Outcomes of Impaction Bone Grafting in the Management of Acetabular Defects with the Use of Uncemented Acetabular Cups: Do Autografts and Irradiated Femoral Head Allografts Integrate?

Introduction: Acetabular impaction bone grafting (AIBG) has been used widely to reconstruct acetabular defects in complex primary and revision cases. The aim of this study was to look at the outcomes AIBG using either frozen irradiated femoral head allografts or autografts with uncemented acetabular cups. Method: We retrospectively reviewed 38 patients who had AIBG and uncemented cup reconstruction of the acetabulum performed between 2008 and 2021 for complex primary and revision surgery. Graft incorporation, radiological loosening and cup migration were evaluated in follow-up X-rays. Result: There were 24 complex primary and 14 revision total hip arthroplasty. Autografts were used in 10 hips with smaller defects, while 28 hips with larger defects required frozen irradiated femoral head allografts. Using Paprosky classification to evaluate acetabular defects; 8 patients were classified as 2A, 12 as 2B, 7 as 2C, 8 as 3A and 3 as 3B. The Kaplan-Meier survival rate for AIBG with uncemented cups in our series is 89.70% in 10 years. Acetabular cup position was anatomically restored in all autograft AIBG cases and in 25 out of 28 in the allograft group. The mean pre-operative Oxford Hip Score (OHS) was 19 (range 10-24) and post-operative OHS was 39 (range 21-48) (p < 0.001). Conclusions: The mid- to long-term results for AIBG and uncemented acetabular cups is good. With newer and more porous uncemented cups especially revision cups, it may serve as an extended indication to achieve solid fixation together with AIBG technique in managing acetabular defects of ≤ 3A.

Outcome of Arthroscopic All-Inside Posterior Cruciate Ligament Reconstruction Using the Posterior Trans-Septal Approach.

Introduction: Posterior Cruciate Ligament (PCL) reconstruction is a complex surgical procedure and often challenging. The newer posterior trans-septal portal technique is thought to make tibial tunnel preparation easier with better visualization of the tibial attachment site. It is also thought to lower the risk of neurovascular injuries. The aim of this study was to evaluate the functional and clinical outcomes of patients who underwent arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal at our institute. Methods: This was a retrospective study with prospectively collected data between 2016 and 2020. Data collected were age, gender, types of graft used, range of movement, posterior drawer test grade, KOOS score, Lysholm knee scoring scale, and post-operative complications. All patients underwent pre- and post-operative PCL rehabilitation. Results: A total of 36 patients (26 males and 10 females) were identified from our database. The mean age was 35.2 years. Mean time from injury to surgery was 20 months. Mean follow-up was 41.2 months (range, 13-72 months). Twenty cases involved multi-ligament injuries and another 16 patients had isolated PCL injury. Post-operative mean posterior drawer test grade improved from 2.7 to 0.7 (p < 0.001). Knee range of movement was 116.3 degrees pre-operatively and 115.6 degrees postoperatively (p = 0.814). Lysholm knee scoring scale improved from 50.9 to 91.0 (p < 0.001). KOOS score improved from 65.1 to 77.2 (p = 0.196). One patient required manipulation under anesthesia for stiffness. No patients needed any additional surgical procedures. All PCLs were clinically intact at the final follow-up. Conclusion: Greater visualization of the PCL tibial attachment minimizes the 'killer turn' giving a huge advantage to this technique. Arthroscopic all-inside PCL reconstruction using the posterior trans-septal portal technique is a safe, reliable and reproducible procedure. From our study, it shows that post-operative clinical and functional outcomes improved significantly.

A Rare Presentation of Patella Button Aseptic Loosening After a Total Knee Replacement Without Evidence of Radiographic Loosening.

Patella resurfacing in total knee replacement (TKR) has been shown to reduce the rate of anterior knee pain, but there are complications from patella resurfacing. A 54-year-old male underwent a left primary TKR with patella resurfacing 15 years ago. He developed spontaneous progressive anterior knee pain for six months. At revision surgery, his patella button was found to be loose. Loosening of a three-peg patella button is rare. A high index of suspicion of patella button loosening should be suspected in patients who present with anterior knee pain after patella resurfacing.

The Modified Spare Piriformis and Internus, Repair Externus Approach for Hip Arthroplasty.

We present the case of an 80-year-old Malaysian gentleman who sustained a displaced intracapsular neck of femur (NOF) fracture and underwent a modified SPAIRE (Sparing Piriformis and Internus, Repair Externus) approach for total hip replacement (THR). The standard approach used in our hospital for THR in NOF fractures is the modified Hardinge approach to the hip. We used this modified SPAIRE approach as this patient lives in a 'Mahjong' center and always sits cross-legged on the floor. Therefore, he is at increased risk of an anterior dislocation. This approach is a modification of the standard SPAIRE approach popularized by the Exeter Hip Unit, United Kingdom. In this report, we describe the modification of the SPAIRE approach that has not been described before and the outcome for this patient.

Effectiveness of Ultrasound-guided versus Anatomical Landmark-guided Genicular Nerve Block to Treat Chronic Knee Osteoarthritis: A Retrospective Cohort Study.

Objectives: There is limited data on the relative effectiveness of different techniques used for administering genicular nerve block (GNB) for pain management of chronic knee osteoarthritis (OA) in the Malaysian population. This study aims to determine and compare the effectiveness of GNB administered using two pain management techniques?"anatomical landmark-guided (ALG) and ultrasound-guided (USG)?"for chronic knee OA in this population. Methods: This retrospective cohort study included 40 patients with chronic knee OA who received GNB, 20 of whom underwent treatment with the USG technique and the other 20 with the ALG technique. Pain, stiffness, and functional limitation scores were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC) and Numeric Rating Scale (NRS-11) at baseline and post-treatment day one, three weeks, and six weeks. Results: Both groups reported a significant reduction in WOMAC and NRS-11 scores as per their feedback on day one, three weeks, and six weeks post-treatment. Greater reductions in WOMAC and NRS-11 scores were reported by patients who received GNB via USG than by ALG technique, the difference achieving statistical significance at six weeks after treatment (p =0.026). Conclusions: GNB administration using USG and ALG techniques are both effective in significantly reducing pain, stiffness, and functional limitation in patients suffering from chronic knee OA. Among the two techniques, USG appears to be more effective. Nevertheless, GNB guided by ALG continues to be a viable treatment modality, especially in healthcare settings with limited to no USG facilities.