Vishal Nigam

Deep vein thrombosis after total hip and knee arthroplasty in Indian patients

Background: Deep vein thrombosis (DVT) is one of the most common complications of total hip (THA) and total knee arthroplasty (TKA). Though the reported incidence of DVT is very high, that of proximal DVT is low and that of fatal thromboembolism is very low. Hence the issue of prophylaxis for DVT remains controversial. The incidence of DVT is based on various studies in European and American populations. The Asian population is genetically and socially quite different from American and European populations, and the incidence of DVT can be quite different. Therefore a prospective study was initiated at our centre to determine incidence of DVT after THA and TKA in Indian patients. Methods: A prospective study was conducted on 60 hips in 45 patients and 46 knees in 26 patients who underwent THA and TKA respectively, without any known risk factors for thromboembolic disease. DVT was studied by preoperative and postoperative serial colour Doppler ultrasonography. No prophylaxis was given to any of the patients. Results: DVT was found in two patients who had undergone THA. No case of DVT was detected in any patient who had undergone TKA. Conclusion: These results suggest that the incidence of DVT in Indian patients is very low and is not comparable with American and European populations. It is therefore not cost effective to advise prophylaxis in Indian patients undergoing THA/TKA who have no known risk factors for DVT.

Spontaneous cervical epidural hematoma: Report of a case managed conservatively

Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

Atlantoaxial rotatory fixation secondary to tuberculosis of occiput: a case report.

Study Design. A case of nontraumatic rotatory fixation of the atlantoaxial joint associated with tuberculosis of the occipital bone in an adult. Objectives. To report a rare case of atlantoaxial rotatory subluxation associated with tuberculosis of the occipital bone in an adult and to discuss the mechanism of fixation. Summary of the Background Data. Atlantoaxial rotatory fixation in adults is rare and has been reported due to variety of causes. To the authors’ best knowledge no case has been reported secondary to tuberculosis of the skull bone. Methods. A 20-year-old male presented with resistant torticollis with a duration of 5 months. Results. The patient had type 1 atlantoaxial rotatory fixation secondary to tuberculosis of the occipital bone. The subluxation was partially reduced by conservative means, and healing of the occiput lesion was achieved. Thereafter, the patient had no restriction of cervical spine motion and had no reoccurrence of subluxation at a follow-up of one and a half years. Conclusions. Effusion in the atlantoaxial joint secondary to infection in the occiput due to close proximity with the joint led to the laxity of ligaments and contributed to the subluxation.

Multifocal skeletal TB or disseminated bone TB

requiring catheterization. Two days after re-admission he had a short generalized convulsion, which responded to diazepam (0.3mg/kg). He was neither dehydrated nor fluid overloaded, and his blood pressure was 120/ 90mmHg. He regained consciousness, but remained prostrated with a stiff neck, but without papilloedema. An LP excluded meningitis. He had five further generalized convulsions that required phenytoin. Subsequently, his total leucocyte count dropped to 2.0 10/L (20% neutrophils), plasma sodium dropped to 96mmol/L (urinary sodium 33mmol/L), while the plasma and urine osmolality were 211 and 410mosm/kg, respectively. These levels were confirmed on a repeat sample (Figure 1). Following fluid restriction, the plasma sodium rose to 135mmol/L, and he was able to be discharged 10 days later. The chemotherapy treatment regime was continued and he completed the full course uneventfully with no recurrence of hyponatraemia.

Noncemented total hip replacement in various disorders of the hip

Background: Noncemented total hip arthroplasty has emerged as effective option in various disorders of hip in young patients and those with good bone stock. Method: Between 1992 and 2002, 34 patients underwent 47 uncemented total hip replacements. Preoperative and postoperative Harris hip scores were compared. Patients were followed up for a minimum period of 2 years and maximum of 10 years. Result: Mean Harris hip score improved from preoperative mean of 36.6 to 89 after average follow up of 5.7 years. Forty one hips had excellent or good result and one had poor result. There was no case of femoral stem failure and one case of acetabular component failure. Conclusion: Noncemented total hip arthroplasty gives excellent results in disabling disorders of the hip.