bluuebunny/crossref_metadata_2025 huggingface dataset:
The Results of Two-stage Revision for Methicillin-resistant Periprosthetic Joint Infection (PJI) of the Hip
Authors: Santoso Asep , Anwar Iwan Budiwan , Sibarani Tangkas SMHS , Soetjahjo Bintang , Yoon Taek-Rim , Park Kyung Soon
Published: May 2020

Patellar tendon rupture after total knee arthroplasty is a rare, but often catastrophic complication. In addition, infection is also a dreaded complication after total knee arthroplasty. We report an 84-year-old female that has late infected total knee arthroplasty with patellar tendon rupture treated with resection arthroplasty and then subsequent arthrodesis with retrograde intramedullary nail.

Objective:

Periprosthetic joint infection (PJI) of the hip due to methicillin-resistant bacteria is difficult to treat and remain a challenge for arthroplasty surgeon.

Methods:

Retrospective review was done to the patients who received two-stage revisions with antibiotic loaded cement-spacer for PJI of the hip between January 2010 to June 2015. We found 65 patients (65 hips) with positive culture findings. Eight patients were lost to followup and excluded from the study. Among the rest of the 57 patients, methicillin-resistant infection (MR Group) was found in 28 cases. For comparison, we also evaluated the 29 other cases that caused by other pathogen (Non-Methicillin resistant group/Non-MR group). We compared all of the relevant medical records and the treatment outcomes between the two groups.

Results:

The mean of follow-up period was 33.7 months in the methicillin-resistant group and 28.4 months in the nonmethicillin-resistant group (p = 0.27). The causal pathogens in the methicillin-resistant group were: Methicillin-resistant Staphylococcus aureus (MRSA) in 10 cases, Methicillin-resistant Staphylococcus epidermidis (MRSE) in 16 cases and Methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in 2 cases. The reimplantation rate was 92.8% and 89.6% in the methicillin-resistant and nonmethicillinresistant groups, respectively (p= 0.66). The rates of recurrent infection after reimplantation were 23.1% (6/26) in the methicillin-resistant group and 7.6% (2/26) in the nonmethicillinresistant group (p= 0.12). The overall infection control rate was 71.4% (20/28) and 89.6% (26/29) in the methicillin-resistant and nonmethicillin-resistant groups, respectively (p = 0.08). Both group showed comparable baseline data on mean age, BMI, gender distribution, preoperative ESR/CRP/WBC and comorbidities.

Conclusion:

Two-stage revision still resulted a higher recurrency rate and lower infection control rate for the treatment of periprosthetic joint infection (PJI) of the hip due to methicillin-resistant infection compared to nonmethicillin-resistant infection.
Hyaluronic Acid in Improving Clinical Outcome of Knee Joint after Anterior Cruciate Ligament Reconstruction: A Systemic Review
Authors: Putra Fajar Defian
Published: May 2020

Hyaluronic acid (HA) is a viscosupplementation which is currently used as treatment option for non-operative management of knee osteoarthritis (OA). HA could be a pain medication and joint regulator, which might play a beneficial role in restoring overall joint homeostasis and reduce pro-inflammatory stimuli after knee surgery, e.g. anterior cruciate ligament (ACL) reconstruction thus reducing pain and accelerating range of motion (ROM). Therefore, there is possibility of administering intraarticular HA to reduce post-operative inflammation, which can reduce pain and hasten recovery

Objectives:

To identify the clinical outcome of the knee joint after HA administration in post ACL reconstruction.

Methods:

We conducted a literature search through medical databases to identify randomized controlled trials (RCTs) that focused on clinical outcome of knee joint after HA administration in post ACL reconstruction patients. Included articles were assessed. The key findings and conclusions from each article were obtained and analyzed.

Results:

We found four included studies from 64 relevant citations. It contained three articles of level of evidence 1 and one article of level of evidence 2. The administration methods are intraarticular in three articles and per oral in one article. We obtained some parameters used to assess the improvement of clinical outcome of knee joint after HA administration. Some parameters, such as VAS, IKDC, SF-36 Health Survey PF and Tegner score showed no significant improvement after HA administration, yet KOOS and LKSS score showed improvement. In three articles, the effect of HA showed improvement in active ROM. Analgesic consumption also showed lower use in patients who was administered HA in two articles.

Conclusion:

The current study suggested that there was limited evidence of HA administration after ACL reconstruction in improving clinical outcome of the knee joint. Future high-quality studies are highly needed to confirm these findings.
Single Stage Hemiarthroplasty Bipolar Surgical Procedure in 1 year Neglected Femoral Neck Fracture with 4cm Limb Shortening: A Case Report
Authors: Dusak I Wayan Suryanto , Prasada I Dewa Gede Bracika Damma
Published: May 2020

The neglected femoral neck fractures in young adults have always presented a difficult problem with high rates of non-union and avascular necrosis. In developing countries many of these fractures present late, often as a result of delayed referral or because of initial management by traditional bone-setters.

Case Presentation:

A 25- year-old female came to the outpatient clinic with chief complain pain on her right groin after a motorcycle accident 1 year ago. On physical examination a 4 cm leg length discrepancy was measured, and the patient walked with limping gait. Conventional x-ray confirmed displaced fracture of neck femur. Patient is treated with hemiarthroplasty bipolar without soft tissue release.

Discussion:

Neglected femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Fracture displacement disrupts the terminal branches to the femoral head and leads to development of osteonecrosis. The goal of treatment in neglected femoral neck fracture is to achieve a painless, mobile and stable hip. In neglected femoral neck fracture more than 6 months, hence prosthetic replacement (hemi or total) is generally preferred. Hemiarthroplasty can be performed when the acetabulum is normal.

Conclusion:

Hemiarthroplasty bipolar give satisfactory outcome for neglected femoral neck fracture and provides a predictable, reproducible functional recovery although long-term results are yet to be seen
DISTRIBUTION OF KNEE OSTEOARTHRITIS CASES IN PERTAMINA BINTANG AMIN HOSPITAL, BANDAR LAMPUNG
Authors: Suleman Imam , Putra Aswedi
Published: May 2020

Osteoarthritis is a degenarative joint disease which affects joint cartilage. Almost 80% patients movement are limited and 25 % of them can not evev perform daily activities. Due to its chronic and progressive nature, socio-economic impacts in many developed and developing countries are enormous. This study aimed to determine the distribution of patient with knee osteoarthritis in Pertamina Bintang Amin Hospital Bandar Lampung.

Methods:

This study is a decriptive cross sectional approach with secondary data taken from medical record. Thirty eight cases were evaluated in this study from January 2019 – Mei 2019. The variables observed include age, sex, body mass index (BMI) and occupations.

Results:

The result show that 36,8 % of the samples were aged 50-59 years,78,9 % of the samples were female, 71,1 % of the samples had BMI obesity, 60,5 % and 43,2 % were work as housewife. A total of 23 of 38 knee samples had grade III, and 3 of 38 knee samples alsohad grade I, and as many as 7 of the 38 knee samples had a” very severe” clinical gradation. These result may be due to patients who have low grade gradation clinics and have received medical attention at the level I health facility or II.

Conclusion:

Form the result of this study, it can be concluded that age, sex, BMI, occupations and Kellgren-Lawrence scoring system at Pertamina Bintang Amin Bandar Lampung is in comformity with research that has been done in many places and theories that exist.

Reference:

Apley, Ag., & Louis Solomon, (2017). Osteoarthritis. In David Warwick (ED). System of Orthopaedics and Trauma (10th Ed., pp. 91-105). London, UK: CRC Press. Fransen M.Bridgett L. March L.Hoy D. Penserga E. Brooks P.The Epidemiolgy os Osteoarthritis in Asia. International Journal of Rheumatic Diseases 2011;14;113-212. Zhang Fu – Quang,Wu Ming – Xia, Liu Xian – Xiang, Gender and Sex distribution of middle and old aged people with osteoarthritis in Fuzhou, Vol II, May 2009. American of Orthopaedic Surgeon, Relatioship of Osteoarthritis and Biochemical Reactions, Journal of Bone and Joint Surgery, 2004 volume II.
AUGMENTATION POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING PERONEAL LONGUS TENDON ON AVULSION PCL : CASE SERIES
Authors: Mulyadi Deri , Rhatomy Sholahudin , Utama Dwikora Novembri
Published: May 2020

Posterior Cruciate Ligament (PCL) avulsion may mimics PCL rupture with positive posterior drawer test. Treatment of choice to PCL avulsion is vary from open surgery to arthroscopic surgery. This study aims is to evaluate the knee functional score using augmented PCL reconstruction on PCL avulsion using peroneus longus tendon.

Presentation of Case:

We report 3 cases, 1 male and 2 females. The result of physical examination, X-ray examination, and MRI of the knee showed a PCL avulsion. Posterior drawer test showed grade 2 result. We performed an augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Knee scoring (IKDC, Modified Cincinnati, TegnerLysholm) collected pre-operative and 2 years post-operative. The result of knee scoring was significant improved in post-operative compare to before surgery.

Discussions:

The use of conventional screw on thin, small, and comminuted fragments cannot fix the bone and may causes bone fragmentation. Fixation technique using sutures produces unstable results and does not provide maximum pressure to fix the bone. Augmented PCL reconstruction surgery gives excellent result based on knee scoring system.

Conclusion:

Augmented PCL reconstruction can be considered to be an alternative treatment of PCL avulsion because the procedure has excellent post-operative knee scoring result.
Superior Dislocation of Patella Without Osteophytes – A Rare Case
Authors: Ho Sheung Tung , Chiu Ming Yu
Published: May 2020

A 66-year-old woman sustained a “sprain” of her right knee while walking inside a supermarket. She complained of sudden knee pain and was unable to walk or move her right knee. She attended Accident and Emergency Department and was admitted into Orthopaedic ward with a diagnosis of “patella tendon rupture”. Physical examination on admission showed swelling, bruise and local tenderness just below the inferior pole of upward migrated patella bone. The extensor mechanism was loss. Passive knee motion was 0-20 degree only, limited by pain. Plain radiographs showed superior migrated patella. Beside ultrasound showed intact patella tendon. Closed reduction without anaesthesia was done successfully with an immediate regain of knee motion to 0-80 degree. Post-reduction x ray showed reduced patella with no fracture. Follow-up at 6 weeks showed normal active motion knee motion with full quadriceps power.

Superior patellar dislocation is a rare condition. At 2016, only 23 cases were reported in English literature. It should be considered as a differential diagnosis of patella tendon rupture or locked knee. Pathognomonic radiographic features include proximal displaced patella with superior pole tilted away from femur and a dimple in skin. Ultrasonography may be used to exclude patella tendon rupture, which is a more common diagnosis in elderly. Most superior dislocations are due to interlocking patella and trochlear osteophyte. This may the second reported case of superior dislocation of patella without osteophytes. Closed reduction may be done without general anaesthesia. After reduction of superior patella dislocation, the functional recovery is rapid.
Gentamycin-Loaded Bone Cement Released Time against Staphylococcus Aureus by using In Vitro Media as the Strategy for the Patient with Prostethic Joint Infection (PJI) after Hip and Knee Joint Arthroplasty
Authors: Pratama Fajar Satria
Published: May 2020

Introduction:

Joint Arthroplasty is the best treatment modality to improves joint function, relieves pain, and increase the quality of life. There were about 0.5% to 0.8% of patients performed primary total knee and hip arthroplasties has been reported with Prostethic Joint Infection (PJI). Staphylococcus aureus is one of the most virulent bacteria which has identified in the isolation caused by PJI. There were increased number of primary arthroplasties. Gentamycin is an antibiotic which has a bactericidal effect for some gram positive and most aerobic and facultative anaerobic gram negative bacteria. They act by inhibiting protein synthesis.

Method:

This research is an experimental study.The object is Staphylococcus aureus which was treated by Gentamycin-loaded bone cement which were divided into 3 concentrations 5%,10%, and 20%. We have observed the antibacterial effect by measured how was the released time while we put it in agar plates. We controlled them every 2 weeks for observing the inhibition of ring assays which were formed. We were also calculated the diameter of ring assay.

Result:

Drug release profiles showed for 5%,10%,20% Gentamycin-loaded bone cement displayed a long enough drug release time about 14 weeks. The diameters of ring assay didn’t showed if they were affected by the released time.

Discussion:

We have been observed about Gentamycin-loaded bone cement released time with Staphylococcus aureus,we found if it can exist more than 14 weeks.There have been no study investigated about it before. In the present study by Gaoyang in 2018,they have been observed with vancomycinloaded bone cement,they had found if vancomisin loaded-bone cement provided sufficient effective antibacterial time at least 8 weeks.

Conclusion:

The Gentamycin-loaded bone cement released time against Staphylococcus aureus more than about 14 weeks.There is no different result between the length of released with ring assay diameters.
Challenging Knee Reconstruction After Resection of Cavernous Hemangioma in Young Patient – A case Report
Authors: Setiawan A , Mulyadi D , Budi MNS , Tandjung FA
Published: May 2020

Background:

One of the most challenging problem of limb salvage is a large tumour involving knee joint. Large aggressive hemangioma could disrupt soft tissue and bone surrounding. Meticulous wide surgical resection was mandatory perfomed to ensure adequate resection in order to minimized recurrence. Reconstructive procedure should be individualized and aiming functional restoration. Knee Reconstruction using arthroplasty should considered Stability, Range of Motion and Longlive survival.

Method:

We are presenting a case 19 years girl who had pain, unable to extent the knee and dislocated patella laterally. Valgus knee deformity 30 ֯ with Range of motion limited extension 30֯ and flexion 45֯ Wide resection was done 2 years ago with clinical large of mass at harmstring muscle, pushed patella to lateral and large of cartilage erosions. The patients was prepared second operation for knee reconstruction. Knee reconstruction using standard Posterior Stabilized implant (Implancast) Approach anterior of knee, osteotomy and anteromedialisation tibial tubercle ( Fulkerson procedure) with lateral retincular release to restore patellar tracking. Exposing Joint line very narrow and fully filled with arthrofibrosis, was identified and did osteotomy . Mostly femoral and tibial cartilage has been damaged. Post operation protocol using long leg cast and delayed weight bearing for 3 weeks. Isometric exercise on the bed to maintance and regain muscle power. During 3 – 6 weeks cast was removed and patient was allowed to partial weight bearing using 2 crutches. Extensor muscle strengthening was performed gradually. Followed up until 6 months post operation.

Results:

After 6 months we evaluate no pain at full weight bearing, x ray no sign of loosening nor progressive deformity, good stability with varus valgus test. Range of motion full extension and 90֯ flexion. Knee Society Score was significantly increase from poor to good.

Conclusion:

Knee Reconstruction following tumor resection using standard implant Posterior Stabilized (PS) is possible to perfomed as long as using meticulous technique combined with selective procedures as needed to regain functional restoration.
Is This Rapid Destructive Hip Osteoarthritis ?
Authors: Sheung Tung HO , Yeung Yip Kan , Chiu Ming Yu , Hoi Yeung IP
Published: May 2020

Rapid destructive hip osteoarthritis is a diagnosis by exclusion. It should be differentiated from septic arthritis, osteonecrosis, neuropathic arthritis and other aetiologies causing rapid bone resorption or destruction around the hip. The present study aims to review the incidence of rapid destructive hip osteoarthritis among those patients who request total hip arthroplasty for end stage arthrosis.

A retrospective review of radiographs of all patients who scheduled for total hip arthroplasty from January 2010 to March 2019 were analysed by 3 orthopaedic fellows. Of 174 hips of 146 patients, 35 hips of 29 patients were considered by at least 2 orthopaedic fellows to have rapid destructive hip osteoarthritis based on radiographic criteria of rapid joint space narrowing or rapid destruction of femoral head with or without acetabular involvement. Clinical history and physical finding, blood biochemistry, cultures and pathology with or without frozen section are reviewed.

Early total hip arthroplasty, rather than routine operation in the long waiting list, is recommended for rapid destructive hip osteoarthritis to prevent technical difficulty in dealing with the bone loss or defect associated with rapid destructive hip osteoarthritis. However, one must exclude septic arthritis before proceeding to total hip arthroplasty. In clinically highly suspected cases, staged total hip arthroplasty was done despite of normal initial blood investigationsand negative hip aspiration with equivocal frozen section on table. In one such patient, the culture was initially negative, but became positive only after extended period of culture. On the other hand, rapid destruction of acetabulum requiring impaction bone grafting and acetabular augmentation for total hip arthroplasty was needed in one patient. Malignancy was suspected in another patient, but there was no evidence of malignancy or infection in the femoral head and tissue obtained by excisional arthroplasty of hip. One patient with hip pain and bilateral hip involvement was found to have Charcot joint.

Rapid destruction hip osteoarthritis represents an uncommon subset of arthrosis with rapid progression. A delicate balance between correct diagnosis and timely early operation should be exercised to prevent rapid loss of bone stock making delayed total hip arthroplasty become technical difficult with possible compromised outcomes.
Isolated Triplane Fracture Of Distal Tibia In Adolescent
Authors: Safie Shaqirin , Shamsudin Zulfahrizzat , Alias Azzamuddin , Ahmad Abdul Rauf
Published: May 2020

Introduction:

Triplane fracture is a traumatic ankle fracture seen in children 10-17 years of age. Name derives from the fact that the fracture exists in the frontal, lateral, and transverse planes and considered as transitional injuries because occur during the period of distal tibial physeal closure. It results from supinationexternal rotation injury, same as tillaux fracture.

Report:

We presented a case of 14 years old male with right ankle pain after fall with twisted position while running. Examination revealed tenderness on his right ankle, and radiograph showed Salter-Harris IV of tibial epiphysis. CT scan was performed to determine fracture configurations. Open reduction and internal fixation was done using posterolateral approach using T buttress plate 6 holes to fix the metaphysis fracture. Subsequently anterolateral incision was done to assess epiphysis fracture however fracture site not displaced thus lag screw was abandoned. Postoperatively, the ankle was protected in a backslab for 2week; thereafter, the ankle was mobilized and subjected to progressively increasing motion. Weight bearing was allowed to resume at 6 weeks postoperatively. A normal gait had been achieved by 12 weeks postoperatively. The diagnosis of Triplane fracture poses a diagnostic challenge and often missed in healthcare centres. On standard AP and lateral radiographs, the fractures cannot be easily detected because of superimposition as radiographic sensitivity for Triplane fracture is only 50%. CT scan of the ankle is recommended if clinical findings are suggestive. The treatment of the Tillaux fragment with compression screws in the case of displacement of >2 mm which achieves anatomical reduction, rigid fixation and early mobilization gives good prognosis. [Figure: see text][Figure: see text][Figure: see text]

Conclusion:

Displacement of >2 mm in any plane is an indication for surgery for both triplane and tillaux fracture, to prevent persistent pain and osteoarthritis in the future. CT scan of the ankle is necessary prior to surgery.

References:

Crawford, Alvin H Triplane and Tillaux fracture : Journal of Pediatric Orthopaedics : June 2012 - volume 32 pg S69-S73
Patella Fracture Fixation Via Wide Awake Local Anesthesia No Tourniquet (Walant) Technique
Authors: Shamsudin Z , Ahmad AA , Ahmad AR
Published: May 2020

Introduction:

Fractures of the patella constitute an estimated 1% of all acute orthopaedic fractures. The fracture fixation is usually performed under general or spinal anesthesia with tourniquet use. We describe a novel approach of anaesthesia for patella fracture fixation using the WALANT technique.

Methods:

We presented a case of 22 years old male with right knee pain following a road traffic accident. Examination revealed tenderness on his right knee with extensor mechanism failure, and radiograph showed comminuted 3 parts patella fracture, requiring fixation. Adequate information regarding WALANT was given and he agreed.

Results:

Open reduction and internal fixation were done using tension band wiring (TBW) technique and screw fixation. WALANT mixture was given 30 minutes prior to skin incision. Visual analog score (VAS) was 0 throughout the surgery. He was able to do active range of movement (ROM) of the knee intraoperatively after the fixation.

Discussion:

The solution used was mixture of 50ml lignocaine 2% (for local anesthesia), 1ml of adrenaline 0.18% (for hemostasis), 10ml of sodium bicarbonate 8.4% (to buffer the solution) and diluted with 50ml normal saline for tumescent anesthesia effect. Safe dosage of lignocaine with adrenaline is 7mg/kg. 10ml of mixture injected subcutaneously over mid-axial longitudinal incision site and 30 ml of mixture injected at patella borders and fracture site subperiosteally. We waited 30 minutes to allow adrenaline to reach maximal vasoconstriction and provide dry operative field. Without usage of tourniquet, we avoid complications such as hematoma and post operation swelling. WALANT also permits active motion of knee intraoperatively, which is particularly helpful in post TBW patella patient. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]

Conclusion:

WALANT is a safe option for patients undergoing patella fracture fixation. It gave a painless surgical experience to the patient and offer another option for high risk patients for general / spinal anaesthesia.

References:

Lalonde D. Wide Awake Hand Surgey (2016): pg 3-32
MIS THR using anterolateral approach – the game changer in Indian scenario, early functional and radiological outcomes
Authors: Patnaik Sanjeev
Published: May 2020

Background:

Minimally invasive surgery has become a trend in the last decade in all aspects of Orthopaedic surgery, including Total Hip Replacement. The debates and the interest generated in MIS THR is considerable and several approaches have been advocated. The potential benefits include lower surgical morbidity, less pain and peri-operative blood loss, quicker rehabilitation, shorter in-patient stay and improved cosmesis. On the other hand, deficient peer-reviewed literature, a steep learning curve, increased rate of complications due to inadequate visualization, component mal-position, neurovascular injuries, dislocation and intra-operative fractures have drawn criticism.

Objectives:

To present the various surgical tips and tricks and early functional and radiological results of MIS THR by anterolateral approach.

Study designs & Methods:

The retrospective analysis of the records of patients undergoing Anterolateral MIS THR between January 2013 and January 2019 was the basis of this study. 72 hips of 70 patients were included in the study. The length of incision , duration of surgery, peri-operative blood loss, were studied. Functional assessment by Harris Hip Score, pain assessment by VAS score and radiological assessment for acetabular component and femoral stem positions were measured on plane X-rays. Data on preoperative and postoperative hemoglobin and hematocrit values, number of blood transfusions,time to ambulate as well as duration of hospital stay was studied.

Results:

We had no major complications in the form of mortality, fatal Pulmonary embolism , temporary femoral nerve neuropraxia was seen in 1 case, component mal-position in 3 cases , superficial infection 1 case and a non displaced proximal femoral fracture line was evident on the early postoperative X-ray of 1 case. Functional assessment by Harris Hip Score (HHS )improved from pre-operative 42 (range:26-46) to postoperative 95 (range:72-98) at 1 yr. Radiologic analysis was carried out at post-operative 6weeks, 3months,6months and 1year. Femoral stem varus alignment was seen in 3 cases, Average Acetabular cup abduction angle was 43degrees (range: 40-55 degrees). Average acetabular cup ante-version angle was 17 degrees (range: 12-25 degrees). Of the 72hips, 64 were within the Lewinnek safe zone. The average postoperative hemoglobin value was 9.7 g/dl ( range: 8.5-12.3g/dl) and the average postoperative hematocrit value was 29.8% (range: 28.1-30.6%).

Conclusions:

The MIS anterolateral approach allows adequate exposure for component placement, less perioperative blood loss and pain in immediate post-op period , earlier discharge from hospital along with early return to function , good cosmesis with better patient satisfaction.
Characteristics Of Neglected Fractures In Ujung Berung General Hospital, Bandung, January-December 2018
Authors: Putra Dimas Harendra S , Gardea G R. Dadan
Published: May 2020

Introduction:

The high mobility of Indonesian people in their daily lives increases the risk of accidents that can cause fractures. However, the people still believe in the handling of fractures by bone setter. Patients come with various complications,mild to severe. It also has an effect on the high total cost of care. This study aims to determine the characteristics and prevalence of neglected fractures in Ujung Berung General Hospital, Bandung, January-December 2018.

Method:

This study is a descriptive retrospective study, data taken from medical records of neglected fractures patients treated in Ujung Berung General Hospital in Bandung in 2018.

Results:

Neglected fractures sufferers treated in Ujung Berung General Hospital in Bandung in 2018 were more prevalent in men 68% and productive age 76%. With a low education level of 8%, and got the handling of a bone setter 68%. The cause of a fracture is a traffic accident 76% with the location of the most neglected fractures being the femur bone 36%. With a 3-6 day length of stay of 64%, there are 84% of patients using the BPJS payment system.

Conclusion:

The characteristics found in neglected fractures sufferers are more inmen, productive age, secondary education level, have been handled by bone setter, causes of fractures due to traffic accidents and femurs are the bones that have the most neglected fractures, with a maximum period of 3-6 days and BPJS payment system is most widely used by the patients.
Kinematic Analysis of Total Knee Arthroplasty using Verasense: Genesis-II prosthesis versus Anthem prosthesis
Authors: Choi Ik-sun , Na Seung-Min , Seon Jong-Keun , Song Eun-Kyoo
Published: May 2020

Purpose

The purpose of this study was to elucidate kinematic change according to the implant’s specific femoral rotation by using orthosensor (Verasense) implant with three degrees external rotation of femoral rotation rebuilt (Genesis-II) and traditional TKA implant without rebuilt of the femoral rotation (Anthem).

Methods

Twenty-eight patients (34 knees) underwent TKA using Anthem (Smith &Nephew, Memphis, TN, USA) and 16 patients (22 knees) underwent TKA using Genesis-II (Smith & Nephew, Memphis, TN, USA). Patients were followed up for at least 1 year. Mean age of patients was 71.1 years (range, 60 to 80 years) at the time of surgery. After implantation of femur and tibial components, we applied Verasense, the orthosensor system, to evaluate femoral rollback of the new artificial joint. Femoral rollback was analyzed using digitized screenshot function of Verasense.

Results

Overall femoral tracking proportion regardless of implants was significantly higher on the medial compartment compared to that on the lateral compartment (13.3 ±8.4% vs. 6.3 ± 5.0%, p < 0.001). Regarding femoral tracking according to each compartment, Genesis-II and Anthem showed 12.1 ± 8.2% and 14.2 ± 8.6% ( p = 0.371) on the medial compartment and 8.0 ± 5.8% and 5.2 ± 4.2% ( p = 0.059) on the lateral compartment, respectively.

Conclusion

Our study showed reverse femoral roll-back movement with higher tracking distance on the lateral compartment during TKA. Genesis-II TKA system with femoral component 3-degree rebuilt showed less roll-back difference between medial and lateral compartments compared to traditional TKA system. Fortunately, both TKA systems had excellent short-term clinical outcomes without having significant difference between the two. With longer follow-up and larger cohort, the advantage and effectiveness of femoral component rotation can be elucidated in the future.
Mechanical Properties of Tensile Strength of ITB Graft, a Promising Graft for Labral Reconstruction of the Hip
Authors: Mahda F , Sasetyo DR
Published: May 2020

Introduction:

Labral repair gives good results on damage in the labral area of the hip, but in cases with extensive labral damage, labral repair is less effective, reconstruction of labral is needed, recently labral reconstruction has been done using the Iliotibial band (ITB), but no one has measured the tensile strength of the ITB. this study intends to measure the ITB tensile strength based on diameter.

Methode:

This is an experimental research, the sample was taken from 8 cadaveric, consisted of 6 cadavercic male sex and 2 cadaveric female sex, the youngest cadaveric age was 25 years and the oldest 63 years with an average age of 47 years. Each cadaver was treated by taking ITB, The ITB were then measured by applying the Hydraulic Servo Pulser tensile test apparatus. ITB was rolled oval and tied with an unabsorbed polyster suture, the ITB which was oval shaped and had been tied with an unabsorbed polyster suture then measured its diameter from 4mm, 5mm, 6mm, 7mm, to 8mm. Samples that have been prepared are measured using a tensile strength gauge to assess ITB tensile strength ranging from 4mm, 5mm, 6mm, 7mm, to 8mm.

Results:

ITB’s tensile strength curve is sigmoid shape , the average tensile strength for all samples is 647 Psi. The larger the sample diameter, the greater the tensile strength it has. The largest tensile strength is obtained in 8 mm diameter, and the smallest tensile strength is obtained in 4 mm diameter.

Conclusion:

ITB is a promising autograft and can be used as an ingredient for the reconstruction of labral.
The Role of Hip Arthroscopy in the Management of Acute Arthritis of Hip
Authors: Ho Sheung Tung , Ip Hoi Yeung , Chiu Ming Yu , Wong Sze Hung
Published: May 2020

Septic arthritis of hip is an orthopaedic emergency requiring early diagnosis and prompt surgical treatment to avoid grave complications like avascular necrosis and chondrolysis and post-infectious arthrosis.

This is a retrospective review of 9 patients who underwent hip arthroscopy for suspected septic arthritis of hip from 2012 to 2018. Medical charts were reviewed to determine the efficacy of the use of hip arthroscopy in the diagnosis and treatment of acute hip arthritis.

The age of patients ranged from 9 to 82. The mean follow-up was 29 months (1 to 49). All presented with hip pain and effusion in imaging by CT scan or ultrasonography. Fever was present in 5 out of 9 patients. Hip arthroscopy with 2 portals technique and joint lavage +/- debridement was done. Two patients had whitish suspension in the joint fluid and pathology confirmed pseudogout of hip. The remaining 7 patients were diagnosed and treated as septic hip arthritis. Only 3 had positive culture, probably related to the prior use of antibiotics. All except one responds well to arthroscopic debridement and lavage with infection eradicated, good hip motion and hip function. One patient of delayed treatment (2 weeks after onset of hip pain) had ongoing infection, requiring further arthrotomy and Girdlestone operation for uncontrolled hip infection with intramuscular abscess of vastus lateralis.

Hip arthroscopy is a useful diagnostic tool in acute hip arthritis. Besides septic arthritis, monoarticular attack of psuedogout is an important differential diagnosis of acute hip pain in elderly. Early hip arthroscopy can result in rapid postoperative recovery. Arthroscopic lavage and debridement is safe and a good alternative to open arthrotomy in hip septic arthritis.
Quadriceps- vs. semitendinosus tendon in ACL reconstruction - a prospective study comparing autologous transplants regarding their clinical outcome
Authors: Karpinski Katrin , Bierke Sebastian , Häner Martin , Hees Tilman , Petersen Wolf
Published: May 2020

Aims and Objectives:

The purpose of this study was to evaluate the knee stability and subjective outcome after primary ACL reconstruction using either autologous semitendinosus or quadriceps tendon.

Materials and Methods:

We evaluated a total of 50 patients who underwent ACL reconstruction - including 25 using the ipsilateral semitendinosus tendon (group I) and 25 patients with autologous quadriceps tendon graft (group II). The follow-up of this prospective comparative study was at least two years after surgery, comprising clinical assessment according to the International Documantation Committee (IKDC), KT1000 arthrometer testing and an additional questionnaire including the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Lysholm score.

Results:

The mean postoperative side-to-side difference assessed by KT1000 arthrometer was 1.8mm for group I and 1.7mm for group II with no statistically significant difference. There was no statistically significant difference neither in the individual KOOS subscores nor the Lysholm score. No re-rupture or positive pivot-shift test occurred during follow-up for both groups.

Conclusion:

Semitendinosus- as well as quadriceps tendon are both equal regarding their clinical outcome. Thus, the quadriceps tendon may serve as a good alternative graft for primary ACL reconstruction.
The arthroscopic popliteus bypass reconstruction for posterolateral instabilities of the knee - clinical results > 2 year follow up
Authors: Drenck Tobias C. , Müllner Maximilian , Preiss Achim , Alm Lena , Kühne Christian A. , Akoto Ralph , Frosch Karl-Heinz
Published: May 2020

Aims and Objectives:

Injuries of the posterior cruciate ligament (PCL) are most often accompanied by injuries of the posterolateral corner (PLC) and the ligamentum collaterale fibulare (LCL). This leads to a combined dorsal- and external rotational instability. Prior to this study a novel arthroscopic technique was developed to treat posterolateral injuries (Popliteus Bypass Graft). To date, there are no long term results reported for arthroscopic techniques to treat these injuries. This study evaluated the clinical outcome of patients undergoing this surgery with a minimum follow up of 2 years.

Materials and Methods:

In the ongoing study, 47 patients with posterolateral instabilities of the knee were treated with an arthroscopic reconstruction of the popliteus bypass graft in combination with a PCL reconstruction. Patients with a minimum follow up of 2 years were included in this study. The clinical outcome was evaluated by subjective and objective scores for stability, pain and activity level: Lysholm, Tegner, KOOS, Dial test, subjective scores (0-10) for function (0 good, 10 poor) und pain (0 no pain, 10 intense pain). The dorsal stability was measured with the rolimeter.

Results:

At the time of the abstract submission 17 patients where evaluated. The mean age at the time of the operation was 36.8 (±15.5) years, the mean BMI was 27.7 (±5.5). The mean time from the injury to the treatment was 6.9 (±5.3) months. The mean follow up time was 46.35 (±12.7) months. The mean postoperative Lysholm score was 88.7 (± 13.4). The mean Tegner score was 6.0 (±2.2) preoperative and changed to 5.3 (±2.2) postoperative. The KOOS score was evaluated for pain 87.2 (±19.5), symptoms 92.5 (±11.1), daily activity 89.2 (±16.9), function 73.1 (±28.9) and life quality 78.5 (±21.7). The mean Rolimeter measurement for the uninjured knee was 7.16mm (±2.2) compared to the operated side with 8,18mm (±1.7). The VAS score for function was 1.6 (±2.1) and 1.6 (±2.2) for pain.

Conclusion:

The arthroscopic reconstruction of posterolateral injuries provides good clinical and subjective results after a minimum follow up of 2 years.
Extra articular lateral tenodesis in patients with revision anterior cruciate ligament (ACL) reconstruction and high-grade anterior instability
Authors: Alm Lena , Frosch Karl-Heinz , Akoto Ralph
Published: May 2020

Aims and Objectives:

While patients following primary anterior cruciate ligament (ACL) surgery show satisfying results, the outcome after revision ACL reconstruction (ACLR) seems to be less favourable. Failure rates of 14 to 33% have been reported for revision ACLR. The purpose of this study was to evaluate the outcome of patients after revision ACLR. We hypothesize that peripheral knee instabilities are risk factors for failure of revision ACLR. Furthermore, we hypothesize that peripheral stabilisation will reduce the risk of failure.

Materials and Methods:

Between 2013 and 2016, 150 patients were operated with revision ACLR (revision surgery after primary ACL reconstruction). Out of these patients, 73 patients preoperative had a high-grade anterior instability and were included in the retrospective study. High-grade knee anterior instability was defined as high-grade pivot-shift and/or side- to- side difference of more than 5mm in Rolimeter®-testing. An additional extra articular tenodesis was performed in 59 patients during revision ACLR. Patients were clinically examined with a minimum of 2 years after revision surgery (mean 35±6 months) and identified as “failed revision ACLR” and “stable revision ACLR”.

Results:

Failure of the revision ACLR occurred in 8.2% (n=6) of the cases. Extra articular lateral tenodesis leads to significant lower failure rates in patients with high-grade anterior instability in comparison to patients without further peripheral stabilization (5% vs. 21%, p=0.045). Also, higher postoperative functional scores were shown in the group of additional extra articular lateral tenodesis (Lysholm 89.5±17 vs. 69.5±12, p=0.041; Tegner 6.6±1.4 vs. 4.5±1.4, p=0.009; Cincinnati Rating Scale 91.2±14 vs. 68.5±17, p=0.006). Failure was associated with male sex (n=6 male failures, p=0.017) and obesity (n=4 obese failures with a BMI >30 kg/m2, p<0.001).

Conclusion:

Additional extra articular tenodesis in patients with revision ACL instability and accompanying high-grade anterior instability significantly reduces the risk of failure of revision ACLR. General risk factors of failure of the revision ACLR are obesity and male sex.
Is the Independent Tape Reinforcement a valid technique to reduce the rerupture rate of ACL reconstructions? A technical instruction and case series with 2-year follow up
Authors: Schneider Stefan , Kaiser René , Ilg Ansgar , Holz Johannes
Published: May 2020

Aims and Objectives:

Although there is an ongoing development in ACL reconstruction techniques, a rerupture rate up to 20% still is discussed in the literature. Is the ACL reconstruction using a quadriple semitendinosus in combination with a polyurethane tape reinforcement a valid technique to reduce the retare rate? A clinical trial with 35 Patients compared to 320 patients using an isolated semitendinosus reconstruction without internal bracing.

Materials and Methods:

Additionally, to the quadruple semitendinosus technique with cortical button fixation, the transplant is parallelly stabilized by a polyurethane tape which is individually fixed in the femoral button. The tape secures the transplant during the remodeling episode since repeated small tensions on the transplant during this time are discussed as a reason for a rerupture. In this prospective case series 35 patients were treated with this technique, reexamined and VAS, Tegner, KOOS Jr. and SANE are preoperatively, two and six weeks, three and six month and after one, two and five years recorded using a PROMS system. Clinical instability and proprioceptive function were also surveyed at these timepoints. The results and rerupture rates were compared with 320 patients of our database who underwent a comparable reconstruction without using the internal brace. Patients with fractures and multi-ligament injuries were excluded.

Results:

Until now no reruptures were reported, there are no significant subjective or objective differences compared to the group without internal bracing. The two years results are pending. Preoperatively the VAS score was 2.2 +/- 2.0. Two weeks after the surgery 2.1 +/- 1.8 and one year postoperatively 0.5 +/- 0.7. Tegner score preoperatively: 4.6 +/- 2.7 after one year 4.7 +/- 3.0. KOOS jun. improves in both groups around 15%.

Conclusion:

Until now the ACL reconstruction using an internal brace seems to be a safe and effective technique. Biomechanical studies show beneficial stabilizing results and a minor rerupture rate might be possible due to reduced microlesions during the remodeling period. The study is still ongoing, longtime results are pending.
Comparison of articular exposure through extended lateral approaches to the tibial plateau
Authors: Frings Jannik , Krause Matthias , Isik Hüseyin , Frosch Karl-Heinz
Published: May 2020

Aims and Objectives:

Comminuted lateral tibial plateau fractures pose a challenge to surgeons, resulting in non-anatomical reductions in 70-89% of all cases. Anatomical reconstruction requires the direct visualization of the joint after a fragment reduction, which is impaired using the common anterolateral approach. Although numerous lateral extended approaches are described, there is currently no data on which approach provides better visibility of the posterolateral tibial plateau. The aim of this study was to evaluate, which parts of the tibial plateau can be visualized with the use of the lateral femoral epicondyle osteotomy or the fibula osteotomy? Further, the study investigated wether the combined osteotomy of the femoral footprints of the lateral collateral ligament (LCL) and popliteus tendon (PLT) provide better access to the posterolateral joint surface than the isolated osteotomy of the femoral LCL footprint or the fibula osteotomy?

Materials and Methods:

Extended lateral (femoral or fibular LCL osteotomy) and posterolateral (additional femoral osteotomy of the PLT tendon) approaches were performed on twelve human cadaver knee joints. After preparing of each surgical approach, the visible joint surface was marked with diathermy. The tibial plateau was disarticulated and the markings were measured digitally with open-source processing software. Differences in mean values were tested with a paired t-test (p < 0.05).

Results:

The greatest articular exposition was realized by the fibula osteotomy (1011.52 ± 227.05 mm2 [86.64 ± 4.84%] compared to either osteotomy of LCL and PLT (p = 0.036) or LCL alone (p<0.001). The lateral femoral epicondyle osteotomy of the LCL including the PLT (937.45 ± 237.84 mm2 [80.29 ± 8.25 %]) exposed a significantly larger articular surface of the lateral tibial plateau than without the PLT (755.71 ± 183.06 mm2 [64.73 ± 6.51 %], p < 0.001).

Conclusion:

The fibula osteotomy provides the greatest articular visibility of the lateral tibial plateau compared to the lateral epicondyle osteotomy of the femoral LCL and PLT attachments. This small benefit should be critically balanced against the considerably greater soft tissue damage caused by the fibula osteotomy. The lateral femoral epicondyle osteotomy including the LCL and PLT increases lateral articular visualization without risk to neurovascular or posterolateral soft tissue structures and represents an important extended approach to treat comminuted lateral plateau fractures.
High incidence of tunnel collision in combined ACL reconstruction and LET
Authors: Jaecker Vera , Herbort Mirco , Bouillon Bertil , Günther Daniel , Shafizadeh Sven
Published: May 2020

Aims and Objectives:

Lateral extra-articular tenodesis (LET) procedures are being increasingly performed as concomitant procedures to both primary and revision intra-articular ACL reconstructions with the purpose of controlling excessive anterolateral rotatory instability and to reduce tension on the ACL graft. There is, however, a lack of evidence on benefits and pitfalls of different femoral LET attachment positions. The purpose of this study was to assess the risk of tunnel convergence in combined ACL and LET procedures comparing two different femoral attachment sites (Lemaire and MacIntosh).

Materials and Methods:

10 fresh-frozen cadaver knees were examined. In each specimen an anatomic ACL femoral tunnel and two LET tunnels were drilled applying the Lemaire and MacIntosh position. Following knee dissection, minimal distances between ACL and LET tunnels were directly measured on the lateral femoral cortex. Furthermore, computed tomography (CT) scans were obtained to measure inter-tunnel convergence and lateral femoral condyle (LFC) width. Based on the average LFC width, knees were divided into large and small knees to determine a relationship between knee size and tunnel convergence.

Results:

Convergence of ACL and LET tunnels occurred in 7 of 10 cases (70%) using the Lemaire attachment position. All tunnel collisions occurred directly on the lateral femoral cortex, while inter-tunnel conflicts were not observed. Collisions emerged in both, small (n=4) and large (n=3) knees. Critical tunnel convergence did not occur using the MacIntosh position. The mean minimal distance between the LET and ACL tunnel using the Lemaire and MacIntosh position was 3.1±4.6 mm and 9.8±5.4 mm, respectively.

Conclusion:

A high risk of tunnel convergence was observed in combined ACL and LET reconstruction using the Lemaire technique, independent of the knee size. LET femoral tunnel positioning according to the MacIntosh reconstruction can significantly reduce the risk of tunnel collision. These findings help to intraoperatively raise the awareness for the risk of tunnel convergence in combined ACL and LET procedures. Adjustments on ACL reconstruction techniques and especially on the femoral fixation have to be considered when applying an additional Lemaire reconstruction.