A case series measuring functional outcomes in adult patients who underwent hip arthroplasty using the modified trochanteric slide approach

Background@#Different trochanteric osteotomies have been developed to aid in surgical exposure and proper removal and placement of arthroplasty components. Objectives. The study aimed to measure functional outcomes of the modified trochanteric slide approach for both primary and revision hip arthroplasty with radiologic and clinical variables, identify preoperative indications for the approach and identify possible postoperative complications. @*Methods@#We conducted a retrospective case series of patients who underwent the modified trochanteric slide approach for hip arthroplasty at the orthopedic department of a tertiary hospital from 2012 to 2016. We reviewed patient charts and radiographs. Descriptive statistics were used to analyze data. @*Results@#Out of nine patients screened, seven were included. The average post-op hip range of motion was 42 degrees abduction and 98 degrees flexion. The union rate was 36% and the non-union rate was 7%. @*Conclusion@#The modified osteotomy is still recommended for difficult primaries and revisions to aid in exposure and hip biomechanics post-operatively.

A Descriptive Analysis of the Hip and Knee Joint Replacement Procedures of the University of the Philippines - Philippine General Hospital (UP-PGH) from 2012 to 2018

@#OBJECTIVE: Hip and knee joint replacement procedures are an effective therapeutic intervention in treating severe joint disorders. Its use has been increasingly performed worldwide, including the Philippines, with its techniques constantly evolving and the science behind it improving. This study aims to describe the demographics, clinical profiles, and outcomes of arthroplasty patients by the Arthroplasty Service, Department of Orthopedics, University of the Philippines – Philippine General Hospital (UP-PGH). METHODS: The study is a descriptive and retrospective review of patients who underwent joint replacement procedures, both primary and revision arthroplasty, from January 2012 to December 2018. Patient demographics and clinical data of patients who underwent total joint arthroplasty at the UP-PGH were collected and evaluated. RESULTS: Data from 279 patients with 306 primary joint replacement procedures were analyzed. There were 195 total hip arthroplasty procedures (THAs) and 111 total knee arthroplasty procedures (TKAs) done. The mean age for THA patients was 55.6 years old, with more females (68.2%) with the left hip being more commonly affected (54.9%). The most common indication for THA was an untreated femoral neck fracture (23.1%) followed by avascular necrosis (20.5%). Cementless fixation was the most commonly used technique (61.5%). Meanwhile, the mean age for TKA was 64.5 years old, with the majority having degenerative osteoarthritis, and using cemented TKA fixation for all knees. A total of 37 revision arthroplasty cases were performed, with 34 in the hip and three in the knee, with infection being the most common overall indication (53%). CONCLUSION: The demographics, clinical profiles, and outcomes of the UP-PGH Arthroplasty Service are comparable to other centers internationally, and further emphasizes the satisfactory outcomes of these procedures. Meanwhile, suggested explanations for the subtle differences are discussed in this study.

Interobserver reliability of the Kellgren-Lawrence classification of degenerative knee osteoarthritis among resident physicians from the University of the Philippines - Philippine General Hospital

@#<p style="text-align: justify;"><strong>Objectives:</strong> To determine the interobserver reliability of the Kellgren-Lawrence classification among selected residents from departments forming the University of the Philippines - Philippine General Hospital (UP-PGH) Osteoarthritis Multidisciplinary Clinic (OAMDC).</p><p style="text-align: justify;"><strong>Methods:</strong> From each department, 3 resident physicians (n = 9) were randomly chosen and tasked to categorize 20 knee anteroposterior and lateral radiographs into KLC grades. Inter-observer reliability was assessed using Fleiss's kappa coefficient (?).</p><p style="text-align: justify;"><strong>Results:</strong> Results show that there was 31.90% (? = 0.3190 ± 0.0228, p-value < 0.05) agreement beyond chance in KLC grading of the radiograph series among all participating residents. Sub-group analyses of interobserver reliability in terms of departmental affiliation noted a range of agreement beyond chance in KLC grading, from 10.52% (? = 0.1052 ± 0.0779, p-value < 0.05) to 56.38% (? = 0.5638 ± 0.0844, p-value < 0.05).</p><p style="text-align: justify;"><strong>Conclusion:</strong> The findings reveal significant variability of agreement beyond chance in KLC grading, both within and among residents of UP-PGH OAMDC-participating clinical departments, which may reflect differences in training or competency and/or the documented limitations of the KLC system. Further investigation to improve diagnostic and severity assessment accuracy and uniformity in the institution is therefore warranted.</p>

A 2-stage distal femur reconstruction with expandable endoprosthesis in a pediatric patient presenting with a pathologic fracture through an osteosarcoma

@#<p style="text-align: justify;">Osteosarcoma in pediatric patients has traditionally been treated with amputation, especially if there is a pathologic fracture through the tumor.</p><p style="text-align: justify;">We report the case of a 12-year-old boy who sustained a pathologic fracture through distal femoral osteosarcoma. After neoadjuvant chemotherapy, he underwent limb saving surgery: wide excision of the osteosarcoma followed by a second-stage reconstruction with an expandable tumor endoprosthesis. He has a functional score of 93% and is free of disease 8 years since diagnosis and 2 years since the end of lengthening.</p><p style="text-align: justify;">This is the first reported case in Philippine medical literature of limb saving surgery in osteosarcoma reconstructed with an expandable endoprosthesis.</p>