Obesity Does Not Affect Outcomes in Hybrid Versus Cemented Total Knee Arthroplasty in Asians.

BACKGROUND: This study aims to evaluate patient reported and functional outcomes following hybrid versus cemented total knee arthroplasty (TKA) in patients, stratified by body mass index (BMI). METHODS: Registry data of patients undergoing primary TKA between January 2004 and January 2013 were collected. Baseline interviews were conducted preoperatively to assess sociodemographic characteristics, BMI, and knee arthritis severity, using the Knee Society Score which consists of the Knee Society Knee Score and the Knee Society Function Score (KSFS) and Oxford Knee Score (OKS). These scores were collected prospectively, preoperatively, and postoperatively up to 2 years. Two-year outcomes and 5-year revision rates were then compared between (1) hybrid and cemented TKA groups and (2) BMI subclasses within the hybrid and cemented TKA groups. RESULTS: Patients who underwent cemented TKA had marginally better flexion range, KSFS, and OKS at 2 years postoperatively. In the overweight category, flexion range, KSFS, and OKS were marginally lower for hybrid TKAs. There were no differences in outcomes between the 2 groups in Class I and II obesity. Within the cemented TKA group, there were no differences in the outcomes between BMI subclasses. There were significant differences in the KSFS (0.023) and OKS (0.030) between the BMI subclasses within the hybrid TKA group, with patients in Class II obesity faring the worst. There was no statistically significant difference in the revision rates. CONCLUSION: We conclude that obesity does not affect outcomes in hybrid versus cemented TKA.

The influenza A (H1N1-2009) experience at the inaugural Asian Youth Games Singapore 2009: mass gathering during a developing pandemic.

From 29 June to 7 July 2009, Singapore hosted the inaugural Asian Youth Games (AYG), which brought 1210 athletes and 810 officials from 43 participating countries. On 11 June, just 1 week before the Games Village Medical Centre started operations, the World Health Organization officially declared a global H1N1 2009 pandemic. Working in close partnership with the Olympic Council of Asia Medical Commission, Singapore AYG Organising Committee and other government agencies, the AYG Medical Services Committee was successful in preventing the local transmission of H1N1, which would have been a threat to the games, as it could have led to the cancellation of these games. This article describes the experience and valuable lessons learnt from managing a sports-related mass gathering during the developing pandemic.

Continuous infiltration of local anaesthetic following total knee arthroplasty.

PURPOSE: To determine whether continuous infiltration of local anaesthetic can reduce the pain score and morphine use over 48 hours after total knee arthroplasty (TKA). METHODS: 11 men and 43 women aged 50 to 82 years who underwent unilateral TKA for osteoarthritis were recruited. They were randomised into 3 groups. In group 1, 17 patients who acted as controls received patient-controlled analgesia (PCA) with intravenous morphine for 48 hours. In group 2, 16 patients received continuous infiltration of bupivacaine to the subcutaneous tissue and intra-articular space for 48 hours, in addition to PCA. In group 3, 21 patients received an intra-articular injection of local anaesthetic, followed by continuous infiltration of bupivacaine to the subcutaneous tissue and intraarticular space for 48 hours, in addition to PCA. For each patient, a visual analogue score (VAS) for pain was recorded postoperatively at 2, 4, 6, 12, 24, 36, and 48 hours. The total amount of morphine used was recorded at 24 and 48 hours. RESULTS: Over 48 hours, the VAS for pain and morphine use was significantly higher in controls than patients in groups 2 and 3. CONCLUSION: Continuous infiltration of local anaesthetic into the intra-articular space and subcutaneous tissues, in addition to PCA with intravenous morphine, provides significantly more pain relief and reduces morphine use.

Comparison of raloxifene and bisphosphonates based on adherence and treatment satisfaction in postmenopausal Asian women.

We evaluated adherence with raloxifene therapy compared with daily bisphosphonate in Asian postmenopausal women at increased risk of osteoporotic fractures. In this 12-month observational study conducted in Asia (Hong Kong, Malaysia, Pakistan, Philippines, Singapore, Taiwan), 984 postmenopausal women (aged 55 years or older) were treated with raloxifene 60 mg/day (n = 707; 72%) or daily bisphosphonate (alendronate 10 mg/day; n = 206; 21%, or risedronate 5 mg/day; n = 71; 7%) during their normal course of care. Patients were assessed at baseline, 6, and 12 months. Baseline characteristics (including age, race, education, menopausal status, and baseline fractures) were comparable between the raloxifene and bisphosphonate groups. More women on raloxifene completed the study compared with those on bisphosphonate (50.2% versus 37.5%; P < 0.001). Patients also took raloxifene for a longer period than bisphosphonate (median, 356 versus 348 days; P = 0.011). Compared with those taking bisphosphonate, significantly fewer patients taking raloxifene discontinued the study because of stopping treatment (5.7% versus 10.1%, P = 0.017) or changing treatment (2.8% versus 9.7%, P < 0.001). Inconvenient dosing was reported as a primary reason for discontinuation due to stopping or changing treatment in 19 (6.9%) bisphosphonate patients compared with 0 raloxifene patients. The percentage of patients who had consumed 80% or more of their study medication was similar for raloxifene patients (48-56 weeks; 95.2%) and bisphosphonate patients (48-56 weeks; 93.3%). More raloxifene patients responded that they were satisfied with their medication than bisphosphonate patients at 48-56 weeks (P = 0.002). We concluded that Asian postmenopausal women at increased risk of osteoporotic fractures showed a greater propensity to remain on raloxifene compared with bisphosphonate. The women on raloxifene exhibited lower discontinuation rates and higher treatment satisfaction.

Impact of a viral respiratory epidemic on the practice of medicine and rehabilitation: severe acute respiratory syndrome.

Severe acute respiratory syndrome (SARS) is a new respiratory viral epidemic that originated in China but has affected many parts of the world, with devastating impact on economies and the practice of medicine and rehabilitation. A novel coronavirus has been implicated, with transmission through respiratory droplets. Rehabilitation was significantly affected by SARS, because strict infection control measures run counter to principles such as multidisciplinary interactions, patients encouraging and learning from each other, and close physical contact during therapy. Immunocompromised patients who may silently carry SARS are common in rehabilitation and include those with renal failure, diabetes, and cancer. Routine procedures such as management of feces and respiratory secretions (eg, airway suctioning, tracheotomy care) have been classified as high risk. Personal protection equipment presented not only a physical but also a psychologic barrier to therapeutic human contact. Visitor restriction to decrease chances of disease transmission are particularly difficult for long-staying rehabilitation patients. At the height of the epidemic, curtailment of patient movement stopped all transfers for rehabilitation, and physiatrists had to function as general internists. Our experiences strongly suggest that rehabilitation institutions should have emergency preparedness plans because such epidemics may recur, whether as a result of nature or of bioterrorism.

SARS transmission and hospital containment.

An outbreak of severe acute respiratory syndrome (SARS) was detected in Singapore at the beginning of March 2003. The outbreak, initiated by a traveler to Hong Kong in late February 2003, led to sequential spread of SARS to three major acute care hospitals in Singapore. The critical factor in containing this outbreak was early detection and complete assessment of movements and follow-up of patients, healthcare workers, and visitors who were contacts. Visitor records were important in helping identify exposed persons who could carry the infection into the community. In the three hospital outbreaks, three different containment strategies were used to contain spread of infection: closing an entire hospital, removing all potentially infected persons to a dedicated SARS hospital, and managing exposed persons in place. On the basis of this experience, if a nosocomial outbreak is detected late, a hospital may need to be closed in order to contain spread of the disease. Outbreaks detected early can be managed by either removing all exposed persons to a designated location or isolating and managing them in place.

Isolated patellar revisions for failed metal-backed components: 2- to 9-year follow-up.

Results of isolated patellar revisions for failed metal-backed patellae remain controversial. Isolated patellar revisions from April 1993 to April 2000 were assessed for complication rates, the Knee Society score (KSS), implant survival, and radiological loosening. Twenty-nine knees were revised in patients aged 71.0 years (range, 61-87; SD, 6.2). At 67.0 months (range, 24-98 months; SD, 22.0), no patient underwent further revision. Knee scores improved by 26.5 (range, 9.0-44.0; SD, 10.9) while function scores improved by 25.0 (range, 0-50.0; SD,14.5) over prerevision values. Early complications included 3 superficial wound infections, 1 hematoma, and a urinary tract infection in 1 patient. One patient had a subluxed patella. One patient had asymptomatic femoral osteolysis on radiological evaluation. Isolated patellar revisions can be performed in low-demand, elderly patients with minimal patellar maltracking.