Recurrence Risk and Functional Outcomes of Total Knee Arthroplasty in Tuberculous Arthritis: A Systematic Review and Meta-Analysis Anil Regmi, Surakshya Baral, Abdus Sami, Vijay Kumar Jain, Karthikeyan. P. Iyengar, Ranusha Ganapathy Indian Journal of Orthopaedics, 2026 Background: Musculoskeletal tuberculosis (TB) of the knee presents major reconstructive challenges due to joint destruction, ankylosis, and deformity. While total knee arthroplasty (TKA) is a proven solution for end-stage arthritis, its use in TB-affected knees raises concerns of recurrence, perioperative complications, and prosthesis survival. This review aims to evaluate functional outcomes and recurrence rates following knee arthroplasty in tuberculosis and assess the impact of ATT duration and surgical strategy. Methods: , and subgroup differences were evaluated using Chi-square tests; P < 0.05 was considered significant. Results: Across 10 studies including 234 knees, postoperative outcomes improved significantly. KSS Knee scores increased from 35.3 to 83.5 (SMD - 3.59, 95% CI - 4.61 to - 2.58, P < 0.05), KSS Function from 32.7 to 84.2 (SMD - 3.99, 95% CI - 6.19 to - 1.79), and HSS from 37.0 to 85.9 (SMD - 6.75, 95% CI - 10.71 to - 2.78). Overall recurrence was 9%, with higher rates seen with preoperative ATT < 3 months and postoperative ATT < 12 months. Single-stage procedures had a slightly higher recurrence rate than two-stage procedures, though not statistically significant. Conclusion: Knee arthroplasty in tuberculosis significantly improves functional outcomes, and adequate pre and postoperative ATT reduces recurrence. Both single and two-stage procedures are effective when combined with optimal medical therapy. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-026-01763-9.
Greening orthopaedic surgery: Carbon footprint, waste generation, environmental impact, and mitigation strategies Anil Regmi, Surakshya Baral, Abdus Sami, Vijay Kumar Jain Journal of Orthopaedics, 2026 Background Orthopaedic surgery is among the most resource-intensive areas of healthcare, generating substantial waste, energy consumption, and carbon emissions. Operating rooms contribute disproportionately to a hospital's environmental footprint due to their high energy loads, extensive use of consumables, and complex supply chains. Despite rising global attention to sustainable healthcare, evidence specific to orthopaedic practice remains fragmented. Objectives This narrative review synthesises current evidence on the environmental impact of orthopaedic surgery, identifies major contributors to waste and carbon footprint, and outlines effective mitigation strategies applicable at institutional, clinical, and policy levels. Methods A structured search was conducted using MeSH and keyword combinations related to carbon footprint, sustainability, and orthopaedic surgery. Eligible studies included original research, reviews, and institutional reports assessing waste generation, CO 2 e emissions, energy use, or sustainability interventions. Two reviewers independently screened studies and performed thematic synthesis. Results Orthopaedic procedures generate 4–10 kg of waste per case, with plastics comprising nearly half. Life-cycle assessments report procedure-level emissions ranging from 28 to >150 kg CO 2 e, highest in arthroplasty and spine surgery. Major footprint contributors include OR energy use, single-use consumables, implant manufacturing, sterilisation, and anaesthetic gases. Evidence demonstrates that tray optimisation, reusable systems, improved waste segregation, low-flow anaesthesia, and environmentally preferable procurement can reduce environmental impact by 20–70 %. However, methodological heterogeneity and limited data from low-income settings hinder the benchmarking process. Conclusion Orthopaedic surgery carries a significant environmental burden; however, multiple evidence-based strategies can substantially reduce its environmental footprint. Standardised assessment methods and broader global data are essential to guide sustainable surgical practice.
Processed nerve allograft for digital nerve reconstruction: A systematic review and pooled outcome analysis Anil Regmi, Surakshya Baral, Abdus Sami, Vijay Kumar Jain Journal of Hand and Microsurgery, 2026 Background: Digital nerve injuries can result in significant sensory impairment, and reconstruction of segmental defects remains challenging when tension-free primary repair is not feasible. Processed nerve allograft (PNA) provides a biological scaffold without donor-site morbidity; however, reported outcomes vary, and there is limited focused evidence for digital nerve reconstruction. This systematic review and pooled analysis evaluated sensory and functional outcomes following digital nerve reconstruction using PNA. Methods: PubMed, Embase, and Scopus were searched for studies reporting clinical outcomes of digital nerve reconstruction using PNA. Eligible studies included human digital nerve reconstructions with quantitative sensory outcomes such as static two-point discrimination (s2PD), moving two-point discrimination (m2PD), or meaningful sensory recovery. Data regarding demographics, defect characteristics, outcomes, and complications were extracted. Pooled analyses for continuous and proportional outcomes were performed using random-effects models. Results: Sixteen studies, with 664 patients and 886 allografts, demonstrated consistent sensory improvement after PNA reconstruction. Pooled s2PD averaged approximately 7-8 mm, while m2PD averaged 5-6 mm. Meaningful sensory recovery was achieved in over 80 % of reconstructions. Complication and infection rates were low, with no significant graft-related adverse events reported. Although clinical outcomes were favourable, notable heterogeneity was observed in study design, outcome measures, and follow-up duration. Conclusion: A processed nerve allograft provides generally favourable sensory recovery in most reported series, in digital nerve gap reconstruction, with low complication rates, and offers an effective alternative to autograft when primary repair is not possible. Standardised outcome measures and prospective comparative studies are needed to refine patient selection and define predictors of optimal recovery.
Temporal onset and steroid-associated risk in post-COVID hip avascular necrosis: A systematic review and pooled analysis Anil Regmi, Abdus Sami, Surakshya Baral, Bishwa Bandhu Niraula, Vijay Kumar Jain, Karthikeyan. P. Iyengar Journal of Orthopaedics, 2026 Background: Avascular necrosis (AVN) of the hip has emerged as a post-COVID musculoskeletal complication, likely driven by corticosteroid therapy and virus-induced microvascular injury. This study systematically reviews published evidence on post-COVID AVN, analyzing pooled data on latency, cumulative steroid dose, staging, and management outcomes. Methods: A systematic review and pooled analysis were conducted following PRISMA guidelines. PubMed, Embase and Scopus, were searched up to June 2024 using predefined keywords. Studies reporting AVN of the hip following confirmed COVID-19 infection were included. Quantitative pooling of latency (days from infection to AVN diagnosis) and cumulative steroid dose (mg prednisolone equivalent) was performed using a random-effects model. Results: Seventeen studies encompassing 209 patients (313 hips) were included. The mean age was 43.7 ± 16.2 years, with a male predominance. Pooled analysis showed a mean latency of 126.48 days (95 % CI: 95.5-157.46) from COVID-19 infection to AVN onset and a mean cumulative steroid dose of 1198.44 mg (95 % CI: 860.99-1535.88). Most cases presented at Ficat-Arlet stages II-III. Core decompression and bisphosphonate therapy were effective in early stages, while total hip arthroplasty was required for advanced disease. Conclusion: Post-COVID AVN of the hip is a delayed yet potentially preventable sequela associated with corticosteroid exposure and COVID-related vascular injury. The mean latency of 126 days from infection to AVN onset and an average cumulative corticosteroid exposure of 1198 mg prednisolone equivalent underscores the delayed yet dose-dependent nature of this condition.
COVID-19 and mortality in doctors Karthikeyan P. Iyengar, Pranav Ish, Gaurav Kumar Upadhyaya, Nipun Malhotra, Raju Vaishya, Vijay Kumar Jain Diabetes and Metabolic Syndrome Clinical Research and Reviews, 2020
Tuberculosis in the era of COVID-19 in India Vijay Kumar Jain, Karthikeyan P. Iyengar, David Ananth Samy, Raju Vaishya Diabetes and Metabolic Syndrome Clinical Research and Reviews, 2020