9 research outputs found

    Risk factors for a post-operative neutrally aligned total knee arthroplasty in the sagittal plane developing fixed flexion deformity at 2 years follow up study

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    Background: The incidence of fixed flexion deformity (FFD) following total knee arthroplasty (TKA) has been reported to be as high as 17%, increasing demand on the quadriceps and hindering mobility. The aim of this study is then to identify these predictors for the development of FFD.Methods: In this retrospective study, all patients who underwent primary TKA from January 2008 to June 2009 at a single institution were identified. All patients with neutral alignment in the sagittal place of the knee intra-operatively were identified and followed up. The knee motion was measured in both operated and contralateral knees and followed-up for a minimum of 24 months post-operatively.Results: Multivariate analysis demonstrated pre-operative FFD of the non-operated knee (p-value 0.03), pre-operative range of motion of the operated knee (p-value 0.01) and non-operated (p-value 0.01) knee and pre-operative maximum flexion of the operated knee (p-value 0.001) to be independent risk factors for development of FFD at 24 months.Conclusions: Independent risk factors for the development of post-operative FFD in TKA are pre-operative FFD of the operated knee, FFD of the non-operated knee and the maximum flexion of the operated knee. The relative risk of a male developing FFD is also as high as 1.34

    Gap difference in navigated TKA: a measure of the imbalanced flexion-extension gap

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    Introduction: The success of Total Knee Arthroplasty (TKA) hinges on balanced flexion-extension gaps. This paper aims to evaluate the correlation between imbalanced gaps and clinical outcomes, and hence help quantify the imbalanced gap in navigation-assisted total knee arthroplasty. Methods: We studied 195 knees with an average follow-up of two years. Flexion-extension gaps were obtained from computer calculation upon cementation of implants in both flexion (90°) and extension. The gap difference (GD) was defined as the measured difference between the gaps in flexion and extension. Results: At 2 years after surgery, the mean ROM in the balanced group, with GD less than or equal to 2 mm, was 115.1° ± 16.6° and the mean ROM in the imbalanced group was 116.7° ± 12.1°. This was not statistically significant with p-value 0.589. Balanced flexion-extension gaps also did not show significant difference in terms of mechanical alignment, with 0.29 ± 0.89 in the balanced group at 2 years, and 0.65 ± 1.51 in the imbalanced group with p-value 0.123. Balanced gaps however, were associated with improved outcomes in terms of physical functioning, bodily pain, social functioning, Oxford and Knee scores at 6 months and improved social functioning scores at 2 years. Conclusions: Computer navigation is a useful tool for assessing the gap balance in TKA. Balanced flexion-extension gaps, with gap differences of less than or equal to 2 mm, is associated with improved clinical outcomes at 6 months

    THINK surgical TSolution-One

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    THINK Surgical TSolution-One® is an active-autonomous, image-based, robotic milling system which enables the surgeon to attain a consistently accurate implant component positioning. The TSolution-One® system is capable of achieving this through an image-based preoperative planning system which allows the surgeon to create, view and analyse the surgical outcome in 3D. The accuracy and precision of component positioning have been attributed to the following factors: customized distal femoral resection, accurate determination of the femoral rotational alignment, minimization of errors and maintenance of bone temperature with robotic milling. Despite all these advantages, there is still a paucity of long-term, high-quality data that demonstrates the efficacy of robotic-assisted total knee arthroplasty (TKA). Questions regarding radiation risks, prolonged surgical duration and cost-effectiveness remain unanswered. This paper aims to describe: (1) TSolution-One® surgical technique; (2) limitations and complications; (3) clinical and radiological outcomes

    Multi-Center Validation of Pain Assessment in Advanced Dementia (PAINAD) Scale in Malaysia

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    The detection of pain in persons with advanced dementia is challenging due to their inability to verbally articulate the pain they are experiencing. Pain Assessment in Advanced Dementia (PAINAD) is an observer-rated pain assessment tool developed based on non-verbal expressions of pain for persons with severe dementia. This study aimed to perform construct validation of PAINAD for pain assessment in persons with severe dementia in Malaysia. This was a prospective cross-sectional study conducted from 27 April 2022 to 28 October 2022 in eight public hospitals in Malaysia. The PAINAD scale was the index test, and the Discomfort Scale—Dementia of the Alzheimer Type (DS-DAT) and Nurse-Reported Pain Scale (NRPS) were the reference tests for construct and concurrent validity assessment. Pain assessment for the study subjects was performed by two raters concurrently at rest and during activity. The PAINAD score was determined by the first rater, whereas the DS-DAT and NRPS were assessed by the second rater, and they were blinded to each other’s findings to prevent bias. PAINAD showed good positive correlations ranging from 0.325 to 0.715 with DS-DAT and NRPS at rest and during activity, with a p-value of <0.05. It also demonstrated statistically significant differences when comparing pain scores at rest and during activity, pre- and post-intervention. In conclusion, the PAINAD scale is a reliable observer-rated pain assessment tool for persons with severe dementia in Malaysia. It is also sensitive to changes in the pain level during activity and at rest, pre- and post-intervention

    Genome-wide association study identifies five new susceptibility loci for primary angle closure glaucoma.

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    Primary angle closure glaucoma (PACG) is a major cause of blindness worldwide. We conducted a genome-wide association study (GWAS) followed by replication in a combined total of 10,503 PACG cases and 29,567 controls drawn from 24 countries across Asia, Australia, Europe, North America, and South America. We observed significant evidence of disease association at five new genetic loci upon meta-analysis of all patient collections. These loci are at EPDR1 rs3816415 (odds ratio (OR) = 1.24, P = 5.94 × 10(-15)), CHAT rs1258267 (OR = 1.22, P = 2.85 × 10(-16)), GLIS3 rs736893 (OR = 1.18, P = 1.43 × 10(-14)), FERMT2 rs7494379 (OR = 1.14, P = 3.43 × 10(-11)), and DPM2-FAM102A rs3739821 (OR = 1.15, P = 8.32 × 10(-12)). We also confirmed significant association at three previously described loci (P < 5 × 10(-8) for each sentinel SNP at PLEKHA7, COL11A1, and PCMTD1-ST18), providing new insights into the biology of PACG

    Genome-wide association study identifies five new susceptibility loci for primary angle closure glaucoma

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    1994 Annual Selected Bibliography: Asian American Studies and the Crisis of Practice

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