Management of chronic lateral instability due to lateral collateral ligament deficiency after total knee arthroplasty: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lateral instability following total knee arthroplasty (TKA) is a rare condition with limited report of treatment options. The objective of this case presentation is to demonstrate the outcomes of different surgical procedures performed in a single patient with lateral collateral ligament (LCL) deficiency.</p> <p>Case presentation</p> <p>We present a case of chronic lateral instability due to LCL deficiency after primary TKA in a 47-year-old Caucasian woman with an obesity problem. Multiple treatment options have been performed in order to manage this problem, including the following: ligament reconstruction; combined ligament reconstruction and constrained implant; and rotating-hinge knee prosthesis that was the most recent surgery. All ligament reconstruction procedures failed within one year. The varus-valgus constrained prosthesis provided stability for six years.</p> <p>Conclusions</p> <p>Ligament reconstruction alone cannot provide enough stability for the treatment of chronic lateral instability in patients with obesity problems and LCL deficiency. When the reconstruction fails, a salvage procedure with rotating-hinge knee is still available.</p

PREVALENCE OF OSTEOPOROSIS AND HYPOVITAMINOSIS D AT SIRIRAJ METABOLIC BONE DISEASE CLINIC

<div><p>ABSTRACT Objective: To identify the prevalence of osteoporosis and hypovitaminosis D among patients at the Siriraj Metabolic Bone Disease (MBD) Clinic, and to compare initial vitamin D levels in patients with and without a history of fragility fractures. Methods: Medical records of patients who attended our MBD clinic between 2012 and 2015 were retrospectively reviewed. Patient baseline demographic, clinical, bone mineral density (BMD), and laboratory data were collected and analyzed. Osteoporosis was diagnosed when patients had a BMD T-score <-2.5 or presented with fragility fractures. Results: There were 761 patients included in this study. Of these, 627 patients (82.4%) were diagnosed with osteoporosis and 508 patients (66.8%) had fragility fractures. Baseline serum 25-hydroxyvitamin D (25(OH)D) levels were available in 685 patients. Of these, 391 patients (57.1%) were diagnosed with hypovitaminosis D. When evaluated only in patients with fragility fractures, the average initial 25(OH)D level was 28.2±11.6 ng/mL, and the prevalence of hypovitaminosis D was 57.6%. Conclusion: A high prevalence of osteoporosis and hypovitaminosis D was found among patients at our clinic; two-thirds of patients had a history of fragility fractures, and no difference in initial 25(OH)D levels was seen between patients with and without fragility fractures. Level of Evidence III, Retrospective Study .</p></div

Randomized clinical trial comparing efficacy and safety of brand versus generic alendronate (Bonmax®) for osteoporosis treatment.

Although the same efficacy and tolerability are anticipated due to both drugs containing the same active ingredients, comparative studies between brand and generic alendronate are limited. Accordingly, the objective of this study was to compare efficacy and safety between brand alendronate and a recently introduced generic alendronate drug.A total of 140 postmenopausal women or men aged older than 50 years who met the indications for osteoporosis treatment were randomized to receive either generic (Bonmax®) or brand alendronate (Fosamax®) 70 mg/week over a 12-month period during the May 2014 to June 2015 study period. Endpoints included bone mineral density (BMD) changes at the lumbar spine, total hip, and femoral neck; percentage of patients with predefined levels of change in total hip and lumbar spine BMD at 12 months; and, changes in biochemical bone markers at 3, 6, and 12 months. Tolerability was evaluated by patient self-reporting of adverse experiences.At 12 months post-treatment, BMD significantly increased at all sites in both groups. There were no differences in BMD percentage changes or the number of patients with stable or increased BMD after 1 year between groups. No significant differences in the amount of biochemical bone marker reduction or incidence of adverse events were observed between groups.Generic and brand alendronate produced similar gains in BMD and reduction in bone turnover markers. Both medicadoitions were also equally well-tolerated. Based on these findings, generic alendronate (Bonmax®) is a viable alternative to the original brand of alendronate.ClinicalTrials.gov NCT02371252

Number and percentage of patients with stable, increased, or decreased bone mineral densities after one year of treatment with generic or brand alendronate.

<p>Number and percentage of patients with stable, increased, or decreased bone mineral densities after one year of treatment with generic or brand alendronate.</p

Quality of Life and Depression Status of Caregivers of Patients with Femoral Neck or Intertrochanteric Femoral Fractures during the First Year after Fracture Treatment

Objective The burden placed on caregivers can negatively affect the functional recovery of patients with hip fractures. It is therefore essential to consider caregivers' well‐being during the hip fracture care pathway. The aim of this study is to evaluate caregivers' quality of life and depression status during the first year after hip fracture treatment. Methods We prospectively enrolled the primary caregivers of patients with hip fractures admitted to the Faculty of Medicine Siriraj Hospital (Bangkok, Thailand) between April 2019 and January 2020. The quality of life of each caregiver was evaluated using the 36‐Item Short Form Survey (SF‐36), EuroQol 5‐Dimensions 5‐Levels (EQ‐5D‐5L), and EuroQol Visual Analog Scale (EQ‐VAS). Their depression statuses were assessed using the Hamilton Rating Scale for Depression (HRSD). The outcome measures were collected during admission as baseline data and 3, 6 months, and 1 year after hip fracture treatment. The repeated measures analysis of variance was used to compare all outcome measures from baseline to each indicated time point. Results Fifty caregivers were included in the final analysis. The mean SF‐36 physical and mental component summary scores decreased significantly from 56.6 to 54.9 (p = 0.012) and 52.7 to 50.4 (p = 0.043), respectively, during the first 3 months after treatment. The physical and mental component summary scores returned to baseline values 12 and 6 months posttreatment, respectively. Although the mean EQ‐5D‐5L and EQ‐VAS scores significantly declined at 3 months, they returned to baseline values within 12 months. As for HRSD, 6%, 56%, 36%, and 6% of the caregivers reported mild depression symptoms at baseline and 3, 6, and 12 months posttreatment, respectively. Conclusions The quality of life and depression status of hip fracture patients' caregivers worsen substantially in the first 3 months and return to baseline 1 year after hip fracture treatment. Specific attention and support should be given to caregivers, particularly during this difficult period. Caregivers should be regarded as “hidden patients” who need to be integrated into the hip fracture treatment pathway

Mean values of biochemical bone markers, and within group and between group <i>p</i>-values.

<p>(A) serum β-isomerized C-terminal telopeptide (β-CTx); and, (B) serum total procollagen type 1 amino-terminal propeptide (P1NP) for the generic and brand alendronate patient groups before treatment (baseline) and at 3, 6, and 12 months after treatment. The error bars indicate standard error. The <i>p</i>-values in the graphs compare levels between the generic and brand alendronate patient groups, while within group <i>p</i>-values are shown in the corresponding table below each graph (<i>p</i>-value <0.05 indicates statistical significance).</p

Type and frequency of observed adverse events.

<p>Type and frequency of observed adverse events.</p

“Spaghetti plot” graphs showing changes in BMD for each patient at the (A) lumbar spine, (B) femoral neck, and (C) total hip.

<p>“Spaghetti plot” graphs showing changes in BMD for each patient at the (A) lumbar spine, (B) femoral neck, and (C) total hip.</p

Changes in bone mineral density after one year of treatment with generic or brand alendronate.

<p>Changes in bone mineral density after one year of treatment with generic or brand alendronate.</p