Unique morphology of intraoperative measurement of distal femur in northern malaysian females and its correlation with total knee arthroplasty implant sizing / Morfología única de la medición intraoperatoria del fémur distal en mujeres del norte de malasia y su correlación con el tamaño del implante en artroplastia total de rodilla

SUMMARY: Accurate implant sizing is one of the major determinants in defining the success of total knee arthroplasty (TKA). Current TKA implants are based on Caucasian knee morphometry which is well documented to be larger than Asian knees. Even more, with regards to sizing, implant mismatch tends to be more evident in the female population. This study was designed to evaluate the distal femur dimensions of Malaysian female patients who underwent TKA in our institution and to compare them with the current prosthetic system in use. A total of 199 female patients (207 knees) who underwent TKA were enrolled in this study. Intraoperatively, the AP dimensions (medial and lateral condyles) and mediolateral (ML) width were measured. Known dimension of the femoral component of the prosthetic knee system currently in use were compared with the morphological data. The average femoral component overhang was 2.11 mm (SD 3.94 mm). There was significant difference between the mean ML width of the resected femur and the femoral component (p<0.01). Analysis also revealed a significant positive and weak relationship between both, AP (medial and lateral) and ML dimension. The aspect ratio (ML/AP) of the native femur was generally smaller than the implant aspect ratio which is likely to cause overhang in our population. In general, this study shows that the knees of our female sub-population are even narrower than the other Asian female knees from previous studies. Implants should be designed based on the morphological data of the local population. Implant manufactures should tailor them to accommodate a smaller change in ML width for an increment in the AP length and provide several ML widths for one AP length to obtain a better fitting prosthesis hence curbing the problem of ML overhang.

RESUMEN: El tamaño exacto del implante es uno de los principales determinantes para definir el éxito de la artroplastía total de rodilla (ATR). Los implantes de TKA se basan en la morfometría de rodilla caucásica, cuyo tamaño está reportado como mayor que las rodillas asiáticas. Más aún, en lo que respecta al tamaño, el desajuste de los implantes tiende a ser más evidente en la población femenina. Este estudio fue diseñado para evaluar las dimensiones del fémur distal de pacientes mujeres malasias que se sometieron a ATR en nuestra institución y compararlas con el sistema protésico actual. En este estudio se incluyeron un total de 199 pacientes (207 rodillas) que se sometieron a ATR. Intraoperatoriamente, se midieron las dimensiones AP (cóndilos medial y lateral) y el ancho mediolateral (ML). Se comparó la dimensión conocida del componente femoral del sistema protésico de rodilla actualmente en uso con los datos morfológicos. El voladizo o sobresaliencia del componente femoral fue de 2,11 mm (DE 3,94 mm). Hubo una diferencia significativa entre el ancho ML medio del fémur resecado y el componente femoral (p <0,01). El análisis también reveló una relación significativa positiva y débil entre las dimensiones AP (medial y lateral) y ML. La relación de aspecto (ML / AP) del fémur nativo fue más pequeña que la relación de aspecto del implante, lo que probablemente cause un voladizo en nuestra población. En general, este estudio muestra que las rodillas de nuestra subpoblación femenina son incluso más estrechas que otras rodillas de mujeres asiáticas reportadas en estudios anteriores. Los implantes deben ser diseñados en base a los datos morfológicos de la población local. Los fabricantes de implantes deben adaptarlos a un cambio más pequeño en el ancho de ML para un incremento en la longitud AP y proporcionar varios anchos ML para una longitud AP con el objetivo de obtener una prótesis de mejor ajuste y frenar el problema del voladizo ML.

A Review of the Effects and Mechanisms of Shockwave Therapy on Enthesopathy

@#Extracorporeal shockwave therapy (ESWT) for the treatment of musculoskeletal diseases is a field that is developing rapidly and attracting increasing attention. Studies exploring the effects of shockwave therapy on enthesopathy have resulted in equivocal findings. Therefore, the purpose of this review article is to collectively review and analyze published literature on the effects of shockwave therapy on enthesopathy in human studies. This is a literature review study however, systematic search was performed on Scopus, EBSCOhost (Medline, CINAHL, and Sport Discus), and Google Scholar databases. The search resulted in 112 articles, nine relevant articles that met the inclusion criteria were selected for analysis in this review. Shockwave therapy can be safe and effective to reduce pain, improve functions and activities as it accelerates the entheses healing. The exact mechanisms of shockwave therapy on enthesopathy are still debatable. Further investigation is needed to confirm and validate the findings of previous related studies.

The Outcome of Delayed Fixation of Patellar Osteochondral Injury Using Suture Fixation at One and Half Years Follow up: A Case Report

Abstract@#Osteochondral fracture fixation could be challenging due to the low healing capacity of cartilage especially when the case is delayed. There are various fixation options available. The personality of the fractured fragment would determine which fixation method is more suitable. This is a case of a 14-year-old girl with right knee patellar osteochondral fracture fixed with suture passed through drilled holes after four weeks of injury. The outcome at eighteen months follow up shows a painless knee with a full range of motion and patient is asymptomatic. Knee radiograph shows union of the fragment and MRI did not show evidence of necrosis.

Irreducible dorsal dislocation of the interphalangeal joint of the big toe: a case report.

Irreducible dislocation of the interphalangeal joint (IPJ) big toe is a rare injury Hitori et al. (2006) . We report a case of the right big toe IPJ dislocation following a trauma. The problem was diagnosed and managed at other medical centers with standard treatment of closed manual reduction and splint. The right big toe was splinted accordingly and the patient was referred to our orthopedic outpatient clinic. At the clinic, a repeat plain radiograph was ordered due to high suspicion of the irreducible IPJ.

The Activity Leading to ACL Injury and the ability to Resume Duty following Reconstructive Surgery in Malaysian Military Patients

Introduction: Anterior cruciate ligament (ACL) injuries are common among Malaysian military patients but has not been studied closely. The purpose of this study was to assess the type of activities leading to the ACL injury and the outcome of reconstructive ACL surgery at one year follow up. Methods: From the registry record, military patients who had undergone ACL reconstruction in two Malaysian military hospitals were identified. Their medical records were reviewed. The activities that they performed when the ACL injury occurred were identified. After ACL reconstruction, the patients’ ability to resume previous duty at one year follow up was evaluated. Results: From 111 patients, 82% of the ACL injuries were due to sporting activities whereas military activities and road traffic accident accounted for 14 % and 4 % respectively. Out of 69 patients with isolated ACL injury who were followed up at one year, all except two were able to resume their previous duty. Conclusions: Among the military patients who underwent ACL reconstruction, ACL injury was mainly due to sporting activity. ACL reconstruction showed good outcome at one year follow up.