Wockhardt Ltd.

While the disruption of the knee's extensor mechanism is rare, its effects can be severe. Surgical intervention is the primary approach for treating these injuries, and proper execution is needed to prevent lasting functional deficits. The Quadriceps muscle-tendon unit is essential for knee extension, and injuries can hinder independent mobility. Numerous surgical techniques are advocated to re-establish the continuity of the quadriceps tendon. We aim to present a reliable technique for quadriceps tendon repair utilized by both authors of this article in a high-volume practice for the past five years.

Background In simultaneous bilateral total knee arthroplasty (bTKA), surgeons often encounter scenarios where femoral or tibial component sizes differ between limbs. While component sizing is routinely individualized, the functional and survivorship implications of such asymmetry remain insufficiently studied. A clearer understanding is clinically relevant, as patient anatomy, bone stock, and soft-tissue balance often necessitate asymmetric sizing, yet evidence guiding its safety and outcomes is limited. This prospective multicenter study evaluated whether inter-limb differences in component sizing influence postoperative function, patient-reported outcomes, or revision risk in bTKA. Methods Patients undergoing cemented bTKA with standardized implants (metal femoral components, metal-backed tibial baseplates, and ultra-high-molecular-weight polyethylene inserts) were prospectively enrolled across 10 high-volume centers. Patients were stratified into Subset A (identical component sizes in both knees) and Subset B (different component sizes between knees). Clinical and functional outcomes were assessed preoperatively and postoperatively at regular intervals up to three years. Endpoints included range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short-Form Health Survey (SF-36). Radiographic assessment evaluated alignment, fixation, and implant stability. Minimal clinically important difference (MCID) thresholds were used to confirm the clinical relevance of improvements. Results A total of 166 patients (332 knees) were analyzed, with 140 in Subset A and 26 in Subset B. Baseline characteristics were comparable between groups. Both subsets demonstrated significant improvements in ROM and functional scores from baseline to three years (p<0.001 for within-group changes). Subset A achieved higher final ROM (123.6° vs. 118.1°; p<0.001) with less variability, and KSS were also significantly greater in this group (p<0.05). Subset B, despite inter-knee size differences, showed improvements similar to Subset A in WOMAC scores and demonstrated higher values in selected SF-36 domains, including physical functioning, role limitations, and emotional well-being (p<0.05). No implant-related complications, revisions, or radiographic failures were reported in either group during the three-year follow-up, and radiographs confirmed stable and well-aligned prostheses. Conclusion A one-size difference in femoral or tibial components between knees does not compromise clinical or functional outcomes in bTKA. While symmetric sizing may provide slightly greater ROM and KSS improvements, minor asymmetry is not detrimental and may even be associated with enhanced patient-reported quality-of-life domains. These findings support the practice of individualized component selection and reassure surgeons that small inter-limb differences in implant sizing do not negatively impact mid-term function or survivorship.

Cefepime (FEP), a fourth-generation cephalosporin combined with tazobactam (TAZ), a β-lactamase inhibitor, is being developed by Wockhardt as a pharmacodynamically optimized fixed dose combination (FEP-2 g + TAZ-2 g) for the treatment of multidrug-resistant Gram-negative infections. To undertake an exposure-response analysis for establishing pharmacokinetic (PK)/pharmacodynamic (PD) targets, it is crucial to characterize the PK profile of compounds in surrogate compartments, such as plasma and lung, in clinically relevant animal infection models used to evaluate in vivo efficacy. In the current study, PKs of FEP and TAZ were assessed in plasma and in epithelial lining fluid (ELF) of neutropenic noninfected, lung-infected, and thigh-infected mice.

Neutropenic mice were infected by intranasal or intramuscular administration of 10 6 –10 7 colony-forming units per milliliter of Escherichia coli to develop infection in lung or thigh. Post 2 hours of infection, single doses of WCK 4282 at 25 + 25, 50 + 50, and 100 + 100 mg/kg were subcutaneously administered. Plasma and bronchoalveolar lavage fluid were collected up to 8 hours post-administration of doses.

The PK of FEP and TAZ in plasma/ELF in healthy and infected mice did not differ significantly. The plasma PK profiles of FEP and TAZ were linear and dose proportional with modest ELF penetrations in the neutropenic infected mice. The ELF exposures of FEP and TAZ were slightly lower in thigh-infected mice and higher in lung-infected mice when compared with healthy mice. Irrespective of health condition, the mean ELF/plasma area under the curve penetration ratio for FEP and TAZ was similar and comparable (0.42–0.43).

The estimates of FEP and TAZ PK parameters estimated in the current study would help in PK–PD studies for the selection of doses for upcoming in vivo efficacy studies.