MyMedR

An intramedullary cement spacer in total hip arthroplasty

Deshmukh RG, Thevarajan K, Kok CS, Sivapathasundaram N, George SV

J Arthroplasty, 1998 Feb;13(2):197-9.

Revision arthroplasty of the hip is often complicated by infection, bone loss, and perioperative fracture of the femur. A simple, inexpensive spacer that keeps tissue planes intact and prevents soft tissue contracture during the interoperative period of a 2-stage revision is described. This can provide intramedullary support to a fractured or weak femur and enable local antibiotic delivery, as well as permit limited mobilization of the patient. It can be easily fabricated during surgery using universally available materials and can be tailored for specific requirements. Such a spacer was used in 5 cases. The experience is presented, and the technique and pitfalls are discussed.

Matched MeSH terms: Arthroplasty, Replacement, Hip/instrumentation*

Fulltext Simultaneous bilateral total knee replacement

Lopez JM, Sivanantham M

Med J Malaysia, 1998 Sep;53 Suppl A:102-6.

PMID: 10968191

This paper summarises our experience of twenty one patients with degenerative arthritis treated by bilateral simultaneous total knee replacement (BSTKR) in Tawakal Hospital in a period of twenty two months vis. January 1994 to November 1995. The results were analysed according to the scoring system of Hospital for Special Surgery. The preliminary observations were encouraging, 90% excellent, 8% good and 2% fair results. The benefits, safety and cost effectiveness of the procedure as compared to the unilateral staged knee replacement are discussed. We recommend that BSTKR be routinely practised for appropriate situations in all institutions where the expertise and facilities are available.

Matched MeSH terms: Arthroplasty, Replacement, Knee*

Fulltext Postal surveys: is it worth the effort?

Yeap JS, Yeap JK, Ruslan NG

Med J Malaysia, 1999 Dec;54(4):539.

PMID: 11072481

Matched MeSH terms: Arthroplasty, Replacement, Hip

Subcutaneous emphysema and pneumomediastinum after endotracheal anaesthesia

Chiu CL, Ong GS

Ann Acad Med Singap, 2000 Mar;29(2):256-8.

PMID: 10895351

INTRODUCTION: We report a case of subcutaneous emphysema and pneumomediastinum that presented postoperatively after tracheal extubation.

CLINICAL PICTURE: A 51-year-old man had an uneventful anaesthesia lasting about 6.5 hours. Intubation was performed by a very junior medical officer and was considered difficult. He developed sore throat, chest pain, numbness of both hands and palpable crepitus around the neck postoperatively. Chest X-ray revealed diffuse subcutaneous emphysema, pneumomediastinum and possible pneumopericardium.

TREATMENT: He was treated conservatively with bed rest, oxygen, analgesia, antibiotic prophylaxis, reassurance and close monitoring.

OUTCOME: The patient made an uneventful recovery.

CONCLUSIONS: We discussed the possible causes.

Matched MeSH terms: Arthroplasty, Replacement, Hip/adverse effects

Fulltext Total hip arthroplasty in Malaysia--the Universiti Kebangsaan Malaysia and Hospital Kuala Lumpur experience

Tay BH, Masbah O, Razak M, Ruslan GNS

Med J Malaysia, 2000 Sep;55 Suppl C:74-85.

PMID: 11200048

The results of 109 primary total hip arthroplasties in 92 patients performed in Hospital Kuala Lumpur from January 1987 to December 1996 were reviewed after a mean follow-up of 30.8 months. There were 22 males and 70 females with the average age of 49.9 years (range 19 to 94 years). Chinese females comprised the largest group of patients (52.2%). Avascular necrosis was the most common diagnosis (33.1%) followed by hip dysplasia and primary osteoarthritis (17.4%). The procedure was performed more on the right hip (64.2%) compared to the left (35.8%). All patients received prophylactic antibiotics but none were given deep vein thrombosis prophylaxis. The Charnley prosthesis was most commonly used and the majority of the arthroplasties were cemented (60.5%). About 80% of the THA were performed via the lateral approach. The functional hip score improved from an average of 8.9 to 15.0 with 66.3% of the patients categorized as good and excellent results. There were 16 patients (17.4%) with poor outcome. The most common complications encountered were dislocation (10.1%), aseptic loosening (9.2%) and periprosthetic fracture (5.5%). Other complications were deep infection (1.8%), deep vein thrombosis (0.9%), trochanteric osteotomy complications (1.8%), superficial infection (7.3%), urinary tract infection (5.5%), pressure sore (3.7%) and respiratory complication (1.8%). Fifteen hips (13.8%) required revision. The causes for revision were aseptic loosening, dislocation and infection. Technical anomalies were recognized as one of the factors contributing to poor results. Five-year survival rate was 87.3%. Better results can be expected with increasing experience and technical skulls.

Matched MeSH terms: Arthroplasty, Replacement, Hip*

Fulltext Risk factors for infection in total hip replacement surgery at Hospital Kuala Lumpur

Yong KS, Kareem BA, Ruslan GN, Harwant S

Med J Malaysia, 2001 Jun;56 Suppl C:57-60.

PMID: 11814251 MyJurnal

Sixty-seven primary THR surgeries in 57 patients between January 1992 and December 1998 were reviewed after a mean follow-up of 35.9 months. The rate of superficial and deep wound infections were 11.9% and 1.5% respectively. The most common organism in superficial wound infection was Staphylococcus aureus. The factors that were significantly associated with superficial wound infection were diabetes mellitus (p= 0.0230) obesity (p=0.0088). The patients who developed superficial wound infection have a significantly longer duration of surgery compared to patients without infection (p=0.014). However, there was no significant difference between the mean age among patients with and without superficial wound infection (p=0.814).

Matched MeSH terms: Arthroplasty, Replacement, Hip/adverse effects*; Arthroplasty, Replacement, Hip/statistics & numerical data*

Fulltext Risk factors for infection in total knee replacement surgery at Hospital Kuala Lumpur

Syahrizal AB, Kareem BA, Anbanadan S, Harwant S

Med J Malaysia, 2001 Dec;56 Suppl D:5-8.

PMID: 14569758 MyJurnal

One hundred primary TKR surgeries done between January 1994 and December 1999 were reviewed after a mean follow-up of 37.4 months. The rate of superficial and deep wound infection were 2% and 9% respectively. The most common organism in wound infection was Staphylococcus aureus. The factors that were significantly associated with superficial wound infection were diabetes mellitus (p = 0.005) and rheumatoid arthritis (p = 0.0000). The factors that were significantly associated with deep wound infection were diabetes mellitus (p = 0.000). There was no significant difference between duration of surgery, and the mean age among patients with and without wound infections.

Matched MeSH terms: Arthroplasty, Replacement, Knee/adverse effects*; Arthroplasty, Replacement, Knee/statistics & numerical data

Small stem Exeter total hip replacement: clinical and radiological follow-up over a minimum of 2.5 years

Sivananthan S, Arif M, Choon DS

J Orthop Surg (Hong Kong), 2003 Dec;11(2):148-53.

PMID: 14676339

To evaluate the clinical and radiological outcome in patients undergoing small stem Exeter total hip replacement.

Matched MeSH terms: Arthroplasty, Replacement, Hip/instrumentation*

Revision of total hip arthroplasty using an anterior cortical window, extensive strut allografts, and an impaction graft: follow-up study

Arif M, Sivananthan S, Choon DS

J Orthop Surg (Hong Kong), 2004 Jun;12(1):25-30.

PMID: 15237118

To report the outcome of revised total hip arthroplasty procedures involving an anterior cortical window, extensive strut allografts, and an Exeter impaction graft.

Matched MeSH terms: Arthroplasty, Replacement, Hip/adverse effects*; Arthroplasty, Replacement, Hip/methods

Fulltext Early results of metal on metal articulation total hip arthroplasty in young patients

Mohamad JA, Kwan MK, Merican AM, Abbas AA, Kamari ZH, Hisa MK, et al.

Med J Malaysia, 2004 Dec;59 Suppl F:3-7.

PMID: 15941153

We report our early experience of 20 cases of metal on metal articulation total hip arthroplasty in 19 young patients. Avascular necrosis of the femoral head (63%) was the commonest diagnosis for patients undergoing this procedure, followed by osteoarthritis (21%). In general, most of the patients were young and physically active with an average age of 43.1 years (range, 25 to 58 years). The average follow-up period was 18 months (range, 7 to 46 months). The mean total Harris Hip Score preoperatively and at final follow-up was 31 points and 89 points respectively. The mean total Pain Score improved from an average of 11.5 to 41.1 points at final follow-up. Sixteen (84%) of the patients had a good to excellent hip score. There was one dislocation, which stabilized after reduction and conservative management. One case of early infection underwent a two-staged revision.

Matched MeSH terms: Arthroplasty, Replacement, Hip/instrumentation*

Fulltext New hips for old! Lessons from the Arabian Nights

Harwant S

Med J Malaysia, 2004 Dec;59 Suppl F:2.

PMID: 15941152

Matched MeSH terms: Arthroplasty, Replacement, Hip/instrumentation*

Fulltext Early results of Rotating Platform total knee replacement

Arif M, Makundala V, Choon DSK

Med J Malaysia, 2005 Jul;60 Suppl C:99-103.

PMID: 16381292 MyJurnal

We report on our early experiences with the Press Fit Condylar Rotating Platform (PFC-RP) total knee replacement prosthesis at University Malaya Medical Centre. This new prosthesis was introduced to Malaysia in 2001. It combines the rotating platform technology of Low Contact Stress (LCS) and the modularity of Press Fit Condylar (PFC) system. We performed 18 knee replacements using cruciate retaining prosthesis without patellar resurfacing in 10 patients and followed them up over a period of 16-month. A new operative strategy was developed to match the flexion and extension gaps. The pre- and post-operative assessments were made according to the American Knee Society Scores (AKSS). Post-operative pain relief, range of motion, knee score and functional score showed promising early results. The average knee rating improved from 28 to 91 (range 75-94). Average functional assessment improved from 26 to 82 (range 75-90). The radiographic assessments show correction of an average pre-operative varus of 140 to post-operative valgus of 50 (range 4-70). Early infection occurred in two knees. Both responded to aggressive debridement and antibiotics. Stiffness was encountered in one patient. There were no spinouts of the insert. We are satisfied that the implants are performing well at the one-year mark and will continue monitor this cohort.

Matched MeSH terms: Arthroplasty, Replacement, Knee*

Midterm results of cemented Press Fit Condylar Sigma total knee arthroplasty system

Asif S, Choon DS

J Orthop Surg (Hong Kong), 2005 Dec;13(3):280-4.

PMID: 16365492

To evaluate the midterm results of 50 patients who underwent total knee replacement using Press Fit Condylar (PFC) Sigma system.

Matched MeSH terms: Arthroplasty, Replacement, Knee/instrumentation*

Fulltext Antimicrobial properties of erythromycin and colistin impregnated bone cement. An in vitro analysis

Ruzaimi MY, Shahril Y, Masbah O, Salasawati H

Med J Malaysia, 2006 Feb;61 Suppl A:21-6.

PMID: 17042224

Deep surgical site infection is a devastating consequence of total joint arthroplasty. The use of antibiotic impregnated bone cement is a well-accepted adjunct for treatment of established infection and prevention of deep orthopaedic infection. It allows local delivery of the antibiotic at the cement-bone interface and sustained release of antibiotic provides adequate antibiotic coverage after the wound closure. Preclinical testing, randomised and clinical trials indicate that the use of antibiotic-impregnated bone cement is a potentially effective strategy in reducing the risk of deep surgical site infection following total joint arthroplasty. The purpose of this study was to assess antibacterial activity of erythromycin and colistin impregnated bone cement against strains of organisms' representative of orthopaedic infections including Gram-positive and Gram-negative aerobic organisms: Staphylococcus aureus, coagulase-negative Staphylococci, Enterococcus sp., Proteus sp., Klebsiella sp., Pseudomonas sp., and Escherichia coli. Pre-blended Simplex P bone cement with the addition of erythromycin and colistin (Howemedica Inc) was mixed thoroughly with 20ml liquid under sterile conditions to produce uniform cylindrical discs with a diameter of 14mm and thickness of 2mm. 24-48 hour agar cultures of Staphylococcus aureus, coagulase-negative Staphylococci, Enterococcus sp.,Proteus sp., Klebsiella sp.,Pseudomonas sp., and Escherichia coli were used for the agar diffusion tests. The agar plates were streaked for confluent growth followed by application of erythromycin and colistin impregnated bone cement disc to each agar plate. The plates were incubated at 30 degrees C and examined at 24, 48, 72 hours, and four and five days after the preparation of the impregnated cement. The susceptibility of Staphylococcus aureus to the control discs was most clearly demonstrated showing a distinct zone of inhibition. The zone observed around coagulase-negative Staphylococci, Klebsiella sp., Pseudomonas sp., and Escherichia coli were also significant. However, there was no zone of inhibition or signs of antibacterial activity at the cemented surface were detected around discs with Enterococcus sp. and Proteus sp. The results showed that Simplex P bone cement with the addition of erythromycin and colistin was effective against most of the broad spectrum organisms encountered during total joint arthroplasty. The activity of Simplex P bone cement impregnated with erythromycin and colistin is mainly during the first 72 hours.

Matched MeSH terms: Arthroplasty, Replacement/adverse effects

Fulltext Biomechanical properties of bone cement with addition of cefuroxime antibiotic

Mohd Fuad D, Masbah O, Shahril Y, Jamari S, Norhamdan MY, Sahrim SH

Med J Malaysia, 2006 Feb;61 Suppl A:27-9.

PMID: 17042225

Antibiotic-loaded bone cement has been used as prophylaxis against infection in total joint replacement surgery. Its effect on the mechanical strength of cement is a major concern as high dose of antibiotic was associated with a significant reduction in mechanical strength of bone cement. However, the cut-off antibiotic that weakens the mechanical strength of cement remains to be determined. This study was undertaken to observe the changes in the mechanical properties of bone cement with gradual increments of Cefuroxime antibiotic. Cefuroxime at different doses: 0, 1.5, 3.0 and 4.5gm were added to a packet of 40gm bone cement (Simplex P) and study samples were prepared by using third generation cementing technique. Mechanical impact, flexural and tensile strength were tested on each sample. Significant impact and tensile strength reduction were observed after addition of 4.5 gm of Cefuroxime. However, flexural strength was significantly reduced at a lower dose of 3.0 gm. The maximum dose of Cefuroxime to be safely added to 40mg Surgical Simplex P is 1.5gm when third generation cementing technique is used. Further study is needed to determine whether it is an effective dose as regards to microbiological parameters.

Matched MeSH terms: Arthroplasty, Replacement, Hip/adverse effects

Fulltext Apollo total knee replacements in University Malaya Medical Centre: a short-term outcome

Abbas AA, Merican AM, Kwan MK, Mohamad JA

Med J Malaysia, 2006 Feb;61 Suppl A:83-7.

PMID: 17042237

Total knee arthroplasty is the most preferred option for treatment of severe osteoarthritis of the knee. We report the short-term outcome of 48 total knee replacements in 31 patients utilizing the Apollo Total Knee System after an average follow-up of 48 months (range 15 to 70 months). Records of all patients who underwent TKA using Apollo Total Knee System were retrospectively reviewed. Functional outcome was evaluated using visual analogue scale for pain rating and the Oxford 12-item questionnaire. Postoperative radiographs of the replaced knees were assessed by using the Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Degenerative osteoarthritis was the commonest indication for TKA. The average patient's age was 63.7 years (range, 30-77 years). The mean visual analogue scale for pre- and post-operative pain was eight and zero respectively. The mean Oxford 12-item questionnaire score pre- and post-operatively was 44.8 and 16.5 respectively. Patient satisfaction was notable in 98% of the cases with an average improvement in arc of flexion of 111 degrees. There were four failures; deep infection (one) and aseptic loosening (three) giving rise to a 94% implant survivor. The short-term results of this series is comparable with or better than a number of outcome studies of the Apollo Knee System or other implants of similar design.

Matched MeSH terms: Arthroplasty, Replacement, Knee/methods*

Fulltext Revision total hip arthroplasty using impaction bone grafting technique

Nisar A, Choon DS, Varaprasad M, Abbas AA

Med J Malaysia, 2006 Feb;61 Suppl A:100-2.

PMID: 17042242

A variety of reconstructive options exist for revision of both femoral and acetabular components in total hip replacement surgery. The use of impaction bone grafting with morsellised allograft has shown promising results in revision total hip arthroplasty. It works as a biologic reconstitution of bone stock defects and provides a solid construct with stable fixation. We present a case of bilateral revision total hip arthroplasty with poor bone stock where reconstructive surgery was done by using impaction bone grafting, mesh and C-stem implants.

Matched MeSH terms: Arthroplasty, Replacement, Knee/instrumentation; Arthroplasty, Replacement, Knee/methods*

Fulltext Early results of prosthetic hip replacement for femoral neck fracture in active elderly patients

Wazir NN, Mukundala VV, Choon DS

J Orthop Surg (Hong Kong), 2006 Apr;14(1):43-6.

PMID: 16598086 DOI: 10.1177/230949900601400110

PURPOSE: To evaluate the short-term clinical and functional outcomes of total hip arthroplasty performed for physiologically active elderly patients with Garden type-3 or -4 femoral neck fracture.
METHODS: Records of 47 consecutive patients (40 female, 7 male) with type-3 or -4 femoral neck fracture (Garden classification) who underwent cemented total hip arthroplasty at our hospital during January 1999 to December 2002 were reviewed. Radiological and clinical (Harris functional hip score and Oxford hip score) assessments of 38 patients were measured with a mean follow-up period of 21 months (range, 4-48 months).
RESULTS: The mean age of the 47 patients was 75 years (range, 62-89 years). Records of 9 patients were excluded because of death, lost to follow-up, and development of deep infection that necessitated implant removal and excision arthroplasty. The mean Harris hip score of the 38 patients was 83 (range, 59-97), whereas the mean Oxford hip score was 25.2 (range, 14-33). Pain in the hips was absent in 30 patients, 6 had slight pain occasionally, and 2 patients had mild-to-moderate hip discomfort. No signs of aseptic loosening or change in implant position were noted on radiographic assessment. Two cases of dislocation were reduced by closed reduction. Two patients had deep wound infection and were treated with debridement, implant removal, and conversion to girdle stone.
CONCLUSION: This short-term study showed that total hip arthroplasty for femoral neck fracture had good postoperative results in functional hip and pain scores. More attention should be paid to coexisting medical illness (e.g. diabetes mellitus, hypertension, and ischaemic heart disease) and prevention of infection.

Matched MeSH terms: Arthroplasty, Replacement, Hip*

Fulltext Total knee replacement subsequent to severe necrotising fasciitis of the lower limb

Ling HT, Kwan MK, Saw A, Choon DS

Med J Malaysia, 2006 Aug;61(3):380-2.

PMID: 17240598 MyJurnal

The incidence of wound related complication following total knee arthroplasty is as high as 10%-20%. To perform total knee arthroplasty in a knee with extensive scarring around the knee can be a challenging task. We report a case of 55-year-old diabetic woman, who had total knee arthroplasty, performed two years after she had recovered from necrotizing fasciitis around the right knee. Understanding the vascular anatomy around the knee is of paramount importance in the planning of skin incision to ensure fewer wound related complications.

Matched MeSH terms: Arthroplasty, Replacement, Knee*

Fulltext Recalcitrant infection following total knee arthroplasty: a report of two cases

Zairul-Nizam ZF, Badaruddin BS

J Orthop Surg (Hong Kong), 2006 Aug;14(2):216-8.

PMID: 16914793

Infection following total knee arthroplasty can be devastating. Even with established treatment protocols, eradication of the infection may not be feasible. We report 2 patients who required above-knee amputation to eradicate recalcitrant infection.

Matched MeSH terms: Arthroplasty, Replacement, Knee*

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