Displaying all 4 publications

  1. Ho JPY, Wong AYF, Ong LH, Rutel A, Abdullah S, Jaffar MSA, et al.
    Geriatr Orthop Surg Rehabil, 2023;14:21514593231164245.
    PMID: 36923160 DOI: 10.1177/21514593231164245
    BACKGROUND: Neck of femur fractures result in impaired function for older people. Despite surgery, many patients experience a decrease in functional level and poorer health status after the injury. The objectives of this study were (1) to determine the short-term mobility and hip function of geriatric patients who underwent hip replacement surgery for a displaced neck of femur fracture in our local population and (2) to identify factors which affect the functional outcome of these patients.

    METHODS: Patients aged 60 years and above, who were admitted for neck of femur fracture from January 2017 to December 2020, and treated surgically with arthroplasty, were included. Information on patient demography, comorbidities, perioperative data, mobility, hip function and complications were retrospectively collected. Outcome measures used were independent ambulation and recovery of pre-fracture mobility at 1 year after surgery while hip function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain, stiffness, and physical function scores. Factors associated with these outcomes were analyzed.

    RESULTS: 168 patients with a mean age of 75.2 (SD 8.4) years met the inclusion criteria. 32.1% of patients regained their pre-fracture mobility and 59.6% remained independent 1 year after surgery. Logistic regression analysis identified age, gender, surgical procedure, and time to surgery as significant contributors to recovery of pre-fracture mobility. Older age and increasing requirement for postoperative ambulatory aid resulted in worse WOMAC total and physical function scores. No significant differences were observed in patient-reported hip function between those who had a total hip arthroplasty and those who had a hemiarthroplasty.

    CONCLUSION: Most geriatric patients with displaced neck of femur fractures did not regain pre-fracture mobility despite surgical treatment with arthroplasty.

  2. Siong FT, Kim TW, Kim SC, Lee ES, Jaffar MSA, Lee YS
    J Arthroplasty, 2020 02;35(2):380-387.
    PMID: 31587980 DOI: 10.1016/j.arth.2019.09.005
    BACKGROUND: The aims of this study were to (1) describe our functional stepwise multiple needle puncturing (MNP) technique as the final step in medial ligament balancing during total knee arthroplasty (TKA) and (2) evaluate whether this technique can provide sufficient medial release with safety.

    METHODS: A total of 137 patients with 212 consecutive knees who underwent TKAs with or without functional stepwise MNP of superficial medial collateral ligament was recruited in this prospective cohort. Eighty-one patients with 129 knees who performed serial stress radiographs were enrolled in the final assessment. Superficial medial collateral ligament was punctured selectively (anteriorly or posteriorly or both) and sequentially depending on the site and degree of tightness. Mediolateral stability was assessed using serial stress radiographs and comparison was performed between the MNP and the non-MNP groups at postoperative 6 months and 1 year. Clinical outcomes were also evaluated between 2 groups.

    RESULTS: Fifty-five TKAs required additional stepwise MNP (anterior needling 19, posterior needling 3, both anterior and posterior needling 33). Preoperative hip-knee-ankle angle and the difference in varus-valgus stress angle showed significant difference between the MNP and the non-MNP groups, respectively (P = .009, P = .037). However, there was no significant difference when comparing the varus-valgus stress angle between the MNP and the non-MNP groups during serial assessment. Clinical outcomes including range of motion also showed no significant differences between the 2 groups.

    CONCLUSION: Functional medial ligament balancing with stepwise MNP can provide sufficient medial release with safety in TKA with varus aligned knee without clinical deterioration or complication such as instability.

    LEVEL OF EVIDENCE: Level II, Prospective cohort study.

  3. Kim JE, Won S, Jaffar MSA, Lee JI, Kim TW, Lee YS
    Knee, 2020 Jun;27(3):940-948.
    PMID: 32331827 DOI: 10.1016/j.knee.2020.04.008
    BACKGROUND: Open-wedge high tibial osteotomy (OWHTO) produces three- dimensional (3D) geometric changes. Among them, increased posterior tibial slope (PTS), and altered coronal inclination that induces unintended tibial translation may affect anterior cruciate ligament (ACL) status. The purpose of current study was to evaluate the geometric changes following OWHTO, such as increasing PTS and decreasing tibial subluxation, which may affect the status of ACL.

    METHODS: From April 2014 to December 2015, a total of 72 knees in 64 patients that underwent OWHTO, second-look arthroscopy, and magnetic resonance imaging (MRI) assessment, were enrolled. Preoperative and postoperative coronal and sagittal translation, joint line orientation angle, the distance between medial femoral notch marginal line and medial tibial spine, and PTS were evaluated. ACL status was arthroscopically graded from grade 1 (best) to 4 (worst). The MRI signal of the graft in three portions (proximal, middle, and distal) was graded from grade 1 (best) to 4 (worst).

    RESULTS: High grade (3: partial, and 4: complete rupture) was noted in 28 cases (38.9%) at the second-look arthroscopy compared with 10 cases (13.9%) at index arthroscopy. The MRI signal grade significantly increased at follow up MRI compared with preoperative MRI (P<0.01). An increased signal was commonly noted in the middle and distal portions of the graft.

    CONCLUSIONS: Geometric changes after OWHTO were related to ACL deterioration. The ACL was commonly affected at the middle and distal portions and rarely at the proximal portion. There is a possibility of impingement because of the geometric changes.


  4. Lee JI, Jaffar MSA, Choi HG, Kim TW, Lee YS
    J Knee Surg, 2022 Feb;35(3):299-307.
    PMID: 32659817 DOI: 10.1055/s-0040-1713898
    The purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to -0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18-74) preoperatively to 94.71 (range: 86-100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10-81) preoperatively to 94.14 (range: 86-100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT-TG distance, or valgus alignment. This is a Level 4, case series study.
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