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Purpose of the study To evaluate the outcomes and complications using cemented megaprosthesis in elderly patients with distal femur nonunions (DFN). Materials and methods Between 2012 and 2016, 24 patients of DFN with an average age of 71.8 years (66–83) and an average 1.9(1–3) prior surgery was managed with distal femur replacement using cemented modular endoprosthesis. Outcomes were analysed on the following criteria: implant status, complications, knee range of motion, Knee Society Score (KSS) and Musculoskeletal Tumor Society (MSTS) score. Results All patients were extremely satisfied with their outcomes. At an average 22.1 months (10–43) follow-up, patients had an average 69.5° (40°-110°) knee flexion, an average KSS of 75.7 (63–88) and an average MSTS score of 19.3 (17–25). Four patients died at an average 21.3 months after surgery due to causes unrelated to the fracture. One patient (4.1%) had implant-related complication; deep infection which required debridement and intravenous antibiotics. There were no late amputations or peri-operative deaths and no patient had aseptic loosening of components. Conclusion By permitting immediate full weight-bearing ambulation and with most patients returning to an acceptable functional status, cemented megaprosthesis is a viable and useful single-stage management option in elderly patients with DFN.

Background The aim of this article is to study the correlation between preoperative pain sensitivity and postoperative pain and analgesic requirements for patients undergoing primary total knee arthroplasty. Methods Between December 2018 and April 2019, the pain sensitivity of 178 consecutive patients undergoing primary total knee arthroplasty was assessed preoperatively with a digital algometer. The patients reported the VAS (visual analog scale) score at 3 instances of needle prick (phlebotomy, glucometer blood sugar, intradermal antibiotic test dose), during the range of movements and completed the Depression Anxiety Stress Scale score. Postoperative VAS score, analgesic requirement, and physiotherapy milestones were recorded in all these patients on day 0 to day 4. Results The average age of the patients was 64.13 years and 69.1% were females. Females had lower mean algometry values (56.12 ± 12.77 [standard deviation]) compared to males (71.09 ± 18.78 [standard deviation]) (P < .001). Higher Depression Anxiety Stress Scale correlated with lower algometry values (P < .001). The postoperative VAS score was 2.54 ± 0.59 on the day of surgery which increased to 3.27 ± 0.69 on day 1 after mobilization (P < .001) and reduced to 1.67 ± 0.62 on day 4. Low algometer score correlated with higher postoperative VAS score (P < .05), increased analgesic requirement, and opioid utilization (P < .001), delay in achieving an optimum range of movements (P < .001) and independent ambulation (P < .001). Conclusion Preoperative assessment of pain sensitivity predicts postoperative analgesic requirements and recovery. Patients with a lower pain threshold should be counseled preoperatively and also receive a better titration of analgesics perioperatively and prolonged physiotherapy.

Introduction: Para-articular osteochondromas are rare osteocartilaginous tumors arising adjacent to the joint, more common around the knee. In contrast to osteochondroma, they occur in elderly patients. Case Report: We report a 60-year-old female with slow-growing, extraosseous soft tissue mass in the infrapatellar fat pad region with coexisting osteoarthritis. Total excision of the mass with total knee arthroplasty (TKA) done. The patient had excellent functional outcome with no recurrence at 2-year follow-up. Conclusion: The incidence of para-articular osteochondromas in elderly patients with coexisting osteoarthritis is very rare. Clinicoradiological features along with histopathology confirm its diagnosis. Total excision is the mainstay of treatment along with TKA if there is coexisting arthritis and its recurrence is very rare.

Purpose:Tibial bowing in valgus knees with arthritis can lead to component malplacement during total knee arthroplasty (TKA). Incidence of valgus knees with medial tibial bowing, its effect on tibial component placement during primary TKA and methods to improve accuracy of the component placement were studied.Methods:Full-length weight-bearing alignment radiograph was taken in 117 patients (149 knees) with valgus deformity undergoing TKA. In these cases, the proximal tibial reference for extramedullary jig placement was planned preoperatively with reference to the tibial spines and classified as four zones.Results:The mean preoperative hip–knee–ankle (HKA) angle was 192.9° (180.3–234.5°). Bowing >3° was considered significant ( p < 0.001) and at this level of bowing, the proximal tibial reference was shifted from centre to medial. Tibial bowing 3° as tibia valga. Tibia was bowed in 70 knees (46.97%). Severity of valgus deformity had strong positive correlation with the tibia valga ( p < 0.001). The post-operative medial proximal tibial angle (MPTA) and HKA angle were 91.63° (87.9–95.7°) and 182.6° (178.1–189.7°), respectively. The mean MPTA and post-operative HKA angle in bowed and straight tibiae were 90.35° versus 89.78° ( p = 0.547) and 181.5° versus 180.7° ( p = 0.5716), respectively, and the difference was not statistically significant.Conclusion:Medial tibial bowing is very common in valgus knees. Tibia valga has a strong positive correlation with the severity of valgus deformity. Accurate tibial component placement can be achieved with a medialized reference point for extramedullary tibial cutting jig in knees with significant tibia valga. The study has been registered in clinical trials registry – India (CTRI/2018/03/012283).