Medial Side Of Femur Research Articles

Boomerang proximal tibial osteotomy for the treatment of severe varus gonarthrosis

Dear Editor, We read with interest the recent article by C. Sangkaew et al. [1], describing the role of boomerang osteotomy for the treatment of severe varus gonarthrosis. There are a large number of research publications clearly indicating that, “HTO is to buy time until future TKR is planned in a properly selected patient”. But here the authors have given a good result in grade IV & V gonarthrosis with severe varus deformity. However, we have a few queries which we would like to communicate with the author: The authors postulate that results of osteotomy would not depend on the number of compartments involved or associated angular deformity, but most authors consider HTO as a procedure for uni-compartmental involvement [2]. Flexion contracture is common in grade IV & V gonarthrosis with severe varus deformity due to shortening of the postero-medial structures including capsule, medial collateral ligament (MCL) and posterior cruciate ligament (PCL). Flexion contracture (FC) cannot be corrected without releasing these structures. But the authors have shown a decrease in FC in 30 of 42 patients (P < 0.001). Grade IV & V gonarthrosis is associated with a large number of osteophytes on the medial side of femur and tibia along with contracted MCL. Thus, it is really difficult to displace the proximal fragment laterally without removing the osteophytes and soft tissue release as shown in figure 1 of the article [3]. Severe gonarthrosis with bone loss on both medial and lateral sides with lateral subluxation of tibia as shown in a photograph in the article, if treated with osteotomy, will definitely exhibit a ‘teeter-totter’ effect, and most probably will remain in varus after HTO. The teeter-totter effect, where simultaneous contact of medial and lateral tibio-femoral compartment is not possible and it will remain unstable [4]. The author has done very well in taking considerations of pathophysiological origin of pain in varus gonarthrosis and relieving of pain by realignment [5], but mere correction of alignment will not relieve the pain, as all three compartments are diseased and unstable.

Sciatic Neuropathy after Caesarean Section under Epidural Anesthesia - A case report -

We report a rare case in which a 35-year-old multiparous healthy woman developed a right sciatic neuropathy after epidural anesthesia and analgesia for caesarean section.She presented with premature rupture of membrane at 37 weeks and 4 days gestation.Epidural anesthesia was done without any paresthesia or pain and there were no special events during operation. Postoperative pain was controlled by fentanyl, ropivacaine and saline through epidural catheter for 2 days.When the epidural catheter was removed, the patient complained of both legs weakness and hypoesthesia.On the 4th day after surgery, she gained normal sensation and motor function of left leg but was still unable to move and sense her right leg without medial side of femur. She dragged her right feet.MRI of the lumbarsacral spine showed no evidence of a lesion in the spinal cord.Electomyographic study (EMG) performed 25 days after surgery showed incomplete right sciatic nerve lesion.She received persistent physical therapies and put a ankle brace.Four months after surgery she had made a recovery but not full yet.