Displaying publications 1 - 20 of 57 in total

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  1. A commentary update on NICE CG124. Hip fracture:management (2023)
    Ong T, Vindlacheruvu M
    Age Ageing, 2023 Jun 01;52(6).
    PMID: 37389557 DOI: 10.1093/ageing/afad110
    The National Institute for Health and Care Excellence released its second update on hip fracture management in early 2023. First published in 2011, the last update was in 2017. The scope of this recent update focussed on surgical implants for hip fracture. This included recommendation to offer total hip replacements instead of hemiarthroplasty for displaced intracapsular hip fractures, and a move away from Orthopaedic Device Evaluation Panel rated implants to a more standardised consistent choice. Other recommendations such as the importance of multidisciplinary orthogeriatric care, early surgery and prompt mobilisation remain. As the literature surrounding hip fracture management continue to grow, guidance such as this needs to continue updating itself to ensure patients with hip fracture receive the best possible care.
    Matched MeSH terms: Arthroplasty, Replacement, Hip*
  2. Fulltext New hips for old! Lessons from the Arabian Nights
    Harwant S
    Med J Malaysia, 2004 Dec;59 Suppl F:2.
    PMID: 15941152
    Matched MeSH terms: Arthroplasty, Replacement, Hip/instrumentation*
  3. An intramedullary cement spacer in total hip arthroplasty
    Deshmukh RG, Thevarajan K, Kok CS, Sivapathasundaram N, George SV
    J Arthroplasty, 1998 Feb;13(2):197-9.
    PMID: 9526214
    Revision arthroplasty of the hip is often complicated by infection, bone loss, and perioperative fracture of the femur. A simple, inexpensive spacer that keeps tissue planes intact and prevents soft tissue contracture during the interoperative period of a 2-stage revision is described. This can provide intramedullary support to a fractured or weak femur and enable local antibiotic delivery, as well as permit limited mobilization of the patient. It can be easily fabricated during surgery using universally available materials and can be tailored for specific requirements. Such a spacer was used in 5 cases. The experience is presented, and the technique and pitfalls are discussed.
    Matched MeSH terms: Arthroplasty, Replacement, Hip/instrumentation*
  4. Fulltext Commentary: Vascularized bone graft is an effective technique for extra-cortical bone bridging to combat cemented megaprosthesis loosening at the bone-implant junction
    Singh VA
    J Orthop Surg (Hong Kong), 2020 12 22;28(3):2309499020972483.
    PMID: 33345709 DOI: 10.1177/2309499020972483
    Matched MeSH terms: Arthroplasty, Replacement, Hip*
  5. Fulltext Surface Acoustic Wave (SAW) Sensors for Hip Implant: A Numerical and Computational Feasibility Investigation Using Finite Element Methods
    Hafizh M, Soliman MM, Qiblawey Y, Chowdhury MEH, Islam MT, Musharavati F, et al.
    Biosensors (Basel), 2023 Jan 02;13(1).
    PMID: 36671914 DOI: 10.3390/bios13010079
    In this paper, a surface acoustic wave (SAW) sensor for hip implant geometry was proposed for the application of total hip replacement. A two-port SAW device was numerically investigated for implementation with an operating frequency of 872 MHz that can be used in more common radio frequency interrogator units. A finite element analysis of the device was developed for a lithium niobate (LiNBO3) substrate with a Rayleigh velocity of 3488 m/s on COMSOL Multiphysics. The Multiphysics loading and frequency results highlighted a good uniformity with numerical results. Afterwards, a hip implant geometry was developed. The SAW sensor was mounted at two locations on the implant corresponding to two regions along the shaft of the femur bone. Three discrete conditions were studied for the feasibility of the implant with upper- and lower-body loading. The loading simulations highlighted that the stresses experienced do not exceed the yield strengths. The voltage output results indicated that the SAW sensor can be implanted in the hip implant for hip implant-loosening detection applications.
    Matched MeSH terms: Arthroplasty, Replacement, Hip*
  6. Fulltext Anatomical Alterations Following Resurfacing Hip Arthroplasty
    Sivananthan, K., Drabu, K.J.
    Malays Orthop J, 2009;3(1):42-45.
    MyJurnal
    The number of hip replacement procedures in the United States is expected to increase four-fold by 2030. Younger patients, those under 65 years old, are expected to account for 53% of hip replacements in 2030, compared to 44% in 2005. As midterm review results are becoming available worldwide now, the problem that perplexes surgeons is the alteration of limb length which has been an ancillary goal of Total Hip Replacements. The lack of modularity in neck lengths and offsets in resurfacing arthroplasty clearly limits the change in limb lengths achievable for the hip. The goal of this study is to scrutinize the various parameters that affect implant seating in resurfacing arthroplasty and to determine the alteration of limb length achievable during surgery.
    Matched MeSH terms: Arthroplasty, Replacement, Hip
  7. Fulltext Retrograde cement extrusion into femoral nutrient vessels following uncomplicated Total Hip Arthroplasty
    Lim, Chia Hua, Jacob, V.A., Premchandran, N.
    International Medical Journal Malaysia, 2017;16(11):46-46.
    MyJurnal
    The present concepts in Total Hip Arthroplasty advocate mechanical cement interlock
    with trabecular bone utilising the third-generation cementing technique. However, the
    force generated can easily reach peak pressure of 122 kPa to 1500 kPa, leading to
    extrusion of cement through nutrient foramina into femoral cortex into nutrient vessels,
    henceforth the retrograde arteriovenogram. (Copied from article).
    Matched MeSH terms: Arthroplasty, Replacement, Hip
  8. Fulltext Bilateral fracture of prostheses post-hip replacement
    Surinder S, George P
    Med J Malaysia, 2017 02;72(1):71-72.
    PMID: 28255148 MyJurnal
    Fracture of hip prostheses is a rare occurrence. A case of bilateral hip prostheses fracture is described here. The need to follow-up and remain vigilant post hip replacement is highlighted.
    Matched MeSH terms: Arthroplasty, Replacement, Hip
  9. Fulltext In defence of Girdlestone excision arthroplasty: a comment on 'Unusual way of loosened total hip arthroplasty treatment with an Austin Moore endoprosthesis'
    Sinha NK, Bhardwaj A, Poduval M, Rao BS
    J Postgrad Med, 2014 Apr-Jun;60(2):222-3.
    PMID: 24823541 DOI: 10.4103/0022-3859.132388
    Matched MeSH terms: Arthroplasty, Replacement, Hip*
  10. Fabrication of low-cost, cementless femoral stem 316L stainless steel using investment casting technique
    Baharuddin MY, Salleh ShH, Suhasril AA, Zulkifly AH, Lee MH, Omar MA, et al.
    Artif Organs, 2014 Jul;38(7):603-8.
    PMID: 24404766 DOI: 10.1111/aor.12222
    Total hip arthroplasty is a flourishing orthopedic surgery, generating billions of dollars of revenue. The cost associated with the fabrication of implants has been increasing year by year, and this phenomenon has burdened the patient with extra charges. Consequently, this study will focus on designing an accurate implant via implementing the reverse engineering of three-dimensional morphological study based on a particular population. By using finite element analysis, this study will assist to predict the outcome and could become a useful tool for preclinical testing of newly designed implants. A prototype is then fabricated using 316L stainless steel by applying investment casting techniques that reduce manufacturing cost without jeopardizing implant quality. The finite element analysis showed that the maximum von Mises stress was 66.88 MPa proximally with a safety factor of 2.39 against endosteal fracture, and micromotion was 4.73 μm, which promotes osseointegration. This method offers a fabrication process of cementless femoral stems with lower cost, subsequently helping patients, particularly those from nondeveloped countries.
    Matched MeSH terms: Arthroplasty, Replacement, Hip/economics
  11. Long-term wear failure analysis of uhmwpe acetabular cup in total hip replacement
    Shahemi N, Liza S, Abbas AA, Merican AM
    J Mech Behav Biomed Mater, 2018 11;87:1-9.
    PMID: 30031358 DOI: 10.1016/j.jmbbm.2018.07.017
    A revision of a metal-on-ultra high molecular weight (UHMWPE) bearing couple for total hip replacement was performed due to aseptic loosening after 23 years in-vivo. It is a major long-term failure identified from wear generation. This study includes performing failure analysis of retrieved polyethylene acetabular cup from Zimmer Trilogy® Acetabular system. The UHMWPE acetabular cup was retrieved from a 61 years old male patient with ability to walk but limited leg movement when he presented to hospital in early 2016 with complaint left thigh pain. It was 23 years after his primary total hip replacement procedure. Surface roughness and morphology condition were measured using 3D laser microscope and Scanning Electron Microscope (SEM) to evaluate and characterize the wear features on polyethylene acetabular cup surface. ATR-Fourier Transform Infra-Red (ATR-FTIR), differential scanning calorimetry (DSC) and gel permeation chromatography (GPC) were used to characterize the chemical composition of carbon-oxygen bonding, crystallinity percentage and molecular weight of the polymer liner that might changes the mechanical properties of polyethylene. Nano indentation is to measure hardness and elasticity modulus where the ratio of hardness to elastic modulus value can be reflected as the degradation of mechanical properties. A prominent difference of thickness between two regions resulted from acentric loading concentration was observed and wear rate were measured. The linear wear rate for thin side and thick side were 0.33 mm/year and 0.05 mm/year respectively. Molecular weight reduction of 57.5% and relatively low ratio of hardness to elastic modulus (3.59 × 10-3) were the indicator of major mechanical properties degradation happened on UHMWPE acetabular cup. This major degradation was contributed by oxidation and polishing wear feature accompanied with delamination, craters, ripple and cracks were the indication of extensive usage of UHMWPE from the suggested life span of acetabular cup application.
    Matched MeSH terms: Arthroplasty, Replacement, Hip*
  12. Reliability and sensitivity of radiographic measures of hip dysplasia in childhood Charcot-Marie-Tooth disease
    Dwan LN, Gibbons P, Jamil K, Little D, Birke O, Menezes MP, et al.
    Hip Int, 2023 Mar;33(2):323-331.
    PMID: 34180253 DOI: 10.1177/11207000211027591
    BACKGROUND: Hip dysplasia is a lack of femoral head coverage and disruption of hip and acetabular alignment and congruency, with severity ranging from mild subluxation in nascent at-risk hips to complete dislocation. Presentation of hip dysplasia in neuromuscular conditions can be sub-clinical or associated with a limp with or without hip pain, abductor and flexor weakness and reduced hip range of motion. Untreated hip dysplasia leads to early onset osteoarthritis requiring hip arthroplasty in early adulthood. Hip dysplasia occurs in 6-20% of children with Charcot-Marie-Tooth disease, however little is known about the reliability and sensitivity of detection on plain film pelvic radiographs.

    METHODS: 14 common measures of hip dysplasia on anteroposterior pelvis radiographs were independently assessed by 2 orthopaedic specialists in 30 ambulant children with Charcot-Marie-Tooth disease. Hip health was also categorised based on clinical impression to assess the sensitivity of radiographic measures to identify hip dysplasia status.

    RESULTS: 8 measures (acetabular index, head width, lateral centre-edge angle, lateral uncoverage, medial joint width, migration percentage, neck shaft angle, triradiate status) exhibited 'excellent' reliability between clinical evaluators. 5 of the 30 patients (17%) were identified as having nascent hip dysplasia. Reliable radiographic measures that significantly distinguished between nascent hip dysplasia and healthy hips were acetabular index, lateral centre edge angle, medial joint width and migration percentage.

    CONCLUSIONS: We have identified a subset of reliable and sensitive radiographic hip measures in children with Charcot-Marie-Tooth disease to prioritise during hip screening to mitigate the deleterious effects of hip dysplasia, pain and disability in adulthood.

    Matched MeSH terms: Arthroplasty, Replacement, Hip*
  13. Downsizing and minimising medialisation of the acetabular component: Novel technique to preserve bone in THA
    Raj JJ, Thompson M, Whitehouse SL, Jaiprakash A, Varughese I, Crawford RW
    Proc Inst Mech Eng H, 2023 Mar;237(3):368-374.
    PMID: 36734414 DOI: 10.1177/09544119231152351
    Standard practice for acetabular component placement in total hip arthroplasty (THA) is to medialise the acetabular component. Bone preservation techniques during primary THA are beneficial for possible future revisions. The goal of this study is to examine the effect of downsizing and minimising medialisation of the acetabular component on bone resection volume. The volume of bone resected during acetabular preparation for different sizes of components was calculated and the volume of bone preserved by downsizing the cup was determined. Minimising medialisation of the acetabular component by 1-3 mm from the true floor was calculated. Absolute values and percentage of bone volume preserved when acetabular components are downsized or less medialised is presented. Downsizing the acetabular component by one size (2 mm) preserves between 2.6 cm3 (size 40 vs 42) and 8.4 cm3 (size 72 vs 74) of bone volume and consistently reduces resected bone volume by at least 35% (range 35.2%-37.5%). Similarly, reducing medialisation of a 56 mm acetabular cup (as an example of a commonly implanted component) by 3 mm reduces bone loss by 5.9 cm3- 44% less bone volume resection. Downsizing and minimising medialisation of the cup in THA substantially preserves bone which may benefit future revision surgeries. Surgeons could consider implanting the smallest acceptable acetabular shell to preserve bone without compromising on head size.
    Matched MeSH terms: Arthroplasty, Replacement, Hip*
  14. Fulltext Outcome of traumatic intracapsular neck of femur fractures in patients aged above 60 years treated by total hip arthroplasty
    Yazid DM, Lim CY, Chopra S
    Malays Orthop J, 2010;4(3):7-10.
    MyJurnal
    This study was undertaken to investigate the outcome of traumatic intracapsular neck of femur fractures treated with total hip arthroplasty (THA). Patients aged >=60 years who underwent THA for traumatic intracapsular neck of femur fractures from January 2005 to March 2009 were included in the study. Telephone or personal interviews were conducted. There were 49 patients identified within the study period. The mean age was 74.12 years. Most patients were females 81.6%), with a male: female ratio of 1: 4.4. In total, 29 patients were available for outcome scoring. The one-month mortality rate was 4.1%, and the one-year mortality rate was 20.5%. Of the 29 patients 82.8% obtained a Zukerman Functional Outcome Score of good (80 – 100) and 13.8% obtained a score of fair (60 – 80). THA for the treatment of traumatic neck of femur fractures in elderly is a good option with 96.6% of patients obtaining a satisfactory functional outcome, with acceptable morbidity and mortality statistics.
    Matched MeSH terms: Arthroplasty, Replacement, Hip
  15. Fulltext Five Year Follow-up of One Stage Bilateral Total Hip Arthroplasty
    Tai, C.C., Abbas, A.A., Varaprasad, M., Choon, S.K.
    Malays Orthop J, 2007;1(1):22-25.
    MyJurnal
    We report on the medium term outcome of five patients (ten hips) who underwent one stage bilateral total hip arthroplasty. Both Harris Hip Scores and Oxford Hip Scores improved postoperatively as did range of motion. There was no radiographic evidence of loosening in any hip arthroplasty involved in this study, however one revision surgery was needed due to periprosthetic fracture. There were no increased medical complications. Based on our limited experience, we believe that one stage bilateral total hip arthroplasty is safe in selected patients.
    Matched MeSH terms: Arthroplasty, Replacement, Hip
  16. Oversized acetabular socket causing groin pain after total hip arthroplasty
    Abbas AA, Kim YJ, Song EK, Yoon TR
    J Arthroplasty, 2009 Oct;24(7):1144.e5-8.
    PMID: 18848418 DOI: 10.1016/j.arth.2008.09.008
    The causes of groin pain after total hip arthroplasty are numerous, and the condition itself is disabling. Therefore, it is imperative that the cause of the pain is identified and managed appropriately. We report a case where the patient had groin pain after total hip arthroplasty as a result of an oversized cementless acetabular component, which caused a breach in the anterior wall of the acetabulum. The anterior wall of the acetabulum was reconstructed with femoral head allograft, and the patient has been symptom free since.
    Matched MeSH terms: Arthroplasty, Replacement, Hip/adverse effects*; Arthroplasty, Replacement, Hip/instrumentation*
  17. Fulltext Risk factors for infection in total hip replacement surgery at Hospital Kuala Lumpur
    Yong KS, Kareem BA, Ruslan GN, Harwant S
    Med J Malaysia, 2001 Jun;56 Suppl C:57-60.
    PMID: 11814251 MyJurnal
    Sixty-seven primary THR surgeries in 57 patients between January 1992 and December 1998 were reviewed after a mean follow-up of 35.9 months. The rate of superficial and deep wound infections were 11.9% and 1.5% respectively. The most common organism in superficial wound infection was Staphylococcus aureus. The factors that were significantly associated with superficial wound infection were diabetes mellitus (p= 0.0230) obesity (p=0.0088). The patients who developed superficial wound infection have a significantly longer duration of surgery compared to patients without infection (p=0.014). However, there was no significant difference between the mean age among patients with and without superficial wound infection (p=0.814).
    Matched MeSH terms: Arthroplasty, Replacement, Hip/adverse effects*; Arthroplasty, Replacement, Hip/statistics & numerical data*
  18. Revision total hip arthroplasty with metal on metal bearing for ceramic bearing fractures
    Park KS, Chan CK, Kim SK, Li QS, Im CJ, Yoon TR
    J Orthop Sci, 2019 May;24(3):452-457.
    PMID: 30415823 DOI: 10.1016/j.jos.2018.10.016
    BACKGROUND: Due to concern of potential metallosis caused by residual microscopic ceramic particles, metal-on-metal (MoM) bearing is deemed undesirable in revision total hip arthroplasty (THA) for ceramic bearing fracture. We determined whether MoM bearing is suitable to be used in revision THA for ceramic fractures and also evaluated whether this treatment increases serum iron levels compared with MoM bearing revision THA for polyethylene failure.

    METHODS: Between 2006 and 2012, 22 patients underwent revision surgery using MoM bearing (28 mm femoral head in 18 hips and 32 mm in 4 hips) for ceramic bearing fracture and followed average 52.1 months. We assessed radiological parameter and functional outcome using Harris hip score (HHS) and WOMAC score. Also, serum cobalt (Co) and chromium (Cr) blood tests were performed and compared with the result obtained from age, sex- and follow-up duration-matched patients with MoM revision THA for failed polyethylene bearing.

    RESULTS: The mean HHS improved from 60.6 preoperatively to 90.3 at final follow-up. There were no changes in cup position, progression of osteolytic lesions, and measurable wear of MoM bearing articulation at final follow-up radiographs. There was one case of recurrent dislocation after surgery, which was treated with greater trochanter distal advancement and one case of deep infection, which underwent two-stage revision. Mean serum Co level (1.7 vs. 1.4 μg/dl; p = 0.211) and Cr level (0.70 vs. 1.01 μg/dl; p = 0.327) showed no significant difference.

    CONCLUSIONS: MoM articulation with liner cementation into the acetabular cup along with total synovectomy can be chosen in revision surgery for ceramic fracture with good midterm follow-up. However, the use of MoM bearing is indicated when the stem and metal shell can be retained and ceramic on ceramic or ceramic on polyethylene bearing cannot be selected. Also long-term outcome needs to be further evaluated.

    Matched MeSH terms: Arthroplasty, Replacement, Hip/adverse effects; Arthroplasty, Replacement, Hip/instrumentation*
  19. Fulltext Femoral Neck Non-Union - A Biomechanical Solution with Valgus Sliding Subtrochanteric Osteotomy: A Case Report
    Teh KH, Ruben JK, Chan CK, Abbas AA
    Malays Orthop J, 2020 Jul;14(2):134-137.
    PMID: 32983389 DOI: 10.5704/MOJ.2007.022
    Avascular necrosis and non-union are two most dreaded complications of femoral neck fracture fixations. Hip replacement seems to be a simple solution for this complex problem. However, the long-term efficacy of prosthetic replacement in the young population with higher functional demand is still questionable. Femoral head preserving valgus subtrochanteric osteotomies in properly selected cases have strong support from literature. The conventional technique of valgus subtrochanteric osteotomy involves lateral based wedge resection. Alternatively, a simpler sliding oblique subtrochanteric osteotomy without any wedge removal can also be performed. We hereby describe a successful case of sliding subtrochanteric osteotomy with 135° dynamic hip screw (DHS) plate fixation in treating non-union neck of femur fracture in a young gentleman.
    Matched MeSH terms: Arthroplasty, Replacement, Hip
  20. Fulltext Morphology of Proximal Femur in South-West Coast of India
    Kamath SU, Agarwal S, Austine J
    Malays Orthop J, 2020 Nov;14(3):143-150.
    PMID: 33403075 DOI: 10.5704/MOJ.2011.022
    Introduction: With a higher proportion of young individuals undergoing uncemented hip arthroplasty, a close match in the dimension of the proximal femur and the implanted prosthesis is paramount. This is a study to gain insight into geographical variation in proximal femur morphology to determine the reference values to design uncemented femoral stems for a south Indian population, and also the effect of ageing and gender on the proximal femur morphology.

    Materials and Methods: The study comprised of two groups. For the first group, 50 unpaired dry femur bones were obtained from adult human cadavers; and the second group was a clinical group of 50 adult patients. Standardised radiographic techniques were used to measure the extra-cortical and intra-cortical morphometric parameters. Based on these, dimensionless ratios were calculated to express the shape of the proximal femur. The data were expressed in terms of mean and standard deviation and a comparison made with other studies.

    Results: A significant difference was noted across various population subsets within the Indian subcontinent and also in comparison to the Western population, suggestive of regional variation. The measurements made in cadaveric bone differed significantly from those in live patients, especially the femoral head diameter and extra-cortical and intra-cortical width. Femoral offset, head height and diameter were significantly less in females.

    Conclusion: The south Indian population needs customised implants with an increase in neck shaft angle and a decrease in intra-cortical and extra-cortical width for press fit in hip arthroplasty. The variation between the two sexes must also be accounted for during prosthesis design.

    Matched MeSH terms: Arthroplasty, Replacement, Hip
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