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The conventional treatment of osteomyelitis with antibiotic‐loaded nondegradable polymethylmethacrylate (ATB‐PMMA) beads has certain limitations, including impeded bone reconstruction and the need for secondary surgery. To overcome this challenge, this study aimed to develop and characterize an injectable vancomycin‐loaded silk fibroin/methylcellulose containing calcium phosphate‐based in situ thermosensitive hydrogel (VC‐SF/MC‐CAPs). The VC‐SF/MC‐CAPs solution can be easily administered at room temperature with a low injectability force of ≤30 N and a high vancomycin (VC) content of ~96%. Additionally, at physiological temperature (37 °C), the solution could transform into a rigid hydrogel within 7 minutes. In vitro drug release performed under both physiological (pH 7.4) and infection conditions (pH 4.5) revealed a prolonged release pattern of VC‐SF/MC‐CAPs following the Peppas–Sahlin kinetic model. In addition, the released VC from VC‐SF/MC‐CAPs hydrogels exhibited antibacterial activity against Staphylococcus aureus for a period exceeding 35 days, as characterized by the disk diffusion assay. Furthermore, at pH 7.4, the VC‐SF/MC‐CAPs demonstrated >60% degradation within 35 days. Importantly, when exposed to physiological pH conditions, CAPs are transformed into bioactive hydroxyapatite, which benefits bone formation. Therefore, VC‐SF/MC‐CAPs showed significant potential as a local drug delivery system for treating osteomyelitis. [ABSTRACT FROM AUTHOR]

This study explores the efficacy of a vancomycin-loaded silk fibroin/calcium phosphate/methylcellulose-based in situ thermosensitive hydrogel (VM-SF/CaP/MC) in promoting the osteogenic differentiation of preosteoblast cells. Three VM-SF/CaP/MC formulations with varying low (L) and high (H) concentrations of silk fibroin (SF) and calcium phosphate (CaP) were prepared: VM-HSF/LCaP/MC, VM-LSF/HCaP/MC, and VM-HSF/HCaP/MC. These hydrogels significantly enhanced MC3T3-E1 cell migration and proliferation in a dose- and time-dependent manner, achieving complete cell migration within 48 h. In addition, they significantly promoted alkaline phosphatase activity, collagen content, and mineralization in MC3T3-E1 cells, indicating their potential for osteogenesis. Among the hydrogel formulations, the VM-HSF/HCaP/MC hydrogel, with high SF and CaP content, demonstrated superior potential in promoting the osteogenic differentiation of MC3T3-E1 cells. It exhibited the highest ALP activity (11.13 ± 0.91 U/mg protein) over 14 days, along with increased collagen content (54.00 ± 1.71 µg/mg protein) and mineralization (15.79 ± 1.48 mM) over 35 days. Therefore, this formulation showed a promising candidate for clinical application in localized bone regeneration, particularly in treating osteomyelitis. [ABSTRACT FROM AUTHOR]

Introduction: Up to one-third of patients with fragility hip fractures are totally dependent in the year following the injury which leads to later morbidity and mortality. Understanding the related factors that affect patients' ambulation helps health care providers prepare for the treatment plans to improve their functional outcomes. This study aimed to evaluate the factors associated with independent walking disability in the early postoperative period after fragility hip fractures. Material and methods: This retrospective cohort study involved 394 patients with fragility hip fractures with either intertrochanteric, subtrochanteric, or femoral neck fractures from January 2018 to June 2023. The related factors including preoperative demographics, perioperative, and postoperative factors, were collected and analyzed. The endpoint was the independent walking disability of patients at 6 weeks after surgery. Results: 110 patients (27.9%) were disabled, whereas 284 patients (72.1%) could walk independently at postoperative 6 weeks. The multivariable risk ratio regression analysis showed that patients with age ≥80 years (RR 1.65; 95% CI 1.21-2.25; P = 0.001), pre-fracture walking with the gait aid (RR 2.03; 95% CI 1.53-2.69; P < 0.001), having ≥2 underlying comorbidities (RR 1.63; 95% CI 1.19-2.23; P = 0.002), preoperative hypoalbuminemia (RR 1.74; 95% CI 1.32-2.29; P < 0.001), and presence of the postoperative medical complication (RR 2.04; 95% CI 1.37-3.02; P < 0.001) were significantly associated with independent walking disability at the early postoperative period of 6 weeks. Conclusions: Post-hip fracture surgery patients with the presence of postoperative medical complication have the highest risk of independent walking disability. Health care providers should concentrate on high-risk patients, correct the modifiable factors, and minimize any postoperative complications to improve functional recovery and decrease morbidity related to non-ambulation after fragility hip fractures. [ABSTRACT FROM AUTHOR]

Background: Cruciate-retaining (CR) total knee arthroplasty (TKA) may provide better physiological knee kinematics, proprioception, and quadricep recovery than posterior-stabilized (PS) TKA. Therefore, we hypothesized that CR TKA with multimodal pain control may provide comparable postoperative pain and recovery as unicompartmental knee arthroplasty (UKA). Methods: This study included patients with isolated medial compartment knee osteoarthritis who underwent CR TKA and UKA. TKA and UKA patients were propensity score-matched with age and body mass index (BMI) and compared using visual analog scales (VAS) for pain scores, total amount of morphine use (TMU), knee flexion angle, straight leg raise (SLR), independent ambulation, length of hospital stay (LOS), and costs during hospitalization. Results: After propensity score matching, 46 patients were included in the TKA and UKA groups, respectively, with no differences in demographic data. VAS at 6– 72 h and TMU at 48 h after surgery were comparable between the groups. The knee flexion angle in the UKA group was significantly higher at 24 h (60.0° vs 46.6°; p< 0.001) and 48 h (76.9° vs 69.1°; p = 0.021) than that in the TKA group. The SLR in the UKA group was significantly higher than that in the TKA group at 24– 72 h. The UKA group ambulated significantly earlier (1.56 vs 2.13 days; p< 0.001), had shorter LOS (3.68 vs 4.28 days; p< 0.004) and incurred 12.43% lower costs when compared to the TKA group. Conclusion: Patients who underwent CR TKA with multimodal pain management did not experience more postoperative pain or morphine use than those who underwent UKA. However, UKA patients seem to experienced faster recovery and shorter LOS than CR-TKA patients during the early postoperative course. Accordingly, UKA may be considered instead of TKA for patients who are good candidates for UKA and require expedited recovery. [ABSTRACT FROM AUTHOR]

Background: While osteoporosis increases the risk of fragility fractures, bisphosphonate has been proven to increase bone strength and reduce the risk of vertebral and non-vertebral fractures. In addition to its efficacy, substituting the brand with generic medication is a strategy to optimize healthcare expenditures. This study aimed to evaluate the efficacy of generic alendronate treatment and assess potential adverse events in patients with osteoporosis. Materials and Methods: A retrospective review was conducted on 120 patients who met the indications for osteoporosis treatment, received weekly generic alendronate (70 mg) for > 1 year, and underwent evaluation through standard axial dual-energy X-ray absorptiometry (DXA). The outcomes of this study were the percent change in bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip after one year of treatment. The major adverse events occurring during medication that led to the discontinuation of drug administration were documented. Results: Most patients were female (96.7%) with an average age of 69.0 ± 9.3 years. The percent change in BMD increased at all sites after one year of generic alendronate treatment (lumbar spine: 5.6 ± 13.7, p-value < 0.001; femoral neck: 2.3 ± 8.3, p-value = 0.023; total hip: 2.1 ± 6.2, p-value = 0.003), with over 85% of patients experiencing increased or stable BMD. Three patients discontinued the medication due to adverse effects: two had dyspepsia, and one had persistent myalgia. Conclusion: Generic alendronate may be considered an effective antiresorptive agent for osteoporosis treatment with a low incidence of adverse effects. [ABSTRACT FROM AUTHOR]

Bone defect is still a challenging problem in orthopedic practice. Injectable bone substitutes that can fill different geometry of bone defect and improve biological environment for bone regeneration are attracting attention. Herein, silk fibroin (SF) is noticeable polymer regarding its biocompatible and biodegradable properties. Thus, the calcium phosphate particles incorporated in silk fibroin/methylcellulose (CAPs‐SF/MC) and only methylcellulose (CAPs‐MC) hydrogels are developed and compared their physicochemical properties. Both CAPs‐hydrogels solutions can be administered with a low injectability force of ~6 N, and they require ~40‐min to change to hydrogel at physiological temperature (37°C). The CAPs are evenly distributed throughout the hydrogel matrix and are capable transformed to bioactive hydroxyapatite at pH 7.4. The CAPs in CAPs‐SF/MC have a smaller size than those in CAPs‐MC. Moreover, CAPs‐SF/MC exhibit gradual degradation, as prediction of the degradation mechanism by the Peppas‐Sahlin model and show a greater ability to sustain CAPs release. CAPs‐SF/MC has good biocompatibility with less cytotoxicity in a dose‐dependent manner on mouse preosteoblast cell line (MC3T3‐E1) when compared to CAPs‐MC. CAPs‐SF/MC hydrogels also have better possibility for promoting cell proliferation and differentiation. In conclusion SF incorporated into composite injectable hydrogel potentially improve biological characteristics and may provide clinical advantages. [ABSTRACT FROM AUTHOR]

Background: We questioned whether the triple analgesic pathways procedure via local infiltration analgesia (LIA), peripheral nerve blocks, and intrathecal morphine (ITM) is superior to LIA only for controlling pain after Total Knee Arthroplasty (TKA). Methods: This retrospective study included 192 primary TKA patients. Group A (76 patients) received LIA only, Group B (61 patients) had ITM, adductor canal block and LIA, while Group C (55 patients) received ITM, femoral nerve block and LIA. A propensity score-matched analysis was used to compare visual analog scales (VAS) for pain intensity, total amount of morphine consumption (TMC), angle of knee flexion, and length of hospital stay (LHS). Results: Group A showed significantly higher VAS than Group B at 12 h (4.27 ± 2.70 vs 2.42 ± 2.35) and 18 h (4.24 ± 2.35 vs 2.18 ± 2.02), and significantly higher than Group C at 6 h (3.46 ± 3.07 vs 0.60 ± 1.50), 12 h (4.27 ± 2.70 vs 0.89 ± 1.48), and 18 h postoperative (4.24 ± 2.35 vs 1.82 ± 2.18). However, the VAS of Group C and B converged to equalize with Group A after 12 and 18 h, respectively. The TMC at 48 h postoperative of Group A was higher than that of Group B (p < 0.01). Nevertheless, there was no difference between groups in terms of knee flexion and LHS, except the LHS of Group B was longer than Group A (p = 0.04). Conclusion: Triple analgesic pathways could provide a better initial analgesic profile. However, the pain seems to be rebound after resolution of nerve block and ITM, with potentially longer LHS. [ABSTRACT FROM AUTHOR]

Background: Severe postoperative pain following total knee arthroplasty [TKA] may cause patients agony and persistent postsurgical pain [PPSP], Periarticular injection [PAI] and femoral nerve block [FNB] are widely accepted as effective options for reducing postoperative pain and morphine consumption. Preemptive analgesia theoretically can has the ability to prevent sensitization of the nervous system and consequent amplification of postoperative pain. Objective: To explore whether the preemptive femoral nerve block [FNB] can provide additional pain relief for periarticular injection [PAI] after primary TKA. Materials and Methods: The records of 112 patients, 53 who had received spinal anesthesia with periarticular injection (PAI group) and 59 who had received spinal anesthesia combined with preemptive femoral nerve block [FNB] and PAI (FNB + PAI group) were retrospective analyzed. All the data had been routinely recorded in a sequential fashion at our institution. Results: Morphine consumption by the FNB + PAI group during the first 24 and 48 hours post operation were 7.13 and 11.61 mg, respectively, significantly lower than the 14.11 and 20.43 mg consumed by the PAI group (p = 0.001, andp = 0.01, respectively). The FNB + PAI group had lower pain scores in the first 24 hours, although that difference was not statistically significant. In terms of knee rehabilitation, the degrees of straight leg raise [SLR] in the FNB + PAI group was significantly higher in the first 24 hours, while, the degrees of knee flexion and extension lag [EL] were comparable between the two groups. Conclusion: Preemptive femoral nerve block [FNB] can reduce morphine consumption in the first 48 hours after total knee arthroplasty. In addition, the FNB tends to reduce the pain score and to facilitate knee rehabilitation on the first day after the index surgery. [ABSTRACT FROM AUTHOR]

Background: Thai Diagnosis Related Group [TDRG] version 5 has been widely used in Thailand as a coding and information system for managing hospital reimbursement. Objective: The present study aimed to examine how well TDRG reflects actual inpatient costs of primary total knee arthroplasty [TKA] at Naresuan University Hospital. Materials and Methods: Records of patients admitted from October 2014 through September 2015 were obtained from the hospital's financial department. A total of 394 TKA patients were identified, including 224 patients covered under the Civil Servant Medical Benefit Scheme [CSMBS] and 170 covered under the Universal Health Coverage Scheme [UHC]. Results: (1) The adjusted relative weights [AdjRWs] of UHC and CSMBS beneficiaries were not statistically significantly different, although CSMBS patients had a longer average length of hospital stay [LOS], (2) Despite the fact that bilateral TKAs doubled the health care cost compared to unilateral TKA, the AdjRW was approximately double that for unilateral TKA, reflecting a fair and reasonable hospital reimbursement. (3) Although the difference was not statistically significant, we found that the variation in the cost of care for primary TKA depended on the severity of the patient's co-morbidity, e.g., greater need for treatment, higher AdjRW, and longer LOS. Hospital reimbursement for patients with comorbidities was higher than hospital care costs for patients none regardless of the severity level of the comorbidity. (4) The vendor managed inventory [VMI] system for knee prostheses did not affect the AdjRW and did not make a statistically significant difference in hospital profit or loss. (5) The AdjRW, LOS, and hospital net profits varied with the surgeon who performed the TKA. Conclusion: TDRG version 5 is a reasonable system for reimbursement of patient' cost for primary TKA, and it seems to reimburse appropriately for comorbid TKA patients as well. Cost containment strategies that focus on shortening LOS and cost-saving related to treatment plans managed by individual surgeons could potentially enhance the hospital's net profit. [ABSTRACT FROM AUTHOR]

Background: Rotational malalignment of a femoral component may lead to chronic pain, patellar maltracking, knee instability, and early failure of a total knee arthroplasty [TKA], The transepicondylar axis of the femur is widely accepted as a good reference for rotational alignment of a tibial component, although it is more controversial for a tibial component. Objective: This study aimed to determine the degree of rotational mismatch between femoral and tibial components implanted using the center-post self-align technique. Materials and Methods: Patients who underwent TKA for osteoarthritis of the knee were enrolled to have postoperative CT scans for determination of the rotational alignment. The study included 51 patients (60 knees), 5 males and 46 females, with a mean age of 64.0 years (range 58 to 73). The posterior cruciate ligament substituting tibial component position was set using the center-post self-align technique. CT digital images in the supine position with the knee at full extension were evaluated. Results: Of the 60 TKAs, the mean rotational mismatch between tibial and femoral prostheses was 2.00° (SD+O.340, range 0.1° to 5.8°). The femoral component was rotated externally and internally within 1.5° while the tibial component was within 2.59° relative to the transepicondylar axis. All knees had good patellar tracking intraoperatively without any lateral release procedure. Conclusion: The center-post self-align technique can achieve good compatibility of rotational alignment between the femoral and tibial components with low variability, particularly with the knee in the extended position. [ABSTRACT FROM AUTHOR]

Purpose: To translate and cross-culturally adapt the English version of the Central Sensitisation Inventory (CSI) into Thai (CSI-Thai) and to evaluate its psychometric properties in individuals with chronic non-specific neck pain., Materials and Methods: Cross-cultural translation and adaptation of the CSI were performed according to standard guidelines. A total of 340 participants were invited to complete the CSI-Thai, Visual Analogue Scale (pain intensity), Neck Disability Index, Fear-Avoidance Beliefs Questionnaire, Pain Catastrophising Scale (PCS), and Short Form-36. Psychometric evaluation included confirmatory factor analysis, internal consistency, test-retest reliability, agreement, and construct validity., Results: Dimensionality analyses indicated that a bifactor model, comprising one general factor plus four orthogonal factors, fit the CSI structure better than unidimensional and the four-factor models. The general factor showed substantial reliability (Cronbach α  = 0.91, Omega ω  = 0.94, and omega hierarchical ω - h  = 0.91). The intraclass correlation coefficient was 0.90, representing excellent stability over a 48 h interval. Moderate-to-strong correlations and acceptable-to-excellent discriminations were found between the CSI-Thai and all questionnaires. The exception was the PCS (no correlation and discrimination). The standard error of measurement and minimal detectable change of the CSI-Thai were 2.33 and 6.47, respectively., Conclusions: The translation and cross-cultural adaptation of the CSI-Thai were successful, with satisfactory reliability and construct validity.Implications for rehabilitationCentral Sensitisation Inventory-Thai version (CSI-Thai) is successfully adapted and demonstrated satisfactory reliability and construct validity.The CSI-Thai can be applicable to assess central sensitisation-related signs and symptoms in Thai-speaking patients with chronic non-specific neck pain (CNSNP) both clinical and research purposes.The CSI-Thai correlated to pain, disability and quality of life among patients with CNSNP.

Background: Femorotibial rotational mismatch can occur when there is a rotational malalignment in either the tibial or femoral component. Self-aligned technique was proposed for orienting the tibial component in relation to the femoral prosthesis to reduce rotational malalignment between components. Therefore, we aimed to compare the rotational angle of the femoral and tibial components, as well as the femorotibial rotational mismatch, between the measured resection (MR) and gap-balancing (GB) techniques when combined with a self-aligned technique., Methods: We conducted a nonrandomized, experimental study with 50 patients in each group. The femoral rotation was set to 3° external rotation relative to the posterior condylar axis in the MR group, whereas the femur was resected to obtain an optimal rectangular flexion gap in the GB group. The self-aligned method was used to set the tibial rotation in both groups. Femoral and tibial rotational alignments were evaluated compared to a surgical transepicondylar axis of the femur using computed tomography. Rotational mismatch was defined as a difference between the femoral and tibial rotational alignments. A positive value indicated that the component was externally rotated relative to the reference line., Results: The femoral component of the GB group was more externally rotated than that of the MR group (1.52° ± 1.31° vs 0.28° ± 1.16°, p < 0.001). However, the tibial rotational angle was not statistically significantly different between the MR and GB groups (1.28° ± 3.17° vs. 1.86° ± 2.81°, p = 0.220), and the rotational mismatch was 1.00° ± 3.28° and 0.34° ± 2.71°, respectively ( p = 0.306)., Conclusions: Although the femoral component of the GB group had a greater degree of external rotation than that of the MR group, the use of a self-aligned technique for tibial component placement resulted in no significant difference in tibial rotational alignment or rotational mismatch. This technique helps align the tibial component with the femoral component and lessen the degree of rotational malalignment in both the MR and GB techniques., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2023 by The Korean Orthopaedic Association.)

Background: Bilateral one-stage total knee arthroplasty (BTKA) is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy. However, postoperative pain and disablement during convalescence from BTKA, and procedure-related complications have been concerning issues for patients and surgeons. Although some studies reported that BTKA in selected patients is as safe as the staged procedure, well-defined guidelines for patient screening, and perioperative care and monitoring to avoid procedure-related complications are still controversial., Aim: To compare the perioperative outcomes including perioperative blood loss (PBL), cardiac biomarkers, pain intensity, functional recovery, and complications between unilateral total knee arthroplasty (UTKA) and BTKA performed with a similar perioperative protocol., Methods: We conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols. The exclusion criteria of this study included patients with an American Society of Anesthesiologists score > 3, and known cardiopulmonary comorbidity or high-sensitivity Troponin-T (hs-TnT) > 14 ng/L. Outcome measures included visual analogue scale (VAS) score of postoperative pain, morphine consumption, range of knee motion, straight leg raise (SLR), length of stay (LOS), and serum hemoglobin (Hb) and hs-TnT monitored during hospitalization., Results: Of 210 UTKA and 137 BTKA patients, those in the BTKA group were younger and more predominately female. The PBL of the UTKA vs BTKA group was 646.45 ± 272.26 mL vs 1012.40 ± 391.95 mL ( P < 0.01), and blood transfusion rates were 10.48% and 40.88% ( P < 0.01), respectively. Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA, whereas preoperative Hb was only a determinant in UTKA patients. The BTKA group had significantly higher VAS scores than the UTKA group at 48, 72, and 96 h after surgery, and also had a significantly lower degree of SLR at 72 h. The BTKA group also had a significantly longer LOS than the UTKA group. Of the patients who had undergone the procedure, 5.71% of the UTKA patients and 12.41% of the BTKA patients ( P = 0.04) had hs-TnT > 14 ng/L during the first 72 h postoperatively. However, there was no difference in other outcome measures and complications., Conclusion: Following similar perioperative management, the blood transfusion rate in BTKA is 4-fold that required in UTKA. Also, BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA. Hence, BTKA patients may require more extensive perioperative management for blood loss and pain, even if having no higher risk of complications than UTKA., Competing Interests: Conflict-of-interest statement: The authors declare that they have no competing interests related to the study design, data collection, and interpretation of results presented in this manuscript., (©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.)

Total knee arthroplasty (TKA) is an effective procedure to treat many patients with end-stage knee arthropathy. However, the extension of TKA for patients with Charcot neuroarthropathy (CNA) is controversial, with relatively limited evidence defining optimal reconstruction techniques.This systematic review of relevant studies that were published from January 2000 to June 2020 aimed to define survivorship, complications, reoperation, and component revision rates of contemporary TKA performed for CNA.We identified 127 TKA performed for CNA in five studies that comprised ≥ 7 knees with ≥ 5 years of follow-up.Overall implant survivorship was 85.4%. The overall complication rate was 26.4%, with the most common complications including instability (24.0%), periprosthetic fracture (17.4%), infection (13.0%), ligament injury (10.9%) and aseptic loosening (10.9%).The aetiology of CNA and prosthesis type had no influence on clinical outcomes, whereas the effect of staging of disease and ataxia status was still inconclusive.Understanding the potential determinants, survivorship and risk of complications related to TKA performed in CNA may help surgeons to deal with patient expectations. Cite this article: EFORT Open Rev 2021;6:556-564. DOI: 10.1302/2058-5241.6.200103., Competing Interests: ICMJE Conflict of interest statement: The authors have no competing interests related to the study design, data collection, and results interpretation of this manuscript., (© 2021 The author(s).)

Backgroud: Postoperative pain following total knee arthroplasty (TKA) may hamper patients from a rapid recovery and increase perioperative blood loss and stress on the cardiovascular system. Therefore, our objective was to assess perioperative outcomes after TKA in patients who were not candidates for the additional nonsteroidal anti-inflammatory drugs (NSAIDs) in a multimodal pain control regimen., Methods: Propensity score matching for age, sex, body mass index, American Society of Anesthesiologists class, and preoperative hemoglobin level was conducted on patients undergoing unilateral TKA, and thereby 52 patients remained in each group. The control group comprised patients who received parenteral parecoxib every 12 hours during the first 48 hours after TKA. The No-NSAIDs group did not receive NSAIDs because of known contraindications. Identical postoperative pain control including intravenous patient-controlled analgesia was applied for all patients. Visual analog scale (VAS) score for pain, knee flexion, blood loss, serum cardiac troponin-T (cTnT), and length of stay (LOS) were determined., Results: The No-NSAIDs group had significantly higher VAS scores in 6-96 hours and consumed more morphine at 24 hours and 48 hours after the surgery than the control group. The No-NSAIDs group had significantly less knee flexion at 48 hours ( p = 0.045) and tended to have more emesis and longer LOS than the control group. The blood loss of the No-NSAIDs and control group was 552.52 mL and 397.65 mL ( p = 0.02), respectively, and blood transfusion rate was 23.1% and 17.3% ( p = 0.63), respectively. The cTnT of the No-NSAIDs group rose over the first 48 hours and was significantly higher than that of the control group at 48 hours., Conclusions: Patients who were not candidates for NSAIDs had significantly higher pain scores and consumed more morphine after TKA. They also tended to have greater blood loss and the rising of cardiac biomarkers during the first 48 hours after TKA. Hence, these patients may benefit from supplementary analgesia and appropriate perioperative monitoring., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported., (Copyright © 2021 by The Korean Orthopaedic Association.)

Background: Hypercoaguable state has been indicated as a major risk factor in predisposing the idiopathic osteonecrosis of the hip. Furthermore, many studies have demonstrated that low molecular weight heparin (LMWH) can reverse the pathophysiology of the osteonecrosis of the hip in thrombophilic patients., Objective: Determine whether LMWH can prevent the progression of idiopathic osteonecrosis of the hip., Material and Method: A retrospective study of 36 patients who had bilateral idiopathic osteonecrosis with at least one hip in the pre-collapsed stage (Ficat & Arlet stage I-II) was conducted. In the study group, 18 patients (26 hips) received 6,000 units of Enoxaparin daily for 12 weeks. In the control group, 18 patients (23 hips) received no Enoxaparin. All patients were given radiographic evaluations every three months for a minimum of24 months., Results: At the last follow-up, 15 hips (57.7%) from the study group and five hips (21.7%) from the control group were observed to remain in the pre-collapse stage (p = 0.042). Coagulation disorder was observed in seven patients (38.9%) of the experimental group and five patients (27.8%) of the control group. One patient from the study group exhibited hematuria with spontaneous resolution after the course ofEnoxaparin injection., Conclusion: A progression rate of idiopathic osteonecrosis of the hip from the pre-collapse stage to the collapsed stage was found to be significantly lower in patients who received LMWH.

Background: An improper femoral and tibial component rotation is one of a major reason leading to a failed TKA. There is controversial on determination of rotational alignment particularly on a tibial component. An anatomical landmarks and a self-aligned technique have been proposed. It is the authors' purpose to determine the difference between two techniques in setting the rotation of tibial component., Material and Method: The authors conducted a prospective, comparative study of 30 consecutive primary total knee arthroplasty. There were 4 men and 26 women with mean age of 68.6 years. All procedures were performed by a single surgeon with a navigation system. The degree of rotation of the tibial trial component established by a just-medial to the tibial tuberosity and self-aligned technique was compared., Results: A mean of the degree of the tibial component rotation with the self-aligned of the center-post technique was 3 degrees more externally rotated than the just-medial to the tibial tuberosity technique. The self-aligned technique had standard deviations of 4.41 degrees, of which was significantly less variable (p < 0.05) than 5.94 degrees of the just-medial to the tibial tuberosity technique., Conclusion: The authors conclude that establishment of the tibial component rotation by using the self-aligned of the center-post technique will rotate the component more external compared with the just-medial to the tibial tuberosity technique.

Enchondroma is a benign tumor that is generally asymptomatic and rarely found in the talus. A forty-nine-year-old man, had a chronic left ankle pain which related to moderate to heavy activity. A plain radiograph and magnetic resonance imaging (MRI) revealed a 1.3 cm benign lobulated intramedullary lesion at the middle 1/3 of medial part of talar dome with sclerotic rim. An arthroscopic intralesional curettage of the ankle joint was performed without bone grafting. Histologic examination was consistent with the diagnosis of an enchondroma. The patient was asymptomatic and without restriction on his job at 6 months. At 1 year of follow-up, the CT scan and MRI demonstrated no recurrence of the tumor but the defect was not filled up.

Background: The accuracy of MRI evaluation for the traumatic knee injury may help the physician selecting the treatment options and informing patient about the prognosis. The purpose of the present study was to analyze the result of the MRI reported from a center in Phitsanulok which would be valuable for orthopaedic surgeons who practicing in the lower northern region of Thailand., Material and Method: The 1.5 Tesla MRI of 51 injured knees that underwent subsequent arthroscopic knee surgery was independently reviewed by one from the group of radiologists. The sensitivity, specificity accuracy and negative predictive value of the MRI evaluation for menisci and cruciate ligament pathology compared to the arthroscopic finding is determined., Results: There were 50 patients with the mean age of 36.7 year old (ranging from 18-75 years) and 30 were males and 20 were females. The sensitivity, specificity accuracy and negative predictive value (NPV) in detecting the complete tear of the ACL injury were 90.9%, 84.6%, 88.6% and 84.6%, respectively. There were 100%, 97.1%, 97.5% and 100%, respectively, for diagnosis of complete PCL tear. The MRI evaluation for definite medial meniscus tear revealed 100% in sensitivity, 52.6% in specificity, 64% in accuracy and 100% in NPV. For the lateral meniscus, it yielded 55.6%, 83.3%, 75.8% and 83.3%, respectively. Among the 22 patients who underwent the ACL reconstruction without the PCL or collateral ligament injury, there was 50% of associated meniscal injury with similar ratio between medial and lateral side., Conclusion: The MRI report from the center in Phitsanulok could be useful in detecting the cruciate ligament tear particularly with uncertain clinical examination. With a high negative predictive value, the MRI could be used as a negative diagnostic tool for the meniscal injury.

Background: A transepicondylar axis is a useful reference for femoral component rotation and is demonstrated as a functional flexion-extension axis of a knee. Conversely, a rotational orientation of the tibial component was less clearly demonstrated and many anatomical landmarks were proposed. It has been reported that Asian people had more medial torsion of the tibia particularly with an osteoarthritic knee. The present study aims to address the relationship between the torsion variation of the tibia and the rotational axis of the tibia., Material and Method: Forty knees of 32 women (mean age of 73.3) with varus osteoarthritis underwent a preoperative CT images to identify a surgical epicondylar axis, an axis perpendicular to this line (femoral reference line), lines connecting between the PCL insertion and 3 reference point on the patellar tendon, an AP axis of the ankle and a tibial torsion angle., Results: The mean value of the angle between the line connecting the PCL insertion and 3 different point of the patellar tendon including the medial border medial one-third and middle of the patellar tendon and the femoral reference line was -4.22, +4.37 and +8.47 degree, respectively. The mean of a tibial torsion angle was +16.51 degree. There were 6 cases having the femoral reference line rotated internally to the medial border of the patellar tendon and having less torsion angle (medial tibial torsion) with a mean of +13.78 degree., Conclusion: The femoral reference line in the Thai osteoarthritic knee is passed between medial edge of patellar tendon and medial 1/3 of patellar tendon. This line rotates more internally compared with the patellar tendon if the degree of medial tibial torsion is more severe. An excessive externally rotated tibial component when using the patellar tendon as guidance should be avoided in the knee presenting with medial tibial torsion.

Background: Although hip fracture surgery treatments have been improved, the mortality rate remains high because of a high risk of complications, such as myocardial infarction and venous thromboembolism. Many studies have identified the benefit of thromboembolism prophylaxis., Objective: To determine the 1-year mortality rate of thromboembolism prophylaxis and non-prophylaxis after the hip fracture surgery., Material and Method: This study is a prospective analytic study. 114 patients who had undergone the hip fracture surgery between 2004-05 were given follow-up examinations every 3 months for 1 year., Results: Of the 114 patients, 25 patients (21.9%) have received the medical thromboprophylactic protocol and 89 patients (78.1%) have not. The 1-year mortality rate was 12.0% (3 cases) and 9.0% (8 cases) in the thromboprophylactic group and nonprophylactic group, respectively (p = 0.704). The mean age was significantly older in the deceased group (86.4 year old, SD 12.86) than the non-deceased group (78.0 years old, SD 8.04) (p = 0.003). The median duration from postoperation to death was 19 weeks after the surgery (range 0.5- 52 weeks). The causes of death were acute myocardial infarction 3 (27.3%), sepsis 2 (18.2%), aspiration pneumonia 1 (9.1%), and unknown cause 5 (45.4%)., Conclusion: The overall 1 year mortality rate after surgery of the hip fracture is 9.6% and it is not different regardless of whether the medical thromboembolism prophylaxis has been established or not. Myocardial infarction was the most common cause (273%). The elderly patient is at a higher risk of mortality in 1 year after the surgery.

Background: Prevention of injury among athletes is of paramount importance for sport events. The incidence of injury differs depending on many factors, such as level of competition, type of sport, and standard of surveillance systems. It is our purpose to provide a descriptive epidemiology of a national level competition multi-sports event., Methods: During the 2008 Thailand National "Phitsanulok" Games, official medical teams of the various sports completed a report form after each match or competition. The demographic data, type of sport, details of injury or illness, diagnosis, and treatment were collected from the PLKGames 2008 program and analyzed by the Medical Surveillance Committee., Results: There were 14,429 athletes and staff participating in the "Phitsanulok" games. A total of 496 injuries were reported during the competition, of which 300 male and 196 female athletes sustained injuries, resulting in an incidence rate of 4.1 injuries per 100 registered athletes. For all sports, 71, 50 and 38 injuries occurred during Rugby, Handball and Basketball, respectively, which accounted for 32% of all injuries. No injury was reported from many sports, such as table tennis, shooting, dancing, and golf The most common diagnoses were sprains and strains. About half of injuries were caused by contact with another athlete, followed by noncontact (28.6%) and limited-contact incidences (27.6%). According to the number of athletes, the risk of incurring an injury was highest in Pencak Silat, handball, basketball, and rugby football. About half of injuries affected lower extremities, while 135, 53, and 49 injuries involved upper extremity, head & neck, and axial body parts, respectively. The knee and ankle were the most common sites of injury., Conclusion: The data demonstrates a potential risk of injury occurring predominately in full-contact sports and limited-contact sports. The data is potentially useful in developing injury surveillance systems for future sporting events.

Objective: Many randomized clinical trials demonstrated that 4-strand hamstring tendon grafts have comparable results both subjectively and objectively with the patellar tendon grafts. The authors hypothesized that the increment of hamstring tendons strength with 6-strand graft could improve the knee stability compared to the result from using the gold standard patellar tendon., Material and Method: Thirty-four patients were prospectively randomized into two groups for arthroscopic anterior cruciate ligament reconstruction. Seventeen patients underwent reconstruction with 6-strand hamstring tendons and the remaining seventeen were treated with bone-patellar tendon-bone graft. Patients were followed-up under the similar rehabilitation protocol for at least 12 months. At the time of final follow-up, all the patients in both groups were evaluated in terms of patient's satisfaction, activity level, and knee stability., Results: Fifteen patients in bone-patellar tendon-bone graft (two lost to follow-up) and thirteen patients used 6-strand hamstring tendons (four were converted to 4-strand hamstring tendons) were evaluated at a mean of 19 months (range 12-31 months). The mean of KT-2000 side-to-side laxity measurement in 6-strand hamstring group (0.96 mm) is less than BPTB group (1.22 mm) significantly (p < 0.05). Eleven of 13 patients (84.62%) that received the 6-strand hamstring tendons could return to sport activities compared to 10 of 15 patients (66.67%) that received BPTB graft. Hamstring group have a lower prevalence of donor-site morbidity resulting in less difficult in kneeling., Conclusion: The authors concluded that using 6-strand hamstring tendons could improve knee stability in the early clinical outcomes. With no difference in subjective assessment, anterior cruciate ligament reconstruction used hamstring tendons have less donor-site morbidity, which is more compatible to Asian life-style.