Search

We present a case of a 26-year-old gentleman with isolated right infraspinatus atrophy arising from a spinoglenoid cyst of the right shoulder. He presented two years following his shoulder injury and failed conservative rehabilitation alone. At initial arthroscopic surgery, a superior labral anterior to posterior (SLAP) tear was diagnosed and the spinoglenoid cyst was debrided without formal labral repair. The patient’s condition did not improve, and second arthroscopy was performed three months following the first with suture anchor repair of the labral tear and cyst decompression. Post- operative magnetic resonant imaging (MRI) scans showed complete resolution of the cyst and recovery of infraspinatus muscle bulk at six months. At final follow-up 18 months post SLAP repair, he has regained full shoulder function and has returned to recreational sports. Our case highlights the importance of proper management of SLAP tears in resolving spinoglenoid cysts by demonstrating the outcomes from two different surgical methods in the same patient.

We report the outcome following arthroscopic ACL reconstruction combined with a Modified LeMaire procedure in a patient who underwent multiple surgeries following an open ipsilateral femoral fracture and an above knee amputation of the contralateral limb at the time of initial trauma. This case highlights the importance of achieving ligamental stability in the contra-lateral limb in aiding proper rehabilitation following amputation and the potential pitfalls of retrograde femoral nailing.

INTRODUCTION: Reverse total shoulder arthroplasty provides a surgical alternative to standard total shoulder arthroplasty for the treatment of cuff tear arthropathy, arthritis and fracture sequelae. This study aimed to assess the short-term outcomes following reverse total shoulder arthroplasty for patients in a large public hospital in Malaysia. MATERIALS AND METHODS: We identified and performed five primary reverse total shoulder arthroplasties between 1 May 2019 and 1 June 2020. All patients were contactable and available for analysis. Assessment of functional outcomes was performed using the Constant-Murley score, the patient satisfaction score (PSS), and imaging studies. The mean follow-up from operation to the time of reporting was 9.6 months (range, 3 to 14 months) RESULTS: The median age for our patients was 58 years (±11.91). The most common indication for surgery was posttraumatic arthritis, followed by rotator cuff arthropathy and osteoarthritis. The mean Constant score improved from 9.0 pre-operatively to 52.3 post-operatively at a mean of 9.6 months. The majority of the patients were satisfied with the surgery as the post-operative range of motion, especially anterior elevation and abduction, improved in four of our patients and there were no short-term complications, for example, of infection or revisions, reported at the last followup. CONCLUSION: This study has shown that reverse total shoulder arthroplasty can yield good short-term outcomes for the treatment of complex shoulder problems in addition to cuff tear arthropathy. It should be considered a treatment for rotator cuff tears, severe arthritis and ≥ 3 parts proximal humeral fractures.

INTRODUCTION: This study was conducted to evaluate the demographics, causes and outcomes of patients who underwent Posterior Cruciate Ligament (PCL) reconstruction and/or Posterolateral Corner (PLC) reconstruction performed at our institution over the last three years. Sub-analysis was performed to assess the impact of delay from injury to surgery and how this affected outcomes. MATERIALS AND METHODS: From an initial number of 10 patients, seven were contactable and available for analysis. All patients underwent PCL and/or PLC reconstruction (modified Larson’s procedure) between 2017 and 2019. The mean age of our cohort was 31.4±9.6 years (range, 21 to 46). Assessment of functional outcomes pre- and postoperatively were done using the Lysholm knee scoring scale, the Knee injury and Osteoarthritis Outcome Score (KOOS) and visual analogue scale (VAS). The mean follow-up from operation at time of reporting was seven months (range, 2 to 12 months). RESULTS: There were four combined PCL and PLCs, two isolated PLCs and one patient who underwent an isolated PCL reconstruction. There were significant improvements between pre-operative and post-operative in all functional outcome scores utilised following PCL reconstruction and/or modified Larson’s reconstruction. Lysholm knee scoring scale improved from pre-operative to post-operative at 41.14±12.32 to 74.86±13.52 (p=0.0001), KOOS from 49.71±11.19 to 71.43±13.84 (p=0.001), and VAS from 5.71±2.06 to 2.86±2.48 (p=0.001). Our sub-analysis showed that higher functional outcomes were present when surgery was done less than six months from the time of index injury. There were no complications (eg. Infections, revisions) in this cohort at the time of reporting. CONCLUSION: Reconstructive surgery for PCL and/or PLC injury is successful in increasing the functional outcomes of patients post-operatively. Delays from injury to surgery remains a problem in the public setting as patients may need to await appropriate imaging and approval of funding. Increased awareness for early surgical intervention may improve overall outcomes of PCL and/or PLC reconstruction in Malaysia

INTRODUCTION: Optimal coronal and sagittal component positioning is important in achieving a successful outcome following total knee arthroplasty (TKA). Modalities to determine post-operative alignment include plain radiography and computer tomography (CT) imaging. This study aims to determine the accuracy and reliability of plain radiographs in measuring coronal and sagittal alignment following TKA. MATERIALS AND METHODS: A prospective, consecutive study of 58 patients undergoing TKA was performed comparing alignment data from plain radiographs and CT imaging. Hip- knee-angle (HKA), sagittal femoral angle (SFA) and sagittal tibial angle (STA) measurements were taken by two observers from plain radiographs and compared with CT alignment. Intra- and inter-observer correlation was calculated for each measurement. RESULTS: Intra-observer correlation was excellent for HKA (r>0.89) with a mean difference of 0.95) and STA (r>0.8) compared to SFA (r=0.5). When comparing modalities (radiographs vs CT), HKA estimations for both observers showed the least maximum and mean differences while SFA observations were the least accurate. CONCLUSION: Radiographic estimation of HKA showed excellent intra- and inter-observer correlation and corresponds well with CT imaging. However, radiographic estimation of sagittal plane alignment was less reliably measured and correlated less with CT imaging. Plain radiography was found to be inferior to CT for estimation of biplanar prosthetic alignment following TKA.

Background: Accelerometer-based, portable navigation devices have been introduced as a less invasive and simpler technique to perform navigated surgical implantation of knee prostheses. They have been postulated to have better accuracy than conventional instruments in restoration of alignment in total knee arthroplasty., Methods: A total of 190 patients were enrolled in this prospective, randomized controlled trial and underwent total knee arthroplasty using either the KneeAlign or conventional guides. Multiplanar alignment was evaluated with a CT imaging protocol., Results: A total of 86.5% of portable navigation device and 82.2% of conventional group had a postoperative hip-knee angle within 3° of neutral alignment (P = .54). There was no significant difference between the 2 groups for component coronal and sagittal plane alignment. Portable navigation device did not significantly increase the time to perform the surgery., Conclusion: Portable navigation device demonstrates accurate restoration of alignment; however, there was no statistically significant difference when compared with conventional guides., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Antithrombotic therapy remains crucial in the peri- and post-operative management of patients who undergo orthopaedic surgical procedures, particularly total joint arthroplasty (TJA) and hip fracture surgery (HFS). Optimal thromboprophylaxis is currently mandatory in most orthopaedic practices to avoid the dreaded complications of venous thromboembolism (VTE). The pathogenesis of VTE is multifactorial and includes the well-known Virchow's triad of hypercoagulability, venous stasis, and endothelial damage. With current advances in orthopaedic surgery, a multimodal approach to thromboprophylaxis, anaesthetic management, and post-operative convalescence have altered the risks of venous thromboembolism after TJA and HFS in the lower extremity. This article reviews the various VTE prophylactic options and current best practice guidelines for orthopaedic TJA and HFS.

Objective: Hyaluronic acid (HA) is a naturally occurring substance within normal synovial joints. Although its efficacy in treating osteoarthritis has been evaluated, it has not been established whether it is of benefit after routine arthroscopic procedures. We hypothesized that immediate supplementation with HA after completion of arthroscopy would result in improved short-term analgesic and functional outcomes after knee arthroscopy., Design: Double-blinded randomized controlled trial., Setting: Tertiary referral center., Patients: One hundred ten patients presenting for routine arthroscopic procedures were invited to participate in the study. After exclusion criteria were applied, 98 patients were randomized to receive either 10 mL of 0.5% bupivacaine or 3 mL of HA into the joint immediately after completion of surgery., Interventions: After completion of surgery, all patients were randomized to receive either 10 mL of 0.5% bupivacaine or 3 mL of HA into the knee joint., Main Outcome Measures: Visual analogue scale (VAS) pain scores were obtained at baseline; 1, 2, and 24 hours; and 1, 2, and 6 weeks after surgery. Western Ontario and McMaster Universities (WOMAC) and Tegner-Lysholm scores were obtained at baseline and then at 1, 2, and 6 weeks after surgery., Results: Forty-nine patients received intra-articular bupivacaine and 49 received HA. There was no statistical difference in any of the outcome measures (VAS pain scores, WOMAC, and Tegner-Lysholm) at any time point between the groups overall., Conclusions: There was no benefit of HA injection immediately at the end of knee arthroscopy in the first 6 weeks after surgery., Clinical Relevance: Routine use of HA at the time of knee arthroscopy cannot be recommended.

Background: Current treatments for the prevention of thromboembolism include heparin and low-molecular weight heparins (LMWHs). A number of studies have suggested that long term administration of these drugs may adversely affect osteoblasts and therefore, bone metabolism. Xarelto™ (Rivaroxaban) is a new anti-thrombotic drug for the prevention of venous thromboembolism in adult patients undergoing elective hip and knee replacement surgery. The aim of this in vitro study was to investigate the possible effects of rivaroxaban on osteoblast viability, function and gene expression compared to enoxaparin, a commonly used LMWH., Methods: Primary human osteoblast cultures were treated with varying concentrations of rivaroxaban (0.013, 0.13, 1.3 and 13 μg/ml) or enoxaparin (1, 10 and 100 μg/ml). The effect of each drug on osteoblast function was evaluated by measuring alkaline phosphatase activity. The MTS assay was used to assess the effect of drug treatments on cell proliferation. Changes in osteocalcin, Runx2 and BMP-2 messenger RNA (mRNA) expression following drug treatments were measured by real-time polymerase chain reaction (PCR)., Results: Rivaroxaban and enoxaparin treatment did not adversely affect osteoblast viability. However, both drugs caused a significant reduction in osteoblast function, as measured by alkaline phosphatase activity. This reduction in osteoblast function was associated with a reduction in the mRNA expression of the bone marker, osteocalcin, the transcription factor, Runx2, and the osteogenic factor, BMP-2., Conclusions: These data show that rivaroxaban treatment may negatively affect bone through a reduction in osteoblast function.