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Iamthanaporn K, Rojjanasirisawat N, Yuenyongviwat V. Superior analgesic efficacy of preemptive low-dose ketorolac compared with parecoxib after total knee arthroplasty: A retrospective propensity score matching study. J Orthop Surg (Hong Kong) 2024; 32:10225536231225758. [PMID: 38182131 DOI: 10.1177/10225536231225758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a routine orthopedic procedure often associated with significant postoperative pain. Efficient pain management is paramount for patient recovery, with nonsteroidal anti-inflammatory drugs (NSAIDs) being a common choice. Nevertheless, the specific NSAID and its dosing regimen can have varying impacts on outcomes. METHODS In this retrospective cohort study spanning from January 2016 to December 2020, we analyzed patients who underwent TKA. These patients were divided into two groups: one receiving preemptive low-dose ketorolac (15 mg) followed by 15 mg every 6 h for 48 h, and the other receiving parecoxib (40 mg) every 12 h for the same duration. We assessed pain scores, opioid consumption, and monitored adverse events. RESULTS Our findings reveal that ketorolac yielded superior results compared to parecoxib. Specifically, patients receiving ketorolac reported significantly lower Visual Numeric Rating Scale (VNRS) scores at 8- and 20-h post-surgery. This trend was further confirmed by linear mixed models (p = .0084). Additionally, ketorolac was associated with reduced opioid consumption during the initial 24 h. Importantly, the rates of adverse events were comparable between the two groups. CONCLUSION The utilization of preemptive low-dose ketorolac demonstrates promising potential in bolstering pain control within the initial 24 h post-TKA, potentially reducing the need for opioids. However, further exploration is required to thoroughly assess its prolonged analgesic effects and safety across various surgical contexts. These investigations could provide invaluable insights for optimizing pain management protocols.
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Affiliation(s)
- Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | | | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Iamthanaporn K, Rojjanasirisawat N, Yuenyongviwat V. Letter re: Reply: Letter to editor: Superior analgesic efficacy of preemptive low-dose ketorolac compared with parecoxib after total knee arthroplasty: A retrospective propensity score matching study. J Orthop Surg (Hong Kong) 2024; 32:10225536241241897. [PMID: 38533837 DOI: 10.1177/10225536241241897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Affiliation(s)
- Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Yuenyongviwat V, Wuttiworawanit B, Panichnantho N, Hongnaparak T, Iamthanaporn K. Efficacy of Periarticular Infiltration with Dexamethasone and Bupivacaine plus Adductor Canal Block Relative to That of Adductor Canal Block Alone for Patients Undergoing Total Knee Arthroplasty: A Retrospective Case-Matched Study. Adv Orthop 2023; 2023:7356192. [PMID: 37868629 PMCID: PMC10586906 DOI: 10.1155/2023/7356192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 10/24/2023] Open
Abstract
Purpose Periarticular infiltration (PI) is a common procedure during total knee arthroplasty (TKA) for postoperative pain management. This retrospective, case-matched study aimed to evaluate the effectiveness of PI with dexamethasone and bupivacaine in combination with an adductor canal block (ACB) and compare it with that of ACB alone in reducing postoperative pain in patients with TKA. Methods Data were collected from 66 patients who underwent TKA performed by a single surgeon. Thirty-three of them received ACB + PI, and 33 received ACB alone. However, both groups underwent identical surgical techniques and postoperative care protocols. The pain scores and fentanyl consumption of the two groups were compared. Results The ACB + PI group had significantly lower pain scores than the ACB alone group at 8, 16, 24, and 48 hours postoperatively (p=0.033, 0.004, 0.038, and 0.049, respectively). The percentage of patients requiring fentanyl as a rescue medication was significantly higher for the ACB alone group (90.9%) than for the ACB + PI group (69.7%, p=0.03). The total fentanyl consumption was also lower for the ACB + PI group (p < 0.001). Conclusion The periarticular injection of the combination of dexamethasone and bupivacaine plus ACB was more effective than ACB alone in reducing postoperative pain and fentanyl consumption in patients undergoing TKA. Further studies comparing different doses of dexamethasone or other cocktail regimens may provide additional insights into this approach.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Bunyaporn Wuttiworawanit
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Nipat Panichnantho
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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Tuntarattanapong P, Iamthanaporn K, Watatham K, Sookjarern C, Hongnaparak T, Yuenyongviwat V. Do cemented standard-length femoral stems have enough longevity for the pathological fractures of the femoral neck with metastatic lesions? A retrospective study. Orthop Rev (Pavia) 2023; 15:77877. [PMID: 37405272 PMCID: PMC10317508 DOI: 10.52965/001c.77877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023] Open
Abstract
Background Cemented long-stem hip arthroplasty is a treatment of choice for the pathological fractures of the femoral neck with metastatic lesions and the prevention of further fracture caused by metastasis progression. Objective The present study was an evaluation of the outcome after treatment of metastatic femoral neck fractures with cemented standard-length hemiarthroplasty. Methods We retrospectively studied 23 patients in whom the pathological fractures of the femoral neck with metastatic lesions were diagnosed. All patients underwent hemiarthroplasty with cemented standard-length femoral stems. The demographic data of the patients and clinical outcomes were obtained from an electronic medical database. Metastasis progression-free survival time was analyzed via the Kaplan-Meier curve. Results The mean age of the patients was 51.5 ± 11.7 years. The median duration of follow-up was 6.8 months (interquartile range, 5-22.6 months). Four patients exhibited tumor progression according to radiographic evaluation, but no patients had new fractures in the same bone or needed reoperation. The Kaplan-Meier curve revealed that 88.2% (74.2,100) of femurs demonstrated 1 year radiographic progression-free survival and 73.5% (49.4,100) demonstrated 2 year progression-free survival. Conclusions Our study demonstrated that the use of cemented standard-length stems in hemiarthroplasty for pathological fractures of the femoral neck with metastatic lesions is safe, and the rate of reoperation was low. We believe that this prosthesis is optimum for treatment in this group of patients because the length of survival in patients is expected to be short and the rate of metastasis progression in the same bone is low.
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Affiliation(s)
- Pakjai Tuntarattanapong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Kraisong Watatham
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Chanon Sookjarern
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
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Iamthanaporn K, Aonsong W, Tuntarattanapong P, Yuenyongviwat V. Screw inserting in different phase of cement affect the pull-out strength of cement augmented screws. Orthop Traumatol Surg Res 2022; 108:103060. [PMID: 34537392 DOI: 10.1016/j.otsr.2021.103060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 03/17/2021] [Accepted: 04/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND For large bone defects, after curettage of aggressive bone tumors; such as giant-cell tumors, cementation with supplement internal fixation was used to prevent subsequent collapse of the cement-bone constructs. The purpose of this study is to compare the pull-out strength of cement augmented screws between inserting screws in the working phase or hard phase of bone cement. HYPOTHESIS Timing at which completed screw insertion takes place affecting the pull-out strength of cement augmented screws. METHODS Pull-out strength was compared between screws; inserted within the working phases of cement, and after the cement was hardened in high viscos cement blocks. Each group consists of 10 cortex screws, 10 cancellous screws and 10 locking screws. The pull-out strength test was followed using the instructions of ASTM F543-13e1 Standard Specification and Test Methods, for Metallic Medical Bone Screws. RESULTS Screws that were inserted in the working phases of cement had significantly higher pull-out strength, than those inserted in hard cement (p=0.021). The pull-out strength was statistically significant in difference among the types of screws (p<0.001), with locking screws having the highest pull-out strength. Furthermore, the pull-out strength of locking screws revealed no significant difference when either; inserted during the working or hardened phases of bone cement. CONCLUSION Insertion of screws during the working periods of PMMA cement had higher pull out strength compared to the hard phase of cement. Hence, we recommend performing internal fixation before cementation after curettage of aggressive bone tumors. However, if the surgeon prefers to pack the cement first, for the benefit of avoiding residual bone defects, we suggest using a locking plate system to achieve comparable pull-out strength. LEVEL OF EVIDENCE In-vitro study.
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Affiliation(s)
- Khanin Iamthanaporn
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Hat Yai, Songkhla, Thailand.
| | - Wachirakorn Aonsong
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Hat Yai, Songkhla, Thailand
| | - Pakjai Tuntarattanapong
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Hat Yai, Songkhla, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Hat Yai, Songkhla, Thailand
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Nawatthakul A, Hongnaparak T, Iamthanaporn K, Yuenyongviwat V. The ability and factors related with floor sitting after total hip arthroplasty with a posterolateral approach. Orthop Rev (Pavia) 2022; 14:37072. [PMID: 35910547 DOI: 10.52965/001c.37072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Prosthesis dislocation following total hip arthroplasty (THA) is one complication that affects treatment outcome and increases the cost of treatment. Currently, many surgeons prohibit patients from performing floor-based activities; however, these prohibitions might affect the lifestyle of a number of patients. Objective This study aimed to evaluate the ability of floor sitting after THA, and factors associated with this ability. Methods This study was a retrospective cohort study, evaluating 240 patients who underwent THA with a posterolateral approach, in a single tertiary hospital. Patient demographic data, preoperative clinical data, prostheses type, and postoperative radiographic were extracted from the electronic medical records. Postoperative ability to perform floor sitting was evaluated at 6 months postoperatively. Results There were 52 patients (21.66%) who were able to sit on the floor postoperatively. Multivariate logistic regression analysis showed independent association between three factors with ability to sit on the floor after surgery: pre-operative external rotation range of motion (OR 1.03; 95% CI, 1.01-1.06; P = 0.01), pre-operative Harris Hip Scores (OR 1.05; 95% CI, 1.01-1.10; P = < 0.01), pre-operative ability to sit on the floor (OR 10.2; 95% CI, 3.65-28.5; P = < 0.01). Conclusion There were a number of patients who could sit on the floor after THA. However, there were factors which were associated with this ability. Hence, these results could be useful for adjusted patient preoperative expectations, and did not preclude all patients to perform floor activities.
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Yuenyongviwat V, Dissaneewate K, Iamthanaporn K, Tuntarattanapong P, Hongnaparak T. EFFICACY OF EXTENDED ORAL TRANEXAMIC ACID ON BLOOD LOSS IN PRIMARY TOTAL KNEE ARTHROPLASTY. Acta ortop bras 2022; 30:e247197. [PMID: 35864836 PMCID: PMC9270054 DOI: 10.1590/1413-785220223001e247197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Introduction: Tranexamic acid is widely used for patients undergoing total knee arthroplasty (TKA). However, the duration of systemic tranexamic acid (TXA) administration varies in many reports. Hence, this study aims to compare blood loss between a single intravenous (IV) TXA dose, and one dose of IV TXA combined with oral TXA, during 48-hour postoperative care in primary TKA. Methods: Ninety-four patients with primary osteoarthritis, who underwent primary TKA, were randomized into two groups. The first group consisted of 47 patients and received a dose of 750 mg IV TXA and 750 mg oral TXA postoperatively at 8-hour intervals for 48 hours. In the second group, 47 patients received a single dose of IV TXA and a placebo at the same intervals for the same time duration. Hemoglobin (Hb) was measured at 4, 24 and 72 hours after operation. Results: The mean total blood loss were not different between the two groups (p=0.37). There was no difference in total Hb reduction or closed suction drainage outputs (p=0.9 and 0.07, respectively). Conclusion: The extended use of oral TXA for 48-hour postoperative care did not decrease the total blood loss following TKA compared with a single dose of IV TXA. Level Of Evidence I; High quality randomized trial .
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Hongnaparak T, Binlateh F, Iamthanaporn K, Tanutit P, Yuenyongviwat V. A eficácia do ácido tranexâmico tópico em pacientes com fraturas no pescoço femoral submetidos a hemiartroplastia bipolar cimentada: Um ensaio controlado duplo-cego randomizado. Rev Bras Ortop 2021; 58:240-245. [DOI: 10.1055/s-0041-1740292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/31/2021] [Indexed: 10/19/2022] Open
Abstract
Resumo
Objetivo O ácido tranexâmico (TXA) é um antifibrinolítico amplamente utilizado para diminuir as taxas de perda de sangue e de transfusão de sangue na artroplastia total do quadril. No entanto, há evidências limitadas de uso tópico de TXA na hemiartroplastia do quadril para fraturas no pescoço femoral. O presente estudo teve como objetivo avaliar os efeitos do TXA tópico na perda de sangue e transfusões de sangue em pacientes com fratura femoral que foram submetidos a hemiartroplastia bipolar cimentada.
Métodos Vinte e seis pacientes com fraturas no pescoço femoral e programados para artroplastia cimentada bipolar foram randomizados em dois grupos. O primeiro grupo de 12 pacientes recebeu TXA tópico durante a operação; no segundo grupo, 14 pacientes receberam placebo. O hematócrito foi medido às 6 e 24 horas no pós-operatório. Também foram registradas transfusões de sangue e complicações pós-operatórias.
Resultados A perda total de sangue não foi diferente entre o grupo TXA e o grupo controle (grupo TXA: 459,48 ± 456,32 ml; e grupo controle: 732,98 ± 474,02 ml; p = 0,14). No entanto, não houve pacientes dentro do grupo TXA que necessitaram de transfusão de sangue, enquanto 4 pacientes no grupo controle fizeram transfusões de sangue halogênicas (p = 0,044). Não houve complicações pós-operatórias, tais como complicação da ferida, tromboembolismo venoso ou complicações cardiovasculares dentro de qualquer grupo.
Conclusão O TXA tópico não conseguiu diminuir a perda total de sangue, mas foi capaz de reduzir as taxas de transfusão, em pacientes submetidos a hemiartroplastia de quadril bipolar cimentada em fraturas no pescoço femoral. Outros estudos com doses de TXA tópico em um tamanho amostral maior seriam benéficos.
Nível de Evidência II.
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Affiliation(s)
- Theerawit Hongnaparak
- Departamento de Ortopedia, Faculdade de Medicina, Prince of Songkla University, Songkhla, Tailândia
| | - Fatin Binlateh
- Departamento de Ortopedia, Faculdade de Medicina, Prince of Songkla University, Songkhla, Tailândia
| | - Khanin Iamthanaporn
- Departamento de Ortopedia, Faculdade de Medicina, Prince of Songkla University, Songkhla, Tailândia
| | - Pramot Tanutit
- Departamento de Radiologia, Faculdade de Medicina, Prince of Songkla University, Songkhla, Tailândia
| | - Varah Yuenyongviwat
- Departamento de Ortopedia, Faculdade de Medicina, Prince of Songkla University, Songkhla, Tailândia
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Hongnaparak T, Janejaturanon J, Iamthanaporn K, Tanutit P, Yuenyongviwat V. Aspirina versus rivaroxabana na prevenção do tromboembolismo venoso após artroplastia total do joelho: Um ensaio clínico randomizado, controlado e duplo-cego. Rev Bras Ortop 2021; 57:741-746. [PMID: 36226201 PMCID: PMC9550362 DOI: 10.1055/s-0041-1735941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/14/2021] [Indexed: 10/31/2022] Open
Abstract
Resumo
Objetivo A aspirina (ácido acetilsalicílico, AAS) e a rivaroxabana são anticoagulantes que vêm ganhando popularidade devido à facilidade de uso na prevenção do tromboembolismo venoso (TEV) após artroplastia total do joelho (ATJ). Este estudo teve como objetivo avaliar a eficácia do AAS em comparação com a da rivaroxabana na profilaxia de TEV em pacientes submetidos a ATJ.
Método Quarenta pacientes com osteoartrite primária do joelho, que seriam submetidos a ATJ, foram randomizados em dois grupos. No total, 20 pacientes do grupo AAS usaram aspirina oral, na dose de 300 mg/dia, para a profilaxia do TEV após ATJ; e 20 pacientes do grupo rivaroxabana receberam uma dose oral de 10 mg/dia. No 4° e 14° dias do pós-operatório, trombose venosa profunda (TVP) dos membros inferiores no lado da cirurgia foi detectada por meio de ultrassonografia duplex. Foram registradas outras complicações durante catorze dias.
Resultados Não foram detectados achados positivos de TVP com a ultrassonografia duplex nos grupos de pacientes, e não se observou a ocorrência de embolia pulmonar. No total, 4 pacientes apresentaram equimose subcutânea no 4° dia do pós-operatório (2 pacientes no grupo AAS e 2 pacientes no grupo rivaroxabana; p = 1,0), e outros 4 pacientes, no 14° dia do pós-operatório (1 paciente no grupo AAS e 3 pacientes no grupo rivaroxabana; p = 0,292). Nenhum paciente da amostra apresentou hematoma da ferida cirúrgica, sangramento de órgão importante, infecção da ferida, ou necessidade de nova cirurgia.
Conclusão A aspirina e a rivaroxabana apresentaram eficácia comparável na prevenção do TEV, sem aumentar a incidência de complicações da ferida e sangramento após ATJ.
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Affiliation(s)
- Theerawit Hongnaparak
- Departamento de Ortopedia, Faculdade de Medicina, Universidade Prince of Songkla, Songkhla, Tailândia
| | - Jiranuwat Janejaturanon
- Departamento de Ortopedia, Faculdade de Medicina, Universidade Prince of Songkla, Songkhla, Tailândia
| | - Khanin Iamthanaporn
- Departamento de Ortopedia, Faculdade de Medicina, Universidade Prince of Songkla, Songkhla, Tailândia
| | - Pramot Tanutit
- Departamento de Radiologia, Faculdade de Medicina, Universidade Prince of Songkla, Songkhla, Tailândia
| | - Varah Yuenyongviwat
- Departamento de Ortopedia, Faculdade de Medicina, Universidade Prince of Songkla, Songkhla, Tailândia
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Anusitviwat C, Hongnaparak T, Yuenyongviwat V, Iamthanaporn K, Tuntarattanapong P, Bvonpanttarananon J, Suwannaphisit S. Relationship between web-based illness scripts and the performance of medical students in orthopedic surgery placements. Int J Med Educ 2021; 12:181-185. [PMID: 34601465 PMCID: PMC8994641 DOI: 10.5116/ijme.6135.d424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES We aimed to explore the relationship between web-based orthopedic illness scripts and medical students' performance as assessed through examination results. METHODS This was a retrospective cohort study with 83 fifth-year medical students in an academic hospital. During a one-month placement, they were instructed to do web-based illness scripts. Their performances were assessed by examination in the last week. All recorded data about illness scripts and examination results were retrieved. The students were separated into high and low response groups based on completed illness scripts. The characteristics of the students between the two groups were compared. Pearson correlation coefficients and regression analysis were used to identify the relationship between illness scripts and examination results. RESULTS There were 56 students in the high-response and 27 in the low-response groups. The characteristics and examination scores were not significantly different between the groups, while there was a significant difference in script completion (t(27)=13.72, p<0.001). Using Pearson correlation, we found weak correlations without significance between completed scripts, illness script scores, and examination scores. We found no relationship between illness script scores and examination scores, even in the high response group, by regression analysis. CONCLUSIONS The use of web-based orthopedic illness scripts did not correlate to the examination performance of medical students. A high number of scripts without variety and limited time for practicing may have obscured potential positive relationships. Illness scripts should be adjusted as appropriate for each school before being assigned. A further multi-center, prospective study is suggested to identify the correlations and investigate the influencing factors.
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Affiliation(s)
- Chirathit Anusitviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Thailand
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Suwannaphisit S, Aonsong W, Suwanno P, Yuenyongviwat V. Comparing the running subcuticular technique versus the Donati technique in open carpal tunnel release: a randomized controlled trial. J Orthop Surg Res 2021; 16:565. [PMID: 34535166 PMCID: PMC8447700 DOI: 10.1186/s13018-021-02710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are various skin suture techniques for wound closure following carpal tunnel release, and well-performed suturing will result in low post-operative scar tenderness. The aim of this study was to compare the Donati suture technique and running subcuticular technique in terms of surgical scar, post-operative pain and functional outcome in open carpal tunnel release. METHODS One-hundred forty-two patients were randomized using a computer-generated random number table into two groups receiving either running subcuticular suturing or Donati suturing after surgical intervention. We evaluated postoperative scarring using the Patient and Observer Scar Assessment Scale (POSAS), pain intensity using a verbal numerical rating scale, and functional outcomes using the Thai version of the Boston Carpal Tunnel Questionnaire after surgical decompression for carpal tunnel syndrome at 2, 6, and 12 weeks. Continuous data are reported as mean ± SD while normally distributed or as median (interquartile range) when the distribution was skewed. RESULTS Lower scores at 2 weeks were given by the patients receiving the running subcuticular suture technique than the Donati suture technique (15.3 ± 4.8 vs 17 ± 4.6, respectively, P < 0.05) while the observer scores were not significantly different (15.6 ± 5.8 vs 16.7 ± 5.2, respectively, P = 0.15). At both 6 and 12 weeks post-surgical decompression both patient and observer scores were not significantly different. There were no differences between the groups in terms of VNRS pain scores and functional Boston Carpal Tunnel Scores at all time points. CONCLUSIONS This randomized controlled trial found that although scarring assessments were slightly better in the earliest period following wound closure after surgical decompression in carpal tunnel syndrome using the running subcuticular suture, the final results at 3 months postoperative were not significantly different. TRIAL REGISTRATION The study was registered at https://www.thaiclinicaltrials.org/ (TCTR20191204002).
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Affiliation(s)
- Sitthiphong Suwannaphisit
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
| | - Wachirakorn Aonsong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Porames Suwanno
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
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Pitathawatchai P, Anuntaseree S, Yuenyongviwat V. Satisfaction with an In-House Nasal Foreign Body Removal Manikin: A Randomized Controlled Trial. Med Devices (Auckl) 2021; 14:249-256. [PMID: 34447275 PMCID: PMC8384347 DOI: 10.2147/mder.s326575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/20/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Nasal foreign bodies can lead to life-threatening conditions. Hence, it is a necessity that physicians be well trained in the appropriate procedures for removal of nasal foreign bodies. However, training on real patients is not only unpractical it is also too dangerous, due to risk of foreign body aspiration during the procedure. Therefore, our goal was to construct a manikin, with a specific design, to serve all possible needs for training. Methods We developed an in-house manikin from 2 materials; these being flexible polyurethane foam and silicone. Silicone, which has elasticity similar to nasal alae, was used to develop the detachable nose and nasal cavity, whilst polyurethane foam, which is light and easy to carry, was used to develop the head. The in-house manikin was compared with a commercial manikin for satisfaction after a nasal foreign body removal procedure was performed in both groups, by 37 physicians, after conducting a randomized controlled trial with a crossover design. Results The satisfaction scores of the in-house manikin were statistically significantly higher than the satisfaction scores of the commercial manikin for 6 dimensions: proper size, ease of use, ease of maintenance, flexibility of nasal alae relative to actual anatomy, similarity of the nasal cavity relative to actual anatomy and confidence that the manikin can upskill the medical students ability to practice on real patients (p value < 0.05). Conclusion This in-house nasal foreign body removal manikin design had high satisfaction for training and could be used to develop further nasal foreign body removal manikins in the future.
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Affiliation(s)
- Pittayapon Pitathawatchai
- Department of Otolaryngology Head & Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| | - Sittichoke Anuntaseree
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
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Yuenyongviwat V, Chunakiat S, Purngpiputtrakul P, Wanasitchaiwat P, Iamthanaporn K, Hongnaparak T. Factors Affecting Adherence to Follow-up Appointments after total knee arthroplasty. Ortop Traumatol Rehabil 2021; 22:245-250. [PMID: 32986009 DOI: 10.5604/01.3001.0014.3461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Regular attendance of follow-up visits after total knee arthroplasty (TKA) is an important aspect of post-TKA patient care. Hence, this study was conducted to evaluate patient adherence to follow-up visits after TKA and analyze the factors that are associated with adherence to follow-up visits following TKA. MATERIAL AND METHODS This study was a retrospective study. The data of 411 knee osteoarthritis patients who had primary TKA were extracted from a single tertiary care hospital's electronic database. All of the pa-tients underwent the same patient care protocol. The log-rank test was used for detecting differences in follow-up survival and influencing factors. Hazard ratios (HR) were calculated using Cox proportional hazard models. RESULTS The percentage of patients attending postoperative follow-up was 99.3 percent at 6 weeks, 61.1 percent after 1 year, 38.4 percent at 2 years, 32.1 percent after 3 years, and 24.6 percent at 4 years. Hazard ratios for loss to follow-up in patients younger than 65 years of age and those 65-75 years old, compared with those over 75 years old were 2.09 and 1.49, respectively (P<0.05). Patients classified as ASA II better adhered to follow-up visits than ASA III patients. (HR 0.71, P = 0.04). Lastly, HR in patients who lived at least 100 km away from the hospital compared with those who lived less than 100 km away was 0.78 (P = 0.033). CONCLUSIONS 1. Adherence to follow-up visits after TKA was lower than we had expected. 2. The importance of follow-up visits should be emphasized to all patients, and especially in those who require special attention, such as patients who are at high risk of post-operative complications.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sahatsa Chunakiat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Pawin Wanasitchaiwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Yuenyongviwat V, Iamthanaporn K, Tuntarattanapong P, Hongnaparak T, Tangtrakulwanich B. A Randomized Placebo-Controlled Trial of Efficacy and Safety: Drug-Free Gel Containing Ultra-Deformable Phospholipid Vesicles (TDT 064) in Osteoarthritic Knees. Clin Med Insights Arthritis Musculoskelet Disord 2021; 14:11795441211031338. [PMID: 34377044 PMCID: PMC8326992 DOI: 10.1177/11795441211031338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022]
Abstract
Background: There are a number of topical agents that are used for treatment of knee
osteoarthritis. Drug-free gels, containing ultra-deformable phospholipid
vesicles (TDT 064) are one such topical therapy, which have been stated to
act as a bio lubricant. However, the evidence of TDT 064 in treatment of
knee osteoarthritis is limited. Hence, the aim of this study was to evaluate
the efficacy of pain control as a primary outcome and safety of TDT 064
compared with a topical placebo. Methods: Sixty-four patients with primary osteoarthritis, with radiographic showing
Kellgren and Lawrence classification grade II to III, were randomized into 2
groups. In the first group of 32 patients TDT 064 was used as topical agent,
whilst in the second group of 32 patients a placebo identical in appearance
was used instead. The verbal numerical rating scale (VNRS) was used for
recording pain levels, Self-reported Knee Injury and Osteoarthritis Outcome
Scores (KOOS) as well as amounts of rescue medication were also recorded.
The data were recorded at the start of the study, and then at follow-up
appointments of 14 days, 6 weeks, and 3 months. Results: The mean VNRS for pain in both groups were significantly improved, when
compared to the start of treatment (P < .0001); however,
there were no differences between groups at any follow up visit. KOOS in all
subscales were not significantly different between both groups at baseline
and at the end of treatment. However, the average amount of NSAIDs in the
TDT 064 group was 26.39 ± 22.11 tabs, which was significantly lower than the
control group; which used an average 37.03 ± 19.22 tabs in 3 months
(P = .047). Conclusions: There were no differences in the VNRS for pain and KOOS scores between the
active and placebo groups. Although, TDT 064 could decrease usage of rescue
medication the difference with use of a placebo was minimal. Further, larger
trials would also be beneficial to demonstrate any differences between TDT
064 and a placebo. Trial Registration: TCTR, TCTR 20190302001. Registered 1 March, 2019: http://www.clinicaltrials.in.th
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pakjai Tuntarattanapong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Boonsin Tangtrakulwanich
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Liawrungrueang W, Tangtrakulwanich B, Yuenyongviwat V. Soft tissue releasing and serial casting for management of flexion contracture after primary total knee arthroplasty in a patient with hemophilia. Int J Surg Case Rep 2021; 83:105995. [PMID: 34049178 PMCID: PMC8170162 DOI: 10.1016/j.ijscr.2021.105995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Flexion contracture following total knee arthroplasty (TKA) in patients with hemophilia is not uncommon, and this complication reduces knee range of motion and produces morbidity for the patient. This report states the success of treatment of flexion contracture after primary TKA in a patient with hemophilia; by open soft tissue contracture releasing and serial casting. CASE PRESENTATION A 20-year-old-man presented with hemophilia type A. He had undergone TKA for treatment of secondary osteoarthritis, following chronic hemophilic arthropathy of his right knee. After surgery, the patient had progressive flexion contracture posture, until he had 45 degrees of knee flexion contracture at his 3 month follow up. The patient received open soft tissue releasing, then serial casting for 6 weeks. After this, the cast was removed and he continued with a home rehabilitation program. At 1 year follow, his knee flexion contraction contracture had improved up to 10 degrees. The patients function had recovered and he was satisfied with this treatment. CLINICAL DISCUSSION The complications after TKA in patients with hemophilia are very challenging in there management; with flexion contracture after TKA being a common complication in patients with hemophilia. CONCLUSION In severe flexion contracture following TKA, soft tissue releasing combined with serial casting is effective, and might be an option that is less invasive than revising all of the TKA components.
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Affiliation(s)
- Wongthawat Liawrungrueang
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Boonsin Tangtrakulwanich
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
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Yuenyongviwat V, Bvonpanttarananon J. Using a Web-Based Quiz Game as a Tool to Summarize Essential Content in Medical School Classes: Retrospective Comparative Study. JMIR Med Educ 2021; 7:e22992. [PMID: 33913813 PMCID: PMC8120432 DOI: 10.2196/22992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/02/2020] [Accepted: 04/13/2021] [Indexed: 06/08/2023]
Abstract
BACKGROUND Kahoot! is a web-based technology quiz game in which teachers can design their own quizzes via provided game templates. The advantages of these games are their attractive interfaces, which contain stimulating music, moving pictures, and colorful, animated shapes to maintain students' attentiveness while they perform the quizzes. OBJECTIVE The aim of this study was to evaluate the use of Kahoot! compared with a traditional teaching approach as a tool to summarize the essential content of a medical school class in the aspects of final examination scores and the perception of students regarding aspects of their learning environment and of process management. METHODS This study used an interrupted time series design, and retrospective data were collected from 85 medical students. Of these 85 students, 43 completed a Kahoot! quiz, while 42 students completed a paper quiz. All students attended a lecture on the topic of bone and joint infection and participated in a short case discussion. Students from both groups received the same content and study material, with the exception that at the end of the lesson, students in the Kahoot! group completed a quiz summarizing the essential content from the lecture, whereas the other group received a paper quiz with the same questions and the teacher provided an explanation after the students had finished. The students' satisfaction was evaluated after the class, and their final examination was held 2 weeks after the class. RESULTS The mean final examination score in the Kahoot! group was 62.84 (SD 8.79), compared to 60.81 (SD 9.25) in the control group (P=.30). The students' satisfaction with the class environment, learning process management, and teacher were not significantly different between the 2 groups (all P>.05). CONCLUSIONS In this study, it was found that using Kahoot! as a tool to summarize the essential content in medical school classes involving a lecture and case discussion did not affect the students' final examination scores or their satisfaction with the class environment, learning process management, or teacher.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hatyai, Thailand
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Chewakidakarn C, Yuenyongviwat V. Comparison of Bone Mineral Density at Hip and Lumbar Spine in Patients with Femoral Neck Fractures and Pertrochanteric Fractures. Ortop Traumatol Rehabil 2021; 23:45-49. [PMID: 33709951 DOI: 10.5604/01.3001.0014.7567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Geriatric hip fractures, including femoral neck and pertrochanteric fractures, are common nowadays, which is related to increasing numbers of elderly people worldwide. Osteoporosis is an important risk factor associated with hip fractures. This study aimed to describe the association of hip fractures and osteoporosis at different BMD measurement sites and determine any differences between these two types of hip fracture. MATERIAL AND METHODS A retrospective study conducted in a university hospital in the south of Thailand enrolled 223 patients aged over 50 years with low-energy trauma hip fractures. Each patient had undergone dual energy x-ray absorptiometry (DXA) within 2 weeks of injury. T-scores were recorded for the total hip, femoral neck and lumbar spine areas and classified as normal, osteopenia and osteoporosis according to WHO osteoporosis diagnostic criteria. RESULTS The highest proportion of T-scores in the osteoporotic range were registered at the femoral neck (68.6%) compared to total hip (52.9%) and lumbar spine (47.7%). At least 31.4% of patients were in the non-osteoporotic range. No significant differences were found at all sites of BMD measurement between the two types of fracture. CONCLUSIONS 1. At least 1/3 of patients with geriatric hip fractures had their T-scores in the normal to oste-ope-nic range. 2. BMD in different areas is not different between types of hip fractures.
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Affiliation(s)
- Chulin Chewakidakarn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Yuenyongviwat V, Iamthanaporn K, Tuntarattanapong P, Dissaneewate K, Tangjatsakow P, Liawrungrueang W, Hongnaparak T. Multiple needle puncture combined with repetitive knee manipulation in total knee arthroplasty for correcting varus deformity. J Orthop Surg (Hong Kong) 2021; 28:2309499020924600. [PMID: 32431216 DOI: 10.1177/2309499020924600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Multiple needle punctures (MNPs), for gap balancing in total knee replacement, have less variability in gap widening compared to the conventional released technique. This study aimed to evaluate the outcome of gap-balancing techniques in varus osteoarthritis (OA) knees, by serial MNP, after a total knee prosthesis trial component was placed, combined with repetitive knee manipulation. METHODS This study was a retrospective, case-matched study of 161 patients. The data were collected from varus OA knee patients, who had total knee arthroplasty by a single surgeon. Sixty-eight patients required MNP, combined with repetitive knee manipulation for gap balancing, and 93 patients did not. Both groups of MNP patients underwent the same surgical technique and postoperative care protocols. RESULTS Knee society scores, in terms of knee score and functional score, were not different in both groups when we started the study, at 6-month and 1-year follow-ups (p > 0.05). The femorotibial angle was not significantly different between groups at the start of the study, initial postoperative, 6 months, and 1 year (p = 0.74, 0.45, 0.99, and 0.82, respectively). Medial joint opening in knee radiographic was found in 3% of the patients in the MNP group and in 4% of patients in the control group at 1-year follow-up (p = 0.65). CONCLUSION This study found MNP combined with repetitive knee manipulation was effective, reproductive, and a safe method for varus OA knee. We believe that the cycle of performed needle punctures, knee manipulation, and reevaluation could gradually lengthen the medial soft tissue without risk of over lengthening or medial collateral ligament rupture.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pakjai Tuntarattanapong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kantapon Dissaneewate
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Preyanun Tangjatsakow
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Liawrungrueang W, Ungphaiboon S, Jitsurong A, Ingviya N, Tangtrakulwanich B, Yuenyongviwat V. In vitro elution characteristics of gentamicin-impregnated Polymethylmethacrylate: premixed with a second powder vs. liquid Lyophilization. BMC Musculoskelet Disord 2021; 22:5. [PMID: 33397342 PMCID: PMC7784340 DOI: 10.1186/s12891-020-03923-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Antibiotic-loaded bone cement, or antibiotic-impregnated polymethylmethacrylate (PMMA), were developed to prevent and treat bone and joint infections. Gentamicin is an antibiotic that is commonly used in combination with PMMA; however, gentamicin powder is hard to obtain in many countries. This study aimed to evaluate the elution characteristics of gentamicin-impregnated PMMA made with lyophilized liquid gentamicin, compared with PMMA; which is made from commercial gentamicin powder. Methods The experimental sample was divided into 2 groups: the gentamicin power group (PG-PMMA) and the lyophilized liquid gentamicin group (LG-PMMA). Ten cement spacers were prepared in each group. These were produced by mixing gentamicin powder, or lyophilized liquid gentamicin, with a powder polymer before adding the liquid monomer (2 g of gentamicin and 40 g of PMMA). The volume and surface area of the antibiotic-impregnated cement spacers were 50 cm3 and 110 cm2, respectively. Each spacer was immersed in phosphate-buffered saline, which was changed daily under sterile conditions. The solutions were collected to measure the level of gentamicin using the enzyme multiplied immunoassay technique (EMIT), at days 1, 2, 3, 4, 5, 6, 7, 14, 21, 28, 35 and 42. Results The collections from both groups had high concentrations of gentamicin on day 1 (113.63 ± 23.42 mg/dL in LG-PMMA and 61.7 ±8.37 mg/dL in PG-PMMA), but experienced a continuous decrease over time. The PMMA spacers from both groups could release gentamicin for up to 6 weeks (3.28 ± 1.17 mg/dL in LG-PMMA and 1.21 ± 0.28 mg/dL in PG-PMMA). However, there were significantly higher levels of gentamicin concentrations in the LG-PMMA group compared to the PG-PMMA group at all time points (P< 0.05). Conclusion Gentamicin-impregnated PMMA made with lyophilized liquid gentamicin had approximately a two times higher rate of antibiotic elution in preliminary in vitro studies, as compared with PMMA made with premixed gentamicin powder.
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Affiliation(s)
- Wongthawat Liawrungrueang
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Suwipa Ungphaiboon
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Science, Prince of Songkla University, Hat Yai, Thailand
| | - Arnurai Jitsurong
- Forensic Medicine and Toxicology Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Natnicha Ingviya
- Microbiology Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Boonsin Tangtrakulwanich
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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Luangwaranyoo A, Suksintharanon M, Tangadulrat P, Iamthanaporn K, Hongnaparak T, Yuenyongviwat V. Factors for Blood Transfusions Following Hemi Hip Arthroplasty for Patients With Femoral Neck Fracture. Geriatr Orthop Surg Rehabil 2020; 11:2151459320972993. [PMID: 33282448 PMCID: PMC7686587 DOI: 10.1177/2151459320972993] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/16/2020] [Accepted: 10/21/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Hemi hip arthroplasty is one treatment option for femoral neck fractures;
however, there has been limited evidence on factors associated with blood
transfusions following hemi hip arthroplasty. Hence, the aim of this study
was to identify the predictors of blood transfusion after hemi hip
arthroplasty, which could lead to the establishment of proper guidelines for
management protocols. Materials and Methods: This study was a retrospective cohort study, conducted in a single center of
323 femoral neck fracture patients having undergone hemi hip arthroplasty.
Peri-operative factors and demographic data were extracted from the
electronic medical records, from 2007 to 2019. A predictive model was
developed by logistic regression (LR), and adjusted by multivariate logistic
regression. Result: One hundred and twenty-six (39%) patients received blood transfusions. On
multivariate analysis, those of a female gender (odds ratio (OR) 2.00, p =
0.037), having a body mass index lower than 18.5 kg/m2 (OR 2.40,
p = 0.028), lower preoperative hemoglobin levels (OR 0.52, p < 0.001) and
given general anesthesia (OR 2.07, p = 0.028) were shown to be significantly
associated with a higher risk of requiring a blood transfusion. Conclusion: The authors recommend that preparation of blood components coupled with the
utilization of blood conserving methods for high risk patients, as studies
have stated, in addition to the consideration of spinal anesthesia; if
patients have no contraindication, should be implemented.
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Affiliation(s)
- Aris Luangwaranyoo
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Methasit Suksintharanon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pasin Tangadulrat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Nawatthakul A, Yuenyongviwat V. Tubercular arthritis presenting as osteonecrosis of the femoral head: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20971408. [PMID: 33224501 PMCID: PMC7656864 DOI: 10.1177/2050313x20971408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022] Open
Abstract
A tuberculosis hip that presents as osteonecrosis of the femoral head is an extremely rare condition. There are no previous reports of this condition, and there is no consensus on the method of total hip arthroplasty for this group of patients. We present a case of a 72-year-old man who had clinical gradual hip pain in both hips for 1 year. He was diagnosed with post-collapsed osteonecrosis of the femoral head in both hips and was scheduled for total hip arthroplasty of the left hip. During his clinical follow-up, he suddenly experienced excruciating acute pain. Investigation to rule out infection was positive for only C-reactive proteins, but his synovial fluid work-up was negative. An intraoperative finding revealed that there was collapse of the femoral head with eroded acetabular cartilage and rice body–like synovitis. Total hip arthroplasty was performed, and the tissue was sent for diagnosis. Tissue acid-fast bacilli were positive, so the patient received anti-tuberculosis drugs for 9 months, with no recurrent infection. Tuberculosis arthritis presenting as osteonecrosis of the femoral head is a complex condition that is difficult to diagnose due to the radiographic pictures of femoral head collapse and arthritic change being similar in both diseases. Acute pain onset with rapid collapse of the femoral head should be a consideration or suspect for this infectious condition. Hence, investigation to rule out infection is important. Anti-tuberculosis drugs are the standard treatment for early or advanced arthritis, and one-stage or two-stage total hip arthroplasty is the choice of treatment for advanced arthritis.
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Affiliation(s)
| | - Varah Yuenyongviwat
- Varah Yuenyongviwat, Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand.
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Yuenyongviwat V, Iamthanaporn K, Tuntarattanapong P, Dissaneewate K, Tangjatsakow P, Liawrungrueang W, Hongnaparak T. Adhesive strips as the sole method for skin closure is effective in total knee arthroplasty. J Orthop Surg (Hong Kong) 2020; 27:2309499019873983. [PMID: 31533548 DOI: 10.1177/2309499019873983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Adhesive strips are used as the sole method for skin closure in many operations except total knee arthroplasty. The claims are decreased wound closure time, less tissue reaction, and lack of stitch marks. The purpose of this study was to compare the efficacy of closure using adhesive strips versus running subcuticular stitches. METHODS This study was a retrospective case-matched study. Running subcuticular stitches or adhesive strips were used for skin closure in 151 and 137 patients, respectively. All of the patients had an operation by a single surgeon and had the same patient care protocol. All of the patients were evaluated postoperatively for wound complication at 2 weeks, 6 weeks, and 3 months follow-up. RESULTS The wounds of most patients in both groups had healed. The incidence of superficial infection was not different between the groups (1.32% in the running subcuticular suture group and 1.46% in the adhesive strip group) (p = 0.92). One case (0.66%) in the running subcuticular suture group had deep infection, which required reoperation (p = 0.34). The patients in the running subcuticular suture group had higher unabsorbable sutures, which required further removal compared to the adhesive strip group (p < 0.001). CONCLUSION The use of adhesive strips is an effective skin closure method with a low rate of infection and skin complications. This technique is easy and there is no need for suture removal. Furthermore, there are no stitch marks and the cost of suturing is lower.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pakjai Tuntarattanapong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Kantapon Dissaneewate
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Preyanun Tangjatsakow
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | | | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Yuenyongviwat V, Duangmanee S, Iamthanaporn K, Tuntarattanapong P, Hongnaparak T. Effect of hip abductor strengthening exercises in knee osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord 2020; 21:284. [PMID: 32380994 PMCID: PMC7206683 DOI: 10.1186/s12891-020-03316-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoarthritis knee (OA) for patients whom had varus malalignment had higher peak adductor moment. Hip abductor strength played an important role in the decreasement of knee adduction moment. This study aimed to evaluate the effect of hip abductor exercises for patients who had medial compartment knees OA. METHODS Patients who had medial compartmental OA knee were randomized into two groups. The first group performed hip abductor strengthening exercises, combined with quadriceps strengthening exercises; whereas, the second group performed standalone quadriceps strengthening exercises. Self-reported Knee Injury and Osteoarthritis Outcome Scores (KOOS) were collected by patients on follow-up visits. RESULTS Eighty-six patients completed the trial. All KOOS subscales were significantly improved in both groups after 10 weeks of treatment. However, there was no significant difference in the scores between either group at 2-10 weeks after treatment. Nevertheless, the effects of exercise for pain, symptoms, function in daily living and knee-related quality of life were found to have faster improvement within the hip abduction exercise group compared to the control group (2 weeks faster; pain, function in daily living and knee-related quality of life, 4 weeks faster; symptoms.) CONCLUSION: Since, adding quadriceps exercises could expedite improvement of less pain, symptoms, activity in daily living and quality of life faster than quadriceps exercises solely for a 2-4 weeks period. However, the effect size was small and there were no differences after this; hence, consideration of adding hip abductor exercises in the treatment protocol should be based on the patients and doctors appraisal. TRIAL REGISTRATION TCTR, TCTR20180517005. Registered 17 May 2018.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Siwakorn Duangmanee
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Pakjai Tuntarattanapong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Anuntaseree S, Kalkornsurapranee E, Yuenyongviwat V. Efficacy of and Satisfaction with an In-house Developed Natural Rubber Cardiopulmonary Resuscitation Manikin. West J Emerg Med 2019; 21:91-95. [PMID: 31913826 PMCID: PMC6948679 DOI: 10.5811/westjem.2019.10.43004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 10/07/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction A barrier to cardiopulmonary resuscitation (CPR) training in low-income countries is limited resources. Our goal was to build a CPR training model of simple design that would provide a good feedback system. Methods We developed a low-cost, Basic Life Support training manikin made entirely of natural rubber. Our in-house manikin provides feedback when performing correct chest compression and rescue breathing. The properties of the manikin were tested using simulated chest compression in a laboratory and compared with a commercial manikin. Forty healthy nurse volunteers with CPR experience performed CPR in both types of manikins and responded to questionnaires. Results A tensile test in a laboratory demonstrated that both types of manikins had acceptable ranges of properties for real-situation CPR in cardiac arrest patients. There were no differences in aesthetic properties, and the manikins felt to the volunteers like a real patient when they were performing chest compression. The feedback response was clear when chest compressions and rescue breathing were performed correctly, and the overall satisfaction with the manikin was good. In addition, the mean scores in terms of the manikin feeling like a real patient when performing rescue breathing and the positive feedback from the rubber manikin were statistically higher than those for the commercial manikin (p=0.001 vs. p=0.023). Conclusion The in-house developed CPR manikin employing real-time feedback by simple mechanics is effective compared with a commercial manikin. The advantage of our manikin is that it is easy to build and costs substantially less than a commercial manikin. The use of an in-house developed manikin could make effective CPR training more available in limited-resource areas.
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Affiliation(s)
- Sittichoke Anuntaseree
- Prince of Songkla University, Department of Orthopedics, Faculty of Medicine, Songkhla, Thailand
| | - Ekwipoo Kalkornsurapranee
- Prince of Songkla University, Department of Materials Science and Technology, Faculty of Science, Songkhla, Thailand
| | - Varah Yuenyongviwat
- Prince of Songkla University, Department of Orthopedics, Faculty of Medicine, Songkhla, Thailand
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Yuenyongviwat V, Iamthanaporn K, Tuntarattanapong P, Hongnaparak T. The "Cough Trick" Reduces Pain During Removal of Closed-suction Drains after Total Knee Arthroplasty: A Randomized Trial. Clin Orthop Relat Res 2019; 477:2687-2691. [PMID: 31764336 PMCID: PMC6907319 DOI: 10.1097/corr.0000000000000901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Drain removal after TKA can be painful. Prior research suggests that the "cough trick," in which a patient coughs at the same time she or he receives an injection, effectively decreases pain. To our knowledge, this intervention has not been evaluated as a way to reduce pain during other brief but painful interventions, such as removal of closed-suction drains after orthopaedic surgery. QUESTION/PURPOSE Does the cough trick reduce pain while a surgeon is removing a closed-suction drain after TKA? METHODS Fifty-six patients with primary osteoarthritis who underwent primary TKA were randomized into two groups: drain removal as the patient coughed (n = 28 patients; three men, 25 women) or drain removal using the usual process, without the cough trick (n = 28 patients; three men, 25 women). The study groups were not different in terms of gender, BMI, surgical time, or other baseline variables, and other than the addition of the cough trick, there were no differences in surgical treatment or other elements of aftercare. Likewise, at baseline, the verbal numeric rating scale (VNRS) score for pain before the drain was removed was not different between the groups (3.1 ± 1.7 versus 3.3 ± 1.3; p = 0.72). The level of pain before and during drain removal was recorded using a VNRS by an orthopaedic surgeon who was not involved in the care of the study patients. We considered the minimum clinically important difference on the 10-point scale to be 2 points, based on prior evidence. RESULTS The mean ± SD VNRS for the pain level during drain removal was lower in the cough trick group than that in the control group (1.6 ± 1.0 versus 3.7 ± 1.9, mean difference 2.1; 95% CI, 1.3-2.9; p < 0.001). CONCLUSIONS The cough trick during removal of a closed-suction drain tube in patients undergoing TKA reduced the level of pain in this small randomized trial. We suggest that surgeons consider this technique when removing drains after TKA because it is a noninvasive technique and it is easy to perform. Because the cough trick has been shown by others to be effective at reducing pain during venipuncture and parenteral injections, and we found it was effective for that purpose during drain removal after TKA, we believe this finding probably generalizes well to most minor procedures that cause transient, sharp pain. We suggest that it could be used to make such procedures more comfortable for patients, as well as for drain removal in other types of surgery where drains still are commonly used (including spine surgery and tumor surgery). LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
- Varah Yuenyongviwat
- V. Yuenyongviwat, K. Iamthanaporn, P. Tuntarattanapong, T. Hongnaparak, Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla Thailand
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Yuenyongviwat V, Kiddee W, Tangtrakulwanich B. Effect of glucosamine sulfate on intraocular pressure in patients with knee osteoarthritis: A prospective randomized controlled trial. J Fr Ophtalmol 2019; 42:711-715. [PMID: 31104873 DOI: 10.1016/j.jfo.2019.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/19/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Glucosamine sulfate is one of the treatment options for patients with osteoarthritis of the knee. It has been postulated that glucosamine sulfate affects intraocular pressure (IOP). This study aimed to evaluate the effect of crystalline glucosamine sulfate on IOP in patients with osteoarthritis of the knee. METHODS Forty-two patients with osteoarthritis of the knee were randomized into two groups. The first group of patients received 1500mg of crystalline glucosamine sulfate once daily for 6 months and the conventional treatment protocol. The second group of patients received only the conventional treatment protocol. IOP was recorded at the start of the study and at 6 weeks, 3 months, 6 months, and 9 months. RESULTS The patient demographic data were not different between the two groups. There were no differences in the IOPs between the groups (P>0.05) nor differences in baseline IOPs within each group compared with each follow-up visit (P>0.05). CONCLUSIONS Glucosamine sulfate is still an option without significant concern over elevated IOP in patients with osteoarthritis of the knee and normal ocular pressure.
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Affiliation(s)
- V Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 90110 Hatyai, Songkhla, Thailand.
| | - W Kiddee
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, 90110 Hatyai, Songkhla, Thailand
| | - B Tangtrakulwanich
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 90110 Hatyai, Songkhla, Thailand
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Chewakidakarn C, Nawatthakul A, Suksintharanon M, Yuenyongviwat V. Septic arthritis following femoral neck fracture: A case report. Int J Surg Case Rep 2019; 57:167-169. [PMID: 30974413 PMCID: PMC6460221 DOI: 10.1016/j.ijscr.2019.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/06/2019] [Accepted: 03/19/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Femoral neck fracture is common in the elderly, especially in the era of aging populations. Septic arthritis of the hip after femoral neck fracture is a rare complication. There are limited reports on this complication especially in patients without a severe medical condition and there is no consensus on the method of treatment of this complication. CASE PRESENTATION A 75-year-old male had right hip pain for two weeks after falling on his right hip. The patient was diagnosed as pathological fracture with hematologic malignancy. He was scheduled for bipolar hemiarthroplasty. However, an intraoperative finding found that the hip joint was filled with pus. The treatment was successful with a two-stage procedure. The first stage was implantation of an antibiotic cement spacer and the second stage was total hip replacement. CONCLUSION Septic arthritis following femoral neck fracture is a complication which requires special attention for the diagnosis and treatment. Increasing hip pain or the developing signs of infection in patients awaiting surgery may indicate infection in the hip. The two-stage procedure is the treatment of choice in this condition.
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Affiliation(s)
- Chulin Chewakidakarn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Anuchit Nawatthakul
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Methasit Suksintharanon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
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Yuenyongviwat V, Tuntarattanapong P, Iamthanaporn K, Hongnaparak T, Tangtrakulwanich B. Intramedullary sealing with a bone plug in total knee arthroplasty to reduce blood loss: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2019; 14:96. [PMID: 30961640 PMCID: PMC6454759 DOI: 10.1186/s13018-019-1141-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/28/2019] [Indexed: 11/18/2022] Open
Abstract
Background An intramedullary guide is an instrument that surgeons use to align the distal femoral cut. The opening may become a channel that drains intramedullary blood to the knee joint after surgery if left open during surgery. The authors aimed to evaluate the effects of an intramedullary bone plug with respect to postoperative blood loss from a meta-analysis. Methods The authors performed a systematic review and meta-analysis to compare a sealed opening using an intramedullary bone plug with no bone plug. PubMed, Ovid, Embase, and Cochrane Library were used to identify all publications before May 2018. All of the included studies were evaluated for bias and heterogeneity. Results Six hundred and thirty-six patients from four randomized controlled trials were included in this meta-analysis. The pooled results demonstrated that patients with intramedullary plug had lower rates of blood transfusion and lower level of reduced postoperative hemoglobin than patients in whom the intramedullary canal was not plugged. Discussion This meta-analysis demonstrated the benefit of intramedullary sealing with a bone plug in total knee arthroplasty with respect to decreased postoperative blood loss.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Pakjai Tuntarattanapong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Boonsin Tangtrakulwanich
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Yuenyongviwat V, Tuntarattanapong P, Chuaychoosakoon C, Iemsaengchairat C, Iamthanaporn K, Hongnaparak T. Aspirin versus rivaroxaban in postoperative bleeding after total knee arthroplasty: a retrospective case-matched study. Eur J Orthop Surg Traumatol 2019; 29:877-881. [PMID: 30627921 DOI: 10.1007/s00590-019-02365-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Venous thromboembolic disease (VTE) is a complication not uncommon following total knee arthroplasty. Postoperative bleeding-related complications are a concern in many guidelines. The authors aimed to compare the amount of postoperative drainage from closed suction drainage, transfusion rate, and postoperative complications between aspirin and rivaroxaban as VTE prophylaxes after total knee arthroplasty. METHODS This study was a retrospective case-matched study of 155 patients. The data were collected between 2008 and 2015 from patients who had total knee arthroplasty using aspirin or rivaroxaban as the VTE prophylaxis. Seventy-nine patients received aspirin, and 76 patients received rivaroxaban. A single surgeon operated on all patients with the same surgical technique and patient care protocol. RESULTS The total closed suction drainage outputs at 48 h were not significantly different between the aspirin and rivaroxaban groups (p = 0.10). Eighteen percent of patients in the aspirin group and 25% of patients in the rivaroxaban group received blood transfusions (p = 0.37). There were no bleeding-related complications or VTE in either group. CONCLUSIONS Aspirin and rivaroxaban were effective and safe as VTE chemoprophylaxis in total knee arthroplasty.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
| | - Pakjai Tuntarattanapong
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | | | - Khanin Iamthanaporn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand
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Iamthanaporn K, Yuenyongviwat V, Laohawiriyakamol T, Tanutit P. Accuracy of medial-side cutting guide compared to anterior cutting guide in distal femoral osteotomy of total knee arthroplasty. J Clin Orthop Trauma 2019; 10:87-90. [PMID: 30705538 PMCID: PMC6349664 DOI: 10.1016/j.jcot.2017.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/19/2017] [Accepted: 08/24/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Minimally invasive surgery (MIS) in total knee arthroplasty has the benefits of less postoperative pain and a faster recovery time. An MIS instrument was designed to help surgeons perform this procedure under reduced visualization conditions. A medial cutting guide of the distal femur is used to cut the distal femoral bone without patella subluxation. This study aimed to compare the accuracy of the distal femoral bone cut between the medial and standard anterior cutting guides. MATERIALS AND METHODS Two orthopedic surgeons, who specialize in total knee arthroplasty and are familiar with both of these cutting guides, performed the procedures. Forty-eight synthetic saw bones were used, and five-degree valgus medial and anterior cutting guides were randomly assigned to the surgeons. After the osteotomies were performed, the synthetic saw bones were investigated via plain radiographs. Two independent radiologists measured the medial distal femoral angle (MDFA) and the posterior distal femoral angle (PDFA). RESULTS The MDFA in the medial cutting group was statistically significantly different from that of the anterior cutting group (94.18° ± 1.47° vs. 94.98° ± 1.14°, P = 0.041). However, the PDFA was not different between the two groups. Likewise, the number of outliers was not different between the groups when a ± 2° error was defined as an outlier (P = 0.609 for MDFA and P = 0.359 for PDFA). Moreover, a high degree of reliability was found in both MDFA and PDFA measurements (intraclass correlation coefficients = 0.813 and 0.824, respectively). CONCLUSIONS In this experimental study, the MIS medial cutting guide was less accurate than the standard cutting guide in the distal femoral cut.
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Affiliation(s)
- Khanin Iamthanaporn
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
- Corresponding author.
| | - Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Teeranan Laohawiriyakamol
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Pramot Tanutit
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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Iamthanaporn K, Geater A, Yuenyongviwat V. Predictability of open superficial medial collateral ligament lengthening technique in total knee arthroplasty. Comparison of multiple needle puncturing and subperiosteal elevation: A cadaver study. Orthop Traumatol Surg Res 2018; 104:977-982. [PMID: 30243679 DOI: 10.1016/j.otsr.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Lengthening of superficial medial collateral ligament (sMCL) is often needed in total knee replacement for varus osteoarthritis knee. This study aimed to compare the relationship of multiple needle puncturing (MNP) and subperiosteal elevation (SE) for sMCL lengthening on the gap increment and sequential lengthening in cadaveric knees. HYPOTHESIS MNP produces more reliable gap increment than SE technique for sMCL lengthening performed in knee flexion. METHODS From 8 pairs of cadaveric knees, one knee from each pair was randomly assigned to undergo MNP and the others to SE. In the MNP group, an 18gauge needle was used to puncture through the sMCL, performing five punctures each time of release. For the SE group, a periosteal elevator was used to sequentially deepen distally beneath the sMCL insertion with an increment depth of 5mm each time of release. The primary outcome was the medial gap increment at knee extension and 90° knee flexion after every attempt in each group. RESULTS At each level of lengthening, the widening of flexion and extension gap were not significantly different between the two techniques except for lengthening after 4 and 6 attempts of SE that gave greater widening in extension gap. Variability (width of mid 95% of values) was significantly greater for any given number of attempts using SE than MNP (0.5 vs. 0.24mm per attempt for extension and 2.28 vs. 0.95mm per attempt for flexion; both p<0.001). CONCLUSION The MNP technique is a reproducible technique for lengthening the sMCL in knee flexion. It has less variability in gap widening compared to the SE technique. LEVEL OF EVIDENCE II, controlled randomized laboratory study.
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Affiliation(s)
- Khanin Iamthanaporn
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Songkhla, Hat Yai, Thailand.
| | - Alan Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, 90110 Songkhla, Hat Yai, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, 90110 Songkhla, Hat Yai, Thailand
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Isaramalai SA, Hounsri K, Kongkamol C, Wattanapisitkul P, Tangadulrat N, Kaewmanee T, Yuenyongviwat V. Integrating participatory ergonomic management in non-weight-bearing exercise and progressive resistance exercise on self-care and functional ability in aged farmers with knee osteoarthritis: a clustered randomized controlled trial. Clin Interv Aging 2018; 13:101-108. [PMID: 29398910 PMCID: PMC5775746 DOI: 10.2147/cia.s144288] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Ergonomic hazards are the most important cause of knee osteoarthritis (OA) in aged para rubber farmers. Ergonomic management comprising improvement of working conditions and muscle-strengthening exercise has been well documented in terms of workers' health benefit. However, those interventions were not adequate to sustain the advantage. Few studies have demonstrated the effect of integrating participatory ergonomic management (PEM) in non-weight-bearing exercise (NWE) and progressive resistance exercise (PRE), and none has focused on aged para rubber farmers with knee OA. Purpose This study investigated the effect of PEM-NWE, PEM-PRE, and standard treatment (ST) on self-care and functional ability in the aged population. Materials and methods A single-blinded, clustered randomized controlled trial was carried out. Participants (n=75) from three different communities in southern Thailand were randomly assigned to PEM-NWE, PEM-PRE, and ST. Self-care and functional ability (pain, stiffness, and physical function) were examined at baseline (B), during the intervention at Week 5 (W5), and after its completion at Week 9 (W9). Mean comparison of those outcomes over time was made using Generalized Linear Mixed Models (GLMMs). Results Compared to the standard treatment, the means of both groups, PEM-NWE and PEM-PRE, were significantly increased in self-care and functional ability. However, no significant difference between PEM-NWE and PEM-PRE was found. Conclusion Either or both interventions should be incorporated into nursing practice in order to promote occupational health and enhance quality of work life for Thai aged farmers. Further study on their cost-effectiveness is highly recommended.
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Affiliation(s)
| | - Kanokwan Hounsri
- Research Center for Caring System of Thai Elderly, Faculty of Nursing
| | - Chanon Kongkamol
- Research Unit of Holistic Health and Safety Management in Community, Faculty of Medicine
| | | | | | | | - Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Jitmuang A, Yuenyongviwat V, Charoencholvanich K, Chayakulkeeree M. Rapidly-growing mycobacterial infection: a recognized cause of early-onset prosthetic joint infection. BMC Infect Dis 2017; 17:802. [PMID: 29281992 PMCID: PMC5745588 DOI: 10.1186/s12879-017-2926-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 12/17/2017] [Indexed: 01/08/2023] Open
Abstract
Background Prosthetic joint infection (PJI) is a major complication of total hip and total knee arthroplasty (THA, TKA). Although mycobacteria are rarely the causative pathogens, it is important to recognize and treat them differently from non-mycobacterial infections. This study aimed to compare the clinical characteristics, associated factors and long-term outcomes of mycobacterial and non-mycobacterial PJI. Methods We conducted a retrospective case-control study of patients aged ≥18 years who were diagnosed with PJI of the hip or knee at Siriraj Hospital from January 2000 to December 2012. Patient characteristics, clinical data, treatments and outcomes were evaluated. Results A total of 178 patients were included, among whom 162 had non-mycobacterial PJI and 16 had mycobacterial PJI. Rapidly growing mycobacteria (RGM) (11) and M. tuberculosis (MTB) (5) were the causative pathogens of mycobacterial PJI. PJI duration and time until onset were significantly different between mycobacterial and non-mycobacterial PJI. Infection within 90 days of arthroplasty was significantly associated with RGM infection (OR 21.86; 95% CI 4.25–112.30; p < .001). Implant removal was associated with improved favorable outcomes at 6 months (OR 5.96; 95% CI 1.88–18.88; p < .01) and 12 months (OR 3.96; 95% CI 1.15–13.71; p = .03) after the infection. Conclusions RGM were the major pathogens of early onset PJI after THA and TKA. Both a high clinical index of suspicion and mycobacterial cultures are recommended when medically managing PJI with negative cultures or non-response to antibiotics. Removal of infected implants was associated with favorable outcomes. Electronic supplementary material The online version of this article (10.1186/s12879-017-2926-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anupop Jitmuang
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand
| | - Varah Yuenyongviwat
- Department of Orthopedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
| | - Keerati Charoencholvanich
- Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Methee Chayakulkeeree
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand.
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Yuenyongviwat V, Ingviya N, Pathaburee P, Tangtrakulwanich B. Inhibitory effects of vancomycin and fosfomycin on methicillin-resistant Staphylococcus aureus from antibiotic-impregnated articulating cement spacers. Bone Joint Res 2017; 6:132-136. [PMID: 28258116 PMCID: PMC5376657 DOI: 10.1302/2046-3758.63.2000639] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/16/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives Vancomycin and fosfomycin are antibiotics commonly used to treat methicillin-resistant Staphylococcus aureus (MRSA) infection. This study compares the in vitro inhibitory effects against MRSA of articulating cement spacers impregnated with either vancomycin or fosfomycin. Methods Vancomycin-impregnated articulating cement spacers and fosfomycin-impregnated articulating cement spacers were immersed in sterile phosphate-buffered saline (PBS) solutions and then incubated. Samples were collected for bioactivity evaluation. The aliquots were tested for MRSA inhibition with the disc diffusion method, and the inhibition zone diameters were measured. The inhibition zone differences were evaluated using the Wilcoxon Rank Sum Test. Results The vancomycin group had significantly larger inhibition zones than the fosfomycin group from day three through to completion of the fourth week of incubation (p < 0.001). The vancomycin group exhibited a MRSA inhibition zone up to four weeks but the fosfomycin group showed an inhibition zone for only three days and after that did not show the the potential to inhibit MRSA. Conclusion This in vitro study found that the inhibitory effect of vancomycin-impregnated articulating cement spacers against MRSA outperformed fosfomycin-impregnated articulating cement spacers. Further comparing our results to other published reports suggests there might be a limitation of the disc diffusion bioassay to show a large inhibitory zone in a high concentration of a highly soluble antibiotic. Cite this article: V. Yuenyongviwat, N. Ingviya, P. Pathaburee, B. Tangtrakulwanich. Inhibitory effects of vancomycin and fosfomycin on methicillin-resistant Staphylococcus aureus from antibiotic-impregnated articulating cement spacers. Bone Joint Res 2017;6:132–136. DOI: 10.1302/2046-3758.63.2000639.
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Affiliation(s)
- V Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - N Ingviya
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - P Pathaburee
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
| | - B Tangtrakulwanich
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand
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Yuenyongviwat V, Iamthanaporn K, Hongnaparak T. Lateral facetectomy decreased patellofemoral contact pressure in total knee replacement: A cadaveric study. J Clin Orthop Trauma 2017; 8:82-84. [PMID: 28360504 PMCID: PMC5359518 DOI: 10.1016/j.jcot.2016.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/28/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To study the patellofemoral contact pressure in patellar non-resurfacing total knee replacement after lateral facetectomy in different amounts of bone removal. METHODS Eight knees from four fresh-frozen whole body cadavers were used for this study. Total knee replacement of all knees was performed by the same surgical technique. The contact pressure was measured and recorded when the knee performed passive motion from full extension to full flexion in native patella, lateral retinacular junction release, 10% lateral facetectomy, and 20% lateral facetectomy. RESULTS Peak patellofemoral contact pressure decreased progressively from native patellar, junctional release of the patella, 10% facetectomy, and 20% facetectomy. The peak patellofemoral contact pressures were statistically significantly different in each patellar condition (p = 0.025). CONCLUSION In the experimental study, lateral facetectomy can reduce the peak patellofemoral contact pressure in patellar non-resurfacing total knee arthroplasty.
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Wattanakitkrileart S, Tangtrakulwanich B, Yuenyongviwat V. Comparing Results between New Aiming Device and Freehand Technique for Distal Locking of Intramedullary Implants. J Med Assoc Thai 2016; 99:1180-1184. [PMID: 29901924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To test the results of a new simple aiming device compared to the freehand method for distal locking screw insertion in the intramedullary (IM) nailing procedure in terms of accuracy, radiation exposure, and operative time. MATERIAL AND METHOD Distal screw locking procedure on 40 synthetic femoral bones with inserted intramedullary nail was done by four senior orthopedic residents using both the freehand and device-assisted techniques. Accuracy, fluoroscopic time, and operative time were recorded for the analysis. RESULTS The new aiming device minimized fluoroscopic time with statistical significance (p-value <0.001). No operating time difference between the two techniques (p-value = 0.67). Screw misdirection was found in two incidences in the freehand technique but not found in the device-assisted technique. CONCLUSION The new simple aiming device can decrease fluoroscopic time and show good precision of distal locking procedure.
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Yuenyongviwat V, Iamthanaporn K, Hongnaparak T, Tangtrakulwanich B. A randomised controlled trial comparing skin closure in total knee arthroplasty in the same knee: nylon sutures versus skin staples. Bone Joint Res 2016; 5:185-90. [PMID: 27190132 PMCID: PMC4921055 DOI: 10.1302/2046-3758.55.2000629] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/09/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Nylon sutures and skin staples are used commonly in total knee arthroplasty (TKA) surgical wound closure. However, there is no study that compares the wound healing efficacy and patient satisfaction scores of both techniques in the same knee. METHODS We randomised 70 patients who underwent primary TKA into two groups. In one group of 34 patients, the skin at the upper half of the wound was closed with skin staples and the lower half of the wound was closed with simple interrupted nylon sutures. In the other group of 36 patients, the skin at the upper half of the wound was closed with nylon stitches and the lower half of the wound was closed with skin staples. We recorded the wound closure time, pain score at the time of stitch removal, wound complication rate, patient satisfaction score, and the Hollander wound evaluation score at the post-operative periods of five days, 14 days, six weeks, three months, and six months. Each half wound was analysed separately. RESULTS The mean patient body mass index was 26.8 kg/m(2) (standard deviation 6.3). A total of 70 nylon stitched wounds and 70 skin stapled wounds were analysed. There were no significant differences in wound complication rates, patient satisfaction score, and the Hollander wound evaluation score between both types of wounds (p > 0.05). The wound closure time for skin stapled wounds was significantly lower than the nylon stitched wounds (p < 0.001). However, the skin stapled wounds had a significantly higher pain score at the time of stitch removal (p < 0.001). CONCLUSION Skin staples and nylon stitches had comparable results with respect to wound healing and patient satisfaction in TKA wound closure in non-obese patients. The benefit of skin staples over nylon stitches was a decrease in operative time, but was more painful upon removal.Cite this article: V. Yuenyongviwat. A randomised controlled trial comparing skin closure in total knee arthroplasty in the same knee: nylon sutures versus skin staples. Bone Joint Res 2016;5:185-190. DOI: 10.1302/2046-3758.55.2000629.
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Affiliation(s)
- V Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Faculty of Medicine, Songkhla 90110, Thailand
| | - K Iamthanaporn
- Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Faculty of Medicine, Songkhla 90110, Thailand
| | - T Hongnaparak
- Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Faculty of Medicine, Songkhla 90110, Thailand
| | - B Tangtrakulwanich
- Department of Orthopaedic Surgery and Physical Medicine, Prince of Songkla University, Faculty of Medicine, Songkhla 90110, Thailand
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Yuenyongviwat V, Tuntarattanapong P, Tangtrakulwanich B. A new adjustable parallel drill guide for internal fixation of femoral neck fracture: a developmental and experimental study. BMC Musculoskelet Disord 2016; 17:8. [PMID: 26754287 PMCID: PMC4709952 DOI: 10.1186/s12891-015-0845-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background Internal fixation is one treatment for femoral neck fracture. Some devices and techniques reported improved accuracy and decreased fluoroscopic time. However, these are not widely used nowadays due to the lack of available special instruments and techniques. To improve the surgical procedure, the authors designed a new adjustable drill guide and tested the efficacy of the device. Methods The authors developed a new adjustable drill guide for cannulated screw guide wire insertion for multiple screw fixation. Eight orthopaedic surgeons performed the experimental study to evaluate the efficacy of this device. Each surgeon performed guide wire insertion for multiple screw fixation in six synthetic femurs: three times with the new device and three times with the conventional technique. The fluoroscopic time, operative time and surgeon satisfaction were evaluated. Results In the operations with the new adjustable drill guide, the fluoroscopic and operative times were significantly lower than the operations with the conventional technique (p < 0.05). The mean score for the level of satisfaction of this device was also statistically significantly better (p = 0.02) than the conventional technique. Conclusions The fluoroscopic and operative times with the new adjustable drill guide were reduced for multiple screw fixation of femoral neck fracture and the satisfaction of the surgeons was good.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Pakjai Tuntarattanapong
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
| | - Boonsin Tangtrakulwanich
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, 90110, Thailand.
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Yuenyongviwat V, Laohawiriyakamol T, Suwanno P, Kanjanapradit K, Tanutit P. Calcific myonecrosis following snake bite: a case report and review of the literature. J Med Case Rep 2014; 8:193. [PMID: 24934373 PMCID: PMC4086687 DOI: 10.1186/1752-1947-8-193] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/01/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Calcific myonecrosis is a rare condition in which muscle in a limb compartment undergoes necrosis and becomes peripherally calcified with central liquefaction. The patient usually presents with a slowly progressive enlarged mass that sometimes can be misdiagnosed as soft tissue sarcoma. Most of the reported cases showed that the disease occurs often after trauma or compartment syndrome. However, the case of calcific myonecrosis following snake bite is rarely reported. Case presentation A 66-year-old Thai woman presented with a gradually progressive enlarged mass over a period of 10 years in her left leg. She had a history of untreated compartment syndrome after she was bitten by a snake (Malayan pit viper) in her left leg when she was 14-years old. At presentation, a plain X-ray showed a large soft tissue mass at the anterior compartment of her left leg. A sheet-like mass with an enlarged central cavity combined with peripheral calcification and cortical erosion of her tibia were observed. A biopsy was performed and the result was negative for neoplastic cells. During a 5-year follow-up, the mass progressively enlarged and then became infected and finally broke through the skin. She was treated by excision of the mass and administration of antibiotics. The wound completed healed at 1 month postsurgery. There was no wound complication or disease recurrence at 1 year postoperation. Conclusions The diagnosis of calcific myonecrosis was done by history taking and radiographic interpretation. In an asymptomatic patient the management should be observation and clinical follow-up. A biopsy should be avoided due to the high rate of postoperative infection. Treatment of choice in a symptomatic condition is mass excision.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.
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Yuenyongviwat V, Iamthanaporn K, Hongnaparak T, Tangtrakulwanich B. Efficacy of new filter suction to decrease the rate of occlusion and total suction time in a simulated total hip replacement operation. Med Devices (Auckl) 2014; 7:7-10. [PMID: 24470778 PMCID: PMC3896275 DOI: 10.2147/mder.s55065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background During orthopedic operations, such as total hip replacement or total knee replacement, there is a lot of bone debris from bone cutting and reaming that commonly causes surgical suction devices to occlude many times, which can prolong the operative time and increase the amount of bleeding for the patient. Materials and methods We developed a surgical filter suction system that we call the VY suction tube. The suction tube assembly consists of a tube filter within a housing assembly. The filter pore size was designed to prevent tissue or bone debris from passing through the filter, though it allows fluid to pass through. A simulated total hip replacement operation was performed to test the efficacy of this new suction device when compared with two other types of tube suction devices. Results The VY suction tube showed that the mean duration to remove all fluid from a simulated field was significantly shorter than the Pool suction tube (P=0.0009) and Frazier suction tube (P=0.0012). The study also showed that the VY suction tube has a lower rate of occlusion when compared with the Pool suction tube (P≤0.0001) and Frazier suction tube (P≤0.0001). Conclusion Our new suction tube design shows good efficacy when removing fluid and debris from a simulated operative field. However, further studies in real clinical settings are needed.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Khanin Iamthanaporn
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Theerawit Hongnaparak
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Boonsin Tangtrakulwanich
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Yuenyongviwat V, Iamthanaporn K, Harnroongroj T. Radiographic manifestation of hip dislocation after total hip arthroplasty. J Med Assoc Thai 2014; 97:60-63. [PMID: 24701730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The authors hypothesized that a patient who has posterior hip dislocation after total hip replacement does not have the same clinical manifestations of malposition as with a natural hip. The present study aimed to study clinical manifestation of hip dislocation after total hip arthroplasty. MATERIAL AND METHOD Thirty-five cases of posterior dislocation after total hip replacement were retrospectively studied by medical records and radiographic evaluation. The study included leg position after hip dislocation, leg length, and leg abduction/adduction angles. RESULTS External rotation of the patient's leg was found in 13 cases (37.1%), neutral position in six cases (17.2%), and internal rotation in 16 cases (45.7%). Measurements of the femoral shaft-vertical axis angle found adduction in 17 cases (average 17.4 degrees, range 1-25 degrees), abduction in 15 cases (average 6 degrees, range 1-15 degrees), and 0 degrees in three cases. Average leg shortening was 3.55 cm (range 0.6-13.5 cm). CONCLUSION The present study shows that patients with hip dislocation after hip replacement can manifest many signs of limb deformity in rotation (internal, external, and neutral) and abduction/adduction positions.
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Yuenyongviwat V, Tangtrakulwanich B. Prevalence of pin-site infection: the comparison between silver sulfadiazine and dry dressing among open tibial fracture patients. J Med Assoc Thai 2011; 94:566-569. [PMID: 21675445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Pin-site infection is one of the most troublesome complications of external fixation. The present study aimed to compare the rate of pin-site infection following silver sulfadiazine with dry dressing. MATERIAL AND METHOD This was a prospective randomized controlled study among 30 clients that compared the outcome of pin dressing using silver sulfadiazine (study group = 15) with dry dressing (control = 15). All eligible subjects of open tibial fracture had an emergency debridement with external fixation. Pin tract infection was considered to be present if superficial inflammation (erythema, cellulitis), serous or purulent discharge occurred around a pin site and deep infection of osteolysis around the pin, and sequestrum. RESULTS Seven subjects (46.7%) had pin-site infection in the present study group while six subjects (40.0%) had it in the control group, with comparable severity. CONCLUSION There was no significant difference in prevalence of pin-site infection between both groups (p = 0.97). Therefore, either silver sulfadiazine or dry dressing could be advocated.
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Affiliation(s)
- Varah Yuenyongviwat
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Wongsiri S, Suwanno P, Tangtrakulwanich B, Yuenyongviwat V, Wongsiri E. A new tool for mini-open carpal tunnel release - the PSU retractor. BMC Musculoskelet Disord 2008; 9:126. [PMID: 18808664 PMCID: PMC2556331 DOI: 10.1186/1471-2474-9-126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 09/22/2008] [Indexed: 12/15/2022] Open
Abstract
Background Mini-open carpal tunnel release has become increasingly popular for the treatment of carpal tunnel surgery. The main advantages are shortening recovery time and return-to-work time. However, the risk of neurovascular injury still remains worrisome. Methods In this study, we developed a new retractor (herein called the PSU retractor) modified from the widely used Senn retractor, with the aim of decreasing the risk of neurovascular problems from normal procedure. 3-Dimensional computer design software (SolidWorks® Office Premium 2007 SP3.1) was used to construct a 3-D PSU retractor prototype. An amputated arm from a 30-year-old woman diagnosed as synovial sarcoma at the shoulder was used to test the maximal visual length. A mini-surgical incision was performed at 3 cm distal to the transverse wrist crease and a tiny flexible ruler was inserted through the tunnel beneath the skin to measure the maximal visual length. Results Our new retractor showed significantly better maximal visual length compared to the Senn retractor (47.7(8.1) mm vs. 39.2(6.5) mm). In addition, most assessors expressed a higher satisfaction rate with the PSU retractor than with the Senn retractor (7.3 (1.9) vs. 6.3 (1.1)). Conclusion In conclusion, we have developed a promising new retractor using a computer design program, which appears to be an improvement on the currently available equipment used for mini-open carpal tunnel surgery. However, further clinical studies are needed to confirm our initial findings.
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Affiliation(s)
- Sunton Wongsiri
- Department of Orthopaedic Surgery and Physical Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.
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