Journal of Southeast Asian Orthopaedics

The Efficacy of Inhaled Methoxyflurane Versus Intravenous Sedation for the Reduction of Acute Shoulder Dislocation

Chavalit Iemsaengchairat — 2024-07-16

Purpose: Anterior shoulder dislocation is one of the most common emergency orthopedic conditions. In general practice, intravenous sedation is the standard treatment to relax patients during shoulder reduction procedures. Sedatives and analgesics are drugs that have side effects after administration, especially when administered intravenously. They can depress neurological function and cause respiratory and cardiovascular system side effects. Self-inhaled methoxyflurane relieves moderate to severe pain. Hospitals may benefit from minimized respiratory and cardiovascular side effects.

Methods: This randomized controlled trial included 50 patients who were randomly assigned to two groups: the inhaled methoxyflurane group (Inh Group) and the intravenous sedation group (IV Group). All patients were assessed for efficacy, procedure duration, pain score during reduction, patient satisfaction, and adverse effects.

Results: Fifty patients satisfied the inclusion requirement: 25 each in the Inh and IV Groups. Reduction was successfully achieved in 92% and 88% of the patients in the Inh and IV Group, respectively. The mean procedural time was 6.4 min and 15.4 min the Inh and IV Group, respectively. Moreover, the mean recovery time was 22.5 min in the Inh Group and 32.4 min in the IV Group.

Conclusions: Inhaled methoxyflurane has better efficacy in reducing acute shoulder dislocation than intravenous sedation alone. Procedural and recovery times were shorter in the Inh Group. Adverse events (hemodynamic instability, desaturation, nausea, vomiting, drowsiness, and dizziness) were more frequent in the IV Group than in the Inh Group.

A Randomized Prospective Study of Short-Term Complications Between Simple Release and Extensor Retinaculum Reconstruction in De Quervain’s Tenosynovitis

Natdanai Chusing — 2024-07-26

Purpose: To study and compare the postoperative complications of De Quervain’s tenosynovitis treatment using two methods: simple release and extensor retinaculum reconstruction.

Methods: This randomized controlled trial included 24 patients divided into two groups: Group 1 (simple release) and Group 2 (extensor retinaculum reconstruction), with 12 patients in each group.

Results: The mean age of the participants was 51.75 and 49.25 years for Groups 1 and 2, respectively. The study participants included three males and 21 females. Intraoperatively, subcompartments were observed in two patients in Group 1 and six patients in Group 2. Additionally, a ganglion cyst in the tendon was found in one patient per group. The mean preoperative visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores for Group 1 were 7.83 and 61.44, respectively, whereas those for Group 2 were 8.17 and 66.52, respectively. Postoperatively, the VAS and DASH scores for Group 1 changed to 2.17 and 15.47, respectively, whereas those for Group 2 changed to 2.67 and 16.33, respectively (p = 0.843 and 0.63, respectively). Tendon subluxation was observed in two patients in Group 1, with none in patients in Group 2 (p = 0.14).

Conclusions: No significant tendon subluxation was observed in either surgery type, with no significant differences in the treatment outcomes.

Outcomes of the Rotating Hinge Knee in Revision Total Knee Arthroplasty: A Short-term Report with a Median Follow-up of 2.75 Years in a Large Asian Institute

Gem Dorjiee — 2024-08-16

Purpose: Revision total knee arthroplasty (TKA) is often necessary because of infection and malalignment and represents significantly greater challenges. Rotating-hinge knee (RHK) play an important role in complex situations, with survival rates varying from 73% to 97.2% over 5 to 10 years. However, most knee arthroplasty concepts are primarily tailored to suit Caucasians, potentially raising concerns about their suitability for Asian populations. The purpose of our research was to determine the rates of survival and complications, as well as to review the factors that contribute to failed RHK revisions in our large Asian institute.

Methods: This retrospective study included all revisions with RHKs performed between January 2013 and December 2021 while excluding those who underwent primary RHK procedures. Data collection included revision diagnoses and reasons for RHK implant failure. Implant survivorship was calculated from the date of surgery to the time of re-revision surgery.

Results: This study included 37 patients, consisting of four men and 33 women participants, with an average age of 75 years. The mean follow-up was 2.75 years. The main causes of revision to RHK were prosthetic joint infection and instability, both accounting for 29.7% of cases, followed by aseptic loosening at 21.6%. The 2-year survival rate was 91.67%. The mean survival time was 2.08 years, with an overall failure rate of 5.4% due to infection.

Conclusions: RHK implants are essential in revision knee arthroplasty under specific conditions. Our large Asian institution has shown a 2-year survival rate of 91.67% and a recurrence-free survival rate of 94.6%.

Seating of the Femoral Stem after Washing versus Un-washing the Femoral Canal in Cementless Short Stem Hip Arthroplasty

Thanut Tippimanchai — 2024-09-11

Purpose: This study aimed to evaluate the effect of washing the femoral canal on the seating of the short femoral stem in cementless short-stem hip arthroplasty.

Methods: This single-center randomized controlled trial included 50 patients divided into unwashed and washed groups. All patients underwent cementless short-stem hip arthroplasty with the Metha® short-stem. The primary outcome measured was the discrepancy between the final rasp and implanted stem, with a mismatch of >2 mm considered clinically significant. Secondary outcomes included intraoperative factors associated with a significant mismatch. Univariate logistic regression analysis was used to identify factors related to a clinically significant mismatch between the final rasp and implant. The subsidence and revision were recorded at 4 years follow-up.

Results: The study found that 44% of the cases in the unwashed group had a clinically significant mismatch, compared with 8% in the washed group (P=0.001). The mean discrepancy was 2.4 mm in the unwashed group and 1.2 mm in the washed group (P<0.001). Univariate regression analysis indicated that not washing the canal was associated with a higher rate of significant mismatches (odds ratio [OR]=9.05, P=0.009). No cases of stem subsidence or revision were observed at 4 years follow-up in either group.

Conclusions: Washing the femoral canal with saline significantly reduced the discrepancy between the final rasp and the implant in cementless short-stem hip arthroplasty, potentially improving surgical outcomes and reducing leg length discrepancies.

Effectiveness of the Capture the Fracture Program for Patients with Hip Fractures at Phrae Hospital: A 2-Year Follow-up After Surgery

Yodpiti Tungtrongjit — 2024-09-14

Purpose: To determine the effectiveness of the Capture the Fracture (CTF) program in preventing refractures, improving Barthel index scores for activities of daily living (ADL), and reducing mortality rates in patients with hip fractures.

Methods: This study enrolled patients with fragile hip fractures aged ≥50 years who underwent hip fracture surgery. The participants were classified into the intervention and control groups, each consisting of 46 patients. The intervention group underwent the CTF program with a multifactorial approach, whereas the control group received routine care. Participants were followed up 1 and 2 years postoperatively to assess outcomes, including the Timed Up and Go test, balance test, Barthel index scores for ADL, fall risk assessment, refracture, and mortality rate.

Results: In the intervention group, no recurrent fractures occurred within 1 year, compared to 6.5% in the control group (p=0.106). At the 2-year postoperative follow-up, 4.9% of the intervention group experienced recurrent fractures, whereas the control group had no fractures (p=0.508). The 2-year postoperative mortality rate was 18.0% and 37.0% in the intervention and control groups, respectively (p=0.042).

Conclusions: Multidisciplinary teams should implement the CTF program using a multifactorial approach to physical rehabilitation in patients with hip fractures. This program improved participants' quality of life and reduced the mortality rate 2 years postoperatively.

Early Hip Dislocation Rate in a Consecutive Series of 1093 Primary Total Hip Arthroplasties Using Imageless Navigation

Pattawat Chuvanichanon — 2024-10-28

Purpose: Postoperative hip dislocation remains a major complication in total hip arthroplasty. Various studies have demonstrated that several factors influence dislocation. While computer-assisted navigation has been proposed to enhance component alignment, its impact on dislocation rates remains unclear. This study aimed to investigate the early dislocation incidence and associated risk factors in primary total hip arthroplasty (THA) using imageless navigation.

Methods: A retrospective review of patients undergoing imageless-navigated THA between February 2013 and December 2022 was conducted. Inclusion criteria comprised primary THA with a minimum 6-month follow-up. Statistical analysis included univariate regression to identify dislocation risk factors.

Results: A total of 1093 THAs were analyzed. Dislocation occurred in 16 cases (1.5%), six in elective procedures (0.76%), and 10 in femoral neck fracture (FNF) (3.28%). The univariate regression analysis revealed that FNF emerged as a significant risk factor (OR = 4.418, P = 0.004), while age, gender, femoral head size, and save zone cup placement of Lewinnek did not significantly affect dislocation rates.

Conclusions: Navigation use showed a reduced rate of early dislocation. FNF is a factor associated with postoperative hip dislocation in primary THA.

Effectiveness of Cannabis Oil as an Adjuvant Therapy in Patients with Severe Knee Osteoarthritis: A Randomized, Double-Blind Study

Warin Prucksikanont — 2024-11-19

Purpose: The removal of cannabis from Thailand's narcotic drug list presents both opportunities and challenges for medical use. The effectiveness of cannabis oil in treating severe knee osteoarthritis in patients awaiting total knee arthroplasty was evaluated in this study.

Methods: Thirty-two patients with severe knee osteoarthritis, unresponsive to conservative treatment, were enrolled and divided into two equal groups. The control and experimental groups received syrup and cannabis oil, respectively, at night for 30 days. Pain and quality of life (QOL) were assessed using the Numeric Rating Scale (NRS), and the Knee Injury and Osteoarthritis Outcome Score (KOOS), respectively. Liver and kidney functions were also assessed.

Results: The experimental group showed a significant reduction in NRS scores compared to the control group (p = 0.00015). Significant improvements were observed in KOOS subscales for pain, activities of daily living (ADL), and QOL (p = 0.01). However, the symptoms subscale improvement was not significant (p = 0.14). When comparing the KOOS subscales, no significant differences were observed between the groups (p > 0.05). Liver and kidney function remained stable in both groups. Despite these improvements, the changes did not reach a minimal clinically important difference (MCID), indicating limited clinical perceptibility to the patients.

Conclusions: Cannabis oil was associated with significant improvements in pain, ADL, and QOL in severe knee osteoarthritis. Although improvements did not meet MCID thresholds, observed benefits suggest potential for pain management. Larger controlled studies are recommended to confirm its clinical efficacy in pain management.