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INTRODUCTION: Periprosthetic joint infection (PJI) of the hip due to methicillin-resistant bacteria is difficult to treat and remain a challenge for arthroplasty surgeon. MATERIALS AND METHODS: Retrospective review was done to the patients who received two-stage revisions with an antibiotic loaded cement-spacer for PJI of the hip between January 2010 to May 2015. We found 65 patients (65 hips) with positive culture findings. Eight patients were lost to follow-up and excluded from the study. Among the rest of the 57 patients, methicillin-resistant infection (MR Group) was found in 28 cases. We also evaluate the 29 other cases that caused by the other pathogen as control group. We compared all of the relevant medical records and the treatment outcomes between the two groups. RESULTS: The mean of follow-up period was 33.7 months in the methicillin-resistant group and 28.4 months in the control group (p = 0.27). The causal pathogens in the methicillinresistant group were: Methicillin-resistant Staphylococcus aureus (MRSA) in 10 cases, Methicillin-resistant Staphylococcus epidermidis (MRSE) in 16 cases and Methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in two cases. The reimplantation rate was 92.8% and 89.6% in the methicillin-resistant and control group, respectively (p= 0.66). The rates of recurrent infection after reimplantation were 23.1% (6/26) in the methicillin-resistant group and 7.6% (2/26) in the control group (p= 0.12). The overall infection control rate was 71.4% (20/28) and 89.6% (26/29) in the methicillin-resistant and control group, respectively (p = 0.08). Both groups showed comparable baseline data on mean age, BMI, gender distribution, preoperative ESR/CRP/WBC and comorbidities. CONCLUSION: Two-stage revision procedure resulted in low infection control rate and high infection recurrency rate for the treatment of methicillin-resistant periprosthetic joint infection (PJI) of the hip. Development of the treatment strategy is needed to improve the outcome of methicillinresistant periprosthetic joint infection (PJI) of the hip.

High tibial osteotomy is a reliable procedure for the correction of knee varus deformity. An opening-wedge high tibial osteotomy (OW-HTO) is the most popular technique. The results of the bone defect after opening the wedge needed special treatment to ensure bone healing. This study aims to evaluate the use of bovine-derived hydroxyapatite graft for defect filling after OW-HTO., Methods: A retrospective study was performed on all patients who received OW-HTO at Prof. Dr R. Soeharso Orthopaedic Hospital from November 2019 to December 2022. A total of 21 patients (24 knees) were included in this study. Clinical dan radiological evaluation was performed on all patients preoperative and postoperatively. The mean of the follow-up period was 12.6 months with a minimum of 4 months follow-up., Results: Primary medial uni-compartment knee osteoarthritis was the most common diagnosis, with 17 of 24 cases (70.8%). Mechanical axis deviation was changed from 31 mm medial deviation (range: 8-52 mm) to 0.45 mm medial deviation (range: 13 - (-8) mm). The anatomic tibiofemoral angle was corrected from a preoperative mean of 4.7 ° of varus to a mean of 5.8 ° of valgus postoperatively. Bone defect height was mean 15.9 mm with a range of 10-23 mm. Bone defect width was mean 46.7 mm (range: 34-60 mm). Hydroxyapatite graft integration with the host bone was found in all patients during the final follow-up period., Conclusions: Bovine-derived hydroxyapatite graft is a safe and effective material for bone defect filling in OW-HTO procedures with a high bone union rate., Competing Interests: The authors declare that they have no financial conflict of interest with regard to the content of this report., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Osteoarthritis is one of the leading causes of disability and the most common degenerative disease of the knee that causes enormous pain. As many as 10-15 % of patients requiring total knee arthroplasty (TKA) present with valgus knee deformity. When fully constrained TKA is not possible, the surgeon must use a different method to achieve a good result., Case Description: A 56-year-old female with 3rd degree (48-degree) and a 62-year-old male with 2nd degree valgus knee (13-degree) with painful osteoarthritis were examined. Both have valgus thrust gait and medial collateral ligament (MCL) laxity and underwent TKA using non-constrained implants. During surgical exposure, MCL insufficiency was found in both patients, and MCL augmentation was performed. Post-operative assessment and 4-month follow-up were done through clinical and radiological parameters using the knee scoring system., Discussion: A good outcome could still be achieved with a primary TKA implant in severe and moderate valgus knees with MCL insufficiency using MCL augmentation. The primary TKA implant proved to improve clinical and radiological parameters after 4 months of follow-up. Clinically, both patients no longer felt pain in their knees and were able to walk with better stability. Radiologically, there was a much-reduced valgus degree. The results were the first case went from 48-degree to 2-degree and the second case went from 13-degree to 6-degree., Conclusion: Knee osteoarthritis with valgus deformity and MCL insufficiency present surgical challenges during TKA. It is still possible to use in severe or moderate valgus with MCL insufficiency, which was proven by satisfactory clinical and radiological findings. Although a non-constrained option is not ideal, it is still the first choice in certain cases., Competing Interests: Declaration of competing interest N/A., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The anterolateral ligament (ALL) of the knee remains a topic of interest. All aspects of the ligament, including its anatomy, biomechanics, imaging, and clinical importance, are areas for research among knee surgeons., Purpose: To evaluate the trends in research on the ALL of the knee, as indicated by studies indexed in PubMed from 2010 to 2019., Study Design: Cross-sectional study., Methods: We searched PubMed for article titles from January 1, 2010, to December 31, 2019, that included the term "anterolateral ligament." The initial search was performed with the terms "anterolateral ligament AND knee" and "anterolateral ligament NOT knee." Next, we performed a search using "anterolateral complex OR anterolateral reconstruction OR lateral extra-articular tenodesis" to avoid missing any studies. A bibliometric evaluation was performed for the search results, and we noted the characteristics of the most cited articles in PubMed., Results: Published studies on the ALL peaked in 2017, with 56 studies, and then declined from 2017 to 2019. The 3 leading journals with articles on the ALL were Arthroscopy ; Knee Surgery, Sports Traumatology, Arthroscopy ; and The American Journal of Sports Medicine . Cadaveric anatomic, cadaveric biomechanical, and clinical imaging studies of the ALL were the most common types of studies published from 2010 to 2019. Clinical studies on the ALL consisted of 18 articles, with the majority displaying a low level of evidence., Conclusion: Cadaveric anatomic/histological, cadaveric biomechanical, and clinical imaging studies of the ALL were the most commonly published studies from 2010 to 2019. More clinical outcome studies with a high level of evidence are needed to increase the supporting data for the future practice of ALL reconstruction., Competing Interests: The authors declared that there are no conflicts of interest in the authorship and publication of this contribution. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)

Background: North Sumatra is one of the regions in Indonesia that produce bananas. Banana stems and peels contain cellulose and it can be isolated in nanofiber form. Carboxymethylcellulose is a cellulose derivative that undergoes an alkalization and etherification process., Aim: This research was conducted to evaluate the alkalization effect on synthesis of carboxymethyl cellulose from stem and peel cellulose of banana., Methods: Stem and peel of banana was extracted with NaOH 17.5% and the extract was synthesized to carboxymethyl cellulose (CMC). The synthesis of CMC was beginning with alkalization process in variation of NaOH concentration and the reaction was then etherificated with sodium monochloroacetate. CMC was characterized by FTIR and DS values were determined., Results: FTIR spectra of synthesized CMC had different pattern compared to cellulose. It showed that an etherification reaction had been occurred in the cellulose compound. Spectra of CMC with variation in alkali concentration was not much different from one another. The synthesized CMC from stem and peel cellulose of banana had different degree of substitution (DS) values due to variate concentration of NaOH in alkalization., Concluson: Alkalization on CMC synthesis affects the DS value of synthesized CMC. The increase DS value is proportional to the rise in NaOH concentration even though there is a boundary concentration to obtain the optimum DS value., (Copyright: © 2019 Sri Yuliasmi, Nahitma Ginting, Henny Sri Wahyuni, Ruth Theresia Sigalingging, Theophani Sibarani.)

Unlabelled: The clinical utility of visualization of blood flow patterns across the tricuspid valve (TV) and pulmonary valve (PV) by M-mode contrast echocardiography was studied in 38 patients with documented valvular or congenital heart disease and in 15 controls. Diastolic turbulence was observed in the TV outflow side in three patients with tricuspid stenosis. Turbulent flow was also detected during systole in patients with septal defects (atrial septal defect in four patients and ventricular septal defect in one patient) in the right ventricular outflow tract and in three atrial septal defect patients also in the inflow tract, presumably because of increased volume of flow. Tricuspid regurgitation (11 patients) was characterized by retrograde laminar jet throughout systole, while in pulmonary regurgitation (six patients) retrograde flow was initially laminar although later on it might become turbulent. In pulmonary hypertension (29 patients) antegrade flow occurred approximately to mid-systole and then was interrupted by retrograde laminar flow which contributed to the mid-systolic closure of the pulmonary valve and pulmonary regurgitation in some cases., Conclusions: contrast echocardiography is a useful technique to analyse right heart blood flow patterns and may aid the diagnosis of various right heart abnormalities.