Background: Osteonecrosis, or avascular necrosis (AVN) of the femoral head, is a progressive and irreversible bone pathological condition with an increasing amount of morbidity each year in Indonesia. Testing therapeutic strategies requires an ethical and reliable protocol for inducing femoral head AVN in animal models. This study evaluates a rabbit protocol's feasibility to support a larger investigation into secretome-based treatments.Methods: In this in vivo study, New Zealand white rabbits were divided into three test groups and one control group (n = 3 per group). Methylprednisolone was injected three times at 24-hour intervals, with lipopolysaccharide administered to the third test group on day four. Following a four-week observation period, effects were evaluated using histology, immunohistochemistry, lipid profiles, and radiology.Results: The results showed that both a dose of 20 mg/kgBW methylprednisolone plus 10 μg/kgBW lipopolysaccharide and 20 mg/kgBW methylprednisolone alone resulted in statistically significant femoral head AVN induction, characterized by an increase number of osteoclasts on caspase-3 staining and empty lacunae on hematoxylin–eosin staining. Conversely, the test group with a lower concentration did not show significant differences.Conclusion: These findings support the recommendation of a credible and promising animal model of femoral head osteonecrosis as a basis for the study of osteocytes, osteoblasts, and osteoclast regeneration, along with secretome therapy, which acts as a potential non-surgical treatment option. The absence of radiological confirmation limits a more established analysis, and further studies on this matter are needed.
Background: Plate fixation is commonly used for humeral fractures, yet plate failure remains a serious complication that can delay union and impair function. This study aimed to identify factors associated with humeral plate failure in two trauma centers.Methods: A retrospective review of electronic medical records from two trauma centers in Medan, Indonesia was performed. Extracted variables included patient demographics, fracture location and pattern, plate type and material, time to clinical union, smoking status, and neurovascular complications. Comparative analyses between failure and non-failure groups were conducted using independent t-tests or Mann–Whitney tests for numerical variables and chi-square or Fisher’s exact tests for categorical variables. Statistical significance was set at p < 0.05.Results: Thirty-one patients were included, and 5 (16.1%) experienced plate failure. No significant differences were found for sex (p = 0.231), age (p = 0.614), or body mass index (p = 0.379). Plate failure was not significantly associated with fracture location (p = 0.175), fracture pattern (p = 1.000), plate material (p = 1.000), time to clinical union (p = 0.525), or plate type (p = 0.700). Smoking (p = 0.020) and neurovascular damage were significantly associated with plate failure (p = 0.008).Conclusions: In this cohort, smoking and neurovascular injury were significantly associated with an increased risk of humeral plate failure. Perioperative identification and management of neurovascular compromise, along with smoking cessation strategies, may reduce the risk of implant failure. Further studies with larger samples are warranted.
Background: The proximal humerus is a common site for primary and metastatic bone tumors. Limb-salvage surgery aims to achieve oncologic clearance while preserving function. The Tikhoff–Linberg procedure combined with hemiarthroplasty is one reconstructive option; however, functional outcomes remain variable. This study aimed to evaluate functional outcomes following this procedure at a tertiary orthopaedic center.Methods: A retrospective observational study was conducted on patients who underwent Type I Tikhoff –Linberg resection with hemiarthroplasty for proximal humerus tumors at Prof. Dr. R. Soeharso National Orthopaedic Hospital between January 2020 and December 2023. Functional outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) and Musculoskeletal Tumor Society (MSTS) scores at a minimum follow-up of 6 months.Results: Eleven patients met the inclusion criteria (6 males, 5 females; mean age 51.2 years). Four patients (36%) had benign tumors and seven (64%) had malignant tumors. The mean DASH score was 42.3, and the mean MSTS score was 15.4. Patients with benign tumors demonstrated better functional outcomes (DASH 39.4; MSTS 17.6) compared to those with malignant tumors (DASH 46.9; MSTS 13.2). Shoulder range of motion was limited, particularly in flexion and abduction, although distal upper limb function was preserved.Conclusion: Tikhoff–Linberg resection with hemiarthroplasty provides acceptable functional outcomes, particularly in terms of hand and elbow function. However, shoulder mobility remains limited. Careful patient selection is required based on functional demand and prognosis.
Background: Osteosarcoma is the most common primary malignant bone tumor, yet comprehensive mapping of its evolving research landscape remains limited. This bibliometric analysis aims to characterize global research trends, identify thematic hotspots, and delineate emerging directions in osteosarcoma research, with a particular focus on publications related to local control, recurrence, and wide surgical margins.Methods: Publications from January 2021 to April 2025 were retrieved from the Dimensions database using the terms “osteosarcoma,” “local control,” “recurrence,” and "wide margins." After screening, 498 eligible records were analyzed using Bibliometrix/Biblioshiny in RStudio and Microsoft Excel.Results: Publication output increased from 2021 to 2023, with China, the United States, and Japan as the leading contributors. Chinese institutions represented 23% of the top 50 productive organizations, whereas Canada, Austria, and Greece showed the highest international collaboration rates. Thematic mapping identified motor themes related to tumor classification, treatment, prognosis, and local recurrence; niche themes such as en bloc sacrectomy and 3D-printed reconstruction; and emerging themes including artificial intelligence-based risk prediction and early metastasis detection.Conclusions: This bibliometric analysis identifies a trend in osteosarcoma research toward technology -driven and precision-oriented surgical strategies, including AI-assisted risk stratification, 3D-printed reconstruction, and immunomodulatory perioperative approaches. These bibliometric trends suggest growing research interest in optimizing local control and minimizing recurrence, although their clinical impact remains to be validated through prospective studies. The findings provide a descriptive overview of current research directions and may inform future research prioritization.
Background: Supplemental acetabular screw fixation is commonly used in cementless total hip arthroplasty (THA) to enhance initial cup stability; however, its routine necessity remains debated, particularly in populations with distinct anatomical and bone quality characteristics.Methods: A prospective observational cohort study was conducted at a tertiary care center in India from January 2023 to July 2024 to evaluate the effects of supplemental screws in primary cementless THA. Based on intraoperative assessment of press-fit stability, 80 consecutive patients were allocated into two groups: Group A (with supplemental screws, n = 40) and Group B (without screws, n = 40). Primary outcomes included functional improvement (Harris Hip Score (HHS) and WOMAC) and radiographic cup stability at 12 months. Secondary outcomes included complications and operative parameters.Results: Baseline characteristics were comparable between groups. Both groups showed significant improvement in HHS and WOMAC scores at 12 months, with no statistically significant intergroup differences (p > 0.05). Mean acetabular cup migration was minimal (0.20 ± 0.21 mm with screws vs 0.21 ± 0.22 mm without screws; p = 0.86). No cup demonstrated migration greater than 1 mm. No screw-related complications or revisions were observed.Conclusion: In primary cementless THA with adequate intraoperative press-fit stability, supplemental acetabular screws did not provide additional short-term clinical or radiographic benefit in this cohort. These findings suggest that routine screw fixation may not be necessary and should be used selectively.
Background: Ganglion cysts around the knee, particularly those originating from the gastrocnemius muscle, are uncommon and may cause significant posterior knee discomfort. Although surgical excision remains the gold standard, it carries risks such as postoperative complications, recurrence, and prolonged recovery.Case Report: A 41-year-old male presented with a 10-year history of posterior knee pain, aggravated during squatting and the Jalsa position during Islamic prayer. Physical examination revealed tenderness in the popliteal fossa without ligamentous instability. Ultrasound (US)-guided aspiration was performed, yielding approximately 4 mL of yellow, viscous fluid, followed by the injection of 10 mL of normal saline to facilitate cyst wall rupture and collapse, without corticosteroid use. This minimally invasive modification may reduce recurrence while avoiding potential steroid-related adverse effects. Immediate improvement in knee mobility was observed. At the 4-month follow-up, complete symptom resolution was reported, and all daily activities, including Islamic prayer, were performed without restriction. Follow-up US imaging confirmed a reduction in cyst size.Discussion: Ganglion cysts can be effectively managed with minimally invasive approaches such as ultrasound-guided aspiration, which offers precise localization and reduced complication risk compared to surgery. In this case, adjunctive saline injection facilitated cyst collapse and resulted in excellent functional recovery, although recurrence remains a possibility.Conclusion: US-guided aspiration with adjunctive saline injection is a promising alternative to surgical excision; however, further studies are needed to confirm its long-term efficacy.
Background: Bone marrow–derived mesenchymal stem cells (BMMSCs) are widely investigated for regenerative medicine applications. During in vitro expansion, BMMSCs may undergo loss of stemness and spontaneous lineage commitment. Hypoxic culture conditions better mimic the physiological bone marrow niche; however, their effects across early and late passages remain incompletely understood. This study aimed to evaluate the effect of hypoxic culture (1% O₂) on stemness-associated features, BMMSC identity, and spontaneous osteogenic mineralization at early and late passages.Methods: BMMSCs were isolated from a New Zealand White rabbit and cultured under normoxic (21% O₂) or hypoxic (1% O₂) conditions. Cells at passages 4 and 8 were analyzed for OCT4, SOX2, and CD105 expression using immunofluorescence and immunocytochemistry. Osteogenic differentiation was assessed by Alizarin Red S staining. Statistical analysis used independent t-tests and Mann–Whitney U tests (p < 0.05).Results: SOX2 and CD105 expression significantly decreased at late passages compared to early passages under both conditions (p < 0.05), whereas OCT4 expression remained stable under hypoxia (p > 0.05). BMMSCs cultured under hypoxia exhibited significantly higher expression of OCT4, SOX2, and CD105 than normoxic cultures at both passages (p < 0.05). Spontaneous calcium deposition was significantly lower under hypoxia (p < 0.05), with no significant difference between early and late passages.Conclusion: Hypoxic culture conditions better preserve stemness-associated features and MSC identity in BMMSCs and suppress spontaneous osteogenic mineralization. Prolonged hypoxic culture supports the maintenance of stem-like characteristics during in vitro expansion, highlighting its relevance for optimizing BMMSC culture strategies.
Background: Osteosarcoma, a primary malignant bone tumor, typically requires limb salvage surgery to maintain function while ensuring complete tumor resection. This case report presents a rare instance of distal tibial osteosarcoma treated through biological reconstruction utilizing liquid nitrogen.Case Report: This report describes a 17-year-old female patient who was initially diagnosed with low-grade osteosarcoma via biopsy, but was later confirmed to have high-grade osteosarcoma after undergoing wide excision and reconstruction using a liquid nitrogen-treated autograft. After the extensive removal of the tumor, the resected bone was devitalized using liquid nitrogen, followed by treatment with liquid nitrogen, reimplantation, and stabilization using double-plate fixation.Discussion: This method significantly diminished the likelihood of local recurrence while restoring both the structural integrity and biological function of the bone defect. This case highlights the benefits of biological reconstruction, specifically the use of recycled autografts with liquid nitrogen, as a cost-effective and sustainable approach for limb preservation in osteosarcoma patients. Conclusion: In this instance, biological reconstruction utilizing liquid nitrogen demonstrated efficacy as a limb salvage method. Liquid nitrogen freezing and inactivation provide a precise and effective method for devitalizing tumor bone while maintaining structural integrity and biological potential.
Background: Postpartum lumbo-pelvic pain (LPP) is a common musculoskeletal problem that may persist for several months after childbirth and interfere with maternal function. Stability exercise, focusing on deep core muscles, has been suggested as a non-pharmacological approach; however, the evidence remains scattered.Methods: A systematic review was carried out following PRISMA 2020 guidelines. Electronic databases (PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar) were searched for studies published between March 2015 and December 2024. Eligible studies included postpartum women (≤ 6 months) with LPP, comparing stability/core-focused exercise with conventional care or other exercise modalities. Primary outcomes were pain intensity measured using the Visual Analogue Scale (VAS) and functional disability assessed by the Oswestry Disability Index (ODI). Quality assessment of included papers was performed using the JBI tools. Data were extracted independently and analyzed narratively. Results: Three randomized controlled trials enrolling a total of 130 postpartum women with lumbopelvic pain were included. Intervention protocols varied from 6 to 12 weeks, with 3–5 sessions per week. All studies consistently reported greater reductions in pain scores in the stability exercise groups compared with control groups. Two studies additionally found significant improvements in functional disability (ODI) following stability training.Conclusion: Stability exercise appears effective in alleviating pain and improving function in postpartum women with LPP. Its integration into postpartum rehabilitation programs may provide a safe, accessible, and beneficial alternative to conventional management strategies. Further large-scale trials are needed to confirm optimal protocols and long-term outcomes.
Background: Juvenile Idiopathic Arthritis (JIA) is the most common chronic rheumatic disease in children, characterized by joint inflammation lasting ≥6 weeks in individuals aged <16 years without a clear etiology. Despite advances in research on genetic, immunological, and environmental factors, its pathogenesis remains incompletely understood. In Indonesia, epidemiological data and clinical characteristics of JIA are still limited. This study aimed to describe the demographic profile and clinical characteristics of JIA patients at the pediatrics outpatient clinic of a tertiary referral hospital in Indonesia from 2021 to 2023.Methods: A descriptive retrospective study was conducted to evaluate medical records of patients who met the diagnostic criteria for JIA based on the International League of Associations for Rheumatology (ILAR) classification.Results: Of the 73 JIA patients, most were male (60.3%) and belonged to the age group >132–216 months (32.9%). Most patients were domiciled in Surabaya (35.6%). The most common chief complaint was joint pain (71.2%), and 58.9% had joint involvement involving <5 joints, suggesting an oligoarthritis subtype. Most patients’ vital signs were within normal limits, while anemia (58.9%) and elevated erythrocyte sedimentation rate (ESR) (80.8%) were the dominant laboratory findings.Conclusion: The majority of JIA patients were late-adolescent boys (132–216 months) presenting with pain and an oligoarthritis subtype. These findings highlight the importance of early detection and appropriate referral to prevent long-term complications.
Background: Osteoarthritis (OA) is a chronic degenerative joint disease that commonly affects weight-bearing joints, such as the knee. A potential treatment is the intra-articular injection of mesenchymal stem cells (MSCs), which may stimulate joint tissue regeneration, cartilage formation, and angiogenesis. This systematic review aimed to evaluate the efficacy and safety of MSC therapy in moderate-to-severe knee OA.Methods: Literature searches were conducted using PubMed, Science Direct, Taylor and Francis, Google Scholar, Springer Link, Wiley, and the Garuda Portal. From the 644 identified articles, only seven randomized controlled trials published within the last 10 years met the inclusion criteria.Results: Five of the seven studies demonstrated significant reductions in pain based on Visual Analog Scale (VAS) scores following MSC injections. Four studies reported significant improvements in WOMAC scores, whereas one study showed no notable change. Adverse effects noted after injections included joint swelling, contusions, postprocedural hematomas, mild effusion, and injection site pain.Conclusions: Intra-articular MSC therapy shows potential for reducing pain and improving joint function in moderate-to-severe knee OA. Improvements in VAS and WOMAC scores suggest clinical benefits that can last up to 12–48 months post-treatment. MSC injections may be considered as a causal therapy in addition to symptomatic treatments, such as analgesics, to enhance patient quality of life.
Background: Intensive Care Unit-Acquired Weakness (ICU-AW) is a common neuromuscular complication in critically ill patients, leading to muscle atrophy, prolonged mechanical ventilation and impaired functional recovery. Effective rehabilitation strategies play crucial role in maintaining muscle strength. Neuromuscular electrical stimulation (NMES) had shown potential in preserving quadriceps femoris muscle thickness. This study aimed to examine the effect of NMES to quadriceps femoris muscle thickness in patient with ICU-AW.Methods: Patients that stayed in ICU more than 48 hours and used mechanical ventilation for at least 24 hours enrolled in one-group pretest-posttest design. Neuromuscular electrical stimulation applied to bilateral quadriceps femoris for 30 minutes daily over five consecutive days. Bilateral quadriceps femoris muscle thickness were assessed with USG day before and after therapy.Results: Twenty ICU-AW patients were enrolled from December 2023 to June 2024, and 13 of them completed the study. There were no significant changes in the thickness of the right and left quadriceps femoris muscle before and after 5-days of NMES therapy (p = 0.910 and p = 0.519, respectively). However, we preserved less than 5% decreased of muscle thickness.Conclusions: Early 5-days of NMES therapy did not increase quadriceps femoris muscle thickness but effectively prevented further muscle degradation in ICU-AW patients. The potential benefits of rehabilitation therapy in ICU-AW patients should be further explored in future studies with controlled indicators and larger sample sizes.
Background: Total knee replacement (TKR) is effective for advanced knee osteoarthritis, but its access can be limited by implant and perioperative costs. Our tertiary center in Kupang, Indonesia, adopted a single implant system to support service delivery. This study quantified early functional change using the Oxford Knee Score (OKS) three months after TKR.Methods: We conducted a retrospective single-centre cohort at Siloam Hospital in Kupang, from December 2022 to May 2024. Consecutive adults with Kellgren–Lawrence grade IV knee osteoarthritis who underwent primary TKR with one implant system (Fixamet) were included. The OKS (0–48; higher scores indicate better function) was collected preoperatively and at three months in Bahasa Indonesia using a standardized protocol. Pre–post change was analyzed as paired data.Results: Forty-seven patients were analyzed (mean age 65.77 ± 7.44 years; 80.9% women). The mean OKS improved from 12.53 ± 3.69 preoperatively to 41.02 ± 2.17 at three months, a mean change of 28.48 points (95% CI 27.24–29.70; p < 0.001). One early complication was documented (arthrofibrosis, 2.1%).Conclusions: In this single-centre cohort, TKR was associated with large early improvements in patient-reported knee function at three months. These findings describe early recovery within our service and do not establish comparative effectiveness versus other implant systems. Future studies should follow patients for a longer period, directly compare Fixamet with other implant systems, and include cost-effectiveness analyses to assess both clinical and economic value.
Background: Spinal neurofibromas are benign peripheral nerve sheath tumors typically occurring in the thoracic region. Involvement of the C2 vertebra is particularly rare. Atypical presentations of solitary neurofibromas can pose diagnostic challenges when their radiological features resemble other neoplastic entities. Case Report: A 35-year-old male presented with a 3-month history of neck pain and no history of trauma. Physical examination revealed mild bulging and localized tenderness in the posterior neck, with restricted neck extension to 30 degrees. Plain radiography showed a round, expansile lytic lesion with well-defined, nonsclerotic borders on the C2 spinous process, while MRI confirmed enhancing solid components and extensive bone involvement, indicative of a giant cell tumor. The histopathology from the core needle biopsy was inconclusive, showing few inflammatory cells and no evidence of malignancy. The lesion was marginally resected from a posterior approach, achieving only subtotal resection to preserve the vertebral artery. Histopathological analysis from the open biopsy confirmed the diagnosis of neurofibroma. At the 3-month follow-up, postoperative imaging showed the residual tumor. Despite this, the patient reported significant neck pain relief.Discussion: Radiography is insufficient for differentiating spinal tumors; therefore, histopathological biopsy is necessary for an accurate diagnosis. Open biopsy offers higher diagnostic accuracy than core needle biopsy.Conclusion: Neurofibroma should be considered in differential diagnosis for patients initially suspected of giant cell tumors based on radiological findings.
Background: The effect of Proprioceptive Neuromuscular Facilitation (PNF) stretching, in addition to standard stretching, improves anticipatory balance in athletes with Cerebral Palsy (CP). We aimed to analyze the effects of PNF stretching to standard training over 4 weeks on anticipatory balance in Cerebral Palsy athletes at 6-month post-intervention evaluation. Methods: The subjects of this study are 24 athletes with Cerebral Palsy at the Indonesian National Paralympic Committee (NPC) training facility. Subjects divided into the treatment group (n = 12) received standard stretching exercises along with PNF stretching, and the control group (n = 12) performed only standard stretching exercises. Both groups received intervention 3 times per week for 4 weeks and evaluation 6 months post-intervention. Y balance tests (YBT) were measured in three directions: anterior (A), posterolateral (PL), and posteromedial (PM), pre- and post-intervention.Results: There was significant improvement of YBT in the treatment group after 4 weeks of intervention. For the right and left limbs, marked increases were observed in all directions (p < 0.05). No significant improvements in YBT were observed at 6 months post-intervention in all directions (p > 0.05).Conclusions: Significant improvements in the Y Balance Test were observed after 4 weeks, but no differences between the two groups at the 6-month evaluation. These findings suggest that while short-term gains in dynamic stability are achievable with PNF, sustained benefits require ongoing reinforcement to maintain neuromuscular adaptations over time.
Background: This study investigates the association between subscapularis tendon tears and the anatomical characteristics of the coracoid process, as assessed by magnetic resonance imaging (MRI) and to determine the predictive cut-off values for significant measurements.Methods: Patients who underwent surgery for rotator cuff injury between 2020 and 2024 were retrospectively reviewed. Those with a subscapularis tear were classified as Group 1, while those with an intact subscapularis were classified as Group 2. MRI images were analyzed to measure axial and sagittal coracohumeral distance (axCHD, sagCHD), coracoid overlap (CO), and coracoid angle (CA). The diagnostic utility of these parameters was assessed using receiver operating characteristic (ROC) curve analysis.Results: A significant association was found between subscapularis tear and axCHD, sagCHD, and CO measurements. Among these, sagCHD demonstrated the strongest predictive power, with an optimal threshold of 9.5 mm, a sensitivity of 77.8% and a specificity of 80.4%.Conclusion: Our study demonstrated that decreased axCHD and sagCHD, and increased CO, are associated with subscapularis tears. The intracoracoid angle, however, does not appear to influence the incidence of subscapularis tears.
Background: Calcaneal fractures are relatively uncommon but account for a significant proportion of tarsal injuries. Often resulting from high-energy trauma, they carry a high risk of complications and remain a clinical challenge. Although open reduction and internal fixation (ORIF) is often successful, certain risk factors may predispose to failure and unexpected complications. Case Presentation: A 49-year-old female sustained a closed, displaced tongue-type calcaneal fracture after a fall from height and underwent acute screw fixation. At four weeks, radiographs revealed fracture recurrence and hardware failure, necessitating urgent reoperation with realignment and re-fixation, followed by a restrictive postoperative regimen. At 14 weeks post-reoperation, radiographs confirmed fracture healing. Upon completion of the treatment course, the patient was referred for continued physiotherapy to support ongoing functional recovery. Despite slight residual limitations, the patient reported minimal discomfort and regained mobility, reflected in an American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score of 81.Discussion: Calcaneal fractures are complex injuries with a high complication rate. Initial fixation of tongue-type calcaneal fractures may fail due to factors such as obesity, age, gender, surgical technique, or inadequate aftercare. A good functional outcome was ultimately achieved through timely reoperation, strict rehabilitation protocols, and close follow-up.Conclusion: This case underscores the importance of early surgical intervention, mitigating risk factors, and structured rehabilitation in managing complex calcaneal fractures. Risk factors should guide both surgical planning and aftercare. Early recognition of fixation failure and reoperation within four to six weeks can still result in favourable outcomes, even in high-risk patients.
Background: Shoulder impingement syndrome (SIS) is the most common cause of shoulder pain. Current conservative management approaches often require years for patients to achieve pain relief. This study aimed to identify the effects of hypertonic dextrose prolotherapy (HDP) injections on pain levels and shoulder functionality in SIS patients with diabetes mellitus. Methods: A quasi-experimental study was conducted recruiting SIS patients at Hajj Regional Hospital, Surabaya, Indonesia, from January 2022 to December 2023. The study group was divided into two: the HDP group, which received a 5 mL injection of HDP at a concentration of 20%, and the control group, which received pharmacotherapy and regular rehabilitation therapy. While the control group received regular pharmacotherapy and rehabilitation therapy only. The study outcomes assessed were the Numeric Rating Scale (NRS) and shoulder Active Range of Motion (AROM). The evaluation was conducted three times: before the intervention, immediately after the intervention, and two weeks after the intervention. Results: A total of 20 study participants were divided into two groups: 10 in the HDP group and 10 in the control group. Inter- and intragroup analyses showed significant differences in NRS mean values between the HDP and control groups (p < 0.05). Similarly, AROM analysis showed significant differences in mean values between the HDP and control groups, both inter- and intra-group (p < 0.05). Conclusions: HDP injection reduces pain intensity and improves shoulder AROM within two weeks after injection.
Background: One of the most common degenerative joint diseases is knee osteoarthritis. This condition leads to pain and reduces functionality of the knee joints, which can negatively impact a patient’s quality of life. Total knee replacement (TKR) has become the standard procedure to treat end-stage osteoarthritis. Evaluating the success of TKR procedures is very important. One instrument that can be used for this purpose is the Oxford Knee Score (OKS). Methods: This observational analytic comparative study involved 40 patients. The data were collected by interviewing patients who had undergone TKR at Dr. Mohamad Soewandhie General Hospital between 2019 and 2024. The data were analyzed using Wilcoxon signed-ranks test, independent samples t-test, and Kruskal-Wallis test. Results: The majority of the sample in this study was aged over 60 years (62.5%), female (87.5%), and had an overweight BMI (47.5%). The analysis showed a significant increase in the OKS after surgery, with a p-value of <0.05. The independent samples t-test showed a significant difference in the improvement of the OKS between males and females. Meanwhile, the Kruskal-Wallis test showed no significant difference in OKS improvement across BMI categories. Conclusions: There is a significant difference in the OKS before and after TKR surgery, which indicates an improvement in knee functionality and quality of life after surgery. Differences in patient gender may affect the outcome of the surgery, including post-surgery recovery rate and knee functionality. Meanwhile, BMI showed no significant difference in the outcome of TKR surgery.
Background: Type III osteogenesis imperfecta (OI) is very rare. In this article, we describe the clinical features and management of a case of type III osteogenesis imperfecta with a review of the literature.Case Report: A 5 – year - old girl presented with deformities of the bilateral lower and upper limbs. Posterior bowing of both humerus, cubitus varus deformity of both elbows, shepherd crook deformities of the femur, and anterolateral bowing of both legs were observed. She was unable to walk. Her face was triangular, and she had a kyphoscoliotic deformity of the spine. Radiographs showed osteopenia and multiple fractures at different stages of healing. The clinical and radiological findings were consistent with those of type III OI. She was treated by deformity correction of the right femur and tibia using the Sofield technique.Discussion: OI is a disorder caused by a mutation in type 1 collagen. It is characterized by increased bone fragility, dentigerous imperfecta, and generalized ligamentous laxity. There are 18 types of OI. We describe a case of type 3 OI in which the child developed deformity of the spine and limb at a later age without involvement of the sclera. Lower limb deformities were corrected using the Sofield technique of multiple osteotomies and intramedullary nailing. The implants were removed once the osteotomies were united. After implant removal, anterolateral bowing of the tibiae recurred.Conclusions: Long bone deformities can be managed using the Sofield technique. Long-term follow-up is essential for the early detection and correction of recurrence.
