Introduction: The only treatment for grade IV knee osteoarthritis is total knee arthroplasty (TKA) irrespective of the age of the patient. Most of the grade IV OA patient are elderly and most likely to have some comorbidities. Age and comorbidities are the major reasons for patient's reluctance to undergo TKA. A clinical pathway with standard length of stay (LOS) could justify the patient's hesitation for TKA. The aim of this study was to determine the factors, including age and comorbidity, that affect the LOS of patients treated with TKA. Materials and Methods: This is a retrospective study of TKA patients in Surabaya Orthopedics and Traumatology Hospital from January 2011 to July 2017. Preoperative comorbidities were scored using Charlson Comorbidity Index (CCI) and physical status by ASA (American Society of Anesthesiologist), classification for age, sex, BMI, blood loss, operation time, method of anaesthesia and postoperative day of rehabilitation were recorded as factors potentially affecting LOS. The discharge criteria for the patients were ability to ambulate to the bathroom and clean operative wound with no complications. The data obtained were analysed statistically. Results: The average LOS was 5.58 days, ranging from three to eight days. There were no demographic factors that affected the patients' LOS. BMI, ASA, CCI, and blood loss did not significantly affect LOS. Operation time was between 90-140 minutes, and spinal anaesthesia showed significant longer LOS, but within the average. Conclusion: Age and comorbidity did not affect length of stay in TKA patients.
Introduction: Percutaneous vertebroplasty (PV) is one of the available treatments for vertebral compression fracture (VCF). Polymethylmethacrylate (PMMA) is the most common bone substitute used in the procedure, but it has several disadvantages. Bioceramic material, such as hydroxyapatite (HA), has better biological activity compared to PMMA. The aim of this study was to find an optimal biomaterial compound which offers the best mechanical and biological properties to be used in PV. Materials and Methods: This was an experimental study with goat (Capra aegagrus hircus) as an animal model. The animals' vertebral columns were injected with PMMA-HA compound. Animal samples were divided into four groups, and each group received a different proportion of PMMA:HA compound. The mechanical and biological effects of the compound on the bone were then analysed. The mechanical effect was assessed by measuring the vertebral body's compressive strength. Meanwhile, the biological effect was assessed by analysing the callus formation in the vertebral body. Results: The optimal callus formation and compressive strength was observed in the group receiving PMMA:HA with a 1:2 ratio. Conclusion: A mixture of PMMA and HA increases the quality of callus formation and the material's compressive strength. The optimum ratio of PMMA:HA in the compound is 1:2.