bluuebunny/crossref_metadata_2025 huggingface dataset:
PRIMARY TOTAL KNEE ARTHROPLASTY FOR SEVERE VALGUS DEFORMITY: A 2YEAR FOLLOW-UP STUDY AT HASAN SADIKIN HOSPITAL
Authors: Luthfi K. A. M. , Mulyadi D. , Tanjung F.A.
Published: May 2020

Valgus deformity (VD) accounts for only 10% of total knee arthroplasties (TKAs), but is frequently considered the most challenging to manage. The aim of this study was to review outcome of primary total knee arthroplasty for severe valgus deformity at Hasan Sadikin Hospital, Bandung.

Methods:

From January 2015 and December 2017 consecutive patients undergoing unconstrained primary total knee arthroplasty with severe VD, grade II and III were enrolled in a prospective observational cohort study. Preoperatively, at 6 weeks, and 2 years after surgery, patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the Knee Society Score (KSS, 2011, modified version). Femorotibial angle were measured on the frontal standing X-rays.

Results and Discussions:

There were twenty-four patients (18 women, 6 men) with mean age of 66 years (55 - 80). The knee range of motion improved from a mean of 71 degrees preoperatively to a mean of 95 degrees. KOOS Quality of life had increased significantly 6 weeks – 2 years after surgery. KOOS pain mean score was 40.3 points before surgery and increased significantly to 86.6 at two year follow up. OKS mean score increased from 22.1 to 41.8 two years after surgery. KSS 2011 mean objective score increased from 22 to 96 and mean function score increased from 32 to 81 two years after surgery. The mean femorotibial angle were improved from valgus 32.72º±9.68º pre-operation to 4.89º±0.90º post-operation (P <0.001).

Conclusion:

Primary total knee arthroplasty can be effective and safe for severe valgus deformity and the clinical results up to two years after surgery are promising. As our results show, if proper ligament balancing techniques are used and proper ligament balance is attained, the knee may not require the use of a more constrained components.
THE COMPARISON BETWEEN TWO METHODS FOR THE RELIEF OF KNEE OSTEOARTHRITIS PAIN USING OXFORD KNEE SCORE (IMPROVEMENT CHANGES AFTER 4 WEEK FOLLOW UP INJECTION) : INTRAARTICULAR AND GENICULAR NERVE BLOCK IN BLAMBANGAN GENERAL DISTRICT HOSPITAL BANYUWANGI
Authors: Karnanda A , Naufal Habibi A
Published: May 2020

Pain is the hallmark symptom of OA. IACI can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with knee OA. Recent study reported successful pain relief by ablation of the three branches of the Genicular nerve [superior lateral (SL), superior medial (SM), and inferior medial (IM). In the ultrasound-guided GNB technique, these three nerves were selected for the same reasons. Previous studies have identified OKS thresholds to aid the clinician in presenting the expected outcome of surgery in a meaningful way to the patient (OKS provides a means of comparing preoperative and post-operative health status).This cross-sectional, respondents were filled OKS questionaire, and they were self-reported a diagnosis of OA at least one knee by a physician, reported more than 3 months of persistent OA pain. These data were collected at the first post-injection (IACI &GNB) and at 4 week followup visit. The analysis was performed by Independent T-test in SPSS version 22. In IACI group the mean of initial OKS was 37,81±6,87 compare to 34,94±6.14 in GNB group. After 4 weeks, it increased to 42±7.14 and 42,84±7,67 respectively. A total of 82 patients were randomized, with patients receiving an injection, 32 receiving IAIC injection and 50 receiving GNB injection. From Independent Samples T Test, GNB injection demonstrated significantly greater pain reductions and greater percent OKS score improvement than IACI up to 4 weeks postinjection. Comparing two methods, there were significant difference between two groups based on OKS: p=0.000
Continuous Intra-articular Analgesic Injection Versus Continuous Adductor Canal Block in Postoperative Total Knee Arthroplasty
Authors: Limtharapond Kadchan , Leelasestaporn AVM Chumroonkiat
Published: May 2020

Continuous adductor canal block (CACB) provides effective analgesia after TKA but this technique requires skill of anesthesiologists and equipment such as ultrasonography. A new technique, continuous intra-articular analgesia injection (CIA) is developed recently and found good results. However, effectiveness of these two techniques after TKA is not established.

Purposes:

We determined whether, after TKA, patients with CIA versus patients with CACB demonstrated (1) decreased pain scores (2) greater ambulatory ability postoperatively (3) decreased daily opioid consumption and hospital length of stay

Methods:

Between October 2016 and October 2018, 50 patients underwent unilateral TKA at our practice site, whom 50% (n = 25) had CACBs and the others had CIAs. The results were collected in postoperative day (POD) 1,2 and 3.

Results:

The results were analyzed by SPSS V18 and used student T-test for measurement of mean visual analog pain scale, time up-and-go test, 6-minute walk test and daily total opioid consumption and knee society score. All results show no statistical significant difference between two groups.

Conclusion:

This study shows continuous intra-articular injection in postoperative TKA is as effective as continuous adductor canal block. It can be used as alternative in postoperative TKA.
TENSION BAND WIRING (TBW) OF DISTAL END CLAVICLE : A FORGOTTEN TECHNIQUE : SIMPLER, CHEAPER AND BETTER
Authors: Zufahrizzat S , Nadzim AS , Saifudin O , Abdul Rauf A
Published: May 2020

Clavicle fracture is a common injury, and can be classified into middle third, medial third, and distal third fractures. Only 10-15% of clavicle fracture occur in the distal third segment. Neer classified the distal clavicle fracture into five types ; type II and V are unstable and requiring fixation . Various common methods of stabilizations are introduced such as K-wiring , tension band fixation , plate fixation, osteosynthesis with hook plate and coracoclavicular screw however all those operative methods have their own advantages and disadvantages.

Materials and Methods:

We presented a case of 21 years old male with left shoulder pain after motor vehicle accident. Examination revealed tenderness on his left shoulder, and radiograph showed fracture of distal end left clavicle Neer type II, requiring fixation. He was counselled for lateral extension clavicle locking plate but unable to pay due to financial constraint.

Results:

The patient underwent open reduction and internal fixation using Kirschner wire with tension band fixation . The fracture site was visualized and the hematoma was curetted and washed. The fracture was reduced and fixed with two 1.4 mm trans-acromial Krischner wires and the reduction was checked with an image intensifier. Then the TBW is applied using stainless steel wire size 1.0 . The K-wires are bent beneath the skin. Sling immobilization is used for 2 weeks after the operation. Unrestricted tolerable shoulder motion is permitted. Stretched and exertional exercise is allowed after radiography shows osseous union and the implants are removed.

Discussions:

TBW is widely employed to treat limb fractures, such as patella and olecranon fracture but seldom used for distal clavicle nowadays. The advantages of TBW are higher antirotation and antibending force compared with that in K-wire fixation and lower profile compared with the bone plate, which reduces tendon irritation and prominent implant. The use of K-wires and TBW also required only the exposure of the fracture site. The soft tissue around the clavicle incurred little damage, leading to a lower infection rate. In addition, the use of K-wires and TBWs can provide a more rigid fixation than K-wires only. Rigid fixation with little complication contributes to good results .

Conclusion:

Surgical management is recommended for unstable distal clavicle fracture. TBW can be preferred because of the simplicity of the procedure, low cost, simple hardware, high union rate and easy availability of the implant.
Hip Transposition as a Limb Salvage Procedure Following Resection of Extensive Ewing Sarcoma of The Pelvis and Proximal Femur
Authors: Budi MNS , Rubiansyah P
Published: May 2020

Pelvic resection in limb salvage surgery always pose a major challenge for orthopedic surgeon, especially in large tumor extension that requires combination of pelvic and femoral resection with sacrificing the hip joint. Complex anatomy and preservation major structure (arteries, veins, nerves, muscle and visceral organs) is a major consideration.

Methods:

We evaluated the oncologic, functional outcome and complications of a patient 27 years old with Ewing sarcoma involving the left pelvis (ilium, ischium and pubic) and femoral proximal until middle third, who underwent pelvic resection type II, III involving hip joint with femoral resection. The reconstruction that has been done were: hip transposition using cemented scaffold and modified Harrington as framework, proximal femoral megaprosthesis, capsuloplasty using polypropylene mesh and reattachment of muscles around the hip.

Results:

Follow-up at 3 months showed a good oncological and tolerable function outcome; by means of no local recurrence or distant metastatic with painless partial weight bearing. Active motion of the hip is preserved with muscle power of 4/5 and LLD of 3 cm. The patient were able to ambulate by himself, sitting in normal position with no pain. There were no major complications were found in this patient such as infection, dislocation, loosening implant or visceral complications.

Conclusion:

The choice of limb salvage in pelvic tumor followed with complex reconstruction of the hip still amenable in patient with malignant tumor of pelvic and femur, regarding the oncological, functional outcome and complication.
THUMB TUBERCULOSIS: A CASE REPORT
Authors: Mohd Yunus R. , Ahmad A.A. , Ahmad A.R.
Published: May 2020

Tuberculosis is caused by Mycobacterium tuberculosis, occurs in about 2 billion people. Approximately 8 million people/year develop the active form.1,2 Tuberculosis in the hand is manifested as osteomyelitis in carpals, metacarpals and phalanges.1 Musculoskeletal tuberculosis occurs, in most cases, through haematogenous dissemination from the primary focus. In immunosuppression circumstances, it is reactivated.

Methods:

47 years old lady, who had underlying pulmonary tuberculosis on anti-TB medications since June 2018, presented to us for swelling over right thumb. Associated with tender, erythematous skin and limited range of motion of right thumb.

Results:

Plain radiograph demonstrated soft tissue swelling, joint space narrowing, mottled lucency of the proximal phalanx and cystic degenerative changes. MRI shows osteomylities proximal phalanx of right thumb. Patient underwent wound debridement of right thumb, culture and sensitivity shows Mycobacterium tuberculosis infections. Post debridement, range of motion of MCP joint of right thumb was improved and anti-TB medications to restart.

Discussions:

Tuberculosis involvement of the metacarpals and phalanges is a rare presentation of extrapulmonary TB. The radiographic features of osseous tuberculosis are present in conditions such as inflammatory arthritis, pyogenic osteomyelitis, osteopenia, softtissue swelling with minimal periosteal reaction, narrowing of the joint space, cysts in bone adjacent to joints, and subchondral erosions. The gold standard to diagnose is culture of Mycobacterium tuberculosis from bone tissue. Current treatment is a 2 month initial phase of isoniazid, rifampin, pyrazinamide, and ethambutol followed by a 6 to 12 month regimen of isoniazid and rifampin.

Conclusion:

Finger swelling is a rare presenting sign of disseminated tuberculosis. Early biopsy and appropriate microbiologic testing can avoid diagnostic delay.

References:

Malaviya AN, et al. Best Pract Res Clin Rheumatol. 2003;17:319–43. Fortún J, et al. Mycobacterium tuberculosis infection? Medicine. 2010;10:3808–19. DOI: 10.1016/S0304-5412(10)70119-0.
Outcomes of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis at Hasan Sadikin General Hospital Bandung
Authors: Pardamean A , Mulyadi D , Tandjung F.A
Published: May 2020

Peripheral joints involvement in Ankylosing spondylitis (AS) has been reported in 73% of these cases, with the hip being the most commonly affected diarthrodial joint. The reported prevalence of hip involvement in AS varies from 19 to 36%. Total Hip Arthroplasty (THA) is often required to manage pain and restore function and mobility. The aim of this study was to retrospectively analyze outcomes related to performing THA on patients with AS.

Methods:

We evaluated the oncologic, functional outcome and complications of a patient 27 years old with Ewing sarcoma Data of 19 AS patients who underwent 29 THAs between 2014 and 2018 were retrospectively analyzed. Clinical and imaging data were collected preoperatively, postoperatively, and during the follow-up period for surgical outcomes.

Results:

There were 14 males and 5 females with 29 affected hips (53% bilateral, 47% unilateral). The average patient at surgery was 31.7 years old (range, 17-47 years). After surgeries, overall inclinations and anteversions of acetabular cups were 44.9°±0.3° (range, 30°–50°) and 18.42°±0.30° (range, 0°–25°) respectively. Mean Visual Analogue Scale (VAS) score decreased from 7.4±0.14 (range, 4–10) preoperatively to 3.21±0.09 (range, 0–4) at final follow-up. Mean Harris Hip Score (HHS) improved from 24.36±2.6 (range, 15–45) to 92±1.66 (range, 80–95) at final follow-up. Postoperative Range of Motion (ROM) was improved from 10.26°±2.61° (range, 0°–50°) preoperatively to 84.26°±0.76° (range, 70°–100°) at final follow-up. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, which shows the activity of disease, was 7.6±0.17, and it decreased to 3.5±0.15 at last follow-up. There were post-operative complications in 8 hips (27.6%). Superficial wound infection was documented in 3 hips (10.3%), sciatic nerve injury in 1 hip (3.4%), implant loosening in 2 hip (6.9%), and heterotopic ossification was documented in 2 hips (6.9%) at final follow-up.

Conclusion:

Surgical outcomes of THA for AS patients with hip involvement are satisfactory.
Treatment of acute hematogenous infection after total knee arthroplasty with open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic infusion: a midterm result with mean follow up of 75 months
Authors: Chaiyakit Pruk , Meknawin Surapoj , Hongkoo Nutthapong
Published: May 2020

Background:

Standard management of acute hematogenous infection after total knee arthroplasty consisted of open arthrotomy debridement and polyethylene exchange. However, the efficacy of this method was inconsistent with successful retention could be less than 50%. Direct intra-articular antibiotic infusion could be a potential adjuvant for this complicated problem.

Objective:

To report our results of open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic for the treatment of acute hematogenous infection after TKA.

Materials and Methods:

We retrospectively review data from 16 knees (13 patients) with this type of infection and being treated by open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic (IA-ATB) with our protocol since 2009.

Results:

all cases were diagnoses with acute hematogenous PJI and treated with semi-urgent basis and underwent open arthrotomy debridement and PE exchange combined with IA-ATB with our protocol were included in this study. 2 cases (2 knees) were loss to follow up after the infection were eradicated at 7 months and 48 months. 2 cases (3 knees) passed away with intact prosthesis at 6 years. 2 cases (2 knees) were reinfected with at 2 years and 5 years after operation and later need to do 2 stage revision. The longest follow up was 11 years with average follow up of 75 months. Therefore, 12 out of 14 infected knees were successful treated with this technique.

Conclusions:

Open arthrotomy debridement and polyethylene exchange combined with direct intra-articular antibiotic infusion is an effective method for the treatment of acute hematogenous infection after total knee arthroplasty.
Augmentation for Acetabular Deficiencies in Complex Total Hip Arthroplasty
Authors: Solayar Gandhi Nathan
Published: May 2020

Introduction:

Complex and revision Total Hip Arthroplasty (THA) is a challenging prospect in patients with acetabular bone deficiencies. Augmentation using allograft and trabecular metal (TM) are among some of the options in these situations. This study report the outcomes of 14 cases of complex and revision THA using acetabular augments performed in our institution between 2015 and 2018

Materials and Methods:

In this retrospective study, data included demographic features, indication for THA, type of augments and clinical outcomes using the Harris hip score were collected for the to determine early results following THA.

Results:

The mean cohort age was 51.3 years. Gender distribution was equal with 7 male and female patients each. 7 THAs were augmented with allograft and 7 cases with TM augments. The average duration of follow-up was 16.9 months. Most patients (11 of 14) required complex primary THA following prior traumatic hip dislocations and its subsequent complications. The mean post-operative Harris hip score for functionality was 80.84 in our cohort at final follow-up (from an average of 33.8 pre-operatively). At present, there have been no reports of wound complications, infections or dislocations in this early cohort.

Discussions:

Complex/revision THA using allografts for acetabular augmentation have been used for decades with good and replicable results as shown in our series. TM is relatively new but current literatures show encouraging results. Both options have resulted in good outcomes in our cohort and further long term studies would be necessary before TM augments were to replace the need for allograft.

Conclusions:

Both allografts and TM acetabular augments showed good early results post-operatively in our cohort. With the improved flexibility of component selection and the lower risk of allograft infection, TM augments is currently our choice of acetabular augmentation and the early results are promising.
Gleno-humeral Joint Functional Outcome in Displaced Scapular Body Fracture Treated with Anatomical Scapula Plate: 2 case series
Authors: Afiq MA , Norhaslinda B , Rizal Z , Rauf A
Published: May 2020

Introduction:

The gleno-humeral (GH) or shoulder joint complexity of its biomechanics had been subjected for a number of study for many years. The ability of the shoulder joint to have multiple degrees of motion is contributed by the interaction between the structures surrounding the joint which maintain its stability.

Methods:

We report 2 cases of displaced scapular body fracture in our trauma centre fixed using anatomical scapular plate. Both underwent surgery within 3 weeks after their accident, using modified Judet approach and used implant from the same provider. All patients were followed up at 6, 12 , 18 and 72 weeks. At 6 months post operation the motion of the gleno-humeral joint were assessed. The functional status and pain score were joint also assessed using QuickDASH score and Visual Analogue Scale respectively.

Results:

Active shoulder range of motion, QuickDASH and VAS score are shown in Table 1. Lower QuickDASH score have better functional outcome while lower VAS score indicate lesser pain experience. [Table: see text]

Discussions:

Scapulo-thoracic joint also important in gleno-humeral joint motion. Scapulothoracic motion allows shoulder movement beyond initial 120o provided by the glenohumeral joint1. This coordinated movement between the scapula-thoracic and glenohumeral joint is termed as scapula-thoracic rhythm2. Displaced scapula fracture will affect the function of the scapula-thoracic rhtym. Scapula bone has uneven bony mass distribution. Anatomical scapular plate is a pre-contoured implant which is specially designed to meet the morphology of the scapula bone. Restoration of the anatomy of the scapula is very important since it will restore the scapula-thoracic rhythm and thus gleno-humeral joint function.

Conclusion:

In our short follow up, displaced scapular body fracture shows good gleno-humeral joint functional outcome when treated with anatomical scapula plate. Scapula bone plays important role in maintaining the biomechanics of gleno-humeral joint.

References:

1. Terry GC, Chopp TM. Functional anatomy of the shoulder. J Athlet Train 2000;35(3):248–55. 2.Halder AM, Itoi E, An K. Anatomy and biomechanics of the shoulder. Orthop Clin NA 2000;31(2).
Acute Traumatic Posterior Shoulder Dislocation With Greater Tuberosity Fracture
Authors: Zufahrizzat S , Nuruddin MY , Saifudin O , Rauf A
Published: May 2020

INTRODUCTION:

Posterior shoulder dislocation is a rare injury and represents 2-5% of all shoulder dislocation cases. Even less frequent , posterior fracture-dislocation represents 0.9 % of shoulder fracture dislocation. Mechanism of injury include a traumatic event with axial loading of the adducted , internally rotated arm or more commonly from violent muscle contraction following a seizure or electrocution injury. Delays in diagnosis it are common, estimating 50 % are missed and it can lead to chronic pain, stiffness and long-term functional disability.

METHOD:

A 44 years old male was brought to our emergency department following road traffic accident. He was riding a motorcycle when he was hit by car from the left side. He complained of severe pain and functional disability of his left shoulder. Radiographs revealed posterior shoulder dislocation (light bulb sign) with quiry greater tuberosity (GT) fracture. CT scan was performed to assess fracture displacement. U slab was then applied, and the patient was taken to operation theatre after a routine blood investigations.

RESULT:

The patient was placed in semi beach position under general anesthesia. Incision was made via transdeltoid approach. Intraoperatively, posterior dislocation of the humeral head was confirmed. GT fragment size 2.7 cm x 1.6 cmwas indentified and reduced with temporary Kirschner-wires. The reduction was confirmed under image guidance and final fixation achieved with two partially threaded 4.0 mm cannulated screws. The shoulder was then immobilized with a sling 2 weeks subsequently pendulum exercise and progressive range of motion exercise was started.

DISCUSSION:

Inadequate radiograph including axillary view and poor physical examination are the main factors of misdiagnosis.The physicalfindings that may present are shoulder locked in an internally rotated posititon with limited external rotation , prominent posterior shoulder and coracoid . Radiograph will showing positive rim sign , absence of the half-moon overlap , light-bulb sign, and the trough line. A delay in diagnosis and treatment of posterior shoulder dislocation or fracture-dislocation has increased risks of nonunion, subsequent humeral head collapse, avascular necrosis and post-traumatic arthritis.

CONCLUSION:

Posterior dislocation of shoulder associated with greater tuberosity fracture is a rare and frequently missed injury. A thorough clinical and radiographic evaluation should avoid the missed diagnosis.

REFERENCES:

Figueiredo A et al Posterior fracturedislocation of the shoulder: An often unrecognized traumatic injury Orthopedics, Traumatology and Sports Med Int Journal (2018) 1 :8-11
Anterior Cruciatel Ligament Reconstruction with Peroneus Longus Tendon Autograft: Functional Outcome and Donor Site Morbidity
Authors: Kusumastutia Auliana Hayu , Rukmoyo Tedjo , Rhatomy Sholahuddin , Sakti Yudha Mathan
Published: May 2020

Anterior Cruciate Ligament (ACL) is a knee ligament that is very important in maintaining the stability of the knee joint. The incidence of isolated ACL tears remain a common orthopaedic injury with significant increase in the rate of ACL reconstruction over time. Several types of autografts used for ACL reconstruction have some potential occurrence of donor site morbidity, including Bone-Patellar Tendon-Bone (BPTB), hamstring tendon, and quadriceps tendon. Peroneus longus tendon can be an option as a graft donor because it has biomechanical characteristics that are not significantly different from the hamstring tendon.

Purpose:

The aim of the study was to evaluate the functional outcome and donor site morbidity of anterior cruciate ligament (ACL) reconstruction using peroneus longus tendon autograft.

Methods:

This study was an observational analytical with retrospective cohort design using medical record. The functional outcomes were assessed with IKDC, Modified Cincinnati, Tegner-Lysholm, and KSS scoring system 12 months after surgery. Donor site morbidity was assessed with AOFAS and FADI scoring system, eversion strength, and plantarflexion strength.

Results:

Seventy five patients fulfilled the inclusion criteria (59 males and 16 females). Mean of peroneus longus tendon graft diameters were 8.39 ± 0.69 mm (range 6.5-10 mm). Significant increase of functional score (p<0.05) were found 12 months after surgery. Mean score of IKDC was 55.26 ± 12.76 preoperative; 96.69 ± 3.36 postoperative, Modified Cincinnati was 65.45 ± 16.25 preoperative; 93.29 ± 7.04 postoperative, Tegner-Lysholm was 67.80 ± 15.29 preoperative; 89.71 ± 8.35 postoperative, KSS (Knee) was 65.33 ± 19.46 preoperative; 95.17 ± 5.94 postoperative, and KSS (Function) was 76.52 ± 20.25 preoperative; 93.20 ± 10.29 postoperative. Mean score of AOFAS was 98.93 ± 3.11 and FADI was 99.80 ± 0.59 at six months after surgery. The eversion and plantarflexion strength were not significantly different (p>0.05) between donor and contralateral side ankle. There was neurapraxia in 3 (4%) patients at six months postoperative.

Conclusion:

The peroneus longus tendon can be an ideal source of graft for ACL reconstruction because it has good functional outcome and minimal donor site morbidity.
Patella Fracture Fixation Via Wide Awake Local Anesthesia No Tourniquet (Walant) Technique
Authors: Safie Shaqirin , Adham Amir , Ahmad  , Ahmad Abdul Rauf
Published: May 2020

Introduction:

Fracture of the tibia are the most common long bone fracture, with an incidence greater than 75,000 per year in the US1. With the recent breakthrough of operation under WALANT (Wide Awake Local Anaesthesia No Tourniquet) technique. We reported a patient with midshaft tibia fracture who underwent plating under the WALANT technique

Methodology:

18 yearold gentleman sustained a closed fracture of his left tibia after his motorbike skidded. He wascounselled for the surgery to be done under the wide-awake technique as we have limited operating theatre time for the case to be done under general/regional anaesthesia. Preoperatively, the WALANT solution is prepared using 50 cc lidocaine 2%, 1cc of epinephrine, 10cc of sodium bicarbonate 8.4% then dilute into 50 cc normal saline. Total of 50 cc WALANT solution was injected along the planned skin incision and at subperiosteum 30 minutes before operation started.

Result:

Pain score patient remain 0-3/10 during and after removal of backslab, throughout the surgery and postoperatively. The use of epinephrine for hemostasis provide good surgical field view since there is minimal bleeding. Postoperatively the anaesthesia effect lasted for 6 hour and was patient able to move the leg straight away without have to keep lying in bed for 6 hours after spinal or drowsiness from sedation.

Conclusion:

Plating of tibia under WALANT is a good alternative for patient who have financial difficulty, high risk operation under general anaesthesia, hospital which have limited slot for operation under general anaesthesia and etc. Additionally, the strength and stability of the plate can be assessed intraoperatively by asking the patient to actively move his limb.

Reference:

Praemer A, Furner S, Rice DP. Musculoskeletal Conditions in the United States. Park Ridge, IL: American Academy of Orthopaedic Surgeons; 1992.
Comparative Biomechanical Study Between Minimally Invasive Popliteus and LCL Reconstruction Versus LaPrade Technique
Authors: Chernchujit Bancha , Artha Arrisna , Anilabol Panin
Published: May 2020

Background:

Many aspects of the posterolateral corner (PLC) of the knee have been extensively studied within the past 20 years. Quantitative anatomic and biomechanical studies have demonstrated the importance of the 3 static stabilizers of the lateral side of the knee: the fibular collateral ligament, the popliteus tendon, and the popliteofibular ligament. There are various methods of reconstruction. However, currently, there is no consensus on the preferred reconstruction technique for treating patients with chronic PLC injuries. We have developed a new reconstructive technique for PLC based on tibiofibular-based technique, similar to LaPrade, and this technique is less invasive than the previous techniques.

Hypothesis:

There is no difference between minimally invasive popliteus and LCL reconstruction and LaPrade’s method in restoring the posterolateral stability of knees

Methods:

Six paired fresh-frozen cadaveric knees were assessed in the intact state and then dissected to simulate a grade III posterolateral knee injury. By using a “Blocked randomization”, each paired knee was randomized into 2 groups (1) reconstruction via LaPrade’s method, (2) minimally invasive popliteus and LCL reconstruction. Biomechanical testing using varus stress radiographs was performed to compare knee stability between 2 groups.

Results:

This study included six paired knees, three males and three females. The mean age of the cadaver was 70.8 years (range 57-85 years). No difference was found in the demographic data (sex distribution, lateral opening gap of intact knee and side-to-side difference of lateral opening gap of sectioned knee) between the 2 groups. The side-to-side difference in lateral joint opening on the varus stress radiographs significantly improved after PLC reconstruction in both groups (p <0.001, p <0.001), However, there were no differences between the 2 groups in side-to-side difference of lateral opening gap after reconstruction (Mean difference=-0.05 (95%CI, -0.46 to 0.36); p- value=0.039).

Conclusion:

Biomechanically, minimally invasive popliteus and LCL reconstruction is equivalent to LaPrade’s technique in restoring the stability of knees in case of grade III PLC injury. Additionally, this technique is less invasive than all traditional open technique of PLC reconstruction. The minimally invasive popliteus and LCL reconstruction technique may be a treatment option for grade III PLC injury. Keywords: posterolateral corner; ligament reconstruction; popliteus tendon; lateral collateral ligament; popliteofibular ligament; knee biomechanics; minimally invasive surgery
Comparison of Bone Marrow Aspirate Concentrate and Allogeneic Human Umbilical Cord Blood-derived Mesenchymal Stem Cells in Patients with Kissing Lesion on Initial Arthrocopy After High Tibial Osteotomy in Medial Unicompartmental Osteoarthritis of Knee
Authors: Na Seung-Min , Choi Ik-sun , Seon Jong-Keun , Song Eun-Kyoo
Published: May 2020

Purpose:

The purpose of this study was to compare the outcome of cartilage regeneration between bone marrow aspirate concentrate (BMAC) augmentation and the stem cell-based medicinal product (a composite of culture-expanded allogeneic hUCB-MSCs and hyaluronic acid hydrogel [Cartistem]) in medial unicompartmental osteoarthritis of knee

Methods:

Out of 81 cases underwent for second look arthroscopy who treated for medial unicompartmental osteoarthritis between 2016 and 2019, 31 cases were kissing lesion which was shown full thickness cartilage defect(over ICRS grade 3B) in medial femoral cartilage and medial tibial cartilage at initial surgery. We retrospectively compared clinical outcomes, including International Knee Documentation Committee (IKDC) subjective score, Knee Society Score (KSS) pain and function, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between BMAC group comprising of 25 cases and Cartistem group comprising of 14 cases at minimum of 1 year follow up. Also, cartilage regeneration was graded by International Cartilage Repair Society Cartilage Repair Assessment (ICRS CRA) grading system at secondary arthroscopy. Radiologic measurement including Hip-Knee-Ankle (HKA) angle, posterior tibial slope angle, and correction angle were assessed.

Results:

At the final follow-up, clinical outcomes were improved. However, there were no statistical significances between two groups in clinical outcome and radiologic outcome(p>0.05). Regarding the findings of second-look arthroscopy, Cartistem group was significantly better than BMAC group in medial femoral cartilage and medial tibial cartilage(p=0.002, 0.000). About medial femoral cartilage, grade I cartilage regeneration was found in 0 case, grade II in 10 cases (40%), grade III in 6 cases (16%), grade IV in 9 cases (36%) in BMAC group and grade I cartilage regeneration was found in 1 case (7.1%), grade II in 11 cases (85.7%), and grade III in 1 case (7.1%) in Cartistem group. About medial tibial cartilage, grade I cartilage regeneration was found in 0 case , grade II in 8 cases (32%), grade III in 4 cases (16%), grade IV in 13 cases (52%) in BMAC group and grade I cartilage regeneration was found in 0 case, grade II in 12 cases (85.7%), and grade III in 1 case(7.1%), grade IV in 1 case (7.1%) in cartistem group.

Conclusion:

Clinical outcomes were improved regardless of which augmentation was administered. However, microfracture with Cartistem is more effective for cartilage regeneration than microfracture with BMAC in medial unicompartmental OA. Keywords : High tibial osteotomy, Unicompartmental osteoarthritis, Microfracture, Cartilage regeneration, Bone marrow aspirate concentrate, Cartistem.
A Prospective Cohort Study of Outcome In Total Knee Arthroplasty With Or Without Drainage At Dr. Hasan Sadikin General Hospital From January 2017 To January 2018
Authors: Magetsari R.M.S.N , Mulyadi D , Tandjung F.A
Published: May 2020

The use of postoperative drainage after total knee arthroplasty (TKA) in osteoarthritis patients was believed effective in decreasing hematoma, swelling, infection, and postoperative pain. However, the drainage can also cause infection due to retrograde migration of bacteria and impair early postoperative rehabilitation. The aim of the study was to compare pain intensity (VAS), hemoglobin level (Hb), range of motion (ROM), clinical results (KSS and WOMAC) in TKA patients with and without postoperative drainage.

This study was a prospective cohort study with samples of 98 patients at Dr. Hasan Sadikin Hospital from January 2017-January 2018. Simple random sampling with closed envelopes was used to determine TKA patients who undergone postoperative drainage and without drainage. The drainage group (K1) was 46 knees, the without drainage group (K2) was 52 knees. Both groups were compared based on VAS, Hb, ROM, KSS and WOMAC score on preoperative, 1st, 3rd, 5th day, 1st, 6th month, and 1 year postoperative.

VAS score on K1 group showed better results (3rd day VAS K2 1.77; K1 1.32; p-value 0.070; 5th day K2 1.46; K1 1.22; p-value 0.090; p-value < 0.1). Based on postoperative Hb, K2 group was better (K2: 11.74;K1: 10.835; p-value 0.06). ROM on K2 is better than K1 (1st day ROM K2 52.50; K1 42.85; p-value 0.64;3rd day K2 53.70; K1 47.24; p-value 0.832; 5th day K2 54, 60; K1 45.85; p-value 0.73). Based on the KSS and WOMAC score there were no significant differences between K2 and K1.

Our study concluded that there are several advantages for not using drainage after TKA in terms Hb, ROM on 1st, 3rd, and 5th day postoperative and early mobilization with weight bearing using walker at 3rd day postoperative. There is no rationale for the use of drain after primary TKA.
Role of Mesenchymal Stem Cell-Conditioned Medium (MSC-CM) in ligament or tendon healing: A Systematic Review from 1998-2018
Authors: Rhatomy Sholahuddin , Sumarwoto Tito , Prijosedjati Andhi , Romaniyanto  , Prasetyo Thomas Edison
Published: May 2020

Background:

The therapeutic value of mesenchymal stem cells (MSCs) in tissue engineering and regenerative medicine is attributable in part to paracrine pathways triggered by several secreted factors secreted into culture media. The secreted factor here is known as the conditioned medium (CM) or secretome.

Objectives:

This review is aimed to investigate and summarise the in-vitro, pre-clinical in-vivo studies regarding the role of CM-MSC in ligament or tendon healing from 1998 until 2018.

Data Sources:

A systematic literature search on PubMed, MEDLINE, OVID, Scopus, Google scholar, and Cochrane library was carried out by using search terms: Secretome, conditioned medium, mesenchymal stem cell, ligament, tendon and healing.

Methods:

A total of 904 articles were reviewed. Five articles were identified as relevant for this systematic literature review.

Results:

One tables of studies were constructed for in vitro studies and in-vivo studies.

Conclusion:

All of the included in-vitro studies and in-vivo studies have shown a promoting effect of ligament or tendon healing at various stages in vitro or in vivo. Although there are no clinical studies regarding the use of CM- MSC in the human ligament or tendon healing that have been conducted, transplantation of secretome has shown a promising result in the acceleration of ligament or tendon healing process.
Corelation Between X-Ray Grading Scale And USG Examination of Knee Joint Osteoarthritis
Authors: Supartono Basuki , Amalia Riza , Satya Ika , Wiyono Sugeng
Published: May 2020

Osteoarthritis is a degenerative joint disease which is related with the damage of cartilage. Xray is one of the osteoarthritis radiological examinations but only to see the damage of bone not cartilage. One of an effective examination to visualize the damage of cartilage is Ultrasound. The objective of this study is to determine the relation between osteoarthritis grading scale with cartilage ultrasonographic in knee osteoarthritis patients. This was a Cross-sectional study on 32 knee osteoarthritis patients. Statistical analysis was performed using Kolmogorov-Smirnov Test showed there was a correlation between osteoarthritis grading scale with cartilage ultrasonographic. The conclusion in this study, there is a significant correlation between osteoarthritis grading scale with cartilage ultrasonographic in knee osteoarthritis patients.
Midterm Results Of Flanged Acetabular Cup Used In Severe Acetabular Defects
Authors: Pandey Arun Kumar
Published: May 2020

Background:

Revision hip arthroplasty complicated by massive acetabular defects and/or pelvic discontinuity has remained difficult to manage, with no definite option to produce predictable results. Acetabular cages and reinforcement rings have high failure rates because of lack of biological fixation. Custom triflange cups are economically demanding like cup-cage constructs, and require time to be fabricated. Cementless acetabular cup having an ischial hook and three iliac flanges is a technically simple but effective option to be used in such situations.

Questions/purposes:

We sought to determine (1) mid-term Kaplan-Meier survival; (2) clinical outcomes based on HSS and WOMACscores; (3) radiological outcomes based primarily on component migration; (5) mean operative time and (4) the complication rate for a series of 18 procedures.

Methods:

We conducted a retrospective review of all the revision hip arthroplasty procedures performed between January 2013 and May 2015 and identified 18 procedures in 18 patients where a cementless porous-coated hemispherical cup (Combicup-R, Link) was used. According to AAOS classification, 8 of the 18 (44%) acetabuli had Type 3 defect and 10 of 18 (56%) acetabuli had Type 4 defect. Structural bone allografts were used in 7 cases and all cases required morsellized allograft. The minimum followup was of 49 months and average was of 58 months (range, 49–67 months; SD, 34.3). Postoperative clinical evaluation was done at 6 weeks, 3, 6, and 12 months, and annually thereafter. HSS and WOMAC scores were recorded at follow up and radiographs were taken. Serial radiographs were compared with the 6-week postoperative radiographs to evaluate for component loosening/migration and structural graft resorption.

Results:

The 6-year Kaplan-Meier survival rate with revision for any cause representing failure was 93% (95% confidence interval [CI], 83.1–97.4). HSS and WOMAC score improved significantly from a preoperative value of 54 and 43 respectively to 87 and 85 postoperatively (p < 0.001). One patient had resorption of structural allograft and subsequent cup migration, which needed re- revision surgery.

Conclusions:

Porous coated acetabular cup supplemented with flanges and hooks is a suitable option to treat severe acetabular defects and pelvic discontinuity in acetabular revision reconstructions, than cages which do not provide biological fixation. Compared to custom triflange cups, they are more economical, technically easier to implant and do not require any waiting period to be fabricated.
Cemented THR In Comminuted Intertrochanteric Multi-Fragmentary Fracture Femur And Previously Failed Hip Surgery Is Really A Challenge
Authors: Hossain Amjad
Published: May 2020

Comminuted intertrochanteric fracture is a common scenario in geriatric patient group. So far only DHS is the choice of implant to fix those fractures. But unfortunately we cannot allow the patient to full weight bearing mobilization before 6 weeks of surgery. And in addition of that due to osteoporotic bone many of the cases present with cut out of DHS later on. So in our center LabaidArthroplasty Center we started in trial basis cemented THR in Comminuted intertrochanteric fracture femur cases. In these cases we can allow patient to full weight bearing mobilization at minimum in 1st POD to maximum 3rd POD as pain permitted. In addition the previously failed hip surgeries also difficult to manage and cemented THA will be one of the best option in those cases. In subsequent follow up we observed better functional outcome in comparison to the cases of DHS. It is a case based study and need to be more theoretical and long term study before any conclusive decision.
A multicenter randomized controlled trial: matrix-augmented bone marrow stimulation with a polyglycolic acid membrane with hyaluronan vs. microfracture alone in local femoral cartilage defects of the femoral condyles
Authors: Glasbrenner Johannes , Petersen Wolf , Raschke Michael J. , Steiger Matthias , Castelli Claudio , Verdonk René , Fritschy Daniel , Herbort Mirco
Published: May 2020

Aims and Objectives:

Microfracture is the gold standard for the treatment of small localized chondral defects of the knee joint. There is evidence from animal studies that the augmentation of bone marrow stimulation by a matrix improves the quality of the repair tissue (matrix-augmented bone marrow stimulation = m-BMS). Aim of this randomized controlled trial was to examine the outcome of a matrix made of polyglycolic acid and hyaluronan in comparison to a conventional microfracture technique.

Materials and Methods:

In a randomized controlled trail (RCT) patients between 18-60 years with an articular femoral cartilage defect of 1-4 cm2 in the weight bearing area of the femoral condyles with indication for MF were enrolled and randomized to MF or m-BMS using a polyglycolic acid membrane with hyaluronan. Defect filling in MRI assessment at 12 weeks postoperatively was defined as primary outcome measure. MRI scans and follow up examinations including patient reported clinical outcome scores (VAS pain, KOOS, IKDC and SF-36) were performed at 12, 54 and 108 weeks after surgery.

Results:

There was no statistically significant difference between both groups in terms of defect filling assessed by MRI at 12, 54 and 108 weeks postoperatively. At 12 weeks there was a tendency towards higher degree of defect filling in the MF group when compared to the m-BMS group, whereas no difference was found after 54 and 108 weeks. The m-BMS group revealed superiority in terms of improvement over time in the KOOS subscales pain, knee-related symptoms, activity of daily living, sports and recreation and quality of life at 54 weeks and 108 weeks after treatment.

Conclusion:

This is the first RCT comparing m-BMS using a polyglycolic acid membrane with hyaluronan to any different treatment strategy in localized cartilage defects of any human joint. The use of the Chondrotissue® membrane in m-BMS of cartilage defects has proven to be a safe procedure with side effects comparable to those of MF. There seems to be an accelerated formation of cartilage repair tissue after MF when compared to m-BMS at 12 weeks postoperatively, whereas at one and two years after treatment there was no difference concerning the quantity of repair tissue. The improvement in clinical outcome scores over time after m-BMS might be due to the formation of cartilage repair tissue of higher quality. Long term follow up studies including histological assessment are desirable for further investigation.
Anteromedial instability of the knee
Authors: Wierer Guido , Milinkovic Danko , Robinson James , Weiler Andreas , Fink Christian , Raschke Michael J. , Herbort Mirco , Kittl Christoph
Published: May 2020

Aims and Objectives:

Anteromedial rotatory instability (AMRI) may result from combined lesions to the medial capsuloligamentous structures and anterior cruciate ligament (ACL). However, the contribution made by individual structures to controlling AMRI remains controversial. The purpose of the present study was to determine how the medial structures and ACL contribute to restraining simulated clinical laxity.

Materials and Methods:

Twenty-eight paired, fresh-frozen human cadaveric knees were tested in a six-degree of freedom robotic setup. After sequentially cutting the dMCL, sMCL, POL, and ACL in 4 different cutting orders, the following simulated laxity tests were applied at 0°, 30°, 60°, and 90° of knee flexion: 4 Nm external tibial rotation (ER), 4 Nm internal tibial rotation (IR), 8 Nm valgus rotation (VR) and anteromedial translation (AMT) - combined 89 N anterior tibial translation and 4 Nm ER. Knee kinematics (AMT, ER, IR, VR) were recorded in the intact state and after each cut using an optical tracking system. Differences in medial compartment translation and rotation from the intact state were then analyzed using Visual 3D. The kinematic data for each tested state, load, and flexion angle were analyzed using a 2-factor repeated-measures analysis of variance (ANOVA) and post-hoc Bonferroni corrections for multiple comparisons.

Study Design:

Controlled laboratory study.

Results:

The sMCL was the most important restraint to AMT (1.3 mm, 3.9 mm, 6.4 mm, 6.1 mm in 0°, 30°, 60°, 90°, respectively; P < 0.05), ER (1.8°, 4.4°, 6.3°, 5.3° in 0°, 30°, 60°, 90°, respectively; P < 0.01), and VR (4.1°, 4.8°, 5.8° in 30°, 60°, 90°, respectively; P < 0.05) at all flexion angles. Cutting the proximal tibial attachment of the sMCL caused no significant increase in laxity if the distal sMCL attachment remained intact. The dMCL was a minor restraint to AMT (1.3 mm, 1.8 mm, 1.6 mm in 0°, 30°, 60°, respectively; P < 0.05) and ER (1.5°, 1.2°, 1.1°, 1.0° in 0°, 30°, 60°, 90°; P < 0.05). The POL controlled IR near extension (3.3° in 0°; P < 0.05) and was a secondary restraint to AMT and ER in the ACL + MCL deficient knee. The ACL contributed in restraining AMT (4.0 mm, 6.2 mm, 4.2 mm, 3.0 mm in 0°, 30°, 60°, 90°, respectively; P < 0.01) and was a secondary restraint to ER and VR in the MCL deficient knee.

Conclusion:

The sMCL was the primary restraint to anterior subluxation of the medial tibial plateau, tibial ER and valgus rotation, which constitutes pathological laxity in AMRI. The dMCL and POL play a more minor role in restraining AMRI. Clinical Relevance: The simulated clinical tests (anteromedial drawer, external/internal rotation dial test and valgus stress test) allow determination of potential injury patterns causing AMRI. Based on the present data we propose a classification of anteromedial instability and suggest that for surgical treatment of AMRI it is important to address the sMCL.