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Papers by Pakpoom Ruangsomboon

Research paper thumbnail of EE414 Cost-Effectiveness of Mobile Intermittent Pneumatic Compression Devices (IPCD) Compared to Traditional IPCD for Early Postoperative Total Knee Replacement: The Hospital’s Perspectives

Research paper thumbnail of Does the accelerometer-based navigation system reduce blood loss and transfusion in one-stage sequential bilateral total knee arthroplasty? A randomized double-blind controlled trial

Research Square (Research Square), Mar 14, 2023

Research paper thumbnail of Efficacy of adding an interspace block to the posterior knee for perioperative pain in total knee arthroplasty: a randomized controlled trial

Acta Orthopaedica

Background and purpose: The interspace between the popliteal artery and the capsule of the poster... more Background and purpose: The interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block is a novel anesthetic technique for total knee arthroplasty (TKA). Our objective was to compare the effect of IPACK and adductor canal block (ACB) and periarticular injection (PAI), relative to ACB and PAI only, from baseline to postoperative day 3, in patients undergoing unilateral primary TKA.Patients and methods: This was a single-center, double-blinded, randomized controlled trial. Adults over the age of 50 who were scheduled for unilateral primary TKA were enrolled. They were randomly assigned to ACB and PAI block (control group), or ACB, PAI, and IPACK block (IPACK group). The primary outcome was mean pain at rest during 24–48 hours post-operation using a numerical rating scale (0–10). We also investigated opioid use and ambulation pain.Results: 89 patients were evaluated, 45 from the control group and 44 from the IPACK group. Despite slightly higher mean pai...

Research paper thumbnail of Efficacy of epinephrine in local infiltration analgesia on pain relief and opioid consumption following total knee arthroplasty: a randomized controlled trial

Acta Orthopaedica

Background and purpose: Local infiltration analgesia (LIA) is one of the effective regimens to re... more Background and purpose: Local infiltration analgesia (LIA) is one of the effective regimens to reduce pain after total knee arthroplasty (TKA). Epinephrine is a commonly used sympathetic adjunct in LIA. It is expected to enhance the intensity and extend the duration of LIA. The primary aim of the study was to evaluate the efficacy of epinephrine on postoperative pain control after primary TKA.Patients and methods: A total of 80 patients who underwent primary TKA were randomized into an epinephrine (EN) and a control (C) group. Postoperative visual analogue pain score (VAPS) and morphine consumption were recorded every 6 hours until 48 hours after operation. The VAPS 6–48 hours were compared using repeated measure statistics. The range of motion (ROM) on discharge and complications were also compared between these 2 groups.Results: The study showed that although VAPS differed statistically between the 2 groups at 12 hours (C higher) and 48 hours (C lower) postoperatively (p = 0.04 an...

Research paper thumbnail of The pre-anesthetic period is the best time to evaluate the knee flexion angle for predicting the flexion angle after total knee arthroplasty: A prospective cohort study

PLOS ONE, Feb 3, 2023

Introduction Knee flexion angle (KFA) is one of the most critical factors for evaluating patient ... more Introduction Knee flexion angle (KFA) is one of the most critical factors for evaluating patient functional outcomes after total knee arthroplasty (TKA). Preoperative KFA and intraoperative drop leg test are both accepted as predictors of postoperative KFA after TKA. Preoperative testing performed after anesthesia helps overcome pain-related limitations; however, the KFA measurement timepoint that best predicts KFA at 6 months after TKA has not yet been established. Methods This prospective cohort study recruited patients who underwent unilateral primary TKA at Siriraj Hospital (Bangkok, Thailand) during August 2012 to August 2017. We recorded KFA at the pre-anesthetic phase, post-anesthetic phase, intraoperation using drop leg test, and at 6-months post-operation. Pearson's correlation coefficient was used to evaluate correlation between different measurement timepoints and 6 months after surgery. Those same relationships were evaluated for overall patients, and for patients with KFA <90˚(poor KFA), 90-120˚(average KFA), and >120˚(high KFA). Results A total of 165 patients with a mean age of 68.7 years were recruited. Pre-anesthetic KFA measurement had the highest positive correlation with the 6-month KFA (r = 0.771, p<0.05). Post-anesthetic measurement and intraoperative drop leg KFA measurement had moderate positive correlation (r = 0.561, p<0.05) and low positive correlation (r = 0.368, p<0.05) with the 6-month KFA, respectively. The average KFA group had the highest positive correlation between pre-anesthetic KFA measurement and the 6-month KFA (r = 0.711, p<0.05).

Research paper thumbnail of The factors influencing the component sizes in Oxford Phase 3 unicompartmental knee arthroplasty

Joint Diseases and Related Surgery

This study aims to investigate the Thai population characteristics that may correlate the compone... more This study aims to investigate the Thai population characteristics that may correlate the component sizes used in the Oxford Phase 3 unicompartmental knee arthroplasty (OUKA) and to examine common matching patterns and variables affecting matching and patient-specific factors while determining the femoral component (Fc) size for Thai patients.

Research paper thumbnail of No association between different in tibial resection level and clinical outcomes six months after Oxford unicompartmental knee arthroplasty: a prospective cohort study

BMC Musculoskeletal Disorders

Background Localized tibial strain is one of the hypotheses to explain residual pain after Oxford... more Background Localized tibial strain is one of the hypotheses to explain residual pain after Oxford UKA. We evaluate whether the depth of the vertical cut during tibial resection correlates with medial knee pain. We aimed to investigate the association between the depth of tibial resection and medial knee pain after OUKA. Methods This prospective cohort study enrolled 85 patients (mean age: 64.5 ± 7.7 years) who underwent cemented OUKA at our institute during October 2018–June 2019. The depth of tibial resection was measured intraoperatively as the thickness of the anterior, middle, and posterior parts. The greatest of the three thicknesses was recorded. Medial knee pain was assessed at 6 weeks and followed to 6 months. Patients were divided into the pain (P) and no pain (NP) groups. Preoperative and postoperative radiographic findings and OKS were compared between groups. We used logistic regression to analyze the independent association. Results The mean preoperative Oxford Knee Sco...

Research paper thumbnail of Alignment accuracy and functional outcomes between hand-held navigation and conventional instruments in TKA: a randomized controlled trial

BMC Musculoskeletal Disorders

Background This study assessed surgical accuracy and functional outcomes using hand-held accelero... more Background This study assessed surgical accuracy and functional outcomes using hand-held accelerometer-based navigation following total knee arthroplasty (TKA). Question: (1) Does hand-held navigation (the iAssist system) improve surgical accuracy (assessed with five parameters commonly used to evaluate surgical alignment: the hip-knee-ankle angle (HKA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), and tibial slope angle (TSA)) compared to conventional instruments in TKA? (2) Which surgical alignment parameters among HKA, FCA, TCA, FSA, and TSA can obtain the most advantage from the iAssist system? (3) Does the iAssist system lead to better functional outcomes at two years of follow-up after TKA? Methods This parallel-group double-blinded randomized controlled trial recruited 60 patients (30 patients each in the iAssist and conventional group) with osteoarthritis who underwent primary TKA by a single surgeon at Siriraj Hospital. There was no...

Research paper thumbnail of Early Intraprosthetic Dislocation After Closed Reduction in Modern Dual-mobility Total Hip Arthroplasty

Arthroplasty Today, 2022

The unique or specific implant-related complication of dual-mobility total hip arthroplasty (DM-T... more The unique or specific implant-related complication of dual-mobility total hip arthroplasty (DM-THA) is intraprosthetic dislocation (IPD), and different mechanisms of IPD have been proposed. Early IPD or IPD without polyethylene wear has been reported in modern DM-THA designs. We report the first case of early IPD in Thailand that occurred after attempted closed reduction of DM-THA.

Research paper thumbnail of Accuracy of empirical distal femoral valgus cut angle of 4° to 6° in total knee arthroplasty: a randomized controlled trial

European Journal of Orthopaedic Surgery & Traumatology, 2021

Introduction Currently, the best and simplest way that used to select the distal femoral valgus c... more Introduction Currently, the best and simplest way that used to select the distal femoral valgus cut (DFVC) angle in total knee arthroplasty (TKA) is standing long leg radiograph. However, this kind of film is still not available in all hospitals. The purpose of this study is to compare the accuracy of different empirical DFVC angles in the restoration of the neutral mechanical alignment of the femoral component after TKA. Method 125 patients who diagnosed primary osteoarthritic knee and underwent unilateral TKA were randomly assigned into three groups: A, B, and C, according to the use of an intramedullary guide with the DFVC angle of 4°, 5°, and 6°, respectively. At three months after surgery, anteroposterior hip-to-ankle computed tomography (CT) scanograms were evaluated. Mechanical axis angle (MAA), mechanical lateral distal femoral angle (LDFA), femoral bowing, femoral neck-shaft angle (FNSA), and outliers of femoral component position were measured and compared among three groups. Independent influencing factors for the outliers > ±3° were determined using binary logistic regression analysis. Results Group B was older than group A. There were no significant differences of postoperative MAA, LDFA, femoral bowing, and FNSA among three groups. Outliers > ±3° of femoral component position in each group were 14.6%, 19.0%, and 16.7%, respectively ( p = 0.865). When considering the outliers > ±2°, group C (35.7%) had a trend to have fewer outliers than groups A and B (41.5 and 42.9%). However, this finding was not reached the statistical significance ( p = 0.778). Femoral bowing was only significantly influencing factors that related to the outliers > ±3° ( p = 0.003). Conclusion This study demonstrates that there are no significant differences in coronal femoral component alignment among using the DFVC angle of 4°, 5°, and 6°. The use of the DFVC angle of 6° had a trend to reduce the outliers. Nevertheless, femoral bowing is the crucial influencing factor for selecting the degree of DFVC angle.

Research paper thumbnail of Complications, Reasons for Reoperation, and 5-Year Prosthesis Survival Compared Between the Cemented and Cementless Oxford Unicompartmental Knee Arthroplasty Fixation Techniques at Thailand’s Largest National Tertiary Referral Center

Background: Oxford unicompartmental knee arthroplasty (OUKA) yields favorable outcomes in patient... more Background: Oxford unicompartmental knee arthroplasty (OUKA) yields favorable outcomes in patients with medial compartmental knee osteoarthritis; however, it remains unknown whether cemented or cementless OUKA fixation delivers better outcomes in Asian population. Accordingly, this study aimed to investigate the complications, reasons for reoperation, and 5-year prosthesis survival compared between cemented and cementless OUKA in Thai patients.Methods: A total of 466 cemented and 36 cementless OUKA that were performed during 2011-2015 with a minimum follow-up of five years were included. With reoperation for any reason as the endpoint, Kaplan-Meier analysis was performed to compare 5-year implant survival between groups. Complications, reasons for reoperation, and 90-day morbidity and mortality were compared between groups. Cox proportional hazards model was used to identify independent predictors of implant survival.Results: There was no significant difference in 5-year implant sur...

Research paper thumbnail of Retrieval Analysis of Polyethylene in Total Knee Arthroplasty in Thailand: A Case Report

Objective: Retrieval analysis is one of the effective methods that can provide the information o... more Objective: Retrieval analysis is one of the effective methods that can provide the information on in-vivo characteristics of wear implants. The clinicians can correlate the damage pattern from this method with other findings in a reproducible manner. Nevertheless, there has been no previous retrieval analyses of PE wear in total knee arthroplasty (TKA) in Thailand. Case Presentation: A 80-year-old female underwent left TKA due to osteoarthritic knee in 1994. She was 135 cm in height and weighed 42.7 kg. The cemented posterior stabilized press-fit condylar (PFC) (Depuy, Warsaw, IN, US) total knee system was used. Patellar resurfacing was performed with a cemented all-polyethylene implant. The femoral component was cobalt-chrome, while the tibial component was titanium alloy. A 12.5-mm thickness of stabilized plus tibial insert was used. After surgery, her knee had functioned well for 20 years. One year ago, she had intermittent swelling and effusion of the knee, together with occasi...

Research paper thumbnail of Effectiveness Testing of Combined Innovative Pressurized Carbon Dioxide Lavage and Pulsatile Normal Saline Irrigation to Enhance Bone Cement Penetration in Total Knee Replacement: A Cadaveric Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Background The cementing technique in total knee arthroplasty (TKA) is essential for a successful... more Background The cementing technique in total knee arthroplasty (TKA) is essential for a successful outcome. Previous studies have shown that deeper cement penetration results in greater tensile and shear strength between the bony part and the prosthetic parts. Objective: Objective To investigate the effectiveness of combined innovative pressurized carbon dioxide lavage and pulsatile normal saline irrigation for enhancing cement penetration into cancellous bone, as compared with standard pulsatile normal irrigation alone. Material and Method An intra-individual comparative cadaveric study was conducted at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University in April 2015. Ten fresh cadavers underwent TKA via the medial parapatellar approach. The proximal tibia was cut perpendicular to its anatomical axis at a point nine millimeters inferior to the lateral plateau. After randomization of knees, the proximal tibia of one side was prepared with ...

Research paper thumbnail of Reoperation rate and implant survivorship compared between cementless and cemented bipolar hemiarthroplasty in femoral neck fracture patients with chronic kidney disease

Injury, 2021

BACKGROUND Chronic kidney disease (CKD) is commonly associated with aging and disorders of minera... more BACKGROUND Chronic kidney disease (CKD) is commonly associated with aging and disorders of mineral and bone metabolism. Femoral neck fracture (FNF) is one of the most common fractures among older adults with coexisting CKD, and bipolar hemiarthroplasty (BHA) is a preferred treatment. However, the optimal method of stem fixation has not been conclusively determined. Accordingly, this study aimed to investigate the reoperation rate and implant survivorship compared between cementless and cemented BHA in FNF patients with CKD. METHODS A total of 183 FNF patients with moderate to severe CKD who underwent BHA during 2003 to 2019 were recruited and divided into either the cemented (CT group, n = 56) or cementless (CL group, 127) groups. Demographic data, preoperative laboratory investigations, preoperative radiographic outcomes, perioperative outcomes, and 90-day morbidity, mortality, and reoperation rates for any reason were recorded and compared between groups. Kaplan-Meier survival analysis was used to compare implant survivorship between the CT and CL groups. Cox proportional hazards regression model was used to identify independent risk factors for implant survivorship. RESULTS There were no significant differences in patient characteristics or preoperative data between groups, except for Dorr's classification of proximal femoral geometry. The CT group had a significantly lower proportion of Dorr type A (p = 0.020), and a higher proportion of Dorr type C (p<0.001). The CT group also had significantly more intraoperative blood loss (p<0.01). No significant differences in morbidity or mortality were observed. The median follow-up time in the CT group and CL group was 22.6 months (range: 0-151) and 22.6 months (range 0-154), respectively (p = 0.607). The reoperation rate was 5.4% and 4.7% among CT and CL patients, respectively (p = 1.000). There was no significant difference in the mean survival time between the CT (139.5 ± 6.3 months, 95%CI: 127.1-151.8) and CL (142.5 ± 4.7 months, 95%CI: 133.2-151.7) groups (p = 0.880). Univariate and multivariate analyses revealed no independent risk factors for implant survivorship. CONCLUSION The results of this study showed no significant differences in the reoperation rate or implant survivorship between cemented and cementless BHA for treating FNF in moderate to severe CKD patients. A well-designed larger and longer-term study is needed to confirm these results.

Research paper thumbnail of Delayed Femoral Artery Occlusion After Total Hip Arthroplasty via the Posterior Approach: A Single-Case Report From Thailand

Arthroplasty Today, 2021

Arterial injury after total hip arthroplasty is rare, but the consequences of this complication a... more Arterial injury after total hip arthroplasty is rare, but the consequences of this complication are serious and potentially life-threatening. Here, we report a case of delayed-onset common femoral artery occlusion after total hip arthroplasty that was performed via the posterior approach at Siriraj Hospital—Thailand’s largest university-based national tertiary referral center. Our case was successfully treated with arterial thromboembolectomy. We postulate that anterior retractor placement caused intimal injury to the vessel. Routine monitoring of postoperative vascular pulse is essential. Early detection and prompt vascular surgeon consultation are the important factors for preventing the potentially catastrophic consequences of this complication.

Research paper thumbnail of Blood loss and transfusion rate compared among different dosing regimens of tranexamic acid administration in patients undergoing hip hemiarthroplasty for femoral neck fracture: A randomized controlled trial

Injury, 2021

BACKGROUND Intravenous tranexamic acid (TXA) administration is a proven safe and effective method... more BACKGROUND Intravenous tranexamic acid (TXA) administration is a proven safe and effective method for reducing both blood loss and transfusion in total joint arthroplasty. However, data specific to its efficacy in hip hemiarthroplasty (HHA) for femoral neck fracture are scarce. Furthermore, no study has investigated the efficacy of an additional dose of TXA administration. Accordingly, this study aimed to assess blood loss and the transfusion rate compared among different regimens of TXA administration in patients undergoing HHA for femoral neck fracture. METHODS Between January 2019 to December 2020, 90 HHA patients were randomized into one of three groups (30 patients/group). Control group patients received intravenous normal saline solution (NSS) 20 mL before skin incision, and NSS 20 mL at 3 hours after surgery. one-dose (1D) group patients received 750 mg of intravenous TXA before skin incision, and NSS 20 mL at 3 hours after surgery. Two-dose (2D) group patients received 750 mg of intravenous TXA before skin incision, and 750 mg of TXA at 3 hours after surgery. The primary outcome was blood transfusion rate. Intraoperative blood loss, hemoglobin levels at 24- and 48-hours postoperation, and calculated total blood loss were compared among the three groups. RESULTS The mean age of the study population was 79.7 years, and 76.7% of participants were women. The transfusion rate in the control, 1D and 2D groups was 43.3%, 16.7%, and 3.3%, respectively. Total hemoglobin loss; total red blood cell loss; intraoperative blood loss; hemoglobin level at 24- and 48-hours postoperation; change in hemoglobin level between 0 and 24 hours, and between 0 and 48 hours; blood transfusion rate; and, the number of patients who did not require blood transfusion were all significantly improved in the 2D group compared to baseline. No parameters were significantly improved in the 1D group compared to controls. CONCLUSIONS The results of this study demonstrate both the efficacy of TXA administration in HHA, and the superiority of two-dose TXA administration over one-dose TXA administration in HHA for femoral neck fracture.

Research paper thumbnail of Duration of Prophylactic Antibiotic and Prosthetic Joint Infection in a Developing Country: a Retrospective Cohort Study

BackgroundPerioperative antibiotic prophylaxis is one of the standard measures for preventing per... more BackgroundPerioperative antibiotic prophylaxis is one of the standard measures for preventing periprosthetic joint infection (PJI). In developing countries, poor surgical environment and patient hygiene are often cited as reasons for prolonged antibiotic duration without any evidence to support its effectiveness. The aim of this study was to investigate the infection rate after TKA compared between standard course (≤24 hours) and extended course (>24 hours) of perioperative antibiotic prophylaxis in a developing country.MethodsThis retrospective study included patients who underwent unicompartmental knee arthroplasty or total knee arthroplasty during January 2013 to December 2018. A total of 3,316 patients were included. Of those, 1,284 and 2,032 patients received standard and extended course of antibiotic prophylaxis, respectively. The incidence of PJI was compared between groups, and we also analyzed for factors significantly associated with PJI.ResultsPJI developed in 0.5% (6/...

Research paper thumbnail of Modified Robert Jones bandage can not reduce invisible blood loss after total knee arthroplasty: a randomized-controlled trial

Archives of Orthopaedic and Trauma Surgery, 2018

Introduction To compare the efficacy and safety of modified Robert Jones bandage (MRJB) and non-c... more Introduction To compare the efficacy and safety of modified Robert Jones bandage (MRJB) and non-compressive dressing (NCD) on reducing invisible blood loss (IBL) after total knee arthroplasty (TKA). Materials and methods Eighty patients who underwent unilateral TKA were randomly assigned into two groups: MRJB and NCD groups. Pre-and post-operative hematocrit levels, amount of drained blood and transfused blood were measured and calculated into IBL. Pain score, amount of morphine usage, range of motion (ROM) at discharge, blood transfusion rate, and complications were also recorded and compared between both groups. Results There was no significant difference in the mean IBL between MRJB (221.2 ± 233.3 ml) and NCD groups (158.5 ± 186.7 ml) (p = 0.219). Post-operative pain score at rest and during ambulation, amount of morphine usage, ROM at discharge, blood transfusion rate, and complications were also similar between two groups. Conclusions This study cannot determine the benefit of MRJB over NCD. The use of MRJB may not be necessary after primary TKA.

Research paper thumbnail of Survivorship of medial opening wedge high tibial osteotomy in the elderly: two to ten years of follow up

International Orthopaedics, 2017

Background and purpose Medial opening wedge high tibial osteotomy (MOWHTO) is a well-accepted pro... more Background and purpose Medial opening wedge high tibial osteotomy (MOWHTO) is a well-accepted procedure, which has been widely used for pain relief and varus deformity correction in the osteoarthritic (OA) knee, especially in the young patient. However, in the elderly patient, the efficacy of this procedure is still unknown. Therefore, this study aims to evaluate the survivorship of MOWHTO in elderly patients as the primary outcome. The secondary outcome is to evaluate the loss of correction angle that is the common complication after MOWTHO. Materials and method A retrospective study of 50 elderly patients (≥ 60 years) was conducted to track survivorship of MOWHTO. All patients were diagnosed with varus OA knee and underwent MOWHTO at our institute. The patients who had previous knee surgery or incomplete data were excluded. Medical records and radiographs of eligible patients were reviewed for recruiting the data. Survivorship of MOWHTO was analyzed using Kaplan-Meier curves. The starting point was the time of operation and the end point was the time of subsequent TKA. The loss of correction angle was defined as the change of medial proximal tibial angle (MPTA) between three months and one year post-operatively. Results The mean age of patients was 66 ± 5.0 years. The majority of patients were female (74%). The mean correction angle was 10.6 ± 3.6 degrees. The union rate of osteotomy site was 100%. In survival analysis, the median follow-up time was 6.0 ± 3.0 years. Two patients required subsequent conversions to TKA. The survivorship of MOWHTO at four years was 95.5% (95%CI, 96.0 to 98.0). For radiographic assessment, the loss of correction angle was 1.0 ± 0.5 degrees at one year post-operatively. Conclusion This study proved that MOWHTO in patient ≥60 years had good mid-term survivorship with acceptable complications. This procedure can be the alternative option for the treatment of varus OA knee in the elderly.

Research paper thumbnail of Effect of Depth of Centrifuged Synovial Fluid on Leukocyte Esterase Test for Periprosthetic Joint Infection

Journal of Orthopaedic Research, 2017

Centrifugation of aspirated synovial fluid before leukocytes esterase (LE) testing for diagnosing... more Centrifugation of aspirated synovial fluid before leukocytes esterase (LE) testing for diagnosing periprosthetic joint infection (PJI) may make blood tinged specimens interpretable. We aimed to establish the proper sampling depth of centrifuged specimens for LE testing as one diagnostic criterion and also AS-D chloroacetate esterase (CAE) staining testing as an adjunctive tool. A definite PJI knee joint group and an aseptic primary total knee arthroplasty control group were studied quasi-experimentally (N ¼ 46). At 2,000 g for 15 min, 3 ml of synovial fluid was centrifuged. LE strip testing and median synovial WBC count were performed at 2, 4, and 6 mm depths. CAE staining test characterized LE particles. ROC curve, area under the curve, and significant differences were determined. The proper predictive depth to diagnose PJI was sought by forward stepwise logistic regression. All fresh bloodtinged specimens had uncertain interpretations. Centrifugation increased interpretability (55-100%). ROC curve and area under the curve at 2, 4, and 6 mm depths were 0.822, 0.804, and 0.786, respectively. The cut point of þþ to diagnose PJI was statistically significant (p < 0.05) at all depths. p-values of forward stepwise logistic regression at 2, 4, and 6 mm were 0.001, 0.752, and 0.756, respectively. CAE staining confirmed extracellular LE release by polymorphonuclear neutrophils (PMN). A specimen at <2 mm from the surface of centrifuged synovial fluid at a grading of þþ or more for PJI diagnosis is proper for LE testing. CAE staining testing adjunctively characterizes LE particles and cell morphology.

Research paper thumbnail of EE414 Cost-Effectiveness of Mobile Intermittent Pneumatic Compression Devices (IPCD) Compared to Traditional IPCD for Early Postoperative Total Knee Replacement: The Hospital’s Perspectives

Research paper thumbnail of Does the accelerometer-based navigation system reduce blood loss and transfusion in one-stage sequential bilateral total knee arthroplasty? A randomized double-blind controlled trial

Research Square (Research Square), Mar 14, 2023

Research paper thumbnail of Efficacy of adding an interspace block to the posterior knee for perioperative pain in total knee arthroplasty: a randomized controlled trial

Acta Orthopaedica

Background and purpose: The interspace between the popliteal artery and the capsule of the poster... more Background and purpose: The interspace between the popliteal artery and the capsule of the posterior knee (IPACK) block is a novel anesthetic technique for total knee arthroplasty (TKA). Our objective was to compare the effect of IPACK and adductor canal block (ACB) and periarticular injection (PAI), relative to ACB and PAI only, from baseline to postoperative day 3, in patients undergoing unilateral primary TKA.Patients and methods: This was a single-center, double-blinded, randomized controlled trial. Adults over the age of 50 who were scheduled for unilateral primary TKA were enrolled. They were randomly assigned to ACB and PAI block (control group), or ACB, PAI, and IPACK block (IPACK group). The primary outcome was mean pain at rest during 24–48 hours post-operation using a numerical rating scale (0–10). We also investigated opioid use and ambulation pain.Results: 89 patients were evaluated, 45 from the control group and 44 from the IPACK group. Despite slightly higher mean pai...

Research paper thumbnail of Efficacy of epinephrine in local infiltration analgesia on pain relief and opioid consumption following total knee arthroplasty: a randomized controlled trial

Acta Orthopaedica

Background and purpose: Local infiltration analgesia (LIA) is one of the effective regimens to re... more Background and purpose: Local infiltration analgesia (LIA) is one of the effective regimens to reduce pain after total knee arthroplasty (TKA). Epinephrine is a commonly used sympathetic adjunct in LIA. It is expected to enhance the intensity and extend the duration of LIA. The primary aim of the study was to evaluate the efficacy of epinephrine on postoperative pain control after primary TKA.Patients and methods: A total of 80 patients who underwent primary TKA were randomized into an epinephrine (EN) and a control (C) group. Postoperative visual analogue pain score (VAPS) and morphine consumption were recorded every 6 hours until 48 hours after operation. The VAPS 6–48 hours were compared using repeated measure statistics. The range of motion (ROM) on discharge and complications were also compared between these 2 groups.Results: The study showed that although VAPS differed statistically between the 2 groups at 12 hours (C higher) and 48 hours (C lower) postoperatively (p = 0.04 an...

Research paper thumbnail of The pre-anesthetic period is the best time to evaluate the knee flexion angle for predicting the flexion angle after total knee arthroplasty: A prospective cohort study

PLOS ONE, Feb 3, 2023

Introduction Knee flexion angle (KFA) is one of the most critical factors for evaluating patient ... more Introduction Knee flexion angle (KFA) is one of the most critical factors for evaluating patient functional outcomes after total knee arthroplasty (TKA). Preoperative KFA and intraoperative drop leg test are both accepted as predictors of postoperative KFA after TKA. Preoperative testing performed after anesthesia helps overcome pain-related limitations; however, the KFA measurement timepoint that best predicts KFA at 6 months after TKA has not yet been established. Methods This prospective cohort study recruited patients who underwent unilateral primary TKA at Siriraj Hospital (Bangkok, Thailand) during August 2012 to August 2017. We recorded KFA at the pre-anesthetic phase, post-anesthetic phase, intraoperation using drop leg test, and at 6-months post-operation. Pearson's correlation coefficient was used to evaluate correlation between different measurement timepoints and 6 months after surgery. Those same relationships were evaluated for overall patients, and for patients with KFA <90˚(poor KFA), 90-120˚(average KFA), and >120˚(high KFA). Results A total of 165 patients with a mean age of 68.7 years were recruited. Pre-anesthetic KFA measurement had the highest positive correlation with the 6-month KFA (r = 0.771, p<0.05). Post-anesthetic measurement and intraoperative drop leg KFA measurement had moderate positive correlation (r = 0.561, p<0.05) and low positive correlation (r = 0.368, p<0.05) with the 6-month KFA, respectively. The average KFA group had the highest positive correlation between pre-anesthetic KFA measurement and the 6-month KFA (r = 0.711, p<0.05).

Research paper thumbnail of The factors influencing the component sizes in Oxford Phase 3 unicompartmental knee arthroplasty

Joint Diseases and Related Surgery

This study aims to investigate the Thai population characteristics that may correlate the compone... more This study aims to investigate the Thai population characteristics that may correlate the component sizes used in the Oxford Phase 3 unicompartmental knee arthroplasty (OUKA) and to examine common matching patterns and variables affecting matching and patient-specific factors while determining the femoral component (Fc) size for Thai patients.

Research paper thumbnail of No association between different in tibial resection level and clinical outcomes six months after Oxford unicompartmental knee arthroplasty: a prospective cohort study

BMC Musculoskeletal Disorders

Background Localized tibial strain is one of the hypotheses to explain residual pain after Oxford... more Background Localized tibial strain is one of the hypotheses to explain residual pain after Oxford UKA. We evaluate whether the depth of the vertical cut during tibial resection correlates with medial knee pain. We aimed to investigate the association between the depth of tibial resection and medial knee pain after OUKA. Methods This prospective cohort study enrolled 85 patients (mean age: 64.5 ± 7.7 years) who underwent cemented OUKA at our institute during October 2018–June 2019. The depth of tibial resection was measured intraoperatively as the thickness of the anterior, middle, and posterior parts. The greatest of the three thicknesses was recorded. Medial knee pain was assessed at 6 weeks and followed to 6 months. Patients were divided into the pain (P) and no pain (NP) groups. Preoperative and postoperative radiographic findings and OKS were compared between groups. We used logistic regression to analyze the independent association. Results The mean preoperative Oxford Knee Sco...

Research paper thumbnail of Alignment accuracy and functional outcomes between hand-held navigation and conventional instruments in TKA: a randomized controlled trial

BMC Musculoskeletal Disorders

Background This study assessed surgical accuracy and functional outcomes using hand-held accelero... more Background This study assessed surgical accuracy and functional outcomes using hand-held accelerometer-based navigation following total knee arthroplasty (TKA). Question: (1) Does hand-held navigation (the iAssist system) improve surgical accuracy (assessed with five parameters commonly used to evaluate surgical alignment: the hip-knee-ankle angle (HKA), femoral coronal angle (FCA), tibial coronal angle (TCA), femoral sagittal angle (FSA), and tibial slope angle (TSA)) compared to conventional instruments in TKA? (2) Which surgical alignment parameters among HKA, FCA, TCA, FSA, and TSA can obtain the most advantage from the iAssist system? (3) Does the iAssist system lead to better functional outcomes at two years of follow-up after TKA? Methods This parallel-group double-blinded randomized controlled trial recruited 60 patients (30 patients each in the iAssist and conventional group) with osteoarthritis who underwent primary TKA by a single surgeon at Siriraj Hospital. There was no...

Research paper thumbnail of Early Intraprosthetic Dislocation After Closed Reduction in Modern Dual-mobility Total Hip Arthroplasty

Arthroplasty Today, 2022

The unique or specific implant-related complication of dual-mobility total hip arthroplasty (DM-T... more The unique or specific implant-related complication of dual-mobility total hip arthroplasty (DM-THA) is intraprosthetic dislocation (IPD), and different mechanisms of IPD have been proposed. Early IPD or IPD without polyethylene wear has been reported in modern DM-THA designs. We report the first case of early IPD in Thailand that occurred after attempted closed reduction of DM-THA.

Research paper thumbnail of Accuracy of empirical distal femoral valgus cut angle of 4° to 6° in total knee arthroplasty: a randomized controlled trial

European Journal of Orthopaedic Surgery & Traumatology, 2021

Introduction Currently, the best and simplest way that used to select the distal femoral valgus c... more Introduction Currently, the best and simplest way that used to select the distal femoral valgus cut (DFVC) angle in total knee arthroplasty (TKA) is standing long leg radiograph. However, this kind of film is still not available in all hospitals. The purpose of this study is to compare the accuracy of different empirical DFVC angles in the restoration of the neutral mechanical alignment of the femoral component after TKA. Method 125 patients who diagnosed primary osteoarthritic knee and underwent unilateral TKA were randomly assigned into three groups: A, B, and C, according to the use of an intramedullary guide with the DFVC angle of 4°, 5°, and 6°, respectively. At three months after surgery, anteroposterior hip-to-ankle computed tomography (CT) scanograms were evaluated. Mechanical axis angle (MAA), mechanical lateral distal femoral angle (LDFA), femoral bowing, femoral neck-shaft angle (FNSA), and outliers of femoral component position were measured and compared among three groups. Independent influencing factors for the outliers > ±3° were determined using binary logistic regression analysis. Results Group B was older than group A. There were no significant differences of postoperative MAA, LDFA, femoral bowing, and FNSA among three groups. Outliers > ±3° of femoral component position in each group were 14.6%, 19.0%, and 16.7%, respectively ( p = 0.865). When considering the outliers > ±2°, group C (35.7%) had a trend to have fewer outliers than groups A and B (41.5 and 42.9%). However, this finding was not reached the statistical significance ( p = 0.778). Femoral bowing was only significantly influencing factors that related to the outliers > ±3° ( p = 0.003). Conclusion This study demonstrates that there are no significant differences in coronal femoral component alignment among using the DFVC angle of 4°, 5°, and 6°. The use of the DFVC angle of 6° had a trend to reduce the outliers. Nevertheless, femoral bowing is the crucial influencing factor for selecting the degree of DFVC angle.

Research paper thumbnail of Complications, Reasons for Reoperation, and 5-Year Prosthesis Survival Compared Between the Cemented and Cementless Oxford Unicompartmental Knee Arthroplasty Fixation Techniques at Thailand’s Largest National Tertiary Referral Center

Background: Oxford unicompartmental knee arthroplasty (OUKA) yields favorable outcomes in patient... more Background: Oxford unicompartmental knee arthroplasty (OUKA) yields favorable outcomes in patients with medial compartmental knee osteoarthritis; however, it remains unknown whether cemented or cementless OUKA fixation delivers better outcomes in Asian population. Accordingly, this study aimed to investigate the complications, reasons for reoperation, and 5-year prosthesis survival compared between cemented and cementless OUKA in Thai patients.Methods: A total of 466 cemented and 36 cementless OUKA that were performed during 2011-2015 with a minimum follow-up of five years were included. With reoperation for any reason as the endpoint, Kaplan-Meier analysis was performed to compare 5-year implant survival between groups. Complications, reasons for reoperation, and 90-day morbidity and mortality were compared between groups. Cox proportional hazards model was used to identify independent predictors of implant survival.Results: There was no significant difference in 5-year implant sur...

Research paper thumbnail of Retrieval Analysis of Polyethylene in Total Knee Arthroplasty in Thailand: A Case Report

Objective: Retrieval analysis is one of the effective methods that can provide the information o... more Objective: Retrieval analysis is one of the effective methods that can provide the information on in-vivo characteristics of wear implants. The clinicians can correlate the damage pattern from this method with other findings in a reproducible manner. Nevertheless, there has been no previous retrieval analyses of PE wear in total knee arthroplasty (TKA) in Thailand. Case Presentation: A 80-year-old female underwent left TKA due to osteoarthritic knee in 1994. She was 135 cm in height and weighed 42.7 kg. The cemented posterior stabilized press-fit condylar (PFC) (Depuy, Warsaw, IN, US) total knee system was used. Patellar resurfacing was performed with a cemented all-polyethylene implant. The femoral component was cobalt-chrome, while the tibial component was titanium alloy. A 12.5-mm thickness of stabilized plus tibial insert was used. After surgery, her knee had functioned well for 20 years. One year ago, she had intermittent swelling and effusion of the knee, together with occasi...

Research paper thumbnail of Effectiveness Testing of Combined Innovative Pressurized Carbon Dioxide Lavage and Pulsatile Normal Saline Irrigation to Enhance Bone Cement Penetration in Total Knee Replacement: A Cadaveric Study

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2016

Background The cementing technique in total knee arthroplasty (TKA) is essential for a successful... more Background The cementing technique in total knee arthroplasty (TKA) is essential for a successful outcome. Previous studies have shown that deeper cement penetration results in greater tensile and shear strength between the bony part and the prosthetic parts. Objective: Objective To investigate the effectiveness of combined innovative pressurized carbon dioxide lavage and pulsatile normal saline irrigation for enhancing cement penetration into cancellous bone, as compared with standard pulsatile normal irrigation alone. Material and Method An intra-individual comparative cadaveric study was conducted at the Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University in April 2015. Ten fresh cadavers underwent TKA via the medial parapatellar approach. The proximal tibia was cut perpendicular to its anatomical axis at a point nine millimeters inferior to the lateral plateau. After randomization of knees, the proximal tibia of one side was prepared with ...

Research paper thumbnail of Reoperation rate and implant survivorship compared between cementless and cemented bipolar hemiarthroplasty in femoral neck fracture patients with chronic kidney disease

Injury, 2021

BACKGROUND Chronic kidney disease (CKD) is commonly associated with aging and disorders of minera... more BACKGROUND Chronic kidney disease (CKD) is commonly associated with aging and disorders of mineral and bone metabolism. Femoral neck fracture (FNF) is one of the most common fractures among older adults with coexisting CKD, and bipolar hemiarthroplasty (BHA) is a preferred treatment. However, the optimal method of stem fixation has not been conclusively determined. Accordingly, this study aimed to investigate the reoperation rate and implant survivorship compared between cementless and cemented BHA in FNF patients with CKD. METHODS A total of 183 FNF patients with moderate to severe CKD who underwent BHA during 2003 to 2019 were recruited and divided into either the cemented (CT group, n = 56) or cementless (CL group, 127) groups. Demographic data, preoperative laboratory investigations, preoperative radiographic outcomes, perioperative outcomes, and 90-day morbidity, mortality, and reoperation rates for any reason were recorded and compared between groups. Kaplan-Meier survival analysis was used to compare implant survivorship between the CT and CL groups. Cox proportional hazards regression model was used to identify independent risk factors for implant survivorship. RESULTS There were no significant differences in patient characteristics or preoperative data between groups, except for Dorr's classification of proximal femoral geometry. The CT group had a significantly lower proportion of Dorr type A (p = 0.020), and a higher proportion of Dorr type C (p<0.001). The CT group also had significantly more intraoperative blood loss (p<0.01). No significant differences in morbidity or mortality were observed. The median follow-up time in the CT group and CL group was 22.6 months (range: 0-151) and 22.6 months (range 0-154), respectively (p = 0.607). The reoperation rate was 5.4% and 4.7% among CT and CL patients, respectively (p = 1.000). There was no significant difference in the mean survival time between the CT (139.5 ± 6.3 months, 95%CI: 127.1-151.8) and CL (142.5 ± 4.7 months, 95%CI: 133.2-151.7) groups (p = 0.880). Univariate and multivariate analyses revealed no independent risk factors for implant survivorship. CONCLUSION The results of this study showed no significant differences in the reoperation rate or implant survivorship between cemented and cementless BHA for treating FNF in moderate to severe CKD patients. A well-designed larger and longer-term study is needed to confirm these results.

Research paper thumbnail of Delayed Femoral Artery Occlusion After Total Hip Arthroplasty via the Posterior Approach: A Single-Case Report From Thailand

Arthroplasty Today, 2021

Arterial injury after total hip arthroplasty is rare, but the consequences of this complication a... more Arterial injury after total hip arthroplasty is rare, but the consequences of this complication are serious and potentially life-threatening. Here, we report a case of delayed-onset common femoral artery occlusion after total hip arthroplasty that was performed via the posterior approach at Siriraj Hospital—Thailand’s largest university-based national tertiary referral center. Our case was successfully treated with arterial thromboembolectomy. We postulate that anterior retractor placement caused intimal injury to the vessel. Routine monitoring of postoperative vascular pulse is essential. Early detection and prompt vascular surgeon consultation are the important factors for preventing the potentially catastrophic consequences of this complication.

Research paper thumbnail of Blood loss and transfusion rate compared among different dosing regimens of tranexamic acid administration in patients undergoing hip hemiarthroplasty for femoral neck fracture: A randomized controlled trial

Injury, 2021

BACKGROUND Intravenous tranexamic acid (TXA) administration is a proven safe and effective method... more BACKGROUND Intravenous tranexamic acid (TXA) administration is a proven safe and effective method for reducing both blood loss and transfusion in total joint arthroplasty. However, data specific to its efficacy in hip hemiarthroplasty (HHA) for femoral neck fracture are scarce. Furthermore, no study has investigated the efficacy of an additional dose of TXA administration. Accordingly, this study aimed to assess blood loss and the transfusion rate compared among different regimens of TXA administration in patients undergoing HHA for femoral neck fracture. METHODS Between January 2019 to December 2020, 90 HHA patients were randomized into one of three groups (30 patients/group). Control group patients received intravenous normal saline solution (NSS) 20 mL before skin incision, and NSS 20 mL at 3 hours after surgery. one-dose (1D) group patients received 750 mg of intravenous TXA before skin incision, and NSS 20 mL at 3 hours after surgery. Two-dose (2D) group patients received 750 mg of intravenous TXA before skin incision, and 750 mg of TXA at 3 hours after surgery. The primary outcome was blood transfusion rate. Intraoperative blood loss, hemoglobin levels at 24- and 48-hours postoperation, and calculated total blood loss were compared among the three groups. RESULTS The mean age of the study population was 79.7 years, and 76.7% of participants were women. The transfusion rate in the control, 1D and 2D groups was 43.3%, 16.7%, and 3.3%, respectively. Total hemoglobin loss; total red blood cell loss; intraoperative blood loss; hemoglobin level at 24- and 48-hours postoperation; change in hemoglobin level between 0 and 24 hours, and between 0 and 48 hours; blood transfusion rate; and, the number of patients who did not require blood transfusion were all significantly improved in the 2D group compared to baseline. No parameters were significantly improved in the 1D group compared to controls. CONCLUSIONS The results of this study demonstrate both the efficacy of TXA administration in HHA, and the superiority of two-dose TXA administration over one-dose TXA administration in HHA for femoral neck fracture.

Research paper thumbnail of Duration of Prophylactic Antibiotic and Prosthetic Joint Infection in a Developing Country: a Retrospective Cohort Study

BackgroundPerioperative antibiotic prophylaxis is one of the standard measures for preventing per... more BackgroundPerioperative antibiotic prophylaxis is one of the standard measures for preventing periprosthetic joint infection (PJI). In developing countries, poor surgical environment and patient hygiene are often cited as reasons for prolonged antibiotic duration without any evidence to support its effectiveness. The aim of this study was to investigate the infection rate after TKA compared between standard course (≤24 hours) and extended course (>24 hours) of perioperative antibiotic prophylaxis in a developing country.MethodsThis retrospective study included patients who underwent unicompartmental knee arthroplasty or total knee arthroplasty during January 2013 to December 2018. A total of 3,316 patients were included. Of those, 1,284 and 2,032 patients received standard and extended course of antibiotic prophylaxis, respectively. The incidence of PJI was compared between groups, and we also analyzed for factors significantly associated with PJI.ResultsPJI developed in 0.5% (6/...

Research paper thumbnail of Modified Robert Jones bandage can not reduce invisible blood loss after total knee arthroplasty: a randomized-controlled trial

Archives of Orthopaedic and Trauma Surgery, 2018

Introduction To compare the efficacy and safety of modified Robert Jones bandage (MRJB) and non-c... more Introduction To compare the efficacy and safety of modified Robert Jones bandage (MRJB) and non-compressive dressing (NCD) on reducing invisible blood loss (IBL) after total knee arthroplasty (TKA). Materials and methods Eighty patients who underwent unilateral TKA were randomly assigned into two groups: MRJB and NCD groups. Pre-and post-operative hematocrit levels, amount of drained blood and transfused blood were measured and calculated into IBL. Pain score, amount of morphine usage, range of motion (ROM) at discharge, blood transfusion rate, and complications were also recorded and compared between both groups. Results There was no significant difference in the mean IBL between MRJB (221.2 ± 233.3 ml) and NCD groups (158.5 ± 186.7 ml) (p = 0.219). Post-operative pain score at rest and during ambulation, amount of morphine usage, ROM at discharge, blood transfusion rate, and complications were also similar between two groups. Conclusions This study cannot determine the benefit of MRJB over NCD. The use of MRJB may not be necessary after primary TKA.

Research paper thumbnail of Survivorship of medial opening wedge high tibial osteotomy in the elderly: two to ten years of follow up

International Orthopaedics, 2017

Background and purpose Medial opening wedge high tibial osteotomy (MOWHTO) is a well-accepted pro... more Background and purpose Medial opening wedge high tibial osteotomy (MOWHTO) is a well-accepted procedure, which has been widely used for pain relief and varus deformity correction in the osteoarthritic (OA) knee, especially in the young patient. However, in the elderly patient, the efficacy of this procedure is still unknown. Therefore, this study aims to evaluate the survivorship of MOWHTO in elderly patients as the primary outcome. The secondary outcome is to evaluate the loss of correction angle that is the common complication after MOWTHO. Materials and method A retrospective study of 50 elderly patients (≥ 60 years) was conducted to track survivorship of MOWHTO. All patients were diagnosed with varus OA knee and underwent MOWHTO at our institute. The patients who had previous knee surgery or incomplete data were excluded. Medical records and radiographs of eligible patients were reviewed for recruiting the data. Survivorship of MOWHTO was analyzed using Kaplan-Meier curves. The starting point was the time of operation and the end point was the time of subsequent TKA. The loss of correction angle was defined as the change of medial proximal tibial angle (MPTA) between three months and one year post-operatively. Results The mean age of patients was 66 ± 5.0 years. The majority of patients were female (74%). The mean correction angle was 10.6 ± 3.6 degrees. The union rate of osteotomy site was 100%. In survival analysis, the median follow-up time was 6.0 ± 3.0 years. Two patients required subsequent conversions to TKA. The survivorship of MOWHTO at four years was 95.5% (95%CI, 96.0 to 98.0). For radiographic assessment, the loss of correction angle was 1.0 ± 0.5 degrees at one year post-operatively. Conclusion This study proved that MOWHTO in patient ≥60 years had good mid-term survivorship with acceptable complications. This procedure can be the alternative option for the treatment of varus OA knee in the elderly.

Research paper thumbnail of Effect of Depth of Centrifuged Synovial Fluid on Leukocyte Esterase Test for Periprosthetic Joint Infection

Journal of Orthopaedic Research, 2017

Centrifugation of aspirated synovial fluid before leukocytes esterase (LE) testing for diagnosing... more Centrifugation of aspirated synovial fluid before leukocytes esterase (LE) testing for diagnosing periprosthetic joint infection (PJI) may make blood tinged specimens interpretable. We aimed to establish the proper sampling depth of centrifuged specimens for LE testing as one diagnostic criterion and also AS-D chloroacetate esterase (CAE) staining testing as an adjunctive tool. A definite PJI knee joint group and an aseptic primary total knee arthroplasty control group were studied quasi-experimentally (N ¼ 46). At 2,000 g for 15 min, 3 ml of synovial fluid was centrifuged. LE strip testing and median synovial WBC count were performed at 2, 4, and 6 mm depths. CAE staining test characterized LE particles. ROC curve, area under the curve, and significant differences were determined. The proper predictive depth to diagnose PJI was sought by forward stepwise logistic regression. All fresh bloodtinged specimens had uncertain interpretations. Centrifugation increased interpretability (55-100%). ROC curve and area under the curve at 2, 4, and 6 mm depths were 0.822, 0.804, and 0.786, respectively. The cut point of þþ to diagnose PJI was statistically significant (p < 0.05) at all depths. p-values of forward stepwise logistic regression at 2, 4, and 6 mm were 0.001, 0.752, and 0.756, respectively. CAE staining confirmed extracellular LE release by polymorphonuclear neutrophils (PMN). A specimen at <2 mm from the surface of centrifuged synovial fluid at a grading of þþ or more for PJI diagnosis is proper for LE testing. CAE staining testing adjunctively characterizes LE particles and cell morphology.