Arthroscopic assisted percutaneous fixation in ankle pilon fracture: A case report

INTRODUCTION

Results of operative fixation for ankle fractures had been suboptimal, with cases of posttraumatic osteoarthritis occurring following the surgeries. Intra-articular injuries have been suggested as the cause of this problem. This case report aims to present an ankle pilon fracture Ruedi Allgower type II case treated with percutaneous fixation and arthroscopy evaluation.

PRESENTATION OF CASE

Female, 17 years old, complained of pain and swelling at the right ankle. The physical examination revealed swelling, deformity, tenderness, and limited range of motion at the right ankle. The radiological examination showed a Ruedi Allgower type II pilon fracture with right ankle dislocation. The patient underwent closed reduction, arthroscopy to evaluate her right ankle and percutaneous internal fixation. The post-surgery evaluation showed a stable ankle.

DISCUSSION

Patients undergoing ankle fracture surgery may benefit from ankle arthroscopy because it may increase visualization of articular reductions, assess and repair cartilage and ligament damage, remove loose bodies, decrease soft tissue exposure, preservative vascularity, and evaluate syndesmosis. Moreover, rapid arthroscopic evaluation has a low complication rate. The ability of arthroscopy to improve syndesmotic instability diagnosis suggests that arthroscopy may play a significant role in managing ankle fractures.

CONCLUSION

Arthroscopy-assisted internal fixation provides more benefits and information as a single case report, and more studies are warranted; regarding patients' intra-articular injuries, preventing future complications, such as posttraumatic osteoarthritis.

The effectiveness ORIF for neglected periprosthetic femoral fractures after hemiarthroplasty: A case report

INTRODUCTION AND IMPORTANCE

Periprosthetic fractures are a growing concern due to the increasing frequency of primary joint replacement surgery, with total hip arthroplasty being the most common. The incidence of periprosthetic fractures after revision surgery ranges from 4 to 11 %, with up to 30 % reported after knee revision surgery. This case report aims to describe the treatment of an 81-year-old woman suffering from neglected periprosthetic femoral fracture post hemiarthroplasty.

CASE PRESENTATION

An 81-year-old woman with a history of hemiarthroplasty surgery and hypertension was admitted to the ER with pain in her right thigh. She had a middle shaft femoral fracture and was scheduled for open reduction and internal fixation. Despite being fully conscious and having an average pulse rate and blood pressure, she had cardiomegaly and congestive pulmonum. Unfortunately, this patient did not receive appropriate medical treatment after it occurred for 1 month. After surgery, we evaluated the implant, and the implant stabilized the fracture. After 1-3 months after surgery, the LEFS (The Lower Extremity Functional Scale) score was found that the score increase significantly after surgery.

CLINICAL DISCUSSION

The Vancouver classification system manages periprosthetic fractures by assessing location, stability, and bone quality. Type A fractures involve the trochanter, while type B fractures are diaphyseal and can extend distally. ORIF is used for subtype B1 fractures, but newer techniques offer shorter operating times and fewer complications.

CONCLUSION

From this study, we can conclude that even though neglected cases procedure with ORIF promises a good outcome based on clinical evaluation.

The Banff Patellar Instability Instrument: validity and reliability of an Indonesian version

BACKGROUND

The Banff Patellar Instability Instrument (BPII) is a valuable scoring tool for assessing patellofemoral instability in patients suffering from patellofemoral pain syndrome (PFPS). The BPII 2.0 is a shortened version of the BPII. However, there is no Indonesian edition of BPII 2.0 that has been validated. This study aimed to determine the validity and reliability of the Indonesian version of the BPII 2.0.

MATERIALS AND METHODS

This was a cross-sectional study that used a forward-backward translation protocol to create an Indonesian version of the BPII 2.0. Thirty patients with PFPS were given the questionnaires. The questionnaire's validity was evaluated by analyzing the correlation between score of each subscale and the overall score to the Indonesian version of the Kujala score using Pearson correlation coefficient, while the reliability was evaluated by measuring the internal consistency (Cronbach α) and test-retest reliability (intraclass correlation coefficient).

RESULTS

The Indonesian version of BPII 2.0 and the Indonesian version of Kujala score had a strong Pearson correlation coefficient for construct validity. For all subscales, Cronbach α was 0.90-0.98, indicating adequate internal consistency. The test-retest reliability was high, with intraclass correlation coefficient ranging from 0.89 to 0.98 for all subscales. There was no difference in the Indonesian version of BPII 2.0 response between the first and second administration of the questionnaire which was taken 7 days afterward.

CONCLUSION

The Indonesian version of BPII 2.0 was determined to be valid and reliable and is therefore an objective instrument to evaluate patellofemoral instability in patients with PFPS in the Indonesian population.

Patellofemoral functional outcome of gracilis sparing compared to gracilis sacrificing ACL reconstruction

Introduction

The hamstring is the most popular autograft used for anterior cruciate ligament reconstruction (ACLR). Despite its excellent outcome, donor site morbidity is also irritating. Patellofemoral problems are reported to be one of the side effects after hamstring autograft harvesting, suggested to be due to both gracilis & semitendinosus sacrificing. Some experts propose retaining gracilis to decrease patellofemoral problems. The all-inside technique is an advantageous ACLR technique that can preserve the gracilis muscle while reducing muscle strength loss of affected limbs and the risk of knee joint instability under rotational load. This study aims to compare the patellofemoral functional outcome of both gracilis sparing and sacrificing using a validated Kujala score three months after ACLR.

Methods

There was total of 20 subjects who underwent ACLR between December 2021 and May 2022 and met the inclusion criteria. They were then grouped into gracilis sparing group (n = 10) and gracilis sacrificing group (n = 10). Follow up assessment (Kujala Score) was conducted during phase II of the rehabilitation program. The assessed variables were surgery technique, time of surgery-to-evaluation, and Kujala Score.

Result

There were no significant differences in Kujala Score between gracilis sparing and gracilis sacrificing groups (p = 0.809). There was a strong positive correlation between the time of surgery-to-evaluation and Kujala Score in each group (p = 0.942 and p = 0.910, respectively).

Conclusion

There are no differences in patellofemoral functional outcomes between patients who undergo gracilis sparing and gracilis sacrificing ACLR with good scores of Kujala, which means both gracilis sparing and sacrificing show no harm to the patellofemoral after the ACLR.

Implant surface modifications as a prevention method for periprosthetic joint infection caused by Staphylococcus aureus: a systematic review and meta-analysis

Abstract. Background: Periprosthetic joint infection is the most common infection due to joint replacement. It has been reported that, over a 5-year time span, 3.7 % of cases occurred annually. This statistic has increased to 6.86 % over 16 years. Thus, an effective method is required to reduce these complications. Several strategies such as coating methods with various materials, such as antibiotics, silver, and iodine, have been reported. However, the best preventive strategy is still undetermined. Therefore, this systematic review aims to evaluate the outcome of coating methods on joint arthroplasty as a treatment or preventive management for infection complications. Methods: Eligible articles were systematically searched from multiple electronic databases (PubMed, Cochrane library, and ScienceDirect) up to 2 June 2022. Based on the criterion inclusion, eight articles were selected for this study. The Newcastle–Ottawa scale (NOS) was used to assess the quality of the study, and the meta-analysis test was conducted with Review Manager 5.4. Results: The quality of the articles in this study is in the range of moderate to good. It was found that the application of modified antibiotic coatings significantly reduced the occurrence of periprosthetic joint infection (PJI) (p 0.03), and silver coating could not significantly (p 0.47) prevent the occurrence of PJI. However, according to the whole aspect of coating modification, the use of antibiotics, silver, and iodine can minimize the occurrence of PJI (p <0.0001). Conclusion: Coating methods using antibiotics are an effective method that could significantly prevent the occurrence of PJI. On the other hand, coating with non-antibiotic materials such as silver could not significantly prevent the incidence of PJI.

Patellar height measurement in Indonesian normal adult population

Background

Patellar height is the distance formed by the patella and the length of the patellar tendon. Patellar height measurement can predispose to various abnormalities in the knee joint. Patellar height can be measured using several sizes, such as the Insall-Salvati ratio (IS), Modified Insall-Salvati ratio (MIS), Caton-Deschamps index (CD), and the Blackburne-Peel (BP) index. In Indonesia, no data on the value of patellar height is available. This study aims to determine the patellar height value in Indonesians and compare if there are differences with the standard values commonly used by other countries.

Matherials and methods

This study is descriptive with 136 research subjects aged 20–40. Data were taken from December 2021 to February 2022. The results of patellar X-ray were measured using the Insall-Salvati, Modified Insall-Salvati, Caton-Deschamps, and Blackburne-Peel methods.

Results

In the measurement of patellar height, the longest measurement was found in the MIS measurement, while the shortest patellar height was measured using the BP method. The normal value of the IS method is 0.78–1.26, the MIS method is > 1.98, the CD method is 0.79–1.23, and the BP method is 0.70–1.10 for patellar height in Indonesia. This study also shows no significant difference in the value of patellar height between male and female sex using the IS measurement method.

Conclusion

There is a difference in the standard value of patellar height, which is commonly used by other countries with the standard value of patellar height in Indonesia, but it is not significant.

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Each country has different standard value of the patella height.

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Patellar height can be measured using several methods.

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Indonesian patellar height standard value different with other countries.

Prosthetic joint infection of the hip and knee due to Mycobacterium species: A systematic review

BACKGROUND

Mycobacterium species (Mycobacterium sp) is an emerging cause of hip and knee prosthetic joint infection (PJI), and different species of this organism may be responsible for the same.

AIM

To evaluate the profile of hip and knee Mycobacterium PJI cases as published in the past 30 years.

METHODS

A literature search was performed in PubMed using the MeSH terms “Prosthesis joint infection” AND “Mycobacterium” for studies with publication dates from January 1, 1990, to May 30, 2021. To avoid missing any study, another search was performed with the terms “Arthroplasty infection” AND “Mycobacterium” in the same period as the previous search. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses chart was used to evaluate the included studies for further review. In total, 51 studies were included for further evaluation of the cases, type of pathogen, and treatment of PJI caused by Mycobacterium sp.

RESULTS

Seventeen identified Mycobacterium sp were reportedly responsible for hip/knee PJI in 115 hip/knee PJI cases, whereas in two cases there was no mention of any specific Mycobacterium sp. Mycobacterium tuberculosis (M. tuberculosis) was detected in 50/115 (43.3%) of the cases. Nontuberculous mycobacteria (NTM) included M. fortuitum (26/115, 22.6%), M. abscessus (10/115, 8.6%), M. chelonae (8/115, 6.9%), and M. bovis (8/115, 6.9%). Majority of the cases (82/114, 71.9%) had an onset of infection > 3 mo after the index surgery, while in 24.6% (28/114) the disease had an onset in ≤ 3 mo. Incidental intraoperative PJI diagnosis was made in 4 cases (3.5%). Overall, prosthesis removal was needed in 77.8% (84/108) of the cases to treat the infection. Overall infection rate was controlled in 88/102 (86.3%) patients with Mycobacterium PJI. Persistent infection occurred in 10/108 (9.8%) patients, while 4/108 (3.9%) patients died due to the infection.

CONCLUSION

At least 17 Mycobacterium sp can be responsible for hip/knee PJI. Although M. tuberculosis is the most common causal pathogen, NTM should be considered as an emerging cause of hip/knee PJI.

Plating technique outcome evaluation in calcaneal fracture based on American orthopaedics foot and ankle score and Böhler-Gissane angle: A case series

Introduction

Intraarticular Calcaneal fracture treatment nowadays is still up for debate. Surgical plating treatment is favorable because of the rapid healing process and better anatomical reduction despite the invasive intervention. Hence, clinical evaluation is needed to assess the quality-of-life index from foot and ankle by the American orthopaedics Foot and Ankle Society (AOFAS) score postoperatively. Then, the outcome evaluation of reduction in calcaneal plating of intraarticular calcaneal fracture with Böhler angle and Gissane angle to see if the calcaneal plating technique is a recommended treatment for the calcaneal fracture.

Methods

We treated six patients from December 2020–July 2021 with a calcaneal fracture that underwent surgical plating, mainly by one surgeon. A calcaneal fracture is classified according to sanders classification. In this study, four patients are above the age of 40, and two are under 25. Pre-operative Böhler angle ranged from 8 to 65°, and Gissane angle ranged from 134 to 158°.

Outcomes

Surgical plating was performed on all six patients. From clinical evaluation using the AOFAS score, we got satisfactory results on all patients who underwent calcaneal plating surgery. Three patients achieved excellent range outcomes with 95% and 99% of AOFAS Scores, and three patients reported AOFAS score good range outcomes with the lowest score of 88%. From the radiological outcome, most of the patient's Böhler and Gissane angles achieved normal value after surgical plating.

Conclusion

The calcaneal plating technique gives better anatomical reduction depending on Bohler and Gissane angle. These results promise that anatomical reduction can improve clinical outcomes based on the AOFAS score. Thus, the plating method can be used effectively to treat an intraarticular calcaneal fracture.

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Limited studies reported the outcome method of “Plating technique” surgery for calcaneal fracture.

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Anatomical reduction achieved with Plating technique

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Satisfactory clinical outcome was concluded after Plating technique surgery for calcaneal fracture.

Hyaluronic Acid Prevent Further Cartilage Damage of Osteoarthritis Based on Expression of Collagen Type II and Collagen Type X

Abstract Objective: Osteoarthritis (OA) is a degenerative joint disease characterized by changes in the structure of the subchondral articular cartilage. Chondrocytes are responsible for the synthesis and integrity of the extracellular matrix of articular cartilage. Hyaluronic acid (HA) is believed to have a potential protective effect on joint cartilage through chondroprotective. Materials and methods: This study is experimental research (pre and post-test control group design) with 20 samples divided into five groups, each consisting of four samples. Four different dosages of HA have been given to the treatment group: 0.1 mg/ml, 1 mg/ml, 2 mg/ml, and 3 mg/ml. Subsequently, collagen type II (COL2) and type X (COL10) were examined using the ELISA method, and data were analyzed with SPSS 20.0 Result: Our study revealed that COL2 expression was not significantly different between the control group and 0.1 mg/ml. Interestingly, with 1 mg/ml of HA, there was a markedly significant increase in the expression of COL2 (p < 0,05), and a further increase in dosage did not give an incremental effect. Conversely, treatment of HA significantly suppressed the expression of COL10, but no enhanced suppression was found with increasing dose.  Conclusion: The administration of HA results in an increased number of COL2 and reduced number of COL10 and has the potential function of inhibiting the degeneration process in joint cartilage.

The Effects of Stromal Vascular Fraction Administration in Stimulating Graft Healing Process after Anterior Cruciate Ligament Reconstruction Surgery in Rattus norvegicus

Introduction: Ligament injuries commonly occur in the knee region, and the anterior cruciate ligament (ACL) being the most usually injured. Currently, autograft or allograft is the most common material used for ACL reconstruction surgery. The result of the ACL reconstruction depends on the healing process of the graft or ligamentization between graft and bone tunnel. This study aims to evaluate the effect of Stromal Vascular Fraction (SVF) intratunnel injection to stimulates graft healing following ACL reconstruction surgery, as measured by histology examination. Method: This study was an experimental laboratory study with a post-test-only control group design using male Rattus novergicus. A random sampling procedure was used to choose the sample, which was then divided into two groups. The two groups consist of the control group that only had ACL reconstruction surgery and the treatment group that had reconstruction surgery with SVF administration. Result: This study used Advanced Ligament Maturity Index (LMI) score and showed a significant improvement of graft healing in the treatment group compared to the control group. The measurement is based on the cellular, collagen, and vascular aspect testing with P < 0,05 for each subscore. Conclusion: SVF intratunnel injection stimulates graft healing after ACL reconstruction surgery and causes a significant increase in cellular, collagen, and vascular aspects in the graft.

Unusual combination of posterior cruciate ligament tibial avulsion fracture and Segond fracture: A case report

Introduction and importance

Posterior cruciate ligament (PCL) avulsion fracture is an uncommon entity, but it poses significant morbidity to patient's knee and activities. A combination of PCL avulsion fracture with Segond fracture is rare and has not been described much before in known literature. In this case report, we present a rare case of a combination of these two injuries.

Case presentation

A 16-year-old cyclist who sustained left knee injury after a high-velocity fall while cycling. He fell with his anteromedial side of his left knee hitting the ground in flexion. After the fall, he felt excruciating pain and unable to bear weight. Examination revealed severe joint effusion, tenderness on posterior and lateral side of the left knee, no vascular injury and neurological deficit present. Radiographic examination revealed PCL avulsion fracture and Segond fracture. Five days after the injury, the avulsed PCL fragment and the lateral tibial plateau fragment were reduced and fixed with 3.5 mm cortical screw and washers. On the follow up, the patient stated that there is no pain on weightbearing position and after evaluated with Knee injury and Osteoarthritis Outcome Score (KOOS), the result is 90%.

Clinical discussion

Although the combination of PCL avulsion fracture and Segond fracture is rare, this pattern of injury could happen and could be considered when evaluating knee injuries.

Conclusion

Both fractures need to be addressed and managed adequately to restore knee stability and prevent early joint degeneration.

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A rare case of combination of PCL avulsion fracture with Segond fracture

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Segond fracture only present in 1.25% of the ACL avulsion cases

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PCL avulsion fracture is rare compare to intrasubstance PCL tear.

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No other identical case has been described or reported previously.

Higher Rate of Patellofemoral Problems After Anterior Cruciate Ligament Reconstruction using Hamstring Autograft

Background: Patellofemoral problems are not uncommon among post-anterior cruciate ligament (ACL) reconstruction patients. Hamstring autograft harvesting-related factor is one of the suspected causes. A lack of tibiofemoral internal rotation force due to strength deficit causes the patella tends to shift laterally. Purposes: Peroneus longus tendon has been proposed as an alternative graft source due to its adequate tensile strength and minimal donor site morbidity to the knee biomechanics, including the patellofemoral joint. This tendon does not cross the knee joint and thus does not affect patellofemoral alignment and biomechanics. This study aims to compare patellofemoral problems between hamstring and peroneus longus autograft harvested-patients following ACL reconstruction. Material and methods: Thirty-one subjects who underwent primary single-bundle ACL reconstruction between September 2018 and September 2019 and met the inclusion criteria were grouped into the hamstring group (n=16) and peroneus longus group (n=15). Both groups were evaluated retrospectively. The follow-up assessment was conducted on the phase II rehabilitation program. The assessed variables were pain, crepitus, and the Indonesian-validated Kujala score. Results: No significant differences in pain and crepitus were found between both groups. There were significant differences in the Kujala score between both groups (P < .001). The peroneus longus group reported an averagely higher score than the hamstring group. Conclusion: Single bundle ACL reconstruction using peroneus longus tendon autograft produces less patellofemoral symptoms and functional limitation than using hamstring tendon autograft.

Peroneus Longus Tendon Autograft: A Promising Graft for ACL Reconstruction

Background:

With the increasing use of hamstring tendon as an autograft in anterior cruciate ligament (ACL) reconstruction, some shortcomings have been found on the donor site. Therefore, an alternative autograft option with adequate strength and less donor site morbidity will be very valuable. Peroneus longus tendon has been found to be a promising option.

Indication:

Primary ACL reconstruction.

Technique Description:

Peroneus longus tendon graft is harvested with a longitudinal skin incision at 2 to 3 cm (2 finger-breadths) above and 1 cm (1 finger-breadth) behind the lateral malleolus, followed by superficial fascia incision in line with skin incision. The peroneus longus and peroneus brevis tendons were then identified. The tendon division location was marked at 2 to 3 cm above the level of the lateral malleolus. After that, an end-to-side suture was performed between the distal part of the peroneus longus tendon and peroneus brevis tendon. The peroneus longus tendon was stripped proximally with a tendon stripper to at least 5 cm from the fibular head to prevent peroneal nerve injury. Graft preparation was performed with a standard procedure to obtain the suitable graft size. In routine arthroscopic ACL reconstruction, peroneus longus tendon graft fixation can be performed with a cortical suspension device, bioabsorbable screws, or a combined technique.

Results:

Recent studies showed that peroneus longus autograft had a comparable outcome with hamstring tendon autograft in primary ACL reconstruction at a 1-year follow-up. The use of peroneus longus tendon autograft resulted in larger graft diameter and less thigh hypotrophy. The mean (±SD) for the AOFAS-Hindfoot Score in the peroneus longus group was 97.3 ± 4.2, while the mean FADI score was 98 ± 3.4, both of which were considered excellent results.

Discussion/Conclusion:

The use of peroneus longus autograft in primary ACL reconstruction is a safe procedure with an excellent outcome. Peroneus longus tendon autograft can be recommended as an alternative graft in single-bundle ACL reconstruction. Further study of the functional outcome and knee stability evaluation is recommended.

Double posterior lateral plating arthrodesis for charcot ankle: A case series

Introduction

Ankle arthrodesis is one of the managements for a significantly unstable Charcot ankle. Some of the methods of internal fixation for ankle arthrodesis include the use of intramedullary nails, screws, and plates. Ankle arthrodesis using intramedullary nails has become more popular. However, studies evaluating the use of plate fixation, particularly double posterior lateral plating, are limited. We report the clinical and radiological outcomes of double posterior lateral plating ankle arthrodesis in three diabetic Charcot ankle patients.

Presentation of case

Three patients, aged 73, 67, and 65 years old, complained of ankle pain and with a history of type 2 diabetes mellitus. The physical examination revealed swelling and erythema without a sign of active infection. The radiological examination showed ankle deformity, and the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores were 5, 10, and 0, respectively. All patients were diagnosed with a diabetic Charcot ankle and underwent ankle arthrodesis using double posterior lateral plating. Four months and six months follow up revealed talus union, improved ankle deformity, and improved AOFAS Ankle-Hindfoot scores to 70, 76, and 73, respectively.

Discussion

Various methods of ankle arthrodesis are retrograde intramedullary nails, screws, and plates. In this report, we opt for plate fixation because it allows for stable internal fixation, adequate compression, high angular stability, and a lower irreversible deformation in osteoporotic bone.

Conclusion

Double posterior lateral plating ankle arthrodesis provided satisfactory clinical and radiological outcomes. This method can be an alternative for patients with Charcot ankle requiring ankle arthrodesis.

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Double posterior lateral plating ankle arthrodesis is satisfactory.

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This method can be an alternative for patients with Charcot ankle.

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Plate fixation allows stable internal fixation and adequate compression.

Changes in Orthopedic Services in Two Indonesian Tertiary-referral Hospitals during the Coronavirus-19 Pandemic

BACKGROUND: Many countries report decreasing on the number of hospital visit even on the emergency cases. AIM: This study aims to reveal the important data on how big the impact of coronavirus-19 pandemic on orthopedic services in two Government’s tertiary-referral hospitals. METHODS: This research is a comparison study to measure the trend of orthopedic services, the monthly orthopedic surgical load and outpatient visit were examined during the period of March to May 2020 (the early pandemic period) then compared to the same period in the 2019. RESULTS: The lowest number of outpatient visits occurred during May 2020 with 715 total number of outpatient visit. The lowest number of orthopedic surgery occurred during May 2020 with 167 total number of orthopedic surgery. Significant decrease of outpatient visits is recorded in 3 months of early pandemic period compared to the same period in 2019 (p < 0.005). Regarding the orthopedic surgical loads, the data show significant decrease in number of orthopedic surgeries in early pandemic period compared to those months in 2019 (p < 0.005). The largest declines were in visits for post-operative control patient (–179), spinal problem (–127,33), and osteoarthritis (–91,33). CONCLUSION: There was a significant difference in outpatient visit and orthopedic surgery number in the early pandemic period compared to the period before the pandemic occur. The largest drops in outpatient visit were in visits for post–operative control patient and spinal problem.

The direct anterior approach in total hip arthroplasty: Publication trends of Asian countries on PubMed

Background

Total hip replacement (THR) is one of the most successful surgical treatment for advanced hip osteoarthritis. Some surgical approaches for THR have been established, one of it is Direct Anterior Approach (DAA), which is a relatively new and less commonly used, especially in Asian countries. This review aims to consolidate information from PubMed on the direct anterior approach (DAA) for total hip replacement (THR) in Asian countries.

Purpose

To collect and consolidate information from PubMed on the total hip replacement (THR) using the direct anterior approach (DAA) in Asian countries.

Methods

A search on the PubMed was done for DAA for THR. There were 461 search results about the DAA for THR publications obtained in total, and 51 articles meet the criteria were analyzed for details. The details include top countries publishing the topics, number of publications per year, top 5 journal publishing the DAA for THR topics, top 5 first authors publishing the articles on this topic, and top 5 author on all position published this topic.

Results

The Journal of Arthroplasty was the leading publisher on this topic, with 10 articles published. Author Yasuhiro Homma, Tomonori Baba, and Kazuhiro Oinuma published the most number with 9 articles as one of the authors. Japan is the leading country for the publication on this topic with 34 published journals in total.

Conclusion

The number of published articles in Asian country per year is still inconsistent, with one year without any publication on this topic. Searching the data on the DAA for THR in PubMed bestow useful information about good sources of publication on this topic.

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Direct anterior approach.

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Total hip arthroplasty.

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Publication trends.

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Asian countries.

Validity and Reliability of the Indonesian Version of the Kujala Score for Patients With Patellofemoral Pain Syndrome

Background:

The Kujala score is a useful diagnostic tool to evaluate patellofemoral pain syndrome (PFPS). However, no validated Indonesian version of the Kujala score has been available.

Purpose:

To develop and validate an Indonesian version of the Kujala score.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

This was a cross-sectional study to develop an Indonesian version of the Kujala score by using a forward-backward translation protocol. The resulting questionnaire was given to 51 patients diagnosed with PFPS. The validity of the questionnaire was evaluated by correlating the final score with the Indonesian version of the 36-Item Short Form Health Survey (SF-36). Reliability was measured by evaluating the internal consistency (Cronbach alpha) and test-retest reliability (intraclass correlation coefficient [ICC]).

Results:

The Indonesian version of the Kujala score had a positive correlation with the physical components of the SF-36. The internal consistency was fairly high (α = .74), and the test-retest reliability was excellent (ICC, 0.996).

Conclusion:

The Indonesian version of the Kujala score was proven to be a valid and reliable tool to diagnose PFPS. Future epidemiological studies could implement this score to find the prevalence of PFPS in Indonesia. Further, ensuing studies could explore the application of this scoring system in posttreatment and postoperative settings.

Union of Brodsky type 1/Eichenholtz stage III Charcot neuroarthropathy after forefoot arthrodesis

INTRODUCTION

One of the surgical intervention options for Charcot neuroarthropathy (CN) is arthrodesis. The arthrodesis procedure for the foot and ankle joint have been widely used in previous studies. This study aimed to evaluate the functional and radiological outcomes after arthrodesis procedure for the CN patient with Brodsky type 1/Eichenholtz stage III.

PRESENTATION OF CASE

A 49-years-old diabetic woman presented with alteration of her right foot's shape and a cracking sensation while walking in the last six months. Rocker-bottom deformity and a decreased sensation on the right foot were found, and the initial American Orthopaedic Foot & Ankle Society (AOFAS) score was 45. Subsequently, forefoot arthrodesis of the right foot was performed.

DISCUSSION

Several studies state that arthrodesis procedure is often used for CN management in order to achieve a plantigrade and stable foot. This study presents an improvement of the foot arch, AOFAS score, and union of the talus six months after surgery.

CONCLUSION

The arthrodesis procedure by using screws and Kirschner wire (K-wire) fixation is an effective method in CN management if the patient is compliant. This study showed a good result, anatomically restored the foot arch, and excellent radiological union, but different tools to analyze foot functional status and longer follow up period are needed for a better analysis.

Primary single stage Total Hip Arthroplasty in a patient 40 years post traumatic Hip dysplasia, a case report

Introduction

Hip dysplasia refers to an abnormal development of size, shape, or organization of the femoral head, acetabulum, or both. Managing acetabular dysplasia is very challenging in arthroplasty especially in traumatic hip dysplasia case. Mostly, hip dysplasia cases need a special implant, procedure and techniques.

Case presentation

We performed primary Total Hip Arthroplasty (THA) + partial tenotomy of hamstring, iliotibial band, hip abductor in a 73 year old male. His main complaint was that he was unable to sit due to an increasingly intense pain since 3 months ago and he has been unable to walk properly since 40 years ago when he had a major traffic accident and received inadequate treatment. The procedure had been successfully done using a well press-fit cementless acetabular cup and a cementless narrow stem application 1 cm on leg length discrepancy (LLD).

Conclusion

Preoperative planning, surgical techniques and a post-surgery rehabilitation are the key to a successful management in this case.