bluuebunny/crossref_metadata_2025_split huggingface dataset:
Small Stem Exeter Total Hip Replacement: Clinical and Radiological Follow-up over a Minimum of 2.5 Years
Authors: Sivananthan S , Arif M , Choon DSK 
Published: October 2016

Purpose. To evaluate the clinical and radiological outcome in patients undergoing small stem Exeter total hip replacement. Methods. A total of 46 small stem Exeter total hip replacements were performed on 44 consecutive patients (18 men and 26 women) attending the University of Malaya Medical Centre. The mean age at the time of operation was 58 years (range, 24–81 years). Of the 46 procedures performed, 35 were primary total hip replacements and 11 were revision operations, with aseptic loosening of the original implant being the main indication for revision. The main indications for surgery in primary cases were avascular necrosis and rheumatoid arthritis. Clinical and radiographic outcomes were assessed at 6 weeks', 12 weeks', 6 months' follow-up, and annually thereafter. Postoperative cementing technique was also assessed. Results. The mean follow-up period was 4 years. The mean Oxford Hip Score improved from 46 points preoperatively to 17 points at the final follow-up examination. There were no revision operations, no implant breakages, and no excessive migration of the implants. The potential complications of implant failure due to smaller implant size and increased patient activity were not observed. Conclusion. Due to the smaller size of Asian femora, the small stem Exeter implant is a very useful development. This study suggests that it will perform as well as its larger counterparts.
The Incidence of Deep Vein Thrombosis after Hip and Knee Arthroplasties in Japanese Patients: A Prospective Study
Authors: Sudo A , Sano T , Horikawa K , Yamakawa T , Shi D , Uchida A 
Published: October 2016

Purpose. To document the incidence of proximal deep vein thrombosis and pulmonary embolism in 58 consecutive Japanese patients undergoing total hip arthroplasty or total knee arthroplasty. Methods. Patients were routinely examined for proximal deep vein thrombosis by B-mode ultrasonography before and after surgery. Those patients who had ultrasonographic findings of deep vein thrombosis were also investigated for pulmonary embolism by ventilation-perfusion lung scan. Results. The incidence of deep vein thrombosis after total hip arthroplasty and total knee arthroplasty were 9.1% and 4.0% respectively, and the incidence of pulmonary embolism were 3.0% and 0%, respectively. There were no cases of fatal pulmonary embolism. Conclusion. The incidence of deep vein thrombosis and pulmonary embolism in Japanese patients may have increased over the last few decades.
Malaysian Orthopaedic Surgeons' Approach to Venous Thromboembolic Disease Prophylaxis: Attitudes and Practice
Authors: Zairul-Nizam ZF , Gul YA 
Published: October 2016

Purpose. To survey Malaysian orthopaedic surgeons' attitudes to and use of venous thromboembolic disease prophylaxis. Methods. A total of 144 orthopaedic surgeons from various governmental and private institutions responded to a questionnaire. Results. Only slightly more than half of these surgeons considered venous thromboembolic disease as common a problem in Malaysia as in western countries. The majority of surgeons (91.0%) reported using prophylaxis selectively for patients based on various indicators such as risk grading of surgery, obesity, and malignancy etc. Bleeding tendencies were cited as the greatest fear against the use of pharmacological prophylaxis. Low-molecular-weight heparin appeared to be the most commonly used pharmacological prophylaxis, used either singly or in combination with other forms of prophylaxis. The majority of surgeons employed prophylaxis until their patients were mobile. Conclusion. There should be greater awareness among surgeons in Malaysia of the need for protection against venous thromboembolic disease. Current practice needs to be reviewed and further recommendations made for existing protocols.
The Incidence of Proximal Deep Vein Thrombosis following Total Knee Arthroplasty in an Asian Population: A Doppler Ultrasound Study
Authors: Nathan S , Aleem Md A , Thiagarajan P , De S Das 
Published: October 2016

Purpose. To investigate the incidence of deep vein thrombosis (DVT) following total knee arthroplasty in an Asian population. Methods. A prospective study of 149 consecutive cases of total knee arthroplasty done for osteoarthritis was conducted over a 5-year period. All patients underwent duplex ultrasonographic assessment of the lower limbs within the first postoperative week. Results. The incidence of proximal DVT was found to be 4.38% in this study. Symptomology was statistically significant in predicting the presence of proximal DVT in all cases. General anaesthesia was associated with a statistically significant–higher incidence of DVT as compared with regional anaesthesia. There was a significant association between a sedentary lifestyle and the development of DVT. Conclusion. The incidence of proximal DVT in Asian patients after total knee arthroplasty is higher than that previously reported for this demographic group.
Revision of Total Hip Arthroplasty Using an Anterior Cortical Window, Extensive Strut Allografts, and an Impaction Graft: Follow-up Study
Authors: Arif M , Sivananthan S , Choon DSK 
Published: October 2016

Purpose. To report the outcome of revised total hip arthroplasty procedures involving an anterior cortical window, extensive strut allografts, and an Exeter impaction graft. Method. Eight patients (9 hips) with a mean age of 58 years underwent revision of total hip arthroplasty using the Exeter hip impaction graft system and strut allografts between 1995 and 1998. An extensile anterior approach was used, and an anterior cortical window was created in the femur, to remove the old implant. External strut allografts were attached by wires to provide cortical support. The mean follow-up duration was 74 months. Indications for surgery were aseptic loosening of previous implants in 8 hips and infection of one hip that had previously undergone total arthroplasty. Results. 19 Dall Miles cables, 4 ordinary cerclage wires, and 8 cerclage wires tightened with the clincher knot technique were used to secure the allograft to the host bone. The strut grafts were found to be incorporated in all cases. No wires became loose. One patient developed 20° of angulation at the allograft-host bone junction. Using the method of Fowler and Gie, we found that one femoral implant had subsided 2 mm within the cement mantle. Two other implants had 1 mm of subsidence at the cement bone interface, and one patient had a major subsidence of 15 mm that required revision. Conclusion. Using an anterior cortical window in the femur to remove the old implant does not predispose to failure of the allograft to incorporate into the host bone.
How Often Should Computed Tomographic Scans following Cross-Table Lateral Cervical Films Be Performed?
Authors: Suzuki T , Morimura N , Sugiyama M , Kitahara T , Soma K 
Published: October 2016

Purpose. In patients with blunt trauma, a cross-table lateral cervical (CTLC) film is followed by a focused computed tomographic (CT) scan of the cervical spine to assess an area inadequately delineated by common techniques and suspected injuries, based on recent guidelines in the United States. The purpose of this study was to calculate the frequency of such supplemental CT scans and to evaluate the efficacy of the recent guidelines describing the use of CTLC films as an indicator of supplemental focused CT scanning in Japan. Methods. A review of CTLC films was performed. 100 initial CTLC films with injuries and another 100 films without injuries were evaluated for the lowest vertebra visualised on the CTLC film. The frequency of abnormal signs on the CTLC films was then examined. Results. Technically adequate CTLC films that showed the upper border of the T1 vertebra were not obtained from 70 patients with injuries and 63 patients without injuries. 88 patients with injuries and 28 patients without injuries had abnormal findings on CTLC films. Overall, 97 patients with injuries and 74 patients without injuries should have received supplemental CT scans. Conclusion. CTLC films require frequent supplemental use of CT, even for patients without cervical spine injuries. Thus, the guidelines that consider CTLC film as an indicator of the necessity for CT scanning are not efficient and need revision.
Factors Leading to Blood Transfusion among Chinese Patients Undergoing Total Knee Replacements: A Retrospective Study
Authors: Yau WP , Tang WM , Ng TP , Chiu KY 
Published: October 2016

Purpose. To investigate the risk factors leading to blood transfusion among Chinese patients undergoing total knee replacement. Methods. From July 2001 to June 2002, a total of 128 primary total knee replacements were performed in 83 Chinese patients (38 unilateral and 45 one-stage sequential bilateral). No pharmaceutical prophylaxis against deep vein thrombosis was used. The risk factors leading to allogenic blood transfusion were analysed. Results. The important predictive factors for postoperative blood transfusion were preoperative haemoglobin level (p=0.005), intra-operative blood loss (p<0.001), and bilateral total knee replacements (p<0.001). Conclusion. To reduce the need of allogenic blood transfusion, we suggest administering erythropoietin or iron supplements to increase the haemoglobin level for patients undergoing total knee replacement. Routine use of intra-operative blood salvage can be considered for patients undergoing one-stage bilateral total knee replacement. Use of a postoperative blood salvage system is recommended for surgeries that may result in major intra-operative blood loss.
Deep Vein Thrombosis after Total Hip Arthroplasty in Indian Patients with and without Enoxaparin
Authors: Jain V , Dhal AK , Dhaon BK , Pradhan G 
Published: October 2016

Purpose. To study the incidence of deep vein thrombosis in Indian patients undergoing total hip arthroplasty with or without prophylaxis, and the effect of enoxaparin on deep vein thrombosis. Methods. The study covered a total of 50 hips in 40 patients who underwent total hip arthroplasty. Patients were assessed for deep vein thrombosis using Doppler ultrasonography. The hips were numbered and divided into 2 groups: the odd-numbered hips did not receive any thrombo-prophylaxis, whereas the even-numbered hips received 40 mg of enoxaparin subcutaneously, once a day for 2 weeks, until the time of discharge. Results. Deep vein thrombosis was not found in both groups. We found wound haematomas in 9 patients (all of whom were on enoxaparin) (p <0.05), superficial infection in 2 patients (one on enoxaparin, one not), and local bruising in 4 patients (all of whom were on enoxaparin). Major haemorrhage did not occur in any of the cases. Conclusion. The incidence of deep vein thrombosis in Indian patients is very low compared to that in European and American patients. Enoxaparin failed to provide any advantage to the patients. It is therefore not advisable to give prophylaxis/low-molecular-weight heparin for deep vein thrombosis to patients undergoing total hip arthroplasty without any risk factors.
Assessment of Blood-Induced Cartilage Damage in Rabbit Knees Using Scanning Electron Microscopy
Authors: Tan AHC , Mitra AK , Chang PCC , Tay BK , Nag HL , Sim CS 
Published: October 2016

Purpose. To investigate the harmful effects of a single episode of intra-articular bleeding on articular cartilage of rabbit knees using scanning electron microscopy. Methods. Autologous blood was injected into the right knee joints of 18 New Zealand white rabbits. Surface and cellular damages were examined by the scanning electron microscope (n=9) and light microscope (n=34), respectively. The injected right knees were then compared with the corresponding control left knees at one, 3, and 6 weeks after the blood injection. Results. The articular surface of the injected knees turned uniformly rough with multiple pits after one week. Maximal changes with elevations and depressions were observed at 3 weeks. These changes reversed at 6 weeks with the irregularities smoothing out. A similar pattern of transient cartilage damage was noted histologically. Conclusion. Both scanning electron microscopic and light microscopic findings suggest that a single episode of intra-articular bleeding leads to articular cartilage damage but this appears to be reversible. Our findings of transient damage to the articular cartilage suggest that there is no need for intra-articular evacuation and washout following an acute episode of haemarthrosis.
Clinical Pathology and Therapeutic Results of Neurilemmoma in the Upper Extremity
Authors: Takase K , Yamamoto K , Imakiire A 
Published: October 2016

Purpose. To evaluate the clinical pathology and postoperative outcomes of patients with neurilemmoma in the upper extremity who underwent tumour enucleation, and the correlation factors for neurological deficits apart from enucleation of nerve fascicles. Methods. Magnetic resonance imaging was used to evaluate the state of lesions of the patients with upper-extremity neurilemmoma who underwent tumour enucleation. To find out the correlation factors for neurological deficits, the patients were then divided into 2 groups based on their recovery period—group A (shorter than 6 months) and group B (at 6 months or longer). Duration of the illness, the affected nerve, and the size and histological type of the tumour were then compared between the 2 groups. Results. Of the 20 patients who underwent tumour enucleation for neurilemmoma in the upper extremity, 19 had a single nerve affected and one had multiple lesions involving two nerves. The tumours in 6 patients were of Antoni A type histology and in the remaining 14 patients were of a mixed type. Antoni B type alone was not observed. 15 patients showed postoperative neurological deficits. No neurological deficits were observed in 5 patients. Neurological deficits were fully recovered in all patients except the one with a lesion in the digital nerve. Apart from enucleation of nerve fascicles, the period required for the recovery of neurological deficits was correlated to the duration of the illness (p=0.04) and the histological type of the tumour (p=0.03). Conclusion. Most of the patients with neurilemmoma (95%) had a single nerve affected. A majority of patients (70%) had the mixed type of Antoni A and Antoni B histology; Antoni B type alone was not observed. Neurological deficits were observed in 75% of patients. In patients with neurilemmoma developing in the upper extremity, the period required for recovery from postoperative neurological deficits was short when the duration of illness was short and when Antoni A type histology was present.
The Effect of Total Knee Arthroplasty on Joint Movement during Functional Activities and Joint Range of Motion with Particular Regard to Higher Flexion Users
Authors: Rowe PJ , Myles CM , Nutton R 
Published: October 2016

Purpose. To evaluate active and functional knee excursion of patients before and after total knee arthroplasty (TKA) and to determine whether TKA restores quality of life related to functional activities of daily living. Methods. Electrogoniometry was used to measure the functional movement of the knee during 11 activities of daily living in 50 patients who underwent TKA. These data were compared with the patient's active range of motion and quality-of-life scores. Results. A cut-off point existed between loss and gain in flexion at between 90 and 95 degrees of preoperative active flexion. Two thirds of patients had preoperative flexion of more than 90 degrees, 83% of them had reduced flexion postoperatively. The remaining one third had preoperative flexion of 90 degrees or less, 85% of them had improved flexion postoperatively. A similar pattern of loss and gain occurred for functional movement of the knee. Reduced functional range was associated with significantly reduced physical quality of life compared with age-matched healthy subjects. Conclusion. Although TKA offers excellent pain relief and contributes to the overall well-being of the patient, these results suggest that it also leads to a reduced range of active and functional motion in the majority of patients. This is associated with a lower-than-normal physical quality of life. The design of implants and rehabilitation programmes should be reconsidered so that better range of motion and quality of life can be achieved for patients.
Volar Fixation of Dorsally Displaced Distal Radial Fracture Using Locking Compression Plate
Authors: Wong KK , Chan KW , Kwok TK , Mak KH 
Published: October 2016

Purpose. To evaluate the functional and radiological results of treating unstable fractures of the dorsal distal radius with a volar locking plate. Methods. Dorsally displaced distal radial fractures in 30 patients (11 men and 19 women; mean age, 58.6 years) were fixed by volar locking compression plate and followed up for a minimum of one year. Results. At final functional assessment, 24 patients achieved excellent and 5 achieved good outcomes, with one patient exhibiting fair results. Radiological scores demonstrated 22 excellent and 8 good outcomes. No nonunion or infection occurred. Conclusion. Volar locking compression plating is a safe and effective treatment for unstable fractures of the dorsal distal radius.
Management of Malignant Atlanto-Axial Tumours
Authors: Fung KY , Law SW 
Published: October 2016

Purpose. To review the management and outcomes of patients with malignant tumours of the atlanto-axial spine treated over a 4-year period at a tertiary hospital. Methods. A total of 12 patients (9 female and 3 male) with a mean age of 56.5 years (range, 35–71 years) were consecutively enrolled. At the time of presentation, 7 patients had received treatment for a known primary malignancy of the lung (n=4), colon (n=1), nasopharynx (n=1), or breast (n=1). The atlanto-axial spine was the first presentation of malignant disease in the remaining 5 patients, whose subsequent diagnoses were multiple myeloma (n=1), carcinoma of the thyroid (n=1), malignant fibrous histiocytoma (n=2), and adenocarcinoma of unknown origin (n=1). Preoperative, postoperative, and follow-up radiographs and computed tomographic and magnetic resonance imaging scans were analysed with regard to the extent of tumour involvement, other spinal metastases, instability, and evidence of cord compression. Surgeries were performed for surgically fit patients with a life expectancy of more than 3 months. Results. All patients presented with severe sub-occipital neck pain. Two had mild neurological deficits (Frankel grade D). Two patients were treated conservatively with rigid neck collars and survived for 3 and 11 months. Surgical stabilisation with posterior instrumentation was performed in 10 patients. One patient received additional anterior surgery for tumour debulking and bone grafting. No neurological complications were recorded in the series. Excellent relief of pain was achieved, and the mean visual analogue scale pain score of the operated patients improved from 9.3 to 1.9. The mean survival of 9 patients after surgery was 13.1 months, while one patient was still living at the time of review (at postoperative 11 months). Conclusion. Surgical stabilisation in selected patients provided pain relief and preserved ambulatory status before the deterioration of overall function.
Radiographic Assessment of Congenital Talipes Equinovarus: Strapping versus Forced Dorsiflexion
Authors: Yeung EHK , Li YH , Ng ON , Chow W 
Published: October 2016

Purpose. To compare 2 radiographic assessment methods for congenital talipes equinovarus: strapping the ankle with tapes versus dorsiflexion with a wooden block. Methods. Anteroposterior and lateral radiographs were taken with the ankle strapped by tapes or dorsiflexed by a wooden block. Talocalcaneal and tibiocalcaneal angles were measured and analysed. Results. 20 radiographic assessments were performed on 14 patients. From the anteroposterior view, the mean talocalcaneal angle with strapping was 19.4 degrees (range, 0–34.0; standard deviation [SD], 11.2 degrees). From the lateral view, the mean talocalcaneal angle with strapping was 22.0 degrees (range, 8.0–38.8; SD, 8.9 degrees) and with forced dorsiflexion was 21.0 degrees (range, 0–52.7; SD, 11.3 degrees), with a mean absolute difference of 9.4 degrees between the 2 groups. The mean tibiocalcaneal angle with strapping was 77.9 degrees (range, 43.2–120.0; SD, 18.8 degrees) and with forced dorsiflexion was 78.2 degrees (range, 29.5–134.0; SD, 24.7 degrees), with a mean absolute difference of 15.7 degrees between the 2 groups. The difference between the tibiocalcaneal measurements in the 2 groups was statistically significant (p=0.026). Conclusion. Similar results were obtained for talocalcaneal and tibiocalcaneal angles measured with strapping and forced dorsiflexion. However, the strapping method provides better stabilisation while radiographs are taken.
Periacetabular Limb Salvage for Malignant Bone Tumours
Authors: Asavamongkolkul A , Pimolsanti R , Waikakul S , Kiatsevee P 
Published: October 2016

Purpose. To evaluate treatment outcomes in primary malignant periacetabular bone tumour removal and limb salvage with or without bone-graft reconstruction. Methods. A total of 13 patients were treated for malignant periacetabular bone tumours at Siriraj Hospital, Bangkok, Thailand. The diagnoses were chondrosarcoma (n=8), Ewing's sarcoma (n=2), osteosarcoma (n=1), well-differentiated osteosarcoma (n=1), and malignant giant cell tumour (n=1). 11 patients did not undergo reconstruction following tumour resection; 2 patients received fibular bone grafts bridging the periacetabulum to the remaining sacrum. Adjuvant chemotherapy was administered for high-grade malignant tumours, and postoperative radiation therapy was performed on patients with a closed surgical margin. Results. At a mean follow-up of 24.3 months (range, 8.9–43.9 months), 9 patients remained disease-free, 3 had died of the disease, and one was alive with disease. According to the Musculoskeletal Tumor Society classification system, the mean functional analysis at final follow-up was 68.7%. Patients who underwent internal hemipelvectomy experienced a subsequent leg-length discrepancy ranging from 3 to 10 cm. Four patients had complications (one each for deep wound infection, skin necrosis, seroma, and vascular spasms) and were successfully treated with multiple debridements and appropriate antibiotics. Three patients had local recurrences; one required a classic hemipelvectomy. Conclusion. Malignant periacetabular tumours are difficult to manage. Functional results of our patients with no reconstruction or with bone-graft bridging were fair. Patients undergoing internal hemipelvectomy may experience leg-length discrepancies, which can be balanced with shoe lifts.