Cross Leg Research Articles

Fixation Techniques to Maintain Position for a Cross Leg Flap: Technical Tips and Algorithmic Approach.

Fixation Techniques to Maintain Position for a Cross Leg Flap: Technical Tips and Algorithmic Approach.

Ab. No. 158 Lack of Rural Rehab: A Case Report of Chronic Stiffness Post Tibia Fracture

Introduction: Even after 7 decades, referral depends on acceptance of physiotherapy as an independent profession. Even if prescribed, rural rehabilitation is not always executed with regular follow up.Neither documentation of rural physiotherapist-population ratio requirements, nor regulatory body to standardize rehabilitation level is available. Only 3% Anganwadi workers were informed about physiotherapy, though Maharashtra has 214 PHCs with wellness room for physiotherapy/yoga. Regain quality of life, return to employment, which was lacking a year after proximal tibial fracture, due to lack of referral to post-operative physiotherapy in Maharashtra’s Mangaon taluka. Methods: A 41-year-old patient with right undisplaced lateral tibial condyle fracture complained of limited knee range, stiffness, pain on standing, prolonged sitting, stairclimbing, reduced walking speed, loss of job as a coal miner. He was explained that restricted flexion was due to internal bony fragments, which caused fear of end range flexion, and was advised to undergo a revision surgery inspite of poor expected outcome. 4-week protocol included strengthening for quadriceps, hamstrings, hip abductors, flexors, calf, stretching, weight bearing exercises. Home exercises were regularly progressed. Adjuncts used were dry cupping, IASTM, dry needling. Result: Range increased from 10°-86° to 0°-112°, extensor lag, antalgic gait was corrected, thigh girth increased by 1.5 cm. Pain reduced while climbing stairs (4/10 to 0/10), standing after prolonged sitting (6/10 to 4/10), and walking (1/10 to 0/10). Squatting, cross leg sitting with minimal pain, return to work as a full-time coal miner was achieved. Revision surgery and disability were prevented. Conclusion: Rural early rehabilitative protocol could have prevented 1 year of unemployment, pain, stiffness. Implications: Highlights need for streamlined referral system to match evidence that recommends early ROM and weight bearing. Stimulate public –private partnerships for creating the role of physiotherapy assistant/technician at the existent PHCs. Facilitate followed-up tele-rehabilitation for rural physiotherapy.

Post radiofrequency ablation management of complications of osteoid osteoma with Ayurveda

Osteoid osteoma is a benign bone tumour that usually develops in the long bones of the body such as femur & tibia. It causes continuous, deep and severe pain at night, Swelling, joint stiffness. Modalities of management in modern medicine are limited and many patients suffer from post RFA complication like pain, general debility, gait disorder etc. Hence, there is a need of more efficient methods to treat this. Our present study comprises of one such way of dealing post radiofrequency management of Osteoid Osteoma through Ayurveda. A single case study of 18 year old male patient, diagnosed with Osteoid Osteoma of right hip joint who underwent RFA for same but did not get relief. Patient came to us with the complaint of severe pain in right hip joint with muscle lag associated with difficulty in doing daily activities such as walking, cross leg sitting, squatting & Gait disorder from last two years.

Prevalence of Musculoskeletal Disorder and Correlation with Core Endurance, Body Mass Index among Indian Classical Musical Instrument Players

Background and need of study: Commonly all classical musical instruments are played in cross leg position and without back support for prolonged periods. Core is the central part of the body, core muscles have to spare the spine from excessive load, to transfer force from the lower body to the upper body and vice versa. Strong, stable core and normal body mass index helps us to prevent musculoskeletal injuries. Therefore; the present study was conducted to find the prevalence of musculoskeletal disorder (MSD) and correlation with core endurance and body mass index (BMI) in Indian classical musical instrument players. Methodology: Observational, analytical study was conducted on 35 Indian classical musical instrument players. Male and female, age 20-60 years old, with ≥2 years of experience as a classical musical instrument player, practicing instrument for minimum 2 hours/day were included. Participation was voluntary and informed consent was taken. Nordic questionnaire was assessed for the prevalence of MSD. Weight and height assessed by BMI. Core endurance was assessed by McGill’s core endurance test. Each subject was given appropriate rest period between all tests. Outcomes were correlated using Spearman’s correlation of coefficient. Results: The common painful sites of the body were as follows: wrist/hand(91%),low back (89%),neck(71%),upperback(49%),shoulders(49%),knees(31%),elbows(29%),ankles(20%),hips(11%) among musical instrument players. Correlation was found between BMI and trunk flexor test (r=-0.696, p≤0.001), BMI and trunk extensor test (r=-0.658, p≤0.001), BMI and right side bridge test (r=-0.649,p≤0.001,)left side bridge test (r=-0.675,p≤0.001). Conclusion: A relatively high prevalence of musculoskeletal pain amongst Indian classical musical instrument players. There is moderate negative correlation between BMI and core endurance in Indian classical musical instrument players. Ergonomic advices, adapting healthy lifestyle along with overall improvement in their working efficiency, prevent MSD and thus indirectly improve their Quality of Life.

Colorado Needle Assisted Cross-Leg Flap

Lower limb injuries are most commonly due to road traffic accidents which cause lower limb defects.The management of lower limb fractures is guided by the Gustilo-Anderson classification of injuries. Simple leg defects are covered by localflap and complex defects by free flap. Complex defects of the lower limbs which were unfit for free flap require management by conventional cross leg flap. Colorado needle allows meticulous dissection of flaps due to the sharp tip and increases the efficiency in raising the flaps.

Determination of the adequate vascular perfusion time of cross-leg free latissimus dorsi myocutaneous flaps in reconstruction of complex lower extremity defects.

Lower limb defects may be present due to various causes including infections, vascular diseases, tumor resections, and crush or avulsion injuries. Management of lower leg defects is acomplex problem, especially when they are large with deep soft tissue loss. These wounds are difficult to be covered with local skin flaps, distant skin flaps or even conventional free flaps because of the compromised recipient vessels. In such cases, the vascular pedicle of the free flap could be anastomosed to the recipient vessels of the contralateral healthy leg temporarily and then divided after adequate neo-vascularization of the flap from the wound bed. The ideal time to divide such pedicles should be investigated and accurately assessed to have the maximum success rate possible for these challenging conditions and procedures. Sixteen patients who did not have asuitable adjacent recipient vessel for free flap reconstruction had been operated with cross leg free latissimus dorsi flap between February 2017 and June 2021. The mean soft tissue defect dimension was 12 ×11 cm (the smallest 6 × 7 cm; the largest 20 × 14cm). Gustilo type 3B tibial fractures were present in 12 patients, while no fractures were present in the other 4 patients. Preoperatively, arterial angiography was performed on all patients. After the fourth week post-operatively, non-crushing clamp was applied around the pedicle for 15minutes. The clamping time was increased by 15 minutes on each consequent day (average 14 days). On the last 2 days, the pedicle was clamped for 2 hours, and bleeding was assessed by aneedle prick test. Clamping time was assessed in each case to reach ascientific calculation of the adequate vascular perfusion time needed for full flap nourishment. All flaps survived completely except two cases of distal flaps necrosis. Cross-leg free latissimus dorsi can provide asolution for large soft-tissue defects in lower extremities especially with absence of any suitable recipient vessels or when the use of vein grafts would not be feasible. However, ideal time before dividing the cross vascular pedicle should be identified to have the maximum success rate possible.

Adolesanda Diz Çıkığı Nedeniyle Yavaş İlerleyen Popliteal Arter Oklüzyonu Sonrası Flep Nekrozu: Bir Olgu Sunumu

Abstract
 Popliteal artery occlusion is a rare vascular complication after blunt knee trauma and may lead to limb loss if diagnosis is delayed. Development of collateral pathways may misguide the surgeon in planning surgeries for defect reconstruction. We report a case of a patient with popliteal artery occlusion resulting from dislocation of knee after fall from height, which developed a defect anteromedial to ankle following orthopedic surgery. After reconstruction with a free flap, ischemia was observed in foot and arteriography confirmed the occlusion of popliteal artery with well-developed collateral arteries. The patient underwent femoro-popliteal bypass surgery for limb salvation. At the end of the recovery time, the defect was reconstructed with cross leg free flap

Soft tissue reconstruction of foot and ankle defect using various flap cover: single centre experience

Introduction: Soft tissue defect at ankle and foot region are very common following road traffic accident. Reconstruction in this region is challenging to surgeon because of poor vascularity and paucity of available surrounding tissue. Purpose of study is to evaluate various ankle and foot defect, advantage and disadvantages of different methods of management, future prospective of suitable method according to defect.Materials and Methods: Retrospective study of 65 patients with soft tissue defects around foot and ankle region underwent various reconstructive procedures at SMS hospital Jaipur from January 2020 to December 2020. Study enumerates various etiological factors and describes different reconstructive surgical procedures.Results: Age at presentation range from 8 to 63 years and males were more common. Road traffic accident is most common cause for defect at foot and ankle region followed by diabetic foot and orthopedic implant exposure. Most common site of defect in foot and ankle defect were dorsum of foot followed by lateral malleolus region. Free ALT flap cover performed most frequently followed by cross leg flap.Conclusion: Reverse sural flap is reliable option for small ankle and foot defect near ankle. Cross leg flap is also most reliable option for large defect in opposite healthy limb. Reverse saphanous flap also used for small defects on medial side ankle. Larger defect of ankle and foot can be covered by free fasciocutaneous or myocutaneous flaps where microsurgical expertise available.

ROLE OF CROSS LEG FLAPS IN LEG AND FOOT RECONSTRUCTION: OUR EXPERIENCE

Introduction: The management of compound trauma has always been challenging. Free aps are the rst choice when soft tissue cover cannot be provided by local aps. When facilities for microsurgery are not available or certain factors preclude the microsurgical anastomosis or in cases of free ap failure, the cross leg aps have a big role to play in lower limb reconstruction. We are presenting our retrospective study on 30 cases of distal leg and foot defects covered successfully by cross leg aps. The aim of this study is to highlight the usefulness of cross legAims and objectives: aps in lower limb reconstruction. A retrospective study was done on 30 patients from January 2015 toMaterial and methods: December 2021 who underwent perforator based fasciocutaneous cross leg ap for post traumatic soft tissue defects of distal leg and foot. The mechanism of injury, size and site of defect were recorded. All aps were planned in reverse and limbs were immobilised with external xator. Post-operative complications if any were noted. The patients were followed till the ap became stable. The mechanism of injury was road side accident in 26 cases, machine injury in 2 cases and fall fromResults: height in 2 cases. 19 patients had soft tissue defect of distal 1/3rd of leg and 11 patients had foot defects. 26(86.67%) patients underwent distally based fasciocutaneous cross leg ap and 4(13.33%) patients underwent conventional anteromedially based fasciocutaneous ap. All aps survived well. 2 patients had discharge and 1 had margin necrosis but were managed conservatively. The perforators based fasciocutaneous cross leg aps provide an easy, simple, reliable and viableConclusion: cover for distal leg and foot reconstruction.

Study of soft tissue cover in compound lower limb trauma

: Early vascularized soft tissue closure has long been recognized to be essential in achieving eventual infection free union. The question of whether muscle or fasciocutaneous tissue is superior in terms of promoting fracture healing remains unresolved.: To study options of different flaps in compound lower limb trauma and to know the pattern of providing flap cover in our setup. This was prospective observational study conducted in all the cases admitted under orthopaedics department who are hemodynamically stabilised, later referred to our department of plastic surgery for the flap cover. Isolated compound lower limb injuries with or without fractures were included in study.: Among 45 cases one patient (2.2%) had defect in the thigh, two patients had defect around knee (6.6%), nine cases had defect in upper third leg (20%), thirteen patients had defect in middle third leg (28.8%), seventeen patients have defect in lower third leg (37.7%) and three patients had in the foot (6.6%). Cross leg flap were used in 11 cases (24.4%) Gastrocnemius myo-cutaneous flap were used in 9 cases (20%). Fascio-cutaneous flaps superiorly based were used in three cases (6.6%) and Inferiorly based Fasciocutaneous flaps were used in 6 cases (13.3%), Reverse sural artery flap were used in six cases (13.3%) and Lateral premalleolar flap were used in 8 cases (17.7) and Advancement flap done in one case over defect of the thigh (2.2%). In a case with defect over thigh (2.2%). Complications like total flap loss was noted in one case (2.2%) marginal necrosis noted in five cases (11.1%) and pin track infection in three cases (6.6%).In Grade IIIB fractures external fixator was the choice of skeletal stabilisation. Delayed flap cover gave good results but it increases duration of hospital stay.

Distally Based Sural Flap in Children: Experience in Our Department

The reverse sural artery flap (RSAF) was first described approximately four decades ago in 1983 by Donski and Fogdestam [1] and has since been used frequently for reconstruction of soft tissue defects in the distal part of the leg. Coverage of soft-tissue defects of the ankle and foot is often challenging. The distally based sural fascio-cutaneous flap is useful for reconstructing the lower leg, ankle, heel, and foot but has rarely been evaluated in paediatric patients. The objectives of this study were to assess the reliability of this flap in children, to get a global experience with the sural flap in our department of plastic and reconstructive pediatric surgery, and to describe the complications. Material and methods: A distally based sural fascio-cutaneous flap was used to cover soft-tissue defects of the ankle and foot in 5 paediatric patients between 2018 and 2021. The median age of patient at surgery was 6 years old. The most frequent mechanism of soft tissue defect was trauma caused by vehicular accident (open fractures) crush injuries, lacerated wound. Results: One of the 5 flaps was a cross leg sural flap, 4 recovered well without necrosis, only one developed partial necrosis requiring excision and skin grafting. The other complications where an early postoperative complications: partial or total necrosis of the flap late complications including impaired touch sensation over the flap and donorsite. Discussion: The distally based sural fascio-cutaneous flap is a method of choice for covering soft-tissue defects of the ankle and foot in paediatric patients. This reliable flap spares the major blood vessels and has a good blood supply. When there is exposure of a vital structure, distal sural flap is the best indication for coverage in a traumatic soft-tissue defect. The use of a distally based sural fascio cutaneous flap is not free from delayed complications most of them at the donor site.

An idea for bringing the recipient pedicle of cross leg free flap closer: Fasciocutaneous flap above pedicle.

Cross leg free flaps are one of the salvage methods used for free tissue transfer in large tissue defects in the absence of recipient vessels. The fasciocutaneous flap above the posterior tibial artery can be harvested to protect the pedicle and to advance a distance to wound, which is equal to the length of fasciocutaneous flap. Patients who were operated with cross leg free flap with the supporting fasciocutaneous flap on unwounded side were included in the study between years 2010 and 2020. Age, sex, location and size of the defects, arterial patencies, flap choices, fascio-cutaneous flap size, duration of operation, cross flap separation timing, complications, and time to return to work were evaluated. There were six patients with the etiology of high-energy electrical burns and trauma. There was only one arterial refilling for three patients and no refilling for others. Latissimus dorsi skin muscle flap was used in all but one patient. The mean defect size was 6.6×14.8 cm. The mean size of fasciocutaneous flaps was 4.08×5 cm. The mean operation time was 360 min. There was no complication except one dehiscence and one marginal necrosis and infection which were healed with wound care. Average time to return to work was 9 months. In similar cases, as wounded lower extremities with one or no artery refill, harvesting a fasciocutaneous flap with recipient vessels will be useful before considering the option of using a bridge free flap in medium to moderate sized defects.

USE OF A COMBINATION OF TWO IPSILATERAL FLAPS TO COVER POST TRAUMATIC LEG DEFECTS

INTRODUCTION-With advancement in the microsurgical techniques the free tissue transfer has become the rst choice to manage large leg defects which cannot be covered with a local ap.The other option is the cross leg ap.Free aps need an expert team, expensive instruments and plenty of time. Cross leg aps lead to a difcult postoperative period for the patient. When the tissues surrounding the defect are healthy and a careful planning is done, a combination of two local aps which are otherwise used singly for smaller defects may obviate the need for a free or cross leg ap in certain cases.In this study we evaluated the patients who had undergone a combination of gastrocnemius muscle and fasciocutaneous aps for covering the large leg defects. AIMS AND OBJECTIVES-The aim is to study the role of a combination of two local aps to provide cover for the large leg defects. MATERIAL AND METHODS-A retrospective analysis of 30 patients operated from June 2016 to July 2021 for the leg defects rd involving the upper 2/3 of the leg was done.In these patients the upper half of the defects was covered with gastrocnemius muscle ap and the lower half was covered with inferiorly based fasciocutaneous ap. All patients had been followed till the wound cover became stable. RESULTS-All patients were males between the age group of 16 to 46 years. Leg defects were exposed tibia or implant and were post-traumatic in all the cases. Size of the defects ranged from 16cm to 18cm. In all the patients both aps survived well. Two patients had marginal necrosis of fasciocutaneous ap and one had discharge from underneath the muscle ap but were managed conservatively. CONCLUSION- A combination of gastrocnemius muscle and fasciocutaneous aps is a safeoption for covering large leg rd defects involving the upper 2/3 where surrounding skin and muscles are healthy

Reconstruction of Achilles region defects: A single-centre experience.

Reconstruction of Achilles tendon and the overlying tissue defects is a challenging undertaking. The spectrum of available repair methods range from secondary healing to the use of free flaps. The aim of this study was to discuss reconstruction options and to help the surgeon to select reliable approach to achieve favourable outcomes. In this study, we retrospectively evaluated 14 patients who underwent reconstruction of Achilles region defect between 2016 and 2019 at a single centre. Reconstructions were performed with secondary healing (n=2), negative pressure wound therapy and skin grafting (n=2), free flaps (n=6) and local and distant flaps (n=4). Satisfactory aesthetic and functional outcomes were achieved in all patients. One patient developed partial skin graft loss. Marginal necrosis occurred in one of the local flaps. Wound dehiscence and flap retraction occurred in one of the free (superficial circumflex iliac artery perforator) flaps. One patient undergoing reconstruction with ulnar artery perforator flap developed intraoperative atrial fibrillation; the operation was terminated and reconstruction completed with skin grafting. Orthoplastic reconstruction should be kept in mind for Achilles tendon defects. The use of special digital imaging techniques facilitates flap surgery and helps minimise the risk of flap complications. Conventional approaches are suitable for shallow small skin lesions. Local flaps are good options for deeper skin defects owing to superior aesthetic outcomes. Super-thin free flaps offer a distinct advantage in skillful hands. The use of multi-content free chimeric flaps for reconstruction of complex defects facilitates better anatomical repair. Cross leg or flow-through flaps may be considered in patients with compromised distal circulation. Selection of the most reliable approach for Achilles reconstruction is a key imperative to achieve favourable outcomes.

A Thin and Short Muscle Flap Acted as a Savior for A Child’s Calcaneal Defect: A Case Report

Managing, a distal leg defect is reconstructive challenge for any plastic surgeon. With the advent of microsurgery, the work hose flap for this area shifted from cross leg to free and local perforator flaps. Children with such defects pose a bigger problem because of smaller caliber of vessels, difficult immobilization and poor compliance. We, hereby, report a case of a 12 year old child who had an exposed distal half of calcaneum, which warranted a cross leg or free flap, but was managed successfully by distally based peroneus brevis muscle.

Assessment of Functional End Ranges of Lower Limb Joints in Positions Commonly Used for ADLs in India

Background: In many countries of Asian continent, floor sitting is preferred instead of chair supported sitting. Indian population differs noticeably in its cultural practice and daily tasks which involves squatting and cross-legged sitting on the ground.
 Aim: The purpose of the study was to assess the functional end-ranges of the hip, knee and ankle joints in healthy Indian subjects in positions commonly used for ADLs in India which includes squatting and cross-legged sitting.
 Methods: 66 healthy subjects were recruited from rural and urban populations with age range 30-50 years. Joint ROM of the lower extremities was measured using Universal Goniometer. All the subjects were asked to acquire squat and cross legged positions which were graded.
 Results: Our results finding showed that the subjects in cross leg sitting grade 2 (independent CLS) had hip flexion ranges ≥1150, hip abduction ≥ 410, hip external rotation ≥ 420, ankle plantar flexion ≥ 460, p<0.005. For squatting, grade 2 (independent squat) had hip flexion ranges ≥ 1130,p>0.005, Knee flexion ≥1200, p>0.005 and ankle dorsiflexion ≥150, p<0.005.
 Conclusion: From the results, it is suggested that squatting and cross-leg sitting multiple times a day can prevent the early closer of end ranges of the lower limbs.

Reverse flow cross leg sural flap as a reconstructive option for traumatic defects in the lower leg circumventing free flaps

Very few flaps described in the literature would be as versatile as the reverse sural flap. In spite of its few shortcomings, it is one of the most widely used flaps for lower third defects in the leg because of the paucity of tissues in the region. In a lot of situations, free tissue transfer is the only feasible option because of non-availability of local options in the involved limb. In such a scenario, a reverse sural flap from the contralateral leg can be manoeuvred in a cross leg fashion as an alternative to free flap. It employs skin and soft tissue from the opposite limb which can easily cover large defects in the lateral malleolar and tendoachilles region which would be unachievable with a traditional cross leg flap. A prospective study was developed from September 2018 to March 2020 at SMS Hospital, Jaipur. A total of 10 patients underwent flap cover. Rigid fixation with the help of external fixator was used to prevent flap avulsion, and flaps were divided at 3 weeks. All cases were done in 2 stages, fixed with external fixator and divided at 3 weeks. All 10 flaps survived without any flap failure. One flap had ischaemic changes in the distal most part of the flap which was later debrided and flap advanced to cover the defect. Successful coverage of defect was achieved in all 10 patients, and donor site healed uneventfully. In our experience, a reverse flow cross leg sural flap is a significant option for leg defects where there is a paucity of nearby tissues for stable flap cover and as an alternative to free flap. It is an excellent option for covering large defects over the lateral side of the leg where a traditional cross leg flap cannot reach. It can also circumvent the use of free flaps in patients who cannot undergo a long duration surgery. The relative simplicity of this flap makes it a very useful flap for large defects of the lower third of leg. Level of evidence: Level IV, therapeutic study.

Determination of outcomes of complex upper end tibial fractures in squatting and cross leg sitting South Asian population.

Treatment of complex upper end tibial fractures has always been a challenge to orthopaedic surgeons. Though the roentgenogram results are satisfactory, the clinical and functional outcomes especially in terms of squatting/cross-leg sitting after long term follow-up are little known. Hence, we have done this study with a primary aim to assess the clinico-radiological and functional outcomes after operative fixation (mostly by locking plates) in complex upper end tibial fractures and a secondary aim to analyze correlation between functional outcome scores/range of motion (ROM) and the ability to squat & sit cross-legged in post-operative period. This prospective study included a total of 33 patients who were mainly treated with locking plates. In the follow-up, patients were assessed clinico-radiologically and outcome measurements were determined using the Tegner-Lysholm (T-L) Knee Score. Patients were categorized according to their ability to squat/sit cross-legged and a subgroup analysis was performed by comparing mean ROM and T-L score in each group. Majority of patients were in young and adult age group with a male to female ratio of 4.5:1. The average age was 42.39 ±14.64 years. Road traffic accident was the most common mode of injury. Average time interval between injury and surgery was 5.8±4.4 days. All the fractures united by 5-9 months. Mean ROM and T-L score at last follow-up were 120.94°±13.63° and 88.12±7.24 respectively. Average shortening, varus and valgus deformity were 0.43±0.09 cm, 2.12°±0.62° and 1.06°±0.45° respectively. 14 patients (42.42%) were able to squat and 15 (45.45%) were able to sit cross-legged postoperatively. Upon subgroup analysis, difference of mean ROM in those who could squat/sit cross-legged was found statistically significant (p≤0.05), however the difference in mean functional scores was not significant (p≥0.05). Complex upper tibial fractures are a difficult entity to deal with. Anatomical locking plates take care of the alignment, articular congruity as well as ligamentous balancing thus giving good mid-term outcomes after ORIF/MIPO. However, applicability of the present functional outcome scores in assessing squatting/cross leg sitting remains doubtful. More weightage needs to be given to these activities to evaluate the outcome in South Asian population.

Efficacy of core decompression with bisphosphonates and Prolotherapy compared with core decompression alone and core decompression with bisphosphonates in the management of avascular necrosis of hip joint

Background: Avascular necrosis (AVN) of hip joint or femoral head is complex disease with complete collapse of the femoral head. Core decompression is the mainstay treatment for grade I and II AVN of hip joint but the results were controversial. In this backdrop, the present study was undertaken to evaluate the combination of core decompression with bisphosphonates and prolotherapy in the treatment of AVN of hip joint. Methods: 36 patients who were diagnosed with for grade I and II AVN of hip joint were recruited and they were divided into three groups (n=12). The patients in three groups were treated with core decompression alone, core decompression with bisphosphonates and core decompression with bisphosphonates, prolotherapy. The patients were followed at 6th month, after 1 year and 2 years respectively. Their outcomes and range of motion were recorded at each follow-up.Results: The outcome of the study shows that the combined treatment of core decompression with bisphosphonates, prolotherapy showed fair outcome at the end of 2 year follow up with effective pain reduction during walking, squatting and cross leg. Meanwhile, core decompression alone and core decompression with bisphosphonates showed poor and good outcome. Conclusion: Thus in patients with grade I and II AVN of hip joint combination of core decompression with bisphosphonates, prolotherapy would be effective in prevention of collapse and pain reduction.

Short-Term Functional Outcome and Satisfaction Rate of Unicompartmental Knee Arthroplasty in Indian Population: A Retrospective Study.

Introduction: Unicompartmental knee arthroplasty (UKA) is a procedure used to treat isolated medial or lateral compartmental osteoarthritis of the knee joint. This procedure involves retention of cruciate ligaments which leads to better functional outcome due to preservation of normal kinematics of the knee joint. In the Indian population, due to requirement of squatting and cross leg sitting habits, knee with more range of movement and with good kinematics is a required feature. The study aims to observe the functional outcome, mortality, revision rate, length of hospital stay and satisfaction rate in two-year postoperative patients in a tertiary health care centre.Methods: A total of 17 knees of 15 patients were recruited for the study after applying strict inclusion and exclusion criteria. These patients were operated during the period from March 2015 to March 2018. Ten female patients (67%) and five males (33%) were included. The average age was 61 years. All operations were performed by a single surgeon, with a similar implant from a single company. Similar protocol was used both for surgical technique (minimal invasive) and postoperative rehabilitation for all the patients.Results: The functional outcome in the form of Oxford Knee Score (OKS) and Euro-Quol (EQ-5D) scores improved significantly in all the patients at one year postoperatively, and the improvement remained significant for two years. Satisfaction rate was 91.7% (SD-12.8) at two years. Except for one patient (5.8%), all patients were able to cross leg and squat easily. At the end of two years, the overall survival rate of the implant was found to be 94.1%.Conclusion: The unicondylar arthroplasty provides excellent satisfaction to the appropriately selected patients with good survivorship of implant. It can be a surgery of choice for Indian population as it restores normal kinematics of knee joint and allows the patient to cross leg and squat with a more range of movement.