Journal of Southeast Asian Orthopaedics https://jseaortho.org/index.php/jsao <p><strong>Editor-in-Chief </strong>▪️ Thanainit Chotanaphuti, MD. <br /><strong>Editorial Secretary </strong>▪️ Satit Thiengwittayaporn, MD.</p> <p><strong>ISSN: XXXX-XXXX (online)<br />ISSN: XXXX-XXXX (print)</strong></p> The Royal College Of Orthopaedic Surgeons Of Thailand en-US Journal of Southeast Asian Orthopaedics 0125-7552 Acute Pseudoseptic Arthritis after Intra-Articular Sodium Hyaluronate Injection: A Case Report and Literature Review https://jseaortho.org/index.php/jsao/article/view/179 <p><strong>Purpose:</strong> This report describes the case of 59-year-old woman with right medial compartment knee osteoarthritis (OA) who experienced an unusual adverse reaction to intra-articular sodium hyaluronate injection.</p> <p><strong>Methods:</strong> The patient received an intra-articular sodium hyaluronate injection for treatment of knee OA. Ten days after injection, she experienced severe pain in her right knee wherein laboratory test results showed inflammatory profiles that could not rule out septic arthritis. Joint lavage was performed, after which the patient was monitored for any changes in her symptoms or laboratory test results.</p> <p><strong>Results:</strong> The patient experienced severe pain in her right knee after intra-articular sodium hyaluronate injection. Additionally, laboratory test results showed inflammatory profiles that could not rule out septic arthritis. One month after joint lavage, the patient's symptoms resolved, and her laboratory test results returned to normal range.</p> <p><strong>Conclusions:</strong> An inflammatory flare could occur as an adverse effect of intra-articular sodium hyaluronate injection, mimicking septic arthritis. Importantly, both physicians and patients should be aware of this potential reaction, particularly, patients should report any unusual symptoms to their healthcare provider.</p> Chayut Chaiperm Puttipol Waipanya Buncha Athikraimongkol Thana Narinsorasak Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand https://creativecommons.org/licenses/by-nc/4.0 2023-04-28 2023-04-28 48 1 43 46 10.56929/jseaortho-023-0179 The Safety and Effectiveness of an In-Depth Esmarch Tourniquet Technique in Achieving Target Pressures for Pediatric Upper Extremity Surgery https://jseaortho.org/index.php/jsao/article/view/188 <p><strong>Purpose:</strong> This study aimed to determine the appropriate number of turns required for an Esmarch tourniquet, using commonly sized Esmarch bandages, to achieve a pressure target of at least 150 mm Hg during pediatric upper extremity surgery.</p> <p><strong>Methods:</strong> Twenty participants who underwent upper extremity surgery were included in the study. Two surgeons used 2- and 3-inch-sized Esmarch bandages to apply an Esmarch tourniquet to each participant’s arm. The pressure and number of turns were recorded from the second to fifth turns. The pressure was measured using a pressure sensor device.</p> <p><strong>Results:</strong> At the third turn of both the 2- and 3-inch-sized Esmarch bandages, a 150 mm Hg pressure was achieved in all participants. Intra-observer reliability resulted was “good”; however, inter-observer revealed “poor” reliability.</p> <p><strong>Conclusions:</strong> The Esmarch tourniquet is an effective and safe method for creating a bloodless operative field for upper extremity surgery in pediatric patients. The results of this present study suggested the application of three turns of the 2- and 3-inch-sized Esmarch bandages.</p> Kanchai Malungpaishrope Prapasiri Charoensri Piyabuth Kittithamvongs Navapong Anantavorasakul Chairoj Uerpairojkit Somsak Leechavengvongs Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand https://creativecommons.org/licenses/by-nc/4.0 2023-08-01 2023-08-01 48 1 3 7 10.56929/jseaortho-2023-0188 Effect of Transdermal Microneedle Patch Plus Nonsteroidal Anti-Inflammatory Drug in Knee Osteoarthritis: A Randomized, Double-Blind Study https://jseaortho.org/index.php/jsao/article/view/192 <p><strong>Purpose:</strong> No recent clinical study has shown the efficacy of transdermal microneedle patch (TDM) plus nonsteroidal antiinflammatory drug (NSAID) in early knee osteoarthritis (OA). This study aimed to determine the effect of TDM plus NSAID on synovial hypertrophy, knee pain, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score in osteoarthritic knees.</p> <p><strong>Methods:</strong> A randomized, controlled, double-blind trial was conducted. One hundred participants, aged 40–70 years, with painful knee OA and radiographic nonstructural changes were randomly assigned into two groups to undergo TDM plus NSAID (ketorolac 30 mg) or TDM (placebo) at the medial joint line of the knee twice (once weekly). The synovial thickness was measured using ultrasonography at pretreatment, weeks 1, 2, and 4. The visual analog scale (VAS) for pain, WOMAC score, and adverse events (AEs) were also recorded.</p> <p><strong>Results:</strong> The TDM plus NSAID group demonstrated a significant reduction in synovial thickness and VAS at weeks 2 and 4 compared with the placebo group (P&lt;0.05). At week 4, the mean synovial thickness reduction was 1.1 and 0.3 mm, and the mean VAS reduction was 3.2 and 1.7 for the TDM plus NSAID and placebo groups, respectively. The mean WOMAC scores at week 4 were significantly reduced (5.7 and 0.9 for the TDM plus NSAID and placebo groups, respectively). No complication and treatment-related AEs occurred.</p> <p><strong>Conclusions:</strong> TDM plus NSAID significantly reduced synovitis and improved the pain score in knee OA after 2 weeks. The WOMAC score improved at week 4 without any AEs.</p> <p>Thai Clinical Trials Registry (TCTR), TCTR identification number is TCTR20200613001.</p> Saradej Khuangsiriguk Mongkon Pisuttanawat Danai Heebthamai Thanainit Chotanaphuti Copyright (c) 2024 The Royal College of Orthopaedic Surgeons of Thailand https://creativecommons.org/licenses/by-nc/4.0 2024-01-10 2024-01-10 48 1 8 14 10.56929/jseaortho-2024-0192 Comparing Clinical Outcomes of Early and Elective Reconstruction in Patients with Anterior Cruciate Ligament Tears https://jseaortho.org/index.php/jsao/article/view/194 <p><strong>Purpose:</strong> The optimal time of treatment for anterior cruciate ligament tears remains controversial. Two times are early (&lt; 6 weeks) and elective (≥ 6 weeks) reconstruction. This retrospective study tested the hypothesis that clinical outcomes are similar between the two time groups for anterior cruciate ligament reconstruction.</p> <p><strong>Methods:</strong> A total of 61 patients were included in this study. Thirty and 31 patients were in the early and elective reconstruction groups, respectively. The collected patient data included a preoperative and 2-year postoperative range of motion, visual analog scale scores, anterior stability tests, and clinical knee scores.</p> <p><strong>Results:</strong> There were no significant differences in the 2-year postoperative range of motion, visual analog scale scores, or anterior stability tests. The Lysholm and International Knee Documentation Committee knee evaluation form scores were significantly higher in the early reconstruction group than in the elective reconstruction group.</p> <p><strong>Conclusions:</strong> Early anterior cruciate ligament reconstruction is a more effective clinical knee score than elective reconstruction in treating anterior cruciate ligament tears.</p> Sombun Wutphiriyaangkun Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand https://creativecommons.org/licenses/by-nc/4.0 2023-10-05 2023-10-05 48 1 15 21 10.56929/jseaortho-2023-0194 Functional Outcome of Vojta Therapy as A Postoperative Protocol for Surgically Treated Patients with Cerebral Palsy https://jseaortho.org/index.php/jsao/article/view/183 <p><strong>Purpose:</strong> To evaluate the efficacy of postoperative Vojta therapy in children with cerebral palsy (CP) who have undergone orthopedic surgical interventions for lower limb deformities.</p> <p><strong>Methods:</strong> We conducted a prospective case series on children with ambulatory CP aged 3 to 15, indicated for orthopedic surgical interventions (contracture release and deformity correction) between January 2020 and December 2022. One month following these interventions, all patients were scheduled for Vojta therapy sessions. Ambulation capability was evaluated using video gait analysis, an expanded timed get-up-and-go (ETGUG) test, and a 6-minute walk test (6MWT) at 2, 4, and 6 months postoperatively. A multivariable multilevel linear regression analysis was employed to demonstrate the adjusted effect of Vojta therapy during the postoperative period.</p> <p><strong>Results:</strong> A total of eleven eligible children with CP were included. Of these, seven were boys (63.6%) with a mean age of 6.3 ± 3.1. The majority of patients were classified as gross motor function classification system (GMFCS) level I (45.4%). We observed a significant improvement in ETGUG (-14.1 sec, p = 0.011), 6MWT (6.3 m, p = 0.014), cadence (2.1 step/min, p = 0.033), and stride time (-0.1 sec, p = 0.027) after being adjusted by baseline function, age, and GMFCS level during the follow-up period. Sub-group analyses revealed no significant difference between patients with GMFCS I and those with GMFCS II to III.</p> <p><strong>Conclusions:</strong> This study demonstrated a significant ambulation capability improvement in surgically treated patients with CP who underwent postoperative Vojta therapy.</p> Phoemlap Phongprapapan Jiraporn Boontawrach Nath Adulkasem Perajit Eamsobhana Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand https://creativecommons.org/licenses/by-nc/4.0 2023-12-05 2023-12-05 48 1 22 29 10.56929/jseaortho-2023-0183 Orthopedic Treatment in the Era of COVID-19: Perspectives from a National Survey in Thailand https://jseaortho.org/index.php/jsao/article/view/207 <p><strong>Purpose:</strong> The coronavirus disease 2019 (COVID-19) pandemic has affected the management of patients with non-emergent orthopedic conditions, resulting in postponed surgical intervention(s) and changes in hospital services. Specific guidelines have been issued for emergency orthopedic cases; however, no definitive guidelines have been proposed for the management of elective or non-urgent conditions during the pandemic. As such, physicians have been obliged to make decisions based on their judgment. This study aimed to analyze data regarding changes in general orthopedic practices during the pandemic, especially those pertaining to surgery, clinical procedures, follow-up periods, referrals, and protective equipment.</p> <p><strong>Methods:</strong> This study investigated the impact of the COVID-19 pandemic on the management of non-urgent orthopedic conditions by outpatient orthopedists. A questionnaire was developed and shared with nationwide orthopedic social media groups and through e-mails.</p> <p><strong>Results</strong> Of the 200 orthopedic surgeons invited to participate, 129 (64.5%) responded. Results revealed that 65.9% of the surgeons preferred conservative treatment to surgery among patients with the appropriate indications. Additionally, follow-up periods were extended in 69.0% of patients, and 70.5% were prescribed more medication. The N-95 mask and home delivery system for medications were the two most desirable protective equipment and innovations that surgeons needed (79.1% and 69.8% of respondents, respectively).</p> <p><strong>Conclusions:</strong> The COVID-19 pandemic has led to changes in general orthopedic practices in outpatient clinics, such as a preference for more conservative treatment than surgery, extension of appointment periods, prescription of medicine for a longer period, and use of drug delivery to patients’ homes.</p> Surut Jianmongkol Kamolsak Sukhonthamarn Chaiyos Vinitpairot Copyright (c) 2022 The Royal College of Orthopaedic Surgeons of Thailand https://creativecommons.org/licenses/by-nc/4.0 2024-01-04 2024-01-04 48 1 30 34 10.56929/jseaortho-2024-0207 Hip Capsular Repair Affect on Joint Laxity in Total Hip Arthroplasty https://jseaortho.org/index.php/jsao/article/view/180 <p><strong>Purpose:</strong> Loss of tissue tension around the hip is a cause of hip dislocation. The shuck test is a simple intraoperative test for soft tissue tension. This study evaluated the soft tissue tightness around the hip joint after capsule repair and compared the joint tension resulting from different capsule repair approaches.</p> <p><strong>Methods:</strong> Fifty-three patients underwent a non-cemented total hip replacement using image-free computer-assisted surgery. The patients were divided into the posterior and the anterolateral approach groups. After the hip was reduce, a computer navigation plan was devise to restore proper leg length. The shuck test was applied to determine the soft tissue tension before and after capsule repair. The leg length was recorded after hip reduction and the shuck test. Data from the computer navigation were collected for analysis.</p> <p><strong>Results</strong> The results of this study showed that after the shuck test, the leg length increased by up to 5.98±1.75 mm. (6.73±1.64 mm. and 5.26±1.56 mm for the posterior and anterolateral approach, respectively). After capsule repaire, the leg was shortened by 4.78±1.31 mm. (5.42±1.10 mm. and 4.15±1.20 mm for posterior and anterolateral approach, respectively). The study found that the leg shortening from the posterior approach was significantly higher than the anterolateral approach (p-value &lt;0.001). There were no hip dislocations in this series.</p> <p><strong>Conclusions:</strong> Hip capsule repair improves the soft tissue tension around the hip joint. This helps reduce the risk of hip dislocation. Hip capsule repair using a posterior approach has a better outcome.</p> Sirisak Boonruksa Nathee Ruangthong Copyright (c) 2024 The Royal College of Orthopaedic Surgeons of Thailand https://creativecommons.org/licenses/by-nc/4.0 2024-01-10 2024-01-10 48 1 35 42 10.56929/jseaortho-2024-0180