the complex fractures. This is the first study from our country presenting the early results of modified Stoppas approach in acetabular fractures.
AF2. Rationale and utility of single approach for management of complex acetabular fractures: Our experience P. Mishra1,2, Ish.K. Dhammi1,2, R.Ul. Haq1,2 1 University College of Medical Sciences, Delhi, India; 2Guru Teg Bahadur Hospital, Delhi, India Introduction: Complex acetabular fractures are the ones that involve both the columns and frequently may necessitate utilization of more than a single approach for stabilization of both the columns. Dual approach, in addition to increasing the morbidity, may also be difficult at times as occasionally fixation of one column may preclude the mobility of the fracture fragment via the second approach. We present our experience in treating 30 cases of complex acetabular fractures from April 2007 to October 2013by utilizing only a single (extensile or a nonextensile) approach and indirect reduction and stabilization of the opposite column. Materials and methods: As per Letournel and Judet classification, there were 12 anterior column with posterior hemitransverse fractures, 7 both column, 1 both column with posterior wall, 2 T fractures, 7 transverse fractures with posterior wall fractures, 1 four month neglected transverse with malunited posterior wall fracture with AVN of femoral head. The single approaches used in the cases were Ilioinguinal approach (19 cases), Kocher Langenbeck approach (4 cases), Trochanteric flip osteotomy via Kocher