Journal of Southeast Asian Orthopaedics

Comparison of One-year Survival Rate of Hip Arthroplasty Performed within and After 72 Hours in Elderly Femoral Neck Fracture

Burin Suttaphakti — 2023-01-27

Purpose: Hip fracture is a common cause of mortality in the elderly. Our study compared the one-year mortality rate in elderly femoral neck fracture who received hip arthroplasty between an early (<72 hours after admission) and delayed group (≥ 72 hours after admission).

Methods: Eighty-one patients were included in the prospective cohort study. The type of operation (total hip arthroplasty or bipolar hemiarthroplasty/cemented or cementless arthroplasty) was chosen as indicated in standard treatment, depending on a patient’s cognitive function, ambulatory status, and comorbidities.

Results: The sample was 81 patients (44 in the early and 37 in the delayed groups). The one-year mortality rate was 9.9% (4.5% in the early and 16.7% in the delayed group; P =0.079). The mean survival time was 11.47 months (11.97 months in the early and 10.88 months in the delayed group (P= 0.094, HR = 3.93)). Operations performed within 72 hours decreased the one-year mortality rate. Subgroup analysis showed that the early surgery group had a lower one-year mortality rate than the delayed group without preoperative medical conditions (P = 0.011, HR = 8.08).

Conclusions: There was no significant difference in the one-year mortality rate between the early and delayed surgery groups. Early surgery was associated with improved mean survival time and a significant reduction in one-year mortality in elderly patients with femoral neck fractures. Early surgery is recommended for these patients to reduce immobilization time, postoperative complications and improve survival.

Factors Affecting Postoperative Functional Outcomes in Older Patients with Hip Fractures at a Large Public Hospital in Thailand

Adisorn Chongmuenwai — 2023-02-21

Purpose: To identify prognostic factors for 6-month postoperative functional outcomes in older patients with hip fractures.

Methods: This single-center prospective cohort study was conducted from January 2020 to December 2020. Patient factors and the preinjury Barthel index were collected from the patients at admission. The Barthel index was assessed again 6 months postoperatively to define functional outcomes. Minimal clinically important differences (MCIDs) between preinjury and 6-month functional outcomes were used to classify patients into satisfactory or unsatisfactory groups. The 6-month mortality rate was evaluated. Multiple logistic regression was used to analyze prognostic factors for postoperative functional outcomes.

Results: In total, 320 patients were included in the analysis. The 6-month mortality rate was 11.8%. The average age and body mass index were 75.74±10.53 years and 20.98±3.96, respectively. Of the patients, 243 were female (75.94%), 210 were diagnosed with intertrochanteric fractures (65.83%), and 54 underwent surgery within 72 h (16.88%). In total, 249 patients (77.81%) had no complications. Multivariate analysis indicated that a time to surgery of < 72 h (odds ratio, 10.51; 95% confidence interval (CI), 5.42 to 20.37; p-value <0.01) was a significant prognostic factor for a satisfactory 6-month outcome.

Conclusions: Time to surgery is a prognostic factor for a satisfactory functional outcome. Early surgery results in better functional outcomes in older patients with hip fractures.

RAPTOR: The Innovation for Making Long Leg Standing Radiography for Total Knee Arthroplasty from Conventional Radiography

Pakorn Srithongkul — 2023-02-23

Purpose: To evaluate the reliability and validity of femoral anatomical-mechanical angle (fAMA), hip knee ankle angle (HKA), and overlap of long leg standing radiography (LLSR) obtained using a Rapid Orthoroentgenography Making Machine (RAPTOR) compared with a standard X-ray generator.

Methods: This observational study was conducted between July 2021 and August 2021, including patients diagnosed with primary knee osteoarthritis that underwent preoperative LLSR for total knee replacement. Three orthopedic surgeons blindly evaluated LLSR (fAMA, HKA, overlap of the femoral shaft) twice within one-month using the Visio program. Intra- and interobserver reliability and validity were analyzed.

Results: Three evaluators assessed 30 LLSRs. The intraobserver agreement levels were -0.951–1.062° for fAMA, -10.338–11.076° for HKA, and -0.418–0.418 mm for overlap of RAPTOR, while for the standard X-ray generator the agreement levels were -1.359–1.114° for fAMA, 11.844–12.467° for HKA, and 0 mm for overlap. The intraclass correlation was 0.55–0.99 for all RAPTOR measurements and 0.56–0.99 for standard X-ray generator. The interobserver’s levels of agreement were -1.441–1.175° for fAMA, -7.453–7.475° for HKA, and -0.681–0.637 mm for overlap of RAPTOR, whereas those of the standard X-ray generator were -1.149–1.424° for fAMA, -4.789–6.171° for HKA, and 0 mm for overlap. The intraclass correlation was 0.69–0.97 for all RAPTOR measurements and 0.71–0.95 for the fAMA and HKA standard X-ray generator measurements. The mean and 95% limits of agreement of the comparison between RAPTOR and standard X-ray generator were -0.131° (-1.187, 0.925) for fAMA, -0.126° (-4.724, 4.471) for HKA, and 0.363 (-) mm for overlap. Only overlap was significantly different between the two methods (p=0.0243). Intraclass correlations between the two radiographic methods were 0.75 (0.63, 0.88) for fAMA and 0.93 (0.89, 0.97) for HKA.

Conclusions: Estimation of fAMA, HKA, and overlap had moderate to excellent reliability and inter- and intra-rater reliabilities in both RAPTOR and standard X-ray generator. Only overlap was different between the two methods.

Functional Outcomes of Varus Osteotomy with Locking Compression Plate Fixation in Legg-Calve-Perthes Disease

Duangjai Leeprakobboon — 2023-03-01

Purpose: Patients with Legg-Calve-Perthes disease are treated to preserve the roundness of the femoral head. Surgical treatment includes the proximal femur or acetabulum operations, however, remains controversial. Herein, we investigated the clinical findings and outcomes of varus osteotomy with locking compression plate fixation.

Methods: We reviewed 19 children (20 hips) with Legg-Calve-Perthes disease who underwent varus osteotomy with locking compression plate fixation at our hospital. The time to re-ossification, Stulberg classification, and Harris hip score were recorded preoperatively and at the final follow-up.

Results: We included 16 boys and two girls with unilateral hip involvement and one girl with bilateral hip disease. The mean age at the time of surgery was 7.9 years. Based on the Catterall classification, one, 10, and nine patients were classified as grades II, III, and IV, respectively. All patients were followed for 33 months. The mean time to re-ossification was 167 days. At final follow-up, based on the Stulberg classification, seven, nine, and four patients were categorized as class II, III, and IV, respectively. Based on the Harris hip score, 21.1%, 47.7%, and 31.6% of patients showed excellent, good, and fair functional outcomes, respectively. The Harris hip scores at the final follow-up were significantly improved compared to preoperative values. Following adjustment for sex and disease severity, age at disease onset and time of surgery were associated with Harris hip scores.

Conclusions: Varus osteotomy with locking compression plate fixation yields good results and significantly improves functional outcomes, although patient age affects the outcomes.

Short-Term Global Instability and Genu Recurvatum Outcomes of Revision Total Knee Arthroplasty with Rotating-Hinged Knee Prosthesis

Pichate Sripadet — 2023-04-20

Purpose: Primary revision total knee arthroplasty (TKA) is associated with bone loss and ligamentous insufficiency. After TKA, patients may have global knee instability or genu recurvatum and require revision TKA with a rotating-hinged knee (RHK) prosthesis. However, several studies have reported variable outcomes. This study aimed to: 1) evaluate the outcomes of revision TKA with an RHK prosthesis; and 2) compare the outcomes and satisfaction of patients with global instability and genu recurvatum following revision TKA.

Methods: The cases of 18 patients (mean age, 71 ± 8.5 years; mean follow-up time, 24 months (range, 12–38 months) who underwent revision TKA with an RHK prosthesis in 2015–2018 were retrospectively reviewed. Patients were further classified into the global instability group (n=11), those who were diagnosed with periprosthetic joint infection (8 patients), TKA dislocation (2 patients), and periprosthetic fracture with a complete tear of the medial collateral ligament (1 patient); and the genu recurvatum group (n=7). Clinical evaluations were performed preoperatively, at 1 year postoperative, and at the last follow-up. Outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), pain visual analog scale (VAS), range of motion (ROM), complications, and radiographic data. Patient satisfaction was assessed at the 1-year follow-up using a self-administered scale.

Results: Overall, the mean KOOS at the 1-year follow-up was significantly improved versus preoperative (71.39 ± 8.65 vs. 22.56 ± 11.58, p<0.001). The mean 1-year postoperative KOOS (50 vs. 47, p=0.028), surgical satisfaction score (p=0.005), home activity satisfaction score (p=0.0029), and recreational activity satisfaction score (p=0.024) were significantly higher in the global instability versus genu recurvatum group, whereas the mean pain VAS score was significantly higher in the global instability versus genu recurvatum group (6 vs. 4, p=0.037). The mean ROM improved from 30° to 90° in the global instability group and from -20° to 0° in the genu recurvatum group. No surgical complications or signs of prosthesis loosening were observed.

Conclusions: Revision TKA with an RHK prosthesis showed better functional outcomes in patients with global instability versus genu recurvatum. Furthermore, patients with global instability showed higher satisfaction with surgery, home, and recreational activities than those with genu recurvatum.

Efficacy of Intra-Articular Ketorolac and Bupivacaine on Postoperative Pain Relief after Arthroscopic Anterior Cruciate Ligament Reconstruction: A Randomized Double-Blind Study

Supahsak Sathonphanit — 2023-05-09

Purpose: The purpose of our study was to determine whether there is any additional benefit to adding ketorolac, a non-steroidal anti-inflammatory drug (NSAID), to bupivacaine compared to bupivacaine alone in patients undergoing anterior cruciate ligament reconstruction (ACLR) surgery.

Methods: Fifty-two American Society of Anesthesiology I-II patients undergoing arthroscopic ACLR under spinal anesthesia were randomly assigned to one of two groups: group A (10 mL of bupivacaine 0.25% with ketorolac 60 mg) and group B (10 mL of bupivacaine 0.25%). At the end of the procedure, 10 mL of each drug was administered intra-articularly. The dose of intravenously administered analgesic medication (morphine) was calculated based on the patient's body weight and visual analog scale (VAS) score. The postoperative time to rescue analgesia, 24-hour analgesic requirement, VAS score at time of rescue (T-rescue), and findings at rest and during movement were observed.

Results: The VAS score at the time of rescue analgesic significantly lower in group A than in group B (33.85 ±19.61 ; 56.15±21.92) (p < 0.001). Group A had significantly lower 24-hour analgesic consumption than group B (0.28±0.07 ; 0.39±0.09) (p < 0.001).the mean duration of analgesia was longer in group A than in group B (320 minutes ; 235 minutes )(p = 0.194) however, this difference was not statistically significant.

Conclusions: Intra-articular administration of a combination of ketorolac and bupivacaine resulted in a significantly longer duration of analgesia and reduced morphine use in the 24-hour postoperative period and is an effective option for reducing postoperative pain.

Short-Term Outcomes of Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Graft: A Randomized Trial Comparing Risk of Injury to the Infrapatellar Branch of Saphenous Nerve in Terms of Knee Hypoesthesia Among Different Oblique Incision Angles

Kraiwut Sooksanit — 2023-05-11

Purpose: To study the short-term outcomes of anterior cruciate ligament reconstruction (ACLR) with hamstring grafts by comparing the risk of injury to the infrapatellar branch of the saphenous nerve (IPBSN) in terms of the incidence of knee hypoesthesia using 30°, 45°, and 60° oblique incisions.

Methods: We conducted a randomized controlled trial among patients who underwent ACLR with hamstring grafts in our hospital between December 1, 2020 and December 31, 2021. We randomly allocated 111 patients to three groups of 37 patients each, and each group underwent either a 30°, 45°, or 60° oblique incision for hamstring graft harvesting. When incisions were being performed, the age, sex, body mass index, diagnosis, incision length, and operating time were recorded. The incidence and area of knee hypoesthesia were evaluated at 1-, 3-, and 6- month follow-ups.

Results: Demographic and surgical data were similar in all three groups. The incidence of knee hypoesthesia was significantly lower in the 45°-incision group than that in other groups at 1-, 3-, and 6-month follow-ups. At the 6-month follow-up, the incidence was 8.1% in the 45° group, 45.9% in the 30° group, and 35.1% in the 60° group. The area of sensory loss in the 45° group was significantly smaller than that in the other two groups at 3- and 6-month follow-ups.

Conclusions: Performing a 45° oblique incision reduced the risk of the IPBSN injury after ACLR with a hamstring graft more significantly than a 30° or 60° incision. This technique is safe, uncomplicated, and efficacious.

Efficacy of Post-Operative Logbook-Based Quadriceps Exercises on Functional Outcome after Total Knee Arthroplasty

Chatchapol Ongkosit — 2023-05-18

Purpose: Most patients who undergo total knee arthroplasty (TKA) are elderly. Some patients have recognition impairments and cannot correctly perform home-based rehabilitation effectively. This study aimed to compare the functional outcomes between logbook- and non-logbook-based quadricep exercises.

Methods: In this prospective cohort study with retrospective case controls scheduled for unilateral primary/bilateral TKA, we compared 57 patients who received post-operative home-based rehabilitation and seated knee extension exercises (non-logbook group) with 60 patients who received the same protocol but were provided a logbook with paper handouts containing the schedule, date, time, and record form (logbook group). The modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and data pertaining to range of motion (ROM) were collected pre-operatively and at 6, 12, and 24 weeks post-operatively.

Results: The logbook group showed a significant improvement in the mean difference in function and total WOMAC scores at 6-weeks post-operatively (p < 0.05). There was no significant difference in the pre- and post-operative ROM at any follow-up time point between the groups.

Conclusions: Logbook-based quadriceps exercises resulted in significant early improvement in the functional outcomes. Logbooks may help patients who have undergone TKA to perform their home-based exercise regimens accurately.