Displaying publications 1 - 20 of 69 in total

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  1. Chan CK, Lam TY, Mohanavel L, Ghani JA, Anuar ASK, Lee CJ, et al.
    Am J Infect Control, 2024 Jan;52(1):35-40.
    PMID: 37423404 DOI: 10.1016/j.ajic.2023.06.022
    BACKGROUND: Recent studies found white coats to be reservoirs for bacteria and medical students did not conform to proper hygiene measures when using these white coats. We investigated the knowledge, attitude, and practice (KAP) of medical students toward white coat use in clinical settings (LAUNDERKAP).

    METHODS: A validated, online-based survey was disseminated to 670 students from four Malaysian medical schools via random sampling. Scores were classified into good, moderate, or poor knowledge and practice, and positive, neutral, or negative attitude. Mann-Whitney U and Kruskal-Wallis tests were used to analyze the relationship between demographic variables and knowledge, attitude, and practice scores.

    RESULTS: A total of 492/670 students responded (response rate: 73.4%). A majority showed negative attitudes (n = 246, 50%), poor knowledge (n = 294, 59.8%), and moderate practice (n = 239, 48.6%). Senior and clinical year students had more negative attitudes. Male students had higher knowledge, while students from private medical schools and preclinical years had better practice. There was a significant relationship between attitude and practice (r = 0.224, P 

  2. Jiang BH, Hsiao FC, Lin YR, Lin CH, Shen YA, Hsu YY, et al.
    ACS Appl Mater Interfaces, 2023 Mar 01;15(8):10907-10917.
    PMID: 36700551 DOI: 10.1021/acsami.2c20527
    Near-infrared (NIR) small-molecule acceptors that absorb at wavelengths of up to 1000 nm are attractive for applications in organic photodetectors (OPDs) and biometrics. In this study, we incorporated IEICO-4F as the third component for PffBT4T-2OD:PC71BM-based OPDs to provide an efficient NIR response while greatly suppressing the leakage current at reverse bias. By varying the blend ratio and thickness (250-600 nm), we obtained an NIR OPD displaying an ultralow dark-current density (JD = 2.62 nA cm-2), ultrahigh detectivity [D* = 7.2 × 1012 Jones (850 nm)], high sensitivity, and photoresponsivity covering the region from the ultraviolet to the NIR. We used tapping-mode atomic force microscopy, optical microscopy, grazing-incidence wide-angle X-ray scattering, and contact angle measurements to investigate the effect of IEICO-4F on the performance of the ternary OPDs. The low compatibility of PffBT4T-2OD and IEICO-4F, originating from weak intermolecular interactions, allowed us to manipulate the degree of phase separation between the donor and acceptor in the ternary blends, leading to an optimized blend morphology featuring efficient charge separation, transport, and collection. To demonstrate its applicability, we integrated our OPD with two light-emitting diodes and used the system for precisely calculated transmissive pulse oximetry.
  3. Mat S, Jaafar MH, Razack AHA, Lim J, Ong TA, Khong SY, et al.
    Neurourol Urodyn, 2023 Mar;42(3):641-649.
    PMID: 36728321 DOI: 10.1002/nau.25136
    INTRODUCTION: The common assumption that urinary incontinence occurs in osteoarthritis (OA) due to poor mobility is supported by limited evidence. The influence of gender in such associations is also yet to be elucidated.

    OBJECTIVE: This study, therefore, identified any potential associations between knee OA symptoms and urinary incontinence and further explore sex differences in the associations.

    DESIGN: Cross-sectional study.

    SETTING: University Hospital.

    PARTICIPANTS: This was a cross-sectional study from a longitudinal research study comprising 1221 community-dwelling older persons (57% women), mean age (SD) 68.95 (7.49) years.

    MAIN OUTCOME MEASURE(S): Presence of urinary incontinence: mixed, stress and urge symptoms. Physical performance and C-reactive protein levels were also assessed.

    RESULTS: Two hundred and seventy-seven (22.83%) individuals reported the presence of urinary incontinence: mixed (41.5%), stress (30%), and urge (28.5%) symptoms. In an unadjusted analysis, stratified by gender, the association between knee pain and urinary incontinence was only present in women with mixed symptoms. After further adjustment of demographics differences and body mass index, the association between knee pain with any urinary incontinence and mixed symptoms remained significant with the odds ratios (95% confidence interval): 1.48 (1.02-2.15) and 1.73 (1.06-2.83), respectively. This relationship was attenuated after further adjustment for waist circumference and impaired lower limb mobility.

    CONCLUSION: Our study refutes previous assumptions that urinary incontinence in individuals with OA is attributed to impaired mobility alone, but introduces the role of abdominal obesity in this relationship, particularly in women. Future studies should assess the temporal relationship between body fat distribution and OA with urinary incontinence.

  4. Chan CK, Lim KS, Low SK, Tan CT, Ng CC
    Epilepsy Res, 2023 Jan;189:107070.
    PMID: 36584483 DOI: 10.1016/j.eplepsyres.2022.107070
    Epilepsy is a complex neurological disease that can be caused by both genetic and environmental factors. Many studies have been conducted to investigate the genetic risk variants and molecular mechanisms of epilepsy. Disruption of excitation-inhibition balance (E/I balance) is one of the widely accepted disease mechanisms of epilepsy. The maintenance of E/I balance is an intricate process that is governed by multiple proteins. Using whole exome sequencing (WES), we identified a novel GABRA1 c.448G>A (p.E150K) variant and ERBB4 c.1972A>T (p.I658F, rs190654033) variant in a Malaysian Chinese family with genetic generalized epilepsy (GGE). The GGE may be triggered by dysregulation of E/I balance mechanism. Segregation of the variants in the family was verified by Sanger sequencing. All family members with GGE inherited both variants. However, family members who carried only one of the variants did not show any symptoms of GGE. Both the GABRA1 and ERBB4 variants were predicted damaging by MutationTaster and CADD, and protein structure analysis showed that the variants had resulted in the formation of additional hydrogen bonds in the mutant proteins. GABRA1 variant could reduce the efficiency of GABAA receptors, and constitutively active ERBB4 receptors caused by the ERBB4 variant promote internalization of GABAA receptors. The interaction between the two variants may cause a greater disruption in E/I balance, which is more likely to induce a seizure. Nevertheless, this disease model was derived from a single small family, further studies are still needed to confirm the verifiability of the purported disease model.
  5. Zaghlul N, Goh SL, Razman R, Danaee M, Chan CK
    PLoS One, 2023;18(1):e0280361.
    PMID: 36649257 DOI: 10.1371/journal.pone.0280361
    The validity and reliability of the Lafayette stability platform are well-established for double leg testing. However, no evaluation of single leg (SL) stance on the platform was discovered yet. Therefore, this study aimed to investigate the reliability of conducting the SL stance on the Lafayette platform. Thirty-six healthy and active university students (age 23.2 ± 3.2 years; BMI 21.1 ± 3.1 kg/m2) were tested twice, one week apart (week 1; W1, week 2; W2). They stood on their dominant leg with eyes-open (EO) and eyes-closed (EC) in random order. Three successful trials of 20 seconds each were recorded. The duration during which the platform was maintained within 0° of tilt was referred to as time in balance (TIB). At all-time points, TIB was consistently longer in EO (EOW1: 17.02 ± 1.04s; EOW2: 17.32 ± 1.03s) compared to EC (ECW1: 11.55 ± 1.73s; ECW2: 13.08 ± 1.82s). A ±10 seconds difference was demonstrated in the Bland-Altman analysis in both EO and EC. Lower standard error of measurement (SEM) and coefficient of variation (CV) indicated consistent output. High intraclass correlation coefficient (ICC) values were seen between weeks (EO = 0.74; EC = 0.76) and within weeks (EOW1 = 0.79; EOW2 = 0.86; ECW1 = 0.71; ECW2 = 0.71). Although statistical measures (i.e., SEM, CV, and ICC) indicated good reliability of Lafayette for SL tasks, the wide agreement interval is yet to be clinically meaningful. Factors underlying the wide variation need to be identified before Lafayette is used for TIB assessment.
  6. Fan Q, Wider W, Chan CK
    Front Psychol, 2023;14:1181930.
    PMID: 37780163 DOI: 10.3389/fpsyg.2023.1181930
    This paper presents a literature review on the topic of organizational performance. The study conceptualizes the overall performance of the organization as comprising of organizational citizenship behaviors (OCB) and counterproductive work behaviors (CWB). While there are numerous research studies on OCB, not many have focused on how OCB and CWB affect organizational performance simultaneously. The paper provides an explanation of the OCB and CWB concepts, followed by the primary research and focus of the study. The article presents a comprehensive framework for understanding the meanings of OCB and CWB, along with an internal hierarchy. This framework will serve as a beneficial resource for working managers, academics, and researchers, who seek to optimize economic productivity through improved understanding and management of OCB and CWB.
  7. Chan CK, Lam TY, Mohanavel L, Ghani JA, Anuar ASK, Lee CJ, et al.
    Am J Infect Control, 2022 Dec;50(12):1374-1380.
    PMID: 35292298 DOI: 10.1016/j.ajic.2022.02.033
    BACKGROUND: Medical students' white coats were found to harbor harmful organisms. This could be due to non-compliance to white coat hygiene measures. Therefore, we aim to develop and validate a questionnaire to assess the of knowledge, attitude, and practice (LAUNDERKAP) of white coat use among medical students in Malaysia.

    METHODS: This study was conducted in 4 local medical schools. LAUNDERKAP was developed via literature review and had 3 domains: attitude, knowledge, practice. An expert panel assessed the content validity and clarity of wording. LAUNDERKAP was then piloted among 32 medical students. To test construct validity and internal consistency, 362 medical students were approached. Construct validity was assessed using exploratory factor analysis. Internal consistency was evaluated using Cronbach alpha for attitude and practice, while Kuder-Richardson 20 (KR-20) was used for knowledge.

    RESULTS: A total of 319 of 362 students responded. Exploratory factor analysis extracted 1 factor each for attitude and knowledge respectively, and 3 factors for practice. Cronbach alpha for attitude was 0.843 while KR-20 for knowledge was 0.457. Cronbach alpha for practice ranged from 0.375 to 0.689. The final LAUNDERKAP contained 32-items (13 attitude, 9 knowledge, 10 practice).

    CONCLUSIONS: LAUNDERKAP had adequate psychometric properties and can be used to assess KAP of medical students towards white coat use.

  8. Wider W, Lim MX, Wong LS, Chan CK, Maidin SS
    Int J Environ Res Public Health, 2022 Dec 01;19(23).
    PMID: 36498158 DOI: 10.3390/ijerph192316084
    The Movement Control Order (MCO) enacted during the COVID-19 pandemic has profoundly altered the social life and behaviour of the Malaysian population. Because the society is facing huge social and economic challenges that need individuals to work together to solve, prosocial behaviour is regarded as one of the most important social determinants. Because it is related with individual and societal benefits, participating in prosocial activities may be a major protective factor during times of global crisis. Rather than focusing only on medical and psychiatric paradigms, perhaps all that is necessary to overcome the COVID-19 risks is for individuals to make personal sacrifices for the sake of others. In reality, a large number of initiatives proven to be beneficial in decreasing viral transmission include a trade-off between individual and collective interests. Given its crucial importance, the purpose of this concept paper is to provide some insight into prosocial behaviour during the COVID-19 period. Understanding prosocial behaviour during the COVID-19 pandemic is crucial because it may assist in the establishment of a post-COVID society and provide useful strategies for coping with future crises.
  9. Choo SW, Chong JL, Gaubert P, Hughes AC, O'Brien S, Chaber AL, et al.
    Sci Total Environ, 2022 Feb 14.
    PMID: 35176378 DOI: 10.1016/j.scitotenv.2022.153666
  10. Lau YS, Tan LK, Chan CK, Chee KH, Liew YM
    Phys Med Biol, 2021 Dec 31;66(24).
    PMID: 34911053 DOI: 10.1088/1361-6560/ac4348
    Percutaneous coronary intervention (PCI) with stent placement is a treatment effective for coronary artery diseases. Intravascular optical coherence tomography (OCT) with high resolution is used clinically to visualize stent deployment and restenosis, facilitating PCI operation and for complication inspection. Automated stent struts segmentation in OCT images is necessary as each pullback of OCT images could contain thousands of stent struts. In this paper, a deep learning framework is proposed and demonstrated for the automated segmentation of two major clinical stent types: metal stents and bioresorbable vascular scaffolds (BVS). U-Net, the current most prominent deep learning network in biomedical segmentation, was implemented for segmentation with cropped input. The architectures of MobileNetV2 and DenseNet121 were also adapted into U-Net for improvement in speed and accuracy. The results suggested that the proposed automated algorithm's segmentation performance approaches the level of independent human obsevers and is feasible for both types of stents despite their distinct appearance. U-Net with DenseNet121 encoder (U-Dense) performed best with Dice's coefficient of 0.86 for BVS segmentation, and precision/recall of 0.92/0.92 for metal stent segmentation under optimal crop window size of 256.
  11. Chong PP, Panjavarnam P, Ahmad WNHW, Chan CK, Abbas AA, Merican AM, et al.
    Clin Biomech (Bristol, Avon), 2020 10;79:105178.
    PMID: 32988676 DOI: 10.1016/j.clinbiomech.2020.105178
    BACKGROUND: Cartilage damage, which can potentially lead to osteoarthritis, is a leading cause of morbidity in the elderly population. Chondrocytes are sensitive to mechanical stimuli and their matrix-protein synthesis may be altered when chondrocytes experience a variety of in vivo loadings. Therefore, a study was conducted to evaluate the biosynthesis of isolated osteoarthritic chondrocytes which subjected to compression with varying dynamic compressive strains and loading durations.

    METHODS: The proximal tibia was resected as a single osteochondral unit during total knee replacement from patients (N = 10). The osteoarthritic chondrocytes were isolated from the osteochondral units, and characterized using reverse transcriptase-polymerase chain reaction. The isolated osteoarthritic chondrocytes were cultured and embedded in agarose, and then subjected to 10% and 20% uniaxial dynamic compression up to 8-days using a bioreactor. The morphological features and changes in the osteoarthritic chondrocytes upon compression were evaluated using scanning electron microscopy. Safranin O was used to detect the presence of cartilage matrix proteoglycan expression while quantitative analysis was conducted by measuring type VI collagen using an immunohistochemistry and fluorescence intensity assay.

    FINDINGS: Gene expression analysis indicated that the isolated osteoarthritic chondrocytes expressed chondrocyte-specific markers, including BGN, CD90 and HSPG-2. Moreover, the compressed osteoarthritic chondrocytes showed a more intense and broader deposition of proteoglycan and type VI collagen than control. The expression of type VI collagen was directly proportional to the duration of compression in which 8-days compression was significantly higher than 4-days compression. The 20% compression showed significantly higher intensity compared to 10% compression in 4- and 8-days.

    INTERPRETATION: The biosynthetic activity of human chondrocytes from osteoarthritic joints can be enhanced using selected compression regimes.

  12. Teh KH, Ruben JK, Chan CK, Abbas AA
    Malays Orthop J, 2020 Jul;14(2):134-137.
    PMID: 32983389 DOI: 10.5704/MOJ.2007.022
    Avascular necrosis and non-union are two most dreaded complications of femoral neck fracture fixations. Hip replacement seems to be a simple solution for this complex problem. However, the long-term efficacy of prosthetic replacement in the young population with higher functional demand is still questionable. Femoral head preserving valgus subtrochanteric osteotomies in properly selected cases have strong support from literature. The conventional technique of valgus subtrochanteric osteotomy involves lateral based wedge resection. Alternatively, a simpler sliding oblique subtrochanteric osteotomy without any wedge removal can also be performed. We hereby describe a successful case of sliding subtrochanteric osteotomy with 135° dynamic hip screw (DHS) plate fixation in treating non-union neck of femur fracture in a young gentleman.
  13. Tsai MH, Muir AM, Wang WJ, Kang YN, Yang KC, Chao NH, et al.
    Neuron, 2020 Apr 22;106(2):237-245.e8.
    PMID: 32097630 DOI: 10.1016/j.neuron.2020.01.027
    Lissencephaly (LIS), denoting a "smooth brain," is characterized by the absence of normal cerebral convolutions with abnormalities of cortical thickness. Pathogenic variants in over 20 genes are associated with LIS. The majority of posterior predominant LIS is caused by pathogenic variants in LIS1 (also known as PAFAH1B1), although a significant fraction remains without a known genetic etiology. We now implicate CEP85L as an important cause of posterior predominant LIS, identifying 13 individuals with rare, heterozygous CEP85L variants, including 2 families with autosomal dominant inheritance. We show that CEP85L is a centrosome protein localizing to the pericentriolar material, and knockdown of Cep85l causes a neuronal migration defect in mice. LIS1 also localizes to the centrosome, suggesting that this organelle is key to the mechanism of posterior predominant LIS.
  14. Chan CK, Low JS, Lim KS, Low SK, Tan CT, Ng CC
    Neurol Sci, 2020 Mar;41(3):591-598.
    PMID: 31720899 DOI: 10.1007/s10072-019-04122-9
    INTRODUCTION: Genetic (idiopathic) generalized epilepsy (GGE) is a common form of epilepsy characterized by unknown aetiology and a presence of genetic component in its predisposition.

    METHODS: To understand the genetic factor in a family with GGE, we performed whole exome sequencing (WES) on a trio of a juvenile myoclonic epilepsy/febrile seizure (JME/FS) proband with JME/FS mother and healthy father. Sanger sequencing was carried out for validation of WES results and variant detection in other family members.

    RESULTS: Predictably damaging variant found in affected proband and mother but absent in healthy father in SCN1A gene was found to be associated with generalized epilepsy and febrile seizure. The novel non-synonymous substitution (c.5753C>T, p.S1918F) in SCN1A was found in all family members with GGE, of which 4/8 were JME subtypes, and/or febrile seizure, while 3 healthy family member controls did not have the mutation. This mutation was also absent in 41 GGE patients and 414 healthy Malaysian Chinese controls.

    CONCLUSION: The mutation is likely to affect interaction between the sodium channel and calmodulin and subsequently interrupt calmodulin-dependent modulation of the channel.

  15. Koh SM, Chan CK, Teo SH, Singh S, Merican A, Ng WM, et al.
    Knee, 2020 Jan;27(1):26-35.
    PMID: 31917106 DOI: 10.1016/j.knee.2019.10.028
    PURPOSE: Osteoarthritis (OA) of the knee is a multifactorial degenerative disease typically defined as the 'wear and tear' of articular joint cartilage. However, recent studies suggest that OA is a disease arising from chronic low-grade inflammation. We conducted a study to investigate the relationship between chronic inflammatory mediators present in both the systemic peripheral blood system and localised inflammation in synovial fluid (SF) of OA and non-OA knees; and subsequently made direct comparative analyses to understand the mechanisms that may underpin the processes involved in OA.

    METHODS: 20-Plex proteins were quantified using Human Magnetic Luminex® assay (R&D Systems, USA) from plasma and SF of OA (n = 14) and non-OA (n = 14) patients. Ingenuity Pathway Analysis (IPA) software was used to predict the relationship and possible interaction of molecules pertaining to OA.

    RESULTS: There were significant differences in plasma level for matrix metalloproteinase (MMP)-3, interleukin (IL)-27, IL-8, IL-4, tumour necrosis factor-alpha, MMP-1, IL-15, IL-21, IL-10, and IL-1 beta between the groups, as well as significant differences in SF level for IL-15, IL-8, vascular endothelial growth factor (VEGF), MMP-1, and IL-18. Our predictive OA model demonstrated that toll-like receptor (TLR) 2, macrophage migration inhibitory factor (MIF), TLR4 and IL-1 were the main regulators of IL-1B, IL-4, IL-8, IL-10, IL-15, IL-21, IL-27, MMP-1 and MMP-3 in the plasma system; whilst IL-1B, TLR4, IL-1, and basigin (BSG) were the regulators of IL-4, IL-8, IL-10, IL-15, IL-18, IL-21, IL-27, MMP-1, and MMP-3 in the SF system.

    CONCLUSION: The elevated plasma IL-8 and SF IL-18 may be associated with the pathogenesis of OA via the activation of MMP-3.

  16. Nizar MHA, Chan CK, Khalil A, Yusof AKM, Lai KW
    Curr Med Imaging, 2020;16(5):584-591.
    PMID: 32484093 DOI: 10.2174/1573405615666190114151255
    BACKGROUND: Valvular heart disease is a serious disease leading to mortality and increasing medical care cost. The aortic valve is the most common valve affected by this disease. Doctors rely on echocardiogram for diagnosing and evaluating valvular heart disease. However, the images from echocardiogram are poor in comparison to Computerized Tomography and Magnetic Resonance Imaging scan. This study proposes the development of Convolutional Neural Networks (CNN) that can function optimally during a live echocardiographic examination for detection of the aortic valve. An automated detection system in an echocardiogram will improve the accuracy of medical diagnosis and can provide further medical analysis from the resulting detection.

    METHODS: Two detection architectures, Single Shot Multibox Detector (SSD) and Faster Regional based Convolutional Neural Network (R-CNN) with various feature extractors were trained on echocardiography images from 33 patients. Thereafter, the models were tested on 10 echocardiography videos.

    RESULTS: Faster R-CNN Inception v2 had shown the highest accuracy (98.6%) followed closely by SSD Mobilenet v2. In terms of speed, SSD Mobilenet v2 resulted in a loss of 46.81% in framesper- second (fps) during real-time detection but managed to perform better than the other neural network models. Additionally, SSD Mobilenet v2 used the least amount of Graphic Processing Unit (GPU) but the Central Processing Unit (CPU) usage was relatively similar throughout all models.

    CONCLUSION: Our findings provide a foundation for implementing a convolutional detection system to echocardiography for medical purposes.

  17. Tan LT, Chan CK, Chan KG, Pusparajah P, Khan TM, Ser HL, et al.
    Cancers (Basel), 2019 Nov 06;11(11).
    PMID: 31698795 DOI: 10.3390/cancers11111742
    New and effective anticancer compounds are much needed as the incidence of cancer continues to rise. Microorganisms from a variety of environments are promising sources of new drugs; Streptomyces sp. MUM256, which was isolated from mangrove soil in Malaysia as part of our ongoing efforts to study mangrove resources, was shown to produce bioactive metabolites with chemopreventive potential. This present study is a continuation of our previous efforts and aimed to investigate the underlying mechanisms of the ethyl acetate fraction of MUM256 crude extract (MUM256 EA) in inhibiting the proliferation of HCT116 cells. Our data showed that MUM256 EA reduced proliferation of HCT116 cells via induction of cell-cycle arrest. Molecular studies revealed that MUM256 EA regulated the expression level of several important cell-cycle regulatory proteins. The results also demonstrated that MUM256 EA induced apoptosis in HCT116 cells mediated through the intrinsic pathway. Gas chromatography-mass spectrometry (GC-MS) analysis detected several chemical compounds present in MUM256 EA, including cyclic dipeptides which previous literature has reported to demonstrate various pharmacological properties. The cyclic dipeptides were further shown to inhibit HCT116 cells while exerting little to no toxicity on normal colon cells in this study. Taken together, the findings of this project highlight the important role of exploring the mangrove microorganisms as a bioresource which hold tremendous promise for the development of chemopreventive drugs against colorectal cancer.
  18. Jin C, Zhao JY, Santoso A, Song EK, Chan CK, Jin QH, et al.
    Medicine (Baltimore), 2019 Sep;98(39):e17134.
    PMID: 31574814 DOI: 10.1097/MD.0000000000017134
    The aim of this study was to determine whether primary repair for intraoperative injury of the medial collateral ligament (MCL) can achieve satisfactory clinical results when compared to the clinical results of patients with no MCL injury. Simultaneously, we sought to determine the differences between 2 methods of primary repair (anchor suture and staple) in terms of their clinical outcomes.In our institute, 3897 total-knee arthroplasties (TKAs) were performed between 2003 and 2014. Sixty-five patients who suffered an MCL injury during the TKA procedure and in whom the injury was repaired with a suture anchor or staple (suture anchor: 36 vs staple: 29) were studied. A matched group of 65 patients without an MCL injury was selected to serve as the control group. Subjective feelings of instability and functional outcomes were assessed using the knee society (KS) score and the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC). Objective stability was evaluated by the measurement of opening angles in extension and at 30° of knee flexion on valgus stress radiographs. The clinical outcomes and stability results were compared between the suture anchor and staple methods.The KS and WOMAC scores in patients who received primary repair of MCL injury during TKA improved from 50.6 ± 13.1 to 87.3 ± 7.3 (P 
  19. Park KS, Chan CK, Kim SK, Li QS, Im CJ, Yoon TR
    J Orthop Sci, 2019 May;24(3):452-457.
    PMID: 30415823 DOI: 10.1016/j.jos.2018.10.016
    BACKGROUND: Due to concern of potential metallosis caused by residual microscopic ceramic particles, metal-on-metal (MoM) bearing is deemed undesirable in revision total hip arthroplasty (THA) for ceramic bearing fracture. We determined whether MoM bearing is suitable to be used in revision THA for ceramic fractures and also evaluated whether this treatment increases serum iron levels compared with MoM bearing revision THA for polyethylene failure.

    METHODS: Between 2006 and 2012, 22 patients underwent revision surgery using MoM bearing (28 mm femoral head in 18 hips and 32 mm in 4 hips) for ceramic bearing fracture and followed average 52.1 months. We assessed radiological parameter and functional outcome using Harris hip score (HHS) and WOMAC score. Also, serum cobalt (Co) and chromium (Cr) blood tests were performed and compared with the result obtained from age, sex- and follow-up duration-matched patients with MoM revision THA for failed polyethylene bearing.

    RESULTS: The mean HHS improved from 60.6 preoperatively to 90.3 at final follow-up. There were no changes in cup position, progression of osteolytic lesions, and measurable wear of MoM bearing articulation at final follow-up radiographs. There was one case of recurrent dislocation after surgery, which was treated with greater trochanter distal advancement and one case of deep infection, which underwent two-stage revision. Mean serum Co level (1.7 vs. 1.4 μg/dl; p = 0.211) and Cr level (0.70 vs. 1.01 μg/dl; p = 0.327) showed no significant difference.

    CONCLUSIONS: MoM articulation with liner cementation into the acetabular cup along with total synovectomy can be chosen in revision surgery for ceramic fracture with good midterm follow-up. However, the use of MoM bearing is indicated when the stem and metal shell can be retained and ceramic on ceramic or ceramic on polyethylene bearing cannot be selected. Also long-term outcome needs to be further evaluated.

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