Geetanjali Arora

Effects of preoperative walking ability and patient's surgical education on quality of life and functional outcomes after total knee arthroplasty

Objective Prospectively analyze the effect of preoperative walking status and the patients surgical education on functional outcomes and the three dimensions of quality of life (QoL) (pain, physical function, and mental health) after elective total knee arthroplasty (TKA). Methods A comparative analysis on the QoL and functional outcomes in patients who underwent total knee arthroplasty between January 2014 and June 2015. To compare effects of the patients walking status and knowledge of the surgical procedure on QoL and functional outcomes following TKA by means of SF-36 questionnaire, CES D10, VAS, KSS, KSFS, WOMAC, as well as Friedmann and Wyman scores, 10MWT, and 30-second timed chair test, assessed before the operation and one, three, and six months after the operation. Results There were 168 knees in 154 patients: 46.75% men and 53.24% women. 52.38% of knees had grade-III OA and 40.47% of knees had grade-IV OA. Preoperatively, SF-36 PCS was 33.2 and MCS was 35.4. Mean KSS and KSFS in females was 37.3 (16.2) and 31.5 (13.8); in males it was 49.2 (18.4) and 42.5 (15.7), respectively. Mean WOMAC scores were 64.2 in females and 56.5 in males. Mean VAS and CES D10 scores were 8.8 and 8.2 in females, and 6.9 and 6.4 in males, respectively. Post operatively at the first, third, and sixth month, significant improvements in QoL and mean SF-36, CES D10, VAS, KSS, KSFS, WOMAC, and Friedmann and Wyman scores were observed, as well as in the 10MWT and 30 s timed chair test scores. Patients with better preoperative functional activity and satisfactory understanding of TKA presented a better functional performance and achieved a good quality life (p < 0.01). Discussion Surgeons educate TKA candidates regarding the surgical procedure, the nature of implants, and how the procedure would affect their lifestyle and what their expectations from TKA should be. These crucial considerations should boost their confidence, enhancing their involvement and cooperation in post-surgical rehabilitation, thereby improving their QoL, functional results, and post TKA experience. Conclusion TKA candidates with good preoperative walking ability and understanding of knee arthroplasty have better QoL in early and late post-surgery periods. Patients lifestyle and understanding significantly enhances the postoperative functional ability.

Evaluation of canal stenosis of herniated lumbar disc and its correlation to anterior-posterior diameter with magnetic resonance imaging morphometry

Background: The term disc prolapse is defined as extrusion of nucleus pulposus through a rent in annulus fibrosus. This prolapse disc causes impairment of function by nerve root compression compelling the patient to seek medical advice for low backache. A lumbar herniated disc is a common cause of low back pain radiating to the leg. The problem of prolapsed intervertebral disc is of great importance in this part of the world, because of the fact that people are subjected to various physical stress due to their living habits, low socioeconomic status. Ninety percent of lumbar disc extrusions occur at L4- L5or L5-S1. Central lesion may cause no symptoms with the exiting nerve roots unaffected whereas paracentral lesions cause symptoms due to compression of the exiting nerve root. Radio imaging technique has a pivotal role in the diagnosis of vertebral disc herniation. Various radiological procedures are used for the diagnosis, but MRI which is a relatively newer technique is treated as the gold standard in the field. Aim of the Study: In the present study, an attempt is made to establish the anatomy of herniated lumbar disc by the help of MRI technique in the patients of Eastern India & to correlate the occurance of disc herniation with age, sex & vertebral level. Methods and Material: The present study included 120 patients who have lumbar disc herniation syndrome & their MRI findingd are compared with MRI findings of 80 normal persons who are used as control. Results and Conclusions: The different parameters are compared & observed that the maximum number of disc prolapse occurs between 31- 40 age group. Taking the vertebral level into consideration, it is seen maximum number of herniation occurs at the level of L4- L5.

Effects of Osteoarthritis on Quality of life in Elderly Population of Bhubaneswar, India A Prospective Multicenter Screening and Therapeutic Study of 2854 Patients

Introduction: Osteoarthritis (OA) is the most common age-related joint disease affecting >80% people beyond 55 years of age. It is a leading cause of elderly visit to outpatient departments and accounts for almost half of all nonsteroidal anti-inflammatory drug prescriptions. The burden and impact of knee OA in Indian population and extent of public health services usage by people with OA are not known. Methods: We performed a prospective blinded multicenter screening and therapeutic study from June 2013 to June 2014 at 3 centers to screen patients >55 years with knee OA to assess quality of life, functional disability, and limitation of functions and to compare the effectiveness of hip and leg strengthening exercise programs in these patients. Functional disability was assessed by Western Ontario and McMaster’s Universities OA index (WOMAC), Friedman, and Wyman Scores; locomotor function was assessed by walking status, Visual Analog Scale (VAS), and 30-second timed chair stand tests; and quality of life was assessed by Short Form-36 (SF-36). Results: Of 2854 patients screened, 2054 (72%) patients had OA (male:female-1.9:1) with mean age of 63 years and standard deviation of 8. Of 2054 patients, 226 patients were randomly selected for therapeutic study. In remaining 1828 patients, baseline 10-meter walk test (10MWT) was 0.3 m/s, mean SF-36 Physical Component Score (PCS) was 31.3, and Mental Component Score (MCS) was 34.2. At 3 months, 79% patients were comfortable with significant VAS, WOMAC, Friedman-Wyman Scores, 10MWT, and timed chair test improvements in patients who performed lifestyle modifications and exercises (P = .04). Short Form-36 improved, mean PCS was 43.6, and MCS was 54.2. At 3 months, 274 (15%) patients were unsatisfied among whom 26% and 74% were treated with arthroscopic procedures and arthroplasty, respectively. Isolated hip and leg strengthening exercise programs similarly improved knee pain, function, and quality of life. Conclusion: Motivation and counseling with hip and leg strengthening exercises should be incorporated with pharmacotherapy in each OA prescription. Physical fitness and weight reduction should be promoted as first-line management of OA.