Femoral Stem Subsidence and its Associated Factors after Cementless Bipolar Hemiarthroplasty in Geiatric Patients

Abstract INTRODUCTION: Early femoral stem subsidence has been a concern as a predictor of the beginning of implant loosening, especially on cementless hip arthroplasty implants. This study aimed to determine the factors that affect femoral stem subsidence and outcome following hemiarthroplasty in the geriatric population. MATERIALS AND METHODS This is a retrospective study of 179 patients who underwent cementless bipolar hemiarthroplasty during the 2011-2019 period at an orthopaedic and traumatology hospital. Data on the patient's demography, pre-operative American Society Anaesthesiologist (ASA) score, body mass index (BMI), canal flare index (CFI), Dorr classification, and stem alignment were obtained. The primary outcomes were post-operative femoral stem subsidence, post-operative pain, and functional outcome using Harris Hip Score (HHS). Statistical analysis was conducted to identify risk factors associated with the primary outcome. RESULTS: The mean femoral stem subsidence was 2.16 ±3.4 mm. The mean post-operative Visual Analog Score (VAS) on follow-up was 1.38 ± 1. Mean HHS on follow-up was 85.28±10.3. American Society Anaesthesiologist score 3 (p = 0.011, OR = 2.77) and varus alignment (p=0.039, OR =6.963) were related to worse stem subsidence. Otherwise, neutral alignment (p = 0.045 and OR = 0.405) gave protection against femoral stem subsidence. The female gender (p = 0.014, OR 2.53) was associated with postoperative pain onset. Neutral alignment had significant relationship with functional outcomes (p = 0.01; OR 0.33). CONCLUSION: A higher ASA score and varus stem alignment were related to a higher risk of femoral stem subsidence. Meanwhile, neutral stem alignment had a protective effect on the femoral stem subsidence and outcome

Acute Hematogenous Osteomyelitis in Children: A Case Series

ABSTRACT Background Chronic osteomyelitis is still a major cause of morbidity and disability in children living in developing countries. Neglect of acute osteomyelitis and its progression to chronic osteomyelitis leads to significant morbidity. This report is the first series to describe such cases in Indonesia. Objective To describe 12 pediatric cases of chronic osteomyelitis in order to remind clinicians about the debilitating complications of musculoskeletal infection. Methods This report is a case series of 12 children with chronic osteomyelitis admitted to dr. Soetomo General Hospital, Surabaya, East Java, in 2011-2017. We acquired data from medical records. The patients' quality of life was measured using the Child Health Assessment Questionnaire Disability Index (C-HAQ-DI). Results The patients' mean age was eight years and they were predominantly male. The most common infection location was the femur (7/12). Microbial cultures were positive in 9/12 of cases, predominantly with Staphylococcus aureus. Erythrocyte sedimentation rate (ESR) was elevated in 11 patients. All patients were diagnosed late, with an average delay of presentation to Orthopedics of 10.5 months. Most of patients experienced mild to moderate disability after the disease, as assessed by the C-HAQ-DI. Conclusion Diagnosis of osteomyelitis in children is quite difficult, given the lack of specific diagnostic tests. Delayed diagnosis and inappropriate treatment may result in long-term morbidity and disability. Clinicians should have an increased awareness of the clinical features of osteomyelitis, including unusual presentations such as calcaneal osteomyelitis

Analysis of prognostic factors in soft tissue sarcoma: Cancer registry from a single tertiary hospital in Indonesia. A retrospective cohort study

Background Soft tissue sarcoma is one cause of mortality in adult malignancies. This tumor is rare, persistent, and highly-recurrent. Many patients are came in late stage. It is important to identify a prognostic tool that is reliable, easily obtainable, and widely applicable. The aim of this study is to investigate and analyze the prognostic value of clinicopathological and biomarker factors in patients with soft tissue sarcoma. Methods This retrospective study extracts data from the musculoskeletal tumor registry from January 2012 to December 2018 in a single tertiary hospital. Eighty patients with diagnosis of soft tissue sarcoma were included. Preoperative modified Glasgow Prognostic Score, Neutrophils/Lymphocytes Ratio, Hemoglobin, serum lactate dehydrogenase data were analyzed along with demographic, clinical, radiological and histopathological data. The relationship between variables on overall survival, distant metastasis, and local recurrence were evaluated using univariate and multivariate Cox regression. Results On univariate analysis, there was significant relationship between hemoglobin, Neutrophils/Lymphocytes Ratio and modified Glasgow Prognostic Score with overall survival (p = 0.031, HR = 1.99; p = 0.04, HR = 1.129; and p = 0.044, HR = 3.89). A significant relationship was found between age and soft tissue sarcoma stage with distant metastasis (p = 0.046, HR = 1.95; and p = 0.00, HR = 3.22). In addition, we also found significant relationship between surgical margin with local recurrence (p = 0.018, OR = 3.44). However, on multivariate analysis the independent prognostic factor for overall survival was only modified Glasgow Prognostic Score (HR = 2.138; p = 0.011). Stage IIIA (HR = 5.32; p = 0.005) and IIIB (HR = 13.48; p = 0.00) were independent prognostic for distant metastasis. Surgical margin was independently associated with local recurrence (HR = 14.84; p = 0.001). Conclusion Modified Glasgow Prognostic Score can be used as prognostic tool of overall survival in soft tissue sarcoma patients. Moreover, stage of STS and surgical margin can be used as a prognostic factor for distant metastasis and local recurrence of soft tissue sarcoma respectively