Patellar tendon rupture after total knee arthroplasty is a rare, but often catastrophic complication. In addition, infection is also a dreaded complication after total knee arthroplasty. We report an 84-year-old female that has late infected total knee arthroplasty with patellar tendon rupture treated with resection arthroplasty and then subsequent arthrodesis with retrograde intramedullary nail. Objective: Periprosthetic joint infection (PJI) of the hip due to methicillin-resistant bacteria is difficult to treat and remain a challenge for arthroplasty surgeon. Methods: Retrospective review was done to the patients who received two-stage revisions with antibiotic loaded cement-spacer for PJI of the hip between January 2010 to June 2015. We found 65 patients (65 hips) with positive culture findings. Eight patients were lost to followup and excluded from the study. Among the rest of the 57 patients, methicillin-resistant infection (MR Group) was found in 28 cases. For comparison, we also evaluated the 29 other cases that caused by other pathogen (Non-Methicillin resistant group/Non-MR group). We compared all of the relevant medical records and the treatment outcomes between the two groups. Results: The mean of follow-up period was 33.7 months in the methicillin-resistant group and 28.4 months in the nonmethicillin-resistant group (p = 0.27). The causal pathogens in the methicillin-resistant group were: Methicillin-resistant Staphylococcus aureus (MRSA) in 10 cases, Methicillin-resistant Staphylococcus epidermidis (MRSE) in 16 cases and Methicillin-resistant coagulase-negative Staphylococcus (MRCNS) in 2 cases. The reimplantation rate was 92.8% and 89.6% in the methicillin-resistant and nonmethicillinresistant groups, respectively (p= 0.66). The rates of recurrent infection after reimplantation were 23.1% (6/26) in the methicillin-resistant group and 7.6% (2/26) in the nonmethicillinresistant group (p= 0.12). The overall infection control rate was 71.4% (20/28) and 89.6% (26/29) in the methicillin-resistant and nonmethicillin-resistant groups, respectively (p = 0.08). Both group showed comparable baseline data on mean age, BMI, gender distribution, preoperative ESR/CRP/WBC and comorbidities. Conclusion: Two-stage revision still resulted a higher recurrency rate and lower infection control rate for the treatment of periprosthetic joint infection (PJI) of the hip due to methicillin-resistant infection compared to nonmethicillin-resistant infection.
Currently, umbilical cord mesenchymal stem cells have the potential to be used as treatment options for any cartilage lesion. This research aimed to evaluate the effects of conditioned medium from umbilical cord mesenchymal stem cells (UC-MSC) on damaged cartilage through the expression of proteins TGF-β1, SOX-9, type II collagen and aggrecan, which are known to be related to chondrogenesis. UC-MSC were isolated from 19-days-pregnant Wistar mice and were cultured using the standard procedure to obtain 80% confluence. Subsequently, the culture was confirmed through a microscopic examination that was driven to be an embryoid body to obtain a pre-condition medium. This research utilized 3-month-old male Wistar mice and was categorized into 6 groups (3 control and 3 treatment groups). Each animal had surgery performed to create a femur condyle cartilage defect. The treatment groups were administered a dose of stem cells at 1 mL/kg. Next, immunohistochemical (IHC) staining was performed to examine the expression of TGF-β1, SOX-9, type II collagen and aggrecan in the 2 nd , 3 rd , and 4 th month of evaluation. The results were analyzed statistically using ANOVA test. For each of the treatment groups, there was increased expression (p < 0.05) in all proteins TGF-β1, SOX-9, type II collagen and aggrecan when compared with control groups at the 2 nd , 3 rd , and 4 th month of evaluation. Pre-conditioned medium from UC-MSC potentially increases the expression of TGF-β1, SOX-9, type II collagen and aggrecan in the damaged cartilage of Wistar mice.
Introduction: Mesenchymal stem cells are multipotent cells present in multiple tissues that have potential for future disease treatment including cartilage damage. This study was aimed to investigate the effect of conditioned medium of umbilical cord stem cells in improving the histological conditions of damaged cartilage in rats. Materials and Methods: Twenty-four of 3-month old male rats that were divided into 6 groups (3 control groups and 3 treatment groups) with different evaluation time (month 2, month 3, and month 4). Treatment in each group was repeated 5 times. The cartilage defect was induced manually and mechanically at the medial condyle of rats' right femur using a Kirschner Wire (D=1.0 mm; h=1.0 mm). The umbilical cord stem cell cultures were obtained from pregnant rats (19 days). Rats in treatment groups were injected with mesenchymal stem cell-conditioned medium (1 mL/kg BW) 5 times with interval a week after cartilage defect. Histopathological examination of chondrocytes formation and fibrosis tissues was done through Haematoxylin Eosin staining. Data were assessed with O'driscoll scoring and analyzed statistically using Kruskal-Wallis test with SPSS 16.0 software statistically using Kruskal-Wallis Test with SPSS 16.0 software. Results: The conditioned medium of umbilical cord mesenchymal stem cells was able to repair the damage in cartilage tissue of Wistar rats. It is indicated by the higher score of nature of predominant tissue, surface regularity, structural integrity, bonding with adjacent cartilage and the level of new tissue formed in the treatment group compared to control group. Statistically, there is a significant difference of bonding to the adjacent cartilage score (0.028, p<0.05) in treatment group than in control group. There is no significant difference of nature of the predominant tissue score (0.064, p>0.05), surface regularity (0.064, p>0.05), structural integrity (0.075, p>0.05), level of newly formed tissue (0.088, p>0.05). Conclusion: The supplementation of conditioned medium of umbilical cord mesenchymal stem cell ameliorate the repair of damaged cartilage.
Background: The anterolateral ligament (ALL) of the knee remains a topic of interest. All aspects of the ligament, including its anatomy, biomechanics, imaging, and clinical importance, are areas for research among knee surgeons. Purpose: To evaluate the trends in research on the ALL of the knee, as indicated by studies indexed in PubMed from 2010 to 2019. Study Design: Cross-sectional study. Methods: We searched PubMed for article titles from January 1, 2010, to December 31, 2019, that included the term “anterolateral ligament.” The initial search was performed with the terms “anterolateral ligament AND knee” and “anterolateral ligament NOT knee.” Next, we performed a search using “anterolateral complex OR anterolateral reconstruction OR lateral extra-articular tenodesis” to avoid missing any studies. A bibliometric evaluation was performed for the search results, and we noted the characteristics of the most cited articles in PubMed. Results: Published studies on the ALL peaked in 2017, with 56 studies, and then declined from 2017 to 2019. The 3 leading journals with articles on the ALL were Arthroscopy; Knee Surgery, Sports Traumatology, Arthroscopy; and The American Journal of Sports Medicine. Cadaveric anatomic, cadaveric biomechanical, and clinical imaging studies of the ALL were the most common types of studies published from 2010 to 2019. Clinical studies on the ALL consisted of 18 articles, with the majority displaying a low level of evidence. Conclusion: Cadaveric anatomic/histological, cadaveric biomechanical, and clinical imaging studies of the ALL were the most commonly published studies from 2010 to 2019. More clinical outcome studies with a high level of evidence are needed to increase the supporting data for the future practice of ALL reconstruction.
BACKGROUND: In the global pandemic of the 2019 coronavirus disease (COVID-19), many countries have reported a decrease in visits to hospitals, and health-care systems around the world are reshaping health protocols. Health service and education in orthopedics are also affected although not at the frontline in dealing COVID-19. METHODS: The data from this study collected from several official databases, including the Indonesian Ministry of Health, Central Java provincial government, general hospital, and orthopedic surgery cases. RESULTS: Pandemic COVID-19 started in March 2020 in Indonesia. Surakarta has become one of the epicenters. Health services in the orthopedic department also experienced a decrease cases on all divisions (outpatient clinics, emergency rooms, and inpatients). Mann–Whitney non-parametric comparative test showed significance result in p value operation of orthopedic cases and inpatients (p = 0.016 and p = 0.016; p < 0.05), meanwhile, outpatient visits did not show significance result with p = 0.0509 (p > 0.05). The decrease in the number of cases being treated in the orthopedic service also has an impact on education and training programs. The digital era is one of the choices in the field of education. However, digital resources cannot substitute for direct patient exposure. CONCLUSION: The average number of orthopedic patients during the pandemic period from January to December 2020 decreased compared to visits in the same period in 2019 so that orthopedic services at tertiary and academic referral hospitals experienced a significant decrease in cases. The education and services department must adapt to the policy on educational activities for residents and medical students. The education department and hospital institutions restructured and reorganized resident doctors to continue providing services. The digital era is an option that supports the education process during a pandemic.
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