Introduction: Postoperative constipation significantly impacts the quality of life during the immediate postoperative period. Non-pharmacological interventions are preferred so that we can reduce the use of synthetic drugs and their complications. This study evaluates the effect of using chewing gum over the perioperative period on improving bowel activity during the postoperative periods in patients who underwent total knee replacement (TKR). Materials and methods: A prospective randomized controlled trial was conducted on 252 patients who underwent TKR between December 2020 and August 2021. Only patients having a natural defecation pattern preoperatively and not suffering from any diseases affecting bowel movements were considered. The Patients were classified into two groups, and computer-generated numbers did the randomization. The postoperative analgesia and rehabilitation protocol were the same for both groups. The sugar-free chewing gum (for better glycemic control) was given to the study group to chew for approximately 15 min every 6th hour from shifting out of the operation theater until the first stool was passed. For the control group, 200 mL of warm water (37 degrees) was given every 6th hour from shifting out of the operation theater until the first stool was passed. The patients were asked whether they passed 1st flatus or 1st stool at fixed intervals. Results: The first flatus was passed on the day of surgery by 71% of patients from the study group and 50% from the control group. The first stool was passed postoperative day 1 by 71% of patients from the study group and 20% from the control group. These differences are statistically significant. Conclusion: Chewing gum significantly improved bowel activity in postoperative TKR patients and would be a safe, effective, non-pharmacological method for decreasing postoperative constipation.

Aim and background: This study aimed to compare clinical and functional outcomes, including joint awareness, knee function, and pain perception, between robotic-assisted and conventional manual total knee arthroplasty (TKA) in patients with end-stage knee osteoarthritis. With rising TKA surgeries and advances in robotics, assessing their impact on patient outcomes in the Indian population is essential. Methodology: A retrospective study was conducted with 200 patients undergoing TKA from January to March 2023. Patients were divided into two groups: robotic-assisted TKA (Cuvis system, 100 patients) and conventional TKA (subvastus approach, 100 patients). Data collected included age, Body Mass Index (BMI), gender, and preoperative scores on the Visual analog scale (VAS), Oxford knee score (OKS), and Forgotten joint score (FJS). Postoperative outcomes were assessed at 3, 6, and 12 months. Results: Both groups completed a 1-year follow-up. At the 3- and 6-month follow-ups, no notable differences were observed in OKS between the groups. However, at 1 year, the robotic-assisted group showed a higher improvement in OKS compared to the conventional TKA group. FJS scores at 1 year also favored the robotic-assisted group, indicating higher satisfaction and reduced joint awareness during daily activities. As measured by VAS, early postoperative pain scores were markedly lower in the robotic group on days 1 and 3 post-surgery, though pain levels equalized between groups by the 1-month follow-up. Complications were minimal, with no notable differences between the groups. Conclusion: Robotic-assisted TKA was associated with higher satisfaction (better FJS scores), reduced early postoperative pain (lower VAS scores), and improved functional outcomes (better OKS scores) after 1 year. These findings suggest that robotic-assisted TKA is a favorable option over conventional TKA in enhancing patient outcomes. Clinical significance: Robotic-assisted TKA offers enhanced joint functionality and patient satisfaction, with evidence of reduced early postoperative discomfort, presenting a promising alternative to conventional TKA in knee arthroplasty.

Background: Porous coating on femoral stems is a critical feature in total hip arthroplasty (THA), which enables a secure, long-lasting and biological form of cement less fixation. The term “extensively coated” femoral stem in THA denotes a prosthesis, wherein the porous coating covers a substantial portion or even the entire surface of the implant. In this article, we comprehensively reviewed the current literature on the status of extensively porous coated femoral stem in different clinical scenarios. Materials and methods: A detailed search was performed using the databases “Embase”, “Google Scholar”, “PubMed”, “Scopus” and “Web of Science” on August 1, 2024. Relevant manuscripts were identified using the inclusion and exclusion criteria. All clinical studies, including prospective or retrospective case series, comparative or noncomparative trials, randomized and nonrandomized studies discussing the role of extensively porous coated femoral stem in primary and revision THA, were considered for inclusion. Experimental or nonclinical studies, other review articles, editorials and opinions were excluded. Results: Overall, 9 manuscripts (6 studies on revision THA) were finally considered for the narrative review. Seven studies reported on functional outcome (patient reported outcome measures – PROM). Studies reported significant improvement in Harris hip score (HHS), satisfaction score (SF-12), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and University of California, Los Angeles (UCLA) scores. The reported complications with extensively porous coated stems include intraoperative femur fracture, thigh pain, infections, and heterotopic ossification. Studies have reported high survivorship rates with this prosthesis (ranging between 94.5 and 99.3%), with re-revision rates between 2.7 and 5%. The radiological osteointegration has been reported to range between 94 and 100%. In addition, studies have reported radiological parameters, including stem subsidence and stress shielding rates, which have remained fairly low. Hydroxyapatite (HA), metallic coatings (such as titanium or cobalt chrome alloys) and coatings with diverse biocompatible materials have been utilized as porous coated materials. Four generations of extensively porous coated femoral stems have been described. With each generation, more sophisticated coating techniques, improved stem geometry and incorporation of modern technological advancements (such as 3D printing, CAD-CAM technology) have been progressively included. Conclusion: Extensively porous-coated femoral stems have remained a durable and reliable option in complex primary and revision THA surgeries. They enhance the extent of osteointegration, resulting in improved longevity and better stabilization of the cement less prosthesis. With the sophistication of porous coating techniques, and incorporation of technological advancements, these stem designs have provided a long-term benchmark for the emerging versions of revision stems.

Purpose: To identify the top articles pertaining to acetabular bone loss and understand the impact that social media platforms have on the dissemination of hip research. Methods: In May 2023, the Altmetric database was searched using the PubMed MeSH terms “acetabular bone loss”. Studies with the highest Altmetric Attention Scores (AAS) were reviewed to exclude topics irrelevant to the treatment or clinical outcomes of acetabular bone loss. Only the top articles that satisfied the inclusion criteria and had an AAS >1 were included in the final analysis. Bibliometric factors for each study were gathered to analyze article characteristics, following the methodology of previous studies. Results: The query yielded 281 studies that had mentions. Following the application of our inclusion criteria, the top 45 articles were identified with a mean AAS of 13.56 ± 62.33 (range: 1–421) and a citation rate of 59.4 ±141 (range: 0–921). The included articles represented 17 journals, with 25 articles attributed to three journals: The Journal of Arthroplasty (JOA; 24.4%), Clinical Orthopedics & Related Research (CORR; 15.6%), and The Bone & Joint Journal (BJJ; 15.6%). More than half of all articles originated from North America (n = 24; 53.3%) followed by Europe (n = 15; 33.3%). A total of 40 of the 45 articles were Level 4 (n = 30; 66.7%) or 5 (n = 10; 22%) evidence. Twitter was the most utilized platform to share acetabular bone loss research (n = 33; 73.3%). There was a statistically significant increase in AAS for every incremental increase in journal impact factor (IF) (P = 0.030) and continent of origin in North America (p = 0.042), but no association between score and citation rate (p > 0.05). Conclusion: Top articles on acetabular bone loss mostly comprise of studies with low levels of evidence performed in North America or Europe with a high citation rate. Twitter was the most utilized social media platform to share acetabular bone loss research. Higher journal IF and article origin in North America were associated with a higher AAS, but no correlation was found between AAS and citation rate.

Post-traumatic arthritis with bone defects occurs following sequelae of comminuted acetabular fractures after fixation. Hip center restoration with acetabular reconstruction at total hip arthroplasty (THA) is required. Infected treated ipsilateral fracture shaft of the femur presented a challenge for this 46-year-old gentleman. Debridement of the femur fracture was done after implant removal, followed by staged fixation after appropriate antibiotic therapy. Stable fixation was achieved with an intramedullary nail with a lateral locking plate. Hip implant removal, debridement and cement spacer were done, followed by THA at the subsequent stage. Stable acetabular reconstruction was done with a sector augment and a cementless shell to restore the hip center. Femoral preparation was done with care to avoid the proximal screw of the plate fixation. Mobilization with a gradual increase in weight-bearing was done. He is doing well at a 2-year follow-up with a united femur fracture, knee movement of 120 degrees, and 1 cm shortening.

End-stage ankle arthritis is a debilitating condition, with pain affecting activities of daily living. Total ankle replacement (TAR) has emerged as a significant advancement in the treatment of end-stage ankle arthritis, as an alternative to traditional ankle arthrodesis surgery. Herein, we present a case of a 51-year-old female with ankle and subtalar arthritis. She underwent a staged subtalar fusion, followed by ankle replacement. One year after the surgery, the patient reported high satisfaction, with decreased visual analog scale (VAS) score from 8 to 1 and increased American Orthopaedic Foot and Ankle Society (AOFAS) score from 22 to 80. The prospects for TAR are encouraging, as ongoing research aims to enhance implant materials and designs. Continued biomechanical studies are expected to improve our understanding of ankle kinetics and kinematics, leading to the creation of more durable and functional implants. Current trends in management of ankle arthritis is seeing a change toward joint replacement option rather than ankle fusion to simulate a more natural walking, with similar pain relief being provided by both the surgeries. With the advent of 3D printing and custom implants, there is potential for even better patient-specific outcomes.