Midterm outcome of total knee arthroplasty in East Coast population of Hospital Tengku Ampuan Afzan Kuantan

Introduction: Total knee replacement (TKR) is an excellent advancement in medical treatment which gives good joint function and pain relief for degenerative diseases of joint since it was introduced in Malaysia since 1970. The purpose of this study was to evaluate the midterm functional outcome of patients undergone TKR using the NexGen LPS Flex prosthesis between January 2005 until April 2006 in primary osteoarthritis patients in our local east coast population. Materials and Methods: Forty six patients, 87% female (n=40) and 13% male (n=6), aged 54 to 81 (mean, 69±5.69) years underwent primary TKR using the hi-flex knee prosthesis (Zimmer) performed by two different surgeons were followed up for a minimal of five years. All used the same technique of surgery, medial parapatellar incision, cruciate substitute and cemented. Assesment were made based on the quality of life outcome score (SF-36) and the Oxford-12 knee scoring system questionnaires. Results: Oxford-12 revealed that patients had mild problems in terms of function and pain with the average function and pain score of 14.35±4.21 and 9.28±3.01 compared to a maximum possible score of 35 and 25 respectively. For eight health domains of SF-36, patients had the highest score (i.e. good health) for role emotional (RE), followed by mental health (MH), and social functioning (SF). This resulted in a higher score for mental component summary (MCS) than physical component summary (PCS). Since a low score of Oxford-12 indicates a better state of health compared to high score for SF-36, negative correlation between them was expected. Conclusion: The NexGen LPS-Flex TKR had good midterm functional outcome. Overall, TKR were found to be effective in terms of improvement in health-related quality-of-life dimensions

OrthoBoard: an orthopaedic app for medical education

Introduction: Use of mobile apps as a pedagogical tool in the medical education has gained popularity as mobile apps have great potentials in perpetuating clinical knowledge and skills. To leverage mobile technology in medical education, we designed a hybrid mobile app based on our undergraduate orthopaedic curriculum. Materials and Methods: The frontend was created using hybrid mobile framework to target both iOS and Android platforms. The backend is powered by Firebase (Google Inc.) to manage authentication and social messaging. The content consisted of basic orthopaedic skills, trauma and resuscitation skills, Islamic input in orthopaedic and information cheatsheets. Results: OrthoBoard is being used by IIUM medical undergraduates as an ancillary source of learning, particularly useful as quick references and visual guides for enhancing orthopaedic knowledge and performing clinical procedures. The social messaging capability built into the app serves as a platform for discussion and exchange of information. This is the first medical app, to our knowledge, that integrates orthopaedic clinical knowledge and practice as well as Islamic input in orthopaedics into teaching and learning with the integration of social messaging as a platform for enhancement of knowledge and practice. Conclusion: Use of mobile apps as pedagogical tool in the medical education will undoubtedly increase in the future. As students and teachers embrace mobile technology in and outside the classroom, better user-centric and subject-specific apps will be required to fulfil the needs. For medical educators, developing mobile apps will possibly be one of the future armamentarium in the delivery of knowledge and skills

The mid term functional outcomes of NexGen legacy posterior stabilized flex fixed bearing total knee replacement in primary osteoarthritis

Introduction: To evaluate the midterm functional outcomes of patients who had undergone total knee replacement (TKR) using posterior stabilized (PS) fixed bearing system from January 2005 until April 2006 for primary osteoarthritis of the knees. Methods: A retrospective study was done on forty-six patients, 87% female (n= 40) and 13% male (n=6), aged 54 to 81 years old (mean 69 ± 5.69) who had undergone primary TKR using the NexGen LPS-Flex Zimmer Warsaw. The patients were followed up for at least five years. A medial parapatellar approach and cemented posterior stabilized fixed bearing TKR system were used performed by one of two arthroplasty surgeons. All patients followed the same rehabilitation protocol post-operatively. Assessments were done using Oxford-12 knee scoring questionnaire to evaluate knee function and SF-36 to assess quality of life outcomes. Results: Oxford knee score revealed patients had lower (better) than average scores in terms of function (score 14.35 ± 4.21 out of 35) and pain (score 9.28 ± 3.01 out of 25). Analysis on the quality of life outcome score with SF-36 revealed a higher (better) score for mental component summary (MCS) relative to physical component summary (PCS). Patients had the highest score for role emotional (RE), followed by mental health (MH), and social functioning (SF). Conclusions: The NexGen LPS-Flex TKR produced a good functional outcome with minimal pain in the operated knee with better mental compared to physical health of patients in the midterm period post-total knee replacement

Orthoboard: An orthopaedic app for medical education

This is a hybrid mobile app developed by our team based on the undergraduate Orthopaedic curriculum to deliver clinical knowledge and skills. The app consisted of core and practical orthopaedic information with step-by-step visual-guided slides to perform orthopaedic procedures in the clinical settings. A social messaging platform is integrated in the app to encourage discussion and interactive learning. The highlight of the app is the integration of Islamic input in medical practice which is the first for medical apps

The functional outcome and quality of life following open diaphyseal tibial fractures

Introduction: The clinical outcome of open tibia fracture been extensively studied in many institutions. However, the functional outcome and quality of life has not been widely studied. The aim of this study is to evaluate the functional outcome and quality of life for patients with open tibia fracture that were treated in Hospital Tengku Ampuan Afzan. Methods: Between 2009 and 2010, we treated 33 patients with open diaphyseal tibial fractures with a minimum period of one year follow up. There were 31 males and 2 females; the mean age of 29 years old (range: 10 to 60). Four patients sustained open fracture grade I, 13 grade II, 12 grade IIIA and 4 with grade IIIB. All patients who fulfill the inclusion criteria were called for interview in the clinic by the investigator. The outcome that were analyzed include health related quality of life (SF36) and Lower Extremity Functional Score (LEFS). Results: All except one fracture achieve union. One patient with grade IIIB open fracture developed infected non union. Quality of life is satisfactory in all domains. The functional outcome score was significantly reduced in grade IIIB (48.5) as compare to other grade (grade I 74.2, grade II 70.4, grade IIIA 74.1). Conclusions: The quality of life and the functional outcome worsened with increasing severity of fracture

Digitalisation of patient data: how a FileMaker Go app can organise information and increase efficiency

Objectives : In orthopaedic oncology, managing large amount of patient data using modern technology is crucial for efficient data storage and retrieval. To achieve this, we explored the intrinsic potential of FileMaker Go as the mobile digital platform. Methods : We created a custom app using FileMaker Pro version 16. The desktop interface requires FileMaker software to run and the iPhone interface require Filemaker Go app which is available on the Apple AppStore. We designed the main interface to have a curated list of patients which can be sorted by name, diagnosis, ward or the hospital number or retrieved with an integrated barcode scanner. The diagnosis, latest review, plan, haematology and pathology results, captured x-rays and MRI images with reports, clinical images and surgical reports are grouped into individual pages and entries can be made in chronological order. Integrated scoring systems such as Enneking classification, AJCC classification and Mirel's score are available for individual patients. MSTS score calculators are integrated for easy calculation and presented as a graphical chart for each patient during follow-up. Results : The FileMaker software is remarkably easy for surgeons to learn and to develop custom apps as many online resources are available. Wide range of development tools are available in the FileMaker software to create complex apps with the capability of capturing images and documents directly from the app, making calculations for different scoring systems and converting data to graphical representation instantaneously. As surgeons' requirement increase or change, improvements to the app can be made easily without dependence on professional service of software developers or involving huge budget. Conclusions : A complete, systematic and highly-capable mobile app built using FileMaker software can complement the services of orthopaedic surgeons in providing a complete data-management platform for monitoring patients and future data-reporting

Comparison of functional outcome between computer navigated total knee replacement with conventional method

Introduction: Total knee replacement (TKR) is considered one of most successful treatment in treating knee arthritis. It aims at restoring neutral mechanical axis, balanced ligaments and normal Q angle. Surgeons have been using manual jig to achieved perfect implant placement. Since 2002 computer assisted surgery (CAS) is gaining popularity in TKR surgery to improved accuracy of implant placement. In a large meta-analysis by Bauwen’s et al, computer assisted surgery reduced number of patients with post-operative malalignment >3 degree. In another study by Kim et al found there was no difference in alignment between computer assisted and conventional method TKR in bilateral TKR with one using conventional and the other computer assisted. In our study we compared the functional outcome between these two methods. Materials and Methods: This was a cross-sectional study conducted in Penang General Hospital comparing the functional outcome using SF-36 questionnaire and Hospital for Special Surgery (HSS) knee scoring. It involved 35 knees in each arm. All patients were operated by single surgeon using same type of implant and navigation system. Patients with post-operative complications were excluded. Results: We found that there was no significant difference (p<0.05) in both SF-36 and HSS knee score using U Mann Whitney test. Conclusion: There was no difference in functional outcome between conventional TKR and CA

Case report: Bilateral total knee replacement in severe knee osteoarthritis

Introduction 40 years old malay gentleman with underlying gout and hyper tension presented with chief complaint of bilateral knee pain for 10 years duration. He was walking with limping gait and unable to squat or sit cross legs. Pain had been increasing for the last 5 years. He was dependent on analgesia. Since pain was worsening patient was on wheelchair ambulation. On examination patient right knee, no swelling, fixed flexion at 10 degree, range of movement 10-100 degree flexion, lateral collateral laxity and varus deformity. Left knee had fixed flexion at 5 degree, range of movement 5-100 degree and varus deformity. Blood investigation showed uric acid. Xray of bilateral knee showed reduced joint space, and sclerotic bone. Methods Patient underwent bilateral total knee replacement. Left total knee replacement was done followed with right total knee replacement after 5 months. Intraoperatively left knee noted intraarticular loose bodies and uncontained posteromedial defect which was build up with bone (screw fixation) and bone grafting. Intraoperatively right knee noted posteromedial defect over tibial articular surface, incomplete iatrogenic fracture over medial tibial plateau, augmented with 5mm metal block over medial tibial plateau, bone quality was good, sclerotic bone over medial tibia plateau and multiple holes was drill over the sclerotic bone. Discussions Post operatively wound was clean. Patient was discharge well with oral antibiotic. He was advised for non-weight bearing for 3 months. He was referred to physiotherapy for range of motion exercises. 1 year post operatively patient able to ambulate with walking stick. Pain score improved. Functional and knee score is good. Range of movement bilateral knee are 0-100 degree. Conclusion Outcome shows that total knee replacement is a reproducible surgery for which a trained surgeon will be able to produce excellent and good results