Improving Acetabular Component Positioning in Supine Direct Anterior Total Hip Arthroplasty with a Transparency Template: A Novel, Simple, and Cost-effective Technique / 대한고관절학회지

Purpose@#A novel and simple method to ensure accurate acetabular component anteversion and inclination intraoperatively with the use of a transparency template is described. @*Materials and Methods@#Patients who underwent total hip arthroplasty (THA) via direct anterior approach (DAA) from June 2019 to January 2020 were included. A transparency template that can be placed over the image intensifier monitor to allow surgeons an accurate reading of the acetabular component position intraoperatively was designed, developed and utilized to determine effectiveness. The first template consists of two perpendicular lines indicating the “trans-ischial line” and the “pubic symphysis/coccyx”. The second template consist of a line indicating 45。inclination and parallel lines of corresponding distances apart required to achieve 20。anteversion based on Lewinnek’s formula: version=sin-1 (D1/D2), where D1: minor axis and D2: major axis of the component. This template was used throughout the acetabular part of the surgery, from reaming to impaction of component. Postoperative acetabular inclination, anteversion, surgical duration, length of stay, as well as complications were recorded. @*Results@#Twenty-six patients were included in this study. Mean postoperative acetabular cup inclination was 43.46±3.09。and mean version was 19.98±2.89。. A total of 21 patients (80.8%) fell within the Callanan safe zone and all 26 patients (100%) were within the Lewinnek safe zone. @*Conclusion@#The transparency template is a simple, reproducible, and effective tool with a minimal learning curve and no requirement for expensive equipment. This template has the potential to assist surgeons, especially those who are less experienced with DAA THA, in obtaining better postoperative radiographic outcomes.

Comparison of outcome measures from different pathways following total knee arthroplasty

<p><b>INTRODUCTION</b>The benefits of extended inpatient rehabilitation following total knee arthroplasty (TKA) in local community hospitals (CHs) are unproven. Our study compared functional outcomes between patients discharged home and to CHs following TKA.</p><p><b>METHODS</b>A case-control study was conducted of patients undergoing primary unilateral TKA. Consecutive patients (n = 1,065) were retrospectively reviewed using the Knee Society Clinical Rating System (KSCRS), 36-item Short Form Health Survey (SF-36) and Oxford Knee Score (OKS) preoperatively, and at the six-month and two-year follow-ups.</p><p><b>RESULTS</b>Overall, 967 (90.8%) patients were discharged home and 98 (9.2%) to CHs. CH patients were older (mean age 70.7 vs. 67.2 years; p < 0.0001), female (86.7% vs. 77.5%; p = 0.0388) and less educated (primary education and above: 61.7% vs. 73.8%; p = 0.0081). Median CH length of stay was 23.0 (range 17.0-32.0) days. Significant predictors of discharge destination were older age, female gender, lower education, and poorer ambulatory status and physical health. Preoperatively, CH patients had worse KSCRS Function (49.2 ± 19.5 vs. 54.4 ± 16.8; p = 0.0201), SF-36 Physical Functioning (34.3 ± 22.6 vs. 40.4 ± 22.2; p = 0.0017) and Social Functioning (48.2 ± 35.1 vs. 56.0 ± 35.6; p = 0.0447) scores. CH patients had less improvement for all scores at all follow-ups. Regardless of preoperative confounders, with repeated analysis of variance, discharge destination was significantly associated with KSCRS, SF-36 and OKS scores.</p><p><b>CONCLUSION</b>Older, female and less educated patients with poorer preoperative functional scores were more likely to be discharged to CHs after TKA. At the two-year follow-up, patients in CHs had less improvement in functional outcomes than those discharged home.</p>

Predictors of Midterm Outcomes after Medial Unicompartmental Knee Arthroplasty in Asians

BACKGROUND: This study was designed to evaluate predictors of good outcomes following medial unicompartmental knee arthroplasty (UKA) in Asian patients. METHODS: Registry data of patients who underwent primary unilateral medial UKA from 2006 to 2011 were collected. Outcomes studied were the Oxford Knee Score (OKS) and the Physical Component Score (PCS) of the Short Form 36 (SF-36) questionnaire. These outcome scores were collected prospectively, pre- and postoperatively up to 5 years. Good outcome was defined as an overall improvement in score greater than or equal to the minimal clinically important difference (MCID). The MCID for the OKS was 5 while the MCID for the PCS was 10. Regression analysis was used to identify predictors of good outcomes following medial UKA. RESULTS: Primary medial UKA was performed in 1,075 patients. Higher (poorer) preoperative OKS (odds ratio [OR], 1.27; p < 0.001), lower (poorer) preoperative PCS (OR, 1.08; p < 0.001), lower (poorer) preoperative Knee Society Knee Score (KSKS; OR, 1.02; p < 0.001) and higher (better) preoperative SF-36 Mental Component Score (MCS; OR, 1.02; p < 0.001) were significant predictors of good outcomes. CONCLUSIONS: Patients with poorer OKS, PCS and KSKS and better SF-36 MCS preoperatively tended to achieve good outcomes by the MCID criterion at 5 years following the index surgery.

Incidence of cancer in nodular goitres

<p><b>INTRODUCTION</b>Nodular goitres occur commonly in the population and this paper aims to determine the incidence of thyroid cancer found in these goitres.</p><p><b>MATERIALS AND METHODS</b>This is a retrospective, consecutive analysis of the histology of 268 nodular goitres that had been operated on, from 2002 to 2004, in a single tertiary hospital in Singapore.</p><p><b>RESULTS</b>Fifty-seven goitres (21.2%) with multiple nodules were found to contain a malignancy. Forty-four thyroid cancers (77%) were of the papillary type. The mean age of presentation for benign nodular goitres was 47.9 years. The mean age of presentation for malignant thyroid tumours was 49.25 years.</p><p><b>CONCLUSION</b>The incidence of cancer is significant in nodular goitres and these malignant tumours are usually of the papillary type.</p>