Anil Kapoor

Purpose Total knee arthroplasty (TKA) is the preferred treatment for end-stage knee osteoarthritis, but challenges arise with severe angular deformities and associated tibial bone loss. The cement screw construct has emerged as a promising technique for managing these defects, offering advantages such as cost-effectiveness, accessibility, and ease of implementation. This research evaluated the clinical, functional and radiological outcome of screw-cement construct for the tibial defects in TKA. Method This retrospective study aimed to evaluate the long-term functional outcomes and success rate of the cement screw construct in patients with significant tibial defects. Sixty-five patients (104 knees) undergoing TKA were divided into two groups: conventional TKA (Group A) and TKA with screw-cement construct (Group B). Demographic, clinical, and radiological data were collected, with a follow-up duration of at least eight years. Results The study revealed comparable demographic characteristics between groups. Both cohorts exhibited significant postoperative improvements in knee morphology and clinical outcomes. Group B demonstrated a higher incidence of radiolucency around the tibial tray, although no progressive complications were observed. Implant survival rates were similar between groups, with complications such as aseptic loosening and infections occurring in both without significant difference. Conclusions This study emphasised the viability of the screw-cement construct for managing uncontained tibial defects during TKA, providing evidence of its efficacy, and cost-effectiveness and suggesting its potential as a standard approach for tibial defects till 20 mm.

Background Elbow fractures are common in elderly patients with osteoporotic bones, typically resulting from falls on the elbow. Common fracture types include distal humerus, olecranon, and radial head fractures. Occasionally, a combination of these fractures occurs, creating complex injuries such as terrible triad injuries. Accurate evaluation using X-rays and CT scans is essential for optimal treatment planning. Careful preoperative planning, including the decision between non-operative and operative treatment and selecting appropriate surgical implants, is critical for achieving successful outcomes. Objective This chapter focuses on common elbow fractures in elderly patients and explores the available treatment options. Given the lack of clear consensus on managing elbow fractures in osteoporotic bones, we address the associated complications and highlight various treatment approaches. Current Knowledge Numerous treatment methods have been proposed for osteoporotic elbow fractures, including various fixation techniques, arthroplasty, and excisions. Despite the availability of multiple treatment options, no method has emerged as superior. Each method has distinct advantages and disadvantages. This chapter aims to compile and compare these options, outlining their respective pros and cons. Conclusions Elbow fractures in osteoporotic bones present significant challenges for surgeons. Although elderly patients with osteoporotic bones generally have lower functional demands compared to younger individuals, they still require adequate, pain-free elbow function for daily activities. Advances in surgical techniques and implant technology have expanded treatment options for these fractures. Achieving successful outcomes requires selecting the appropriate implant, meticulous preoperative planning, and expert surgical execution tailored to the specific fracture characteristics.

Background Osteoporosis, whether generalized or localized, presents significant challenges in arthroscopic procedures, particularly in surgeries such as ligament reconstructions and rotator cuff repairs, which depend on fixation through interference screws and/or anchors. These challenges are especially pronounced in women, the elderly, and individuals with chronic injuries. The literature discusses various techniques to mitigate these issues. Objective Despite the recognition of these challenges, there is no clear consensus on the most effective methods to address them. Current literature lacks comprehensive information on the specific difficulties surgeons encounter when managing sports injuries in osteoporotic bones, particularly around the knee. This manuscript aims to outline and describe various treatment strategies to manage sports injuries in patients with osteoporotic bones. Current Knowledge Numerous studies acknowledge the heightened risk of fixation failure in osteoporotic bones. Surgeons have described various techniques to address these fixation issues, such as alternative fixation methods, preserved insertion techniques, bone bridge techniques, larger diameter screws, and supplementary fixation strategies. Techniques such as transosseous equivalent (TOE) repair, special suture configurations, multiple fixation points, medial anchor placement in subchondral bone, and bone cement augmentation are among the methods used to improve anchor fixation in osteoporotic bone. Literature Gap Although multiple surgical techniques are available for graft and tendon fixation in osteoporotic bones, there is no clear guideline on which method offers the best combination of biological and mechanical superiority. This article reviews the various fixation techniques and explores innovative approaches to graft fixation. In addition, the authors emphasize the importance of medical management of osteoporosis in patients undergoing surgical interventions, highlighting the role of bisphosphonate, teriparatide, denosumab. Medical therapy not only reduces the risk of fixation failure but also plays a crucial role in post-operative recovery. Conclusions With the growing emphasis on healthy lifestyles, increasing numbers of elderly patients are participating in sports activities. As a result, more patients with low bone mineral density (BMD) are seeking treatment for sports injuries. Anticipating the issue of regional low BMD is essential, even in younger patients, to ensure that alternative fixation techniques are employed when necessary.

Objective This study aims to enhance our understanding of the morphological pattern, causes and pathogenesis of meniscal root injuries in the Indian population. Materials and Methods Sixty-four patients with meniscus root tears were included in the study. The patients were categorized into two groups based on the location of the meniscus tear: Group 1 (n = 41) comprised patients with lateral meniscus root injury (LMRI), and Group 2 (n = 23) included patients with medial meniscus root injury (MMRI). Demographic and patient-specific data, such as age, gender, BMI, history of injury, and injury type, were recorded. All patients underwent surgical treatment, and intraoperative findings (chondral damage grade, type of root injury, associated ligamentous injuries) were documented. Meniscus root tears are further classified into 5 categories depending upon their morphological types. A minimum 12-month follow-up assessed functional outcomes using the Lysholm and IKDC knee scores. Results The mean age for MMRI and LMRI was 50.3 years and 29.4 years, respectively. In the MMRI group, 48% (11/23) were female compared to only 15% (6/41) in the LMRI group. The mean BMI in the MMRI and LMRI groups was 30.1 and 25.4, respectively. Nine patients in MMRI and 4 patients in LMRI group exhibited grade 3 or higher chondral damage. Type 2 meniscus root tear was most common type in both the groups (51% in MMRI vs. 74% in LMRI). Both LMRI and MMRI groups demonstrated significant improvement in functional outcomes. Conclusions Medial meniscus root injuries predominantly occur in the elderly without a significant history of trauma, often associated with a high grade of medial femoral chondral damage, suggesting a degenerative etiology. In contrast, lateral meniscus root injuries tend to occur in younger patients with a notable history of knee injury, indicative of a traumatic etiology for LMRI.

Objectives: This study aimed to see the mean quadruple hamstring tendon (HT) graft in the North Indian population and the effect of height and gender on graft diameter. Materials and Methods: Three hundred and twelve patients who underwent anterior cruciate ligament reconstruction using quadruple HT graft with preserved insertions were included in the study. Quadruple graft diameter is calculated using a sizing tube and its correlation with height, gender, and body mass index was calculated. All patients were followed up for a minimum of 2 years, and the incidence of graft failure was calculated. Results: The mean graft diameter in the present study was 7.6 mm; taller patients and male gender have thicker grafts. About 63% of patients had graft diameters <8 mm. The incidence of graft failure rate was 2.5% and 0.8% in patients with graft diameters <8 mm and ≥8 mm, respectively. Conclusion: In the present study, the average quadruple HT graft diameter in the Indian population was 7.6 mm, and graft diameter depends on the height and gender of the patient.

Introduction The surgical management of intertrochanter femur fracture in elderly patient is still under debate. Various implants can be utilised but prosthetic replacement is gaining popularity. This study was performed to evaluate the functional and clinical outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in elderly patients (> 70 years). Materials and methods Thirty-seven patients with unstable intertrochanteric fracture in elderly patient (> 70 years) who underwent cemented bipolar hemiarthroplasty. Intra-operative and post-operative complications were noted; functional outcomes were assessed using Harris hip score (HHS). All patients were followed up for a minimum of 12 months. Results Overall 90% of patients has some minor or major intra or post-operative complication. One year mortality rate was 16% (6/37). Cardiopulmonary events were the most common life threatening incident. Mean fall in Haemoglobin was 1.6 gm/dL. The average time for full weight bearing mobilisation with the help of walker was 2.8 ± 1.2 days (1–8 days). The average duration of surgery was 58 ± 6 min (44–96 min) with an average blood loss of 126 ± 24 mL (90–380 mL). HHS at the end of 12 months was 77. Conclusions The use of bipolar hemiarthroplasty in senile patient with unstable hemiarthroplasty gives an advantage of early weight bearing. However, it is associated with risk of significant intra or post-operative morbidity due to intra-operative trauma, surgical time and blood loss during the surgery. Although hemiarthroplasty can be a single-time solution to the complexities of intertrochanter fracture in elderly patients but should be performed in selected patients only.

Objectives: Recently, low levels of Vitamin D levels in sportspersons are observed by many studies. However, the role of low Vitamin D levels on anterior cruciate ligament (ACL) injury is not well studied. The purpose of this study was to find out the correlation between serum Vitamin D levels and ACL injury. Materials and Methods: This is a case–control study in which 55 athletes were enrolled in both cases (ACL deficient) and controls (ACL intact). Serum Vitamin D levels were measured in both the groups (preoperatively and 12 months postoperatively) and depending on the Vitamin D levels, athletes were categorized as Vitamin D deficient (30 ng/mL). Functional outcomes were assessed using the Lysholm score and Tegner activity score at 12 months follow-up. Results: Overall, 91% of cases and 93% of controls were observed to be Vitamin D deficient or insufficient (n.s.). There was no significant difference among mean Vitamin D levels in cases (16.34 ± 11.89 ng/mL) and controls (18.08 ± 9.9; n.s.). There was no significant difference in post-operative function outcomes (Lysholm score) between the three groups among cases at 12 months follow-up (n.s.). Conclusion: The presence of low Vitamin D levels is not a risk factor for ACL injuries and low Vitamin D levels are not a hindrance to recovery after ACL reconstruction.