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Fulltext Review Article: Stem Cell Therapy in Orthopaedic Surgery:Current Status and Ethical Considerations

Hui,J.H.P., Azura M., Lee, E.H.

Malays Orthop J, 2009;3(1):4-12.
MyJurnal

Regenerative medicine using stem cell therapy has sparked much interest in this 21st century not only because of the controversies that surround the ethics involving pluripotent stem cells but their potential for use in the clinic. The ability of stem cells to repair and regenerate new tissues and organs holds tremendous promise for the treatment of many serious diseases and injuries. This review provides a brief summary of the current status of research in stem cells with special emphasis on where we are in terms of the possible clinical application of stem cell therapy in orthopaedic surgery. We look at the available evidence and examine the ethical issues and considerations associated with the clinical use of stem cells.

Matched MeSH terms: Orthopedics
Fulltext Robotic surgery: where are we today?

Obaid, Kadhim Jawad, Sood, Suneet

Medical Health Reviews, 2009;2009(1):59-73.
MyJurnal

Robotic surgery is a technique that uses mechanical, computercontrolled arms to conduct surgical operations. It carries the advantages of minimal access associated with laparoscopic surgery, and of precision associated with open surgery. It is also feasible to conduct robotic surgery with the surgeon far away, by “telerobotics”. The robot is more versatile than the human arm, and less susceptible to tremors. The view is excellent, and it is possible to conduct more intricate procedures than are possible with the human hand. Robotics has been in use for over seven years, and the initial experience shows that the success rate is over 90%, with only about 10% of cases needing to be converted to open surgery. Blood loss is low, and tumour margins in cancer surgery are satisfactory. Surgeons have used robotics for procedures in urology, gastrointestinal surgery, gynecology, cardiac surgery, neurosurgery, orthopedics, and other specialties. Presently, robotics suffers from two major disadvantages: one, that it is very expensive, and two, that robotic procedures take significantly longer than do open or laparoscopic procedures.

Matched MeSH terms: Orthopedics
Satkunaraja Ayaduray

N Z Med J, 1976 Jan 28;83(556):57.
PMID: 766781
Matched MeSH terms: Orthopedics/history
Sedation with dexmedetomidine versus propofol during regional anaesthesia: comparing haemodynamic parameters, respiratory rates and offset times

Nadia, M.N., Samsul Johari, M.A., Muhammad, M., Raha, A.R., Nurlia, Y.

Journal of Surgical Academia, 2012;2(2):15-20.
MyJurnal

This study aimed to compare dexmedetomidine and propofol, in terms of haemodynamic parameters, respiratory rates and offset times, when used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia. This was a prospective, randomised, single-blind study where 88 patients were recruited. Patients were randomised into two groups to receive either dexmedetomidine or propofol infusion. Central neuraxial blockade (spinal, epidural or combined spinal epidural) was performed. After ensuring an adequate block and stable haemodynamic parameters, dexmedetomidine was infused 15 minutes later at 0.4 μg/kg/hr, and propofol, at a target concentration of 2.5 μg/ml. Both drugs were titrated to achieve a bispectral index score of 70 before surgery commenced. Sedation level was monitored using the bispectral index score and assessed by the Observer Assessment of Alertness Scale score. Drug infusion was adjusted to maintain bispectral index scores ranging between 70-80 during surgery. Both groups showed reductions in mean arterial pressure and heart rate from baseline readings throughout the infusion time. However there was no significant reduction in the first 15 minutes from baseline (p > 0.05). Haemodynamic parameters and respiratory rate between both groups were not significantly different (p > 0.05). No patient demonstrated significant respiratory depression or SpO2 ≤ 95%. Offset times were also not significantly different between both groups (p = 0.594). There were no significant differences in haemodynamic parameters, respiratory rates and offset times between dexmedetomidine and propofol used for sedation in patients undergoing elective orthopaedic and surgical procedures under regional anaesthesia.

Matched MeSH terms: Orthopedics
Skills assessment for undergraduate orthopaedic education

Harwant S, Pravin D, Teng EM

Med J Malaysia, 2005 Aug;60 Suppl D:69-70.
PMID: 16315628
Matched MeSH terms: Orthopedics/education*
Fulltext Surgical Management of Freiberg Disease by Dorsal Closing Wedge Osteotomy

Dhar SA, Mir NA, Dar TA

Malays Orthop J, 2020 Nov;14(3):161-165.
PMID: 33403078 DOI: 10.5704/MOJ.2011.025

Introduction: The purpose of the study was to assess the efficacy of the dorsal closing wedge osteotomy for the treatment of Freiburg's infraction.
Material and Methods: Twenty patients with Freiburg's infraction were admitted at our hospital over a period of six years. Patients with a normal plantar contour of the metatarsal head were included. All patients underwent a dorsal closing wedge osteotomy of the metatarsal.
Results: The mean Leeds Movement Performance Index (LMPI) score was 84 (range 70-86). The mean metatarsal shortening was 2mm. the passive flexion restriction was 16° and extension restriction was 10°. Also, a strong negative correlation was found between Smillie classification and American Orthopaedic Foot and Ankle Score (AOFAS) final score (r's = -0.85, P < .001).
Conclusion: The dorsal closing wedge osteotomy is an efficient and reproducible method for the management of Freiburg's infraction.

Matched MeSH terms: Orthopedics
Survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association

Lee JK, Mitchell PJ, Ang SB, Mercado-Asis LB, Rey-Matias R, Li J, et al.

Arch Osteoporos, 2024 Apr 02;19(1):24.
PMID: 38565791 DOI: 10.1007/s11657-024-01375-6

A survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association conducted in 2022 found considerable variation in care across the region. A Call to Action is proposed to improve acute care, rehabilitation and secondary fracture prevention across Asia Pacific.
PURPOSE: Fragility fractures impose a substantial burden on older people and their families, healthcare systems and national economies. The current incidence of hip and other fragility fractures across the Asia Pacific region is enormous and set to escalate rapidly in the coming decades. This publication describes findings of a survey of awareness and attitudes to the management of fragility fractures among the membership of the Asia Pacific Orthopaedic Association (APOA) conducted in 2022.
METHODS: The survey was developed as a collaboration between the Asia Pacific Osteoporosis and Fragility Fracture Society and the Asia Pacific Fragility Fracture Alliance, and included questions relating to aspects of care upon presentation, during surgery and mobilisation, secondary fracture prevention, and access to specific services.
RESULTS: In total, 521 APOA members completed the survey and marked variation in delivery of care was evident. Notable findings included: Fifty-nine percent of respondents indicated that analgesia was routinely initiated in transit (by paramedics) or within 30 minutes of arrival in the Emergency Department. One-quarter of respondents stated that more than 80% of their patients underwent surgery within 48 hours of admission. One-third of respondents considered non-hip, non-vertebral fractures to merit assessment of future fracture risk. One-third of respondents reported the presence of an Orthogeriatric Service in their hospital, and less than a quarter reported the presence of a Fracture Liaison Service.
CONCLUSION: A Call to Action for all National Orthopaedic Associations affiliated with APOA is proposed to improve the care of fragility fracture patients across the region.

Matched MeSH terms: Orthopedics*
Fulltext Systemic Absorption of Gentamicin Irrigation in JointReplacement Surgery: A cause of concern

Lee, K.H., Ng, A.B.Y., Tan, T.B., Mossinac, K., To, B.C. Se

Malays Orthop J, 2008;2(2):11-15.
MyJurnal

Gentamicin, whether administered either intravenously, incorporated into bone cement or for local intra-operative irrigation, is a commonly used antibiotic in orthopaedic practice. The former two have been well studied, however the literature on the therapeutic efficacy and safety of gentamicin irrigation is sparse. The objective of this study was to assess systemic absorption of gentamicin irrigation in joint replacement surgery. This was a non-randomised, prospective study. Ninety-eight patients (group A) who underwent total joint replacement and 40 patients (group B) who underwent hemi-arthroplasty were treated traoperatively with gentamicin irrigation. Serum gentamicin levels were assayed at 4 hours and 24 hours post-surgery. Sixteen of 98 patients in group A (16%) and 12 out of 40 patients in group B (30%) were found to have serum gentamicin level above 2mcg/ml at 4 hours post-surgery. We conclude that intra-articular gentamicin irrigation is systemically absorbed at substantial levels.

Matched MeSH terms: Orthopedics
Teaching and training in orthopaedics at undergraduate level in Malaysia: the consumers' viewpoint

Harwant S

Med J Malaysia, 2002 Dec;57 Suppl E:27-30.
PMID: 12733189
Matched MeSH terms: Orthopedics/education*
Fulltext The Malaysian Orthopaedic Association humanitarian mission to Indonesia and Sri Lanka

Sharaf I, Saw A, Hyzan Y, Sivananthan KS

Med J Malaysia, 2005 Jul;60 Suppl C:3-7.
PMID: 16381273

The tsunami which occurred off the west coast of North Sumatra on December 26, 2004 devastated the coastal areas of North Sumatra, South-West Thailand, South-East India and Sri Lanka killing more than a quarter of a million people. The destruction was enormous with many coastal villages destroyed. The other countries affected were Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Kenya, Tanzania and the Seychelles. In January 2005, volunteers went in weekly rotation to Banda Aceh in collaboration with Global Peace Mission. These were Dr Hyzan Yusof, Dr Suryasmi Duski, Dr Sharaf Ibrahim, Dr Saw Aik, Dr Kamariah Nor and Dr Nor Azlin. In Banda Aceh, the surgical procedures that we could do were limited to external fixation of open fractures and debriding infected wounds at the Indonesian Red Crescent field hospital. In February, a team comprising Dato Dr K S Sivananthan, Dr T Kumar and Dr S Vasan spent a week in Sri Lanka. In Sri Lanka, Dato Sivananthan and his team were able to perform elective orthopaedic operations in Dr Poonambalam Memorial Hospital. We appealed for national and international aid and received support from local hospitals and the orthopaedic industry. International aid bound for Banda Aceh arrived in Kuala Lumpur from the Philippine Orthopaedic Association, the Chiba Children's Hospital in Japan and the Chinese Orthopaedic Association. The COA donated 1.5 tons of orthopaedic equipments. A special handing over ceremony from the COA to the Indonesian Orthopaedic Association was held in Putrajaya in March. Malaysia Airlines flew in the donated equipment to Kuala Lumpur while the onward flight to Aceh was provided by the Royal Malaysian Air Force. In April, Dr Saw Aik and Dr Yong Su Mei joined the Tsu-Chi International Medical Association for volunteer services on Batam Island, Indonesia. The MOA acknowledges the many individuals and organizations, both governmental and non-governmental, for their contributions in the humanitarian efforts.

Matched MeSH terms: Orthopedics*
Fulltext The Role of Real Time Ultrasound in Differentiatingbetween Osteomyelitis and Tumour in Long Bones

George, J., Teo, S.C., Adan, M.

Malays Orthop J, 2008;2(1):33-37.
MyJurnal

Aim: This study was designed to evaluate the use of ultrasound in diagnosis of infection and tumour of long bones. Methodology: Patients referred from the orthopaedic unit with doubt regarding long bone clinical and/or radiological signs which could be tumour or infection were enrolled in this study. Analysis of ultrasound characteristics included presence of pericortical fluid over normal cortex well away from the primary lesion, wavy contour sign (fluid tracking in and out muscle planes), subperiosteal fluid and soft tissue mass displacing adjacent muscle planes. Results: Fourteen out of 15 patients with confirmed osteomyelitis were diagnosed by ultrasound examination. Ultrasound as a diagnostic tool has a sensitivity of 93% and specificity of 100%. The most accurate indicator was pericortical fluid noted up to several centimetres from the long bone abnormality seen on plain x-rays. Conclusion: Ultrasound is a safe, fast, cost-effective imaging modality that can play an important role in diagnosis of osteomyelitis as it then serves as a tool for ultrasound guided aspiration.

Matched MeSH terms: Orthopedics
Fulltext The formulation of classification for Islamization in medicine: review on 15 years of publications from Kulliyyah of Medicine

Mohammad Arif Shahar, Mohd Faiz Idris, Che Anuar Che Mohamad, Zul Azlin Razali

International Medical Journal Malaysia, 2018;17(101):43-48.
MyJurnal

The Kulliyyah of Medicine of IIUM has pioneered the Islamization of Medicine in Malaysia since its establishment in year 1994. Therefore, it is timely to review publications on Islamization by the kulliyyah and also to propose a classification system in the field of researches to promote an organized, comprehensive, inclusive and relevant Islamization process. The aim is to review and classify publications on Islamization performed by the members of Kulliyyah of Medicine, International Islamic University Malaysia (IIUM). All researches and publications deposited in the IIUM Repository (IREP) under the Kulliyyah of Medicine between 1st of January 2000 and 31st of August 2016 were reviewed. Journal articles, posters and proceedings with Islamization themes were identified. These publications were classified based on common themes to either of the following; 1) "Islamic Principles and Related Rulings in Medicine"; 2) "Medical Treatment for Muslim Patients"; 3) "Islamic Input in Medical Practices"; 4) "Ruqyah and Tibb an-Nabawi in Contemporary Medicine". A total of 1616 items (journal articles, abstracts and proceedings) were reviewed. Sixty-one (3.8%) of them were related to Islamization. The major contributors to writings in Islamization are the Orthopaedics, Traumatology and Rehabilitation Department (10%) followed by the Internal Medicine Department (7.9%), from their total deposits in the IREP database. Majority (36.5%) of work were done in "Islamic Principles and Related Rulings in Medicine", which dwells in subjects such as euthanasia, autonomy and doctor-patient relationship followed by "Islamic Input in Medical Practice" (28.6%) which was related to topics in the medical curriculum such as Fiqh Ibadah for the sick. Twenty-three point eight percent (23.8%) of work were in the "Medical Treatment for Muslim Patients" which focuses on Ramadan and diabetes and joint problems and Solat. Minimal work (7.9%) was done in the "Ruqyah and Tibb an-Nabawi in Contemporary Medicine" category. Low number of publications on Islamization was deposited in the IREP database for the past 15 years. Based on the proposed classification system, majority of publications were on "Islamic Principles and Related Rulings in Medicine" and "Islamic Input in Medical Practice". More work is required on the theme of "Medical Treatment for Muslim Patients" and "Ruqyah and Tibb an-Nabawi in Contemporary Medicine".

Matched MeSH terms: Orthopedics
The incidence of post-operative deep vein thrombosis in general surgical patients of hospital universiti sains malaysia

Tun M, Shuaib IL, Muhamad M, Mat Sain AH, Ressang AS

Malays J Med Sci, 2004 Jan;11(1):75-80.
PMID: 22977363

The incidence of deep vein thrombosis is believed to be rare in Asians. During recent years, a few reports have appeared with high incidence in orthopaedic patients comparable to Western studies. This study was carried out to find out the incidence of post-operative deep vein thrombosis (DVT) after major surgical procedures in general surgical patients in an Asian population. In a prospective study of 45 consecutive Asian patients after major general surgery, colour-flow duplex scan of the legs as an initial screening was done twice within two weeks. Mean age of the patients was 54 years 5 months and 87% of patients were included in the moderate and high risk group for deep vein thrombosis. Ascending venography was used to confirm deep vein thrombosis on patients with equivocal or positive results from colour flow duplex scan. One patient showed positive evidence of post-operative deep vein thrombosis on colour flow duplex scan which was further confirmed by ascending venography; giving an incidence of 2.2%. The incidence of post-operative deep vein thrombosis in general surgical patients is lower than the Western studies.

Matched MeSH terms: Orthopedics
Fulltext The incidence of post-operative wound infection in orthopaedic surgery

Dhillon KS, Kok CS

Med J Malaysia, 1995 Sep;50(3):237-40.
PMID: 8926901

With the increase in the number of orthopaedic surgeons and the aggressive marketing by manufacturing companies, high technology orthopaedic surgery is being more frequently carried out in Malaysia. Post-operative sepsis complicating this type of surgery can have disastrous consequences. No data is available in this country on the incidence of post-operative infection in Orthopaedic Surgery. The aim of this study was to determine the incidence of post-operative infection. A retrospective survey of 703 patients undergoing elective Orthopaedic Surgery in the year 1991 was carried out. We found an overall post-operative infection rate of 6.8% and a deep infection rate of 3.3%. This figure of 3.3% is higher than the internationally accepted figure of less than 2%. A need for ongoing surveillance and concerned effort to reduce the infection rate is stressed.

Matched MeSH terms: Orthopedics/statistics & numerical data*
Fulltext The prevalence of accidental needle stick injury and their reporting among healthcare workers in orthopaedic wards in General Hospital Melaka, Malaysia

Bhardwaj, A., Sivapathasundaram, N., Yusof, M. F., Minghat, A. H., Swe, K. M. M., Sinha, N. K.

Malays Orthop J, 2014;8(2):6-13.
MyJurnal

Accidental needle-stick injuries (NSIs) are a hazard for health-care workers and general public health. Orthopaedic surgeons may be more prone to NSIs due to the prevalence of bone spikes in the operative field and the use of sharp orthopaedic instruments such as drills, saws and wires. A hospital-based cross sectional study was conducted in the orthopedic wards of Melaka General Hospital. The prevalence of NSIs was 32 (20.9%) and majority of it occurred during assisting in operation theatre 13(37.4%). Among them six (18.8%) were specialist, 12(37.5%) medical officer, 10 (31.2%) house officer and four staff nurses (12.5%). Among the respondents 142 (92.8%) had been immunized against Hepatitis B and 148 (96.7%) participants had knowledge regarding universal precaution. The incidence of NSI among health care workers at orthopaedics ward was not any higher in comparison with the similar studies and it was found out that the prevalence was more in junior doctors compared with specialist and staff nurses and it was statistically significant.

Matched MeSH terms: Orthopedics
Fulltext The prevalence of postoperative symptoms within 24 hours after ambulatory surgery in a University Hospital

Adlin Dasima, A.K., Karis, M.

Journal of Surgical Academia, 2013;3(2):32-38.
MyJurnal

Ambulatory surgery has now becoming increasingly popular and it is generally well accepted. Major complications following ambulatory surgery are very rare but certain postoperative symptoms can be very unpleasant and distressing to the patients. Follow-up phone calls regarding their well being at home following the surgery may give us the clue and allow us to identify certain problems that can be sorted out immediately or as a reference for a better service in future. The present study was carried out to determine the prevalence of common postoperative symptoms and their subsequent effects within 24 hours after ambulatory surgery by follow-up phone calls. We prospectively studied 199 ASA I and II patients, but only 187 patients were analyzed. Patients had undergone general surgery, orthopaedic, urology, gynaecology or ear, nose and throat (ENT) surgery. Pain was scored based on Numerical Rating Scale (NRS). Majority of patients (70.8%) had only mild pain prior to discharge home. At 24 hours postoperatively, pain was the commonest symptom reported (92.5%) followed by sleepiness (72.2%), dizziness (49.7%), sore throat (17.1%), nausea and vomiting (7.5%) and headache (7%). Sleep was mildly affected in nearly 50% of the patients. Fifty seven percent of patients did not need assistance in performing daily activities during the 24 hours, post surgery. Majority of patients were satisfied (81.3%) with ambulatory surgery. In conclusion, pain was the commonest postoperative symptom encountered following the surgery. Sleep was mildly affected by the postoperative symptoms. Most of the patients did not need assistance in performing their daily activities following surgery. All patients were able to return to at least more than 50% of their normal daily activities at 24 hours after the surgery. Overall satisfaction towards ambulatory surgery was good.

Matched MeSH terms: Orthopedics
The unusual traumatic locked young knee

Mohd Miswan MF, Latiff Alsagoff S, Muhamad Effendi F, Ibrahim MI

Malays Fam Physician, 2019;14(2):26-28.
PMID: 31827732

Locked knee is an orthopaedic condition requiring urgent treatment. Although the condition can be diagnosed via history, physical examination and imaging studies, the cause of the mechanical obstruction may only be apparent during arthroscopic examination of the knee joint. It is known that imaging plays a role in evaluating the integrity of intra-articular structures, however in some atypical cases, imaging cannot identify the definitive cause of locked knee. Here we report on two cases of locked knee, due to uncommon conditions which were unobservable via normal imaging studies.

Matched MeSH terms: Orthopedics
Thermomechanical investigations of PEKK-HAp-CS composites

Singh R, Singh G, Singh J, Kumar R, Rahman MM, Ramakrishna S

Proc Inst Mech Eng H, 2019 Nov;233(11):1196-1203.
PMID: 31545132 DOI: 10.1177/0954411919877979

In this experimental study, a composite of poly-ether-ketone-ketone by reinforcement of hydroxyapatite and chitosan has been prepared for possible applications as orthopaedic scaffolds. Initially, different weight percentages of hydroxyapatite and chitosan were reinforced in the poly-ether-ketone-ketone matrix and tested for melt flow index in order to check the flowability of different compositions/proportions. Suitable compositions revealed by the melt flow index test were then taken forward for the extrusion of filament required for fused deposition modelling. For thermomechanical investigations, Taguchi-based design of experiments has been used with input variables in the extrusion process as follows: temperature, load applied and different composition/proportions. The specimens in the form of feedstock filament produced by the extrusion process were made to undergo tensile testing. The specimens were also inspected by differential scanning calorimetry and photomicrographs. Finally, the specimen showing the best performance from the thermomechanical viewpoint has been selected to extrude the filament for the fused deposition modelling process.

Matched MeSH terms: Orthopedics
Fulltext Tissue Diagnosis for Musculoskeletal Tumours

Saw, A.

Malays Orthop J, 2007;1(2):1-2.
MyJurnal

Musculoskeletal tumour is much less common compared to tumours of epithelial origin. Most of these tumours are benign, with only about 1% malignant in nature. A general orthopaedic surgeon may only come across a malignant primary bone or soft tissue tumour a few times in his entire medical career. The current recommendation is for these conditions to be investigated and treated in centres with musculoskeletal oncology service. Careful clinical evaluation with appropriate plain radiography can provide adequate information for definitive diagnosis and treatment for most cases, especially the benign tumours. For some other cases, further investigations will be necessary. Magnetic resonance imaging (MRI) can provide excellent details on anatomical location of a tumour and delineate vital structures that may have been distorted by the lesion. For primary malignant tumours, computerized tomography scanning is still the gold standard for evaluation of pulmonary metastasis, and bone scan can allow early detection of distant metastasis to other bones. Whole body MRI has recently been recommended for tumour staging but the potential benefit for musculoskeletal tumour is not that convincing. PET may be very helpful for follow up detection of tumour recurrence but its role in diagnosis and staging of musculoskeletal tumours is still being evaluated...

Matched MeSH terms: Orthopedics
Fulltext Titanium and titanium based alloys as metallic biomaterials in medical applications – spine implant case study

Nur Azida Che Lah, Muhamad Hellmy Hussin

Pertanika Journal of Science & Technology, 2019;27(1):459-472.
MyJurnal

Titanium (Ti) and Ti-based alloys presence the most widely applied as advanced biomaterials
in biomedical implant applications. Moreover, these alloys are known to be the most
valuable metallic materials including spinal cord surgical treatment. It becomes an interest
due to its advantages compared to others, including its bio compatibility and corrosion
resistant. However, an issue arises when it comes for permanent implant application as
the alloy has a possible toxic effect produced from chemical reaction between body fluid
environments with alloys chemical compositions. It also relies on the performance of
neighbouring bone tissue to integrate with the implant surface. Abnormalities usually
happen when surrounding tissue shows poor responses and rejection of implants that would
leads to body inflammation. These cause an increase in foreign body reaction leading to
severe body tissue response and thus, loosening of the implant. Corrosion effects and
biocompatibility behaviour of implantation usage also become one of the reasons of
implant damage. Here, this paper reviews the importance of using Ti and Ti-based alloys
in biomedical implantation, especially in orthopaedic spinal cord injury. It also reviews the
basic aspects of corrosion effects that lead to implant mechanical damage, poor response
of body rejection and biocompatibility behaviour of implantation usage.

Matched MeSH terms: Orthopedics

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