Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar belakang: Osteoartritis (OA) adalah kelainan sendi lutut degeneratif tersering, jumlah pasien OA semakin bertambah dengan bertambahnya harapan hidup. Artroplasti distraksi adalah sebuah alternatif yang relatif lebih tidak invasif untuk tatalaksana OA dengan menghilangkan stres mekanis dan mempertahankan tekanan intermiten cairan sendi, sehingga menghentikan siklus kerusakan pada OA. Penelitian ini bertujuan mempelajari perubahan anatomi dan histopatologi setelah artroplasti distraksi pada model hewan osteoartritis. Metode: Penelitian dilakukan pada 32 lutut kambing (16 kambing) yang terlebih dahulu diinduksi secara mekanis menjadi OA dengan menisektomi lateral. Selama masa penelitian, 6 kambing mati. Artroplasti distraksi dilaksanakan menggunakan fiksasi eksterna pada 10 lutut selama 4 minggu, dan 10 lutut kontralateral dibiarkan, kemudian diperiksa secara anatomis dan histopatologis untuk diperbandingkan mengunakan staging International Cartilage Repair Society (ICRS) dan skoring Osteoarthritis Research Society International (OARSI). Perbedaan anatomis dan histopatologis diuji kemaknaannya menggunakan uji Wilcoxon. Hasil: Terdapat perburukan secara anatomi dan histopatologi pada lutut yang diberikan perlakuan. Nilai median perbandingan secara makroskopis dengan staging ICRS berbeda bermakna (1,5 vs 2,5; p < 0,002). Perbandingan secara histopatologi dengan skoring OARSI berbeda bermakna (6 vs 10; p < 0,002). Kesimpulan: Arthroplasti distraksi pada model OA kambing dalam penelitian ini, tidak memberikan perbaikan, melainkan memperburuk OA. Penelitian lebih lanjut diperlukan untuk memberikan dasar biologis yang kuat dari artroplasti distraksi sebagai terapi alternatif untuk OA.

---

Background: Osteoarthritis (OA) is the most common knee degenerative disease, the number of OA patients increases along with the increase of life expectancy. Distraction arthroplasty is a less invasive alternatif for OA management by releaving mechanical stress while maintaining intermitten joint fluid pressure changes, thus halting the OA destructive cycle and inducing repair. This study aims to evaluate the anatomical and histopathological changes after distraction arthroplasty on osteoarthritic animal models. Methods: The study was performed on 32 goat stiffle joint (16 goats) with mechanically induced OA by lateral meniscectomy. During the study 6 goats were decreased. Distraction arthroplasty was performed using external fixation on 10 knees for 4 weeks, and the contralateral knees left untreated. The knees were anatomically and histopathologically examined using International Cartilage Repair Society (ICRS) staging and Osteoarthritis Research Society International (OARSI) scoring. The differences of the anatomical and histopathological changes are tested for significance using the Wilcoxon test. Results: There was anatomical and histopathological worsening of the OA on treated knees. The anatomical difference assessed using ICRS stage gave median values of 1.5 and 2.5 respectively (p < 0.002). The histopathological difference assessed using OARSI scoring was significant (6 vs 10; p < 0.002). Conclusion: Distraction arthroplasty in OA goat models in this study, worsens the OA instead of inducing repair. Further studies are required to find out a convincing biological basis of distraction arthroplasty as an alternative treatment for OA.

Abstrak :
Drs. Buechel, an orthopaedic surgeon, and Pappas, a professor of Mechanical Engineering, are the designers of several successful joint replacement systems. The most well-known of these is the pioneering LCS knee replacement. They have written this book for the users and designers of joint replacements. It is an attempt to convey to the reader the knowledge accumulated by the authors during their thirty five year effort on the development of replacement devices for the lower limb for the purpose of aiding the reader in their design and evaluation of joint replacement devices. The early chapters describe the engineering, scientific and medical principles needed for replacement joint evaluation. One must understand the nature and performance of the materials involved and their characteristics in vivo, i.e. the response of the body to implant materials. It is also essential to understand the response of the implants to applied loading and motion, particularly in the hostile physiological environment. A chapter describes the design methodology now required for joint replacement in the USA and EU countries. The remaining chapters provide a history of joint replacement, an evaluation of earlier and current devices and description of the design rationale for some of the authors devices with which the authors are, of course, quite familiar.

Abstrak :
Total hip arthroplasty (THA) adalah tindakan ortopedi popular, yaitu prosedur mengganti secara keseluruhan sendi panggul yang mengalami kerusakan dengan implan atau prosthesis. Utilitas THA diperkirakan akan terus tumbuh dimasa yang akan datang. enhance recovery after surgery (ERAS) diperkenalkan sebagai pendekatan multidisiplin yang bertujuan untuk mengoptimasi dan mempercepat proses penyembuhan berdasarkan praktik berbasis bukti. Berdasarkan literatur, implementasi ERAS pada THA terbukti mampu mengurangi jumlah hari rawat dan menghembat biaya perawatan. Evaluasi ekonomi ini bertujuan untuk menganalisis efektivitas/luaran intermediate yang terdiri dari length of stay dan persen sukses operasi serta biaya yang dikeluarkan antara THA protokol ERAS dan konvensional. Studi ini menggunakan desain studi potong lintang dengan perspektif penyedia layanan kesehatan. Data dikumpulkan mulai Januari 2020 hingga Mei 2023. Hasil uji bivariat dengan SPSS menujukkan tidak ada perbedaan yang signifikan pada efektivitas. Evaluasi radiografi menunjukkan persentase sukses 100% pada kedua protokol, sedangkan persentase LOS ≤5 hari menunjukkan hasil sebesar 88% pada THA ERAS dan 75% pada THA konvensional. Hasil perhitungan ACER menunjukkan hal yang sebaliknya, yaitu nilai ACER untuk THA ERAS lebih rendah dibandingkan Konvensional (Rp47.187.729 dan Rp54.460.322). Berdasarkan nilai ACER, THA ERAS berpotensi lebih efisien dibandingkan THA Konvensional dengan efektivitas yang lebih baik. Namun, hasil CMA menunjukkan bahwa biaya rata-rata satu tindakan dengan pendekatan Konvensional lebih rendah daripada ERAS, yaitu Rp40.845.242 dibandingkan Rp41.525.202. Efektivitas ERAS dapat lebih ditingkatkan lagi dan memiliki efektivitas biaya dibandingkan Konvensional bila dapat diperoleh data yang lebih besar sampelnya, prosedur yang lebih jelas untuk pemulangan pasien dan clinical pathway yang tersusun baik. ......Total hip arthroplasty (THA) is a widely performed orthopedic procedure involving the complete replacement of a damaged hip joint with an implant or prosthesis. With its increasing popularity, the utilization of THA is expected to grow in the future. Enhance recovery after surgery (ERAS) has emerged as a multidisciplinary approach aimed at optimizing and expediting the healing process through evidence-based practices. Literature supports the implementation of ERAS in THA, as it has been shown to reduce hospitalization duration and treatment costs. This economic evaluation aims to analyze the effectiveness in the form of intermediate outcomes, including length of stay (LOS) and the success rate of the operation, as well as the costs associated with ERAS and conventional THA protocols. The study employs a cross-sectional design from the perspective of healthcare providers, collecting data from January 2020 to May 2023. Bivariate tests conducted using SPSS demonstrate no significant difference in effectiveness. Radiographic evaluation indicates a 100% success rate in both protocols, while LOS ≤5 days is observed in 88% of THA ERAS cases and 75% of conventional THA cases. Calculated ACER values show that THA ERAS has a lower cost (Rp. 47,187,729) compared to Conventional (Rp. 54,460,322), suggesting greater potential in efficiency and effectiveness. However, the cost-minimization analysis (CMA) reveals that the average cost of a single action using the Conventional approach (IDR 40,845,242) is lower than that of ERAS (IDR 41,525,202). To further enhance the effectiveness of ERAS and ensure cost-effectiveness relative to Conventional THA, obtaining a larger sample size, establishing clear patient discharge procedures, and implementing well-organized clinical pathways are recommended

Abstrak :
Total hips arthroplasty (THA), atau operasi penggantian sendi pinggul dengan prostesis buatan, adalah prosedur rekonstruksi yang terakhir dilakukan apabila cara pengobatan maupun terapi medis konvensional lainnya tidak dapat menyembuhkan/memperbaiki fungsi sendi tulang pinggul yang diakibatkan oleh suatu penyakit sendi pinggul. Zirconia-Toughened Alumina (ZTA) merupakan salah satu material keramik yang banyak digunakan untuk komponen femoral head komersil.. Riset ini bertujuan untuk mendapat material komponen femoral head yang memenuhi standard, maka penambahan fraksi material TiO2 sebanyak 4,6,8,10,12 wt% pada variasi komposisi keramik campuran Al2O3, YSZ, dan MgO dilakukan. Kekerasan Vickers dan koefisien gesek yang diperoleh dari ZTA-MgO-TiO2 dievaluasi sebagai fungsi penambahan TiO2 yang berbeda. Dalam fabrikasi sampelnya setiap sampel dicampur dengan metode ball milling, dicetak secara uniaksial dan disinter pada suhu 1500 °C selama 10 jam dalam kondisi tanpa tekanan. Sifat tribologi diamati menggunakan tribometer dengan metode pin on disk serta morfologi mikrostruktur dan komposisi unsur dikarakterisasi dengan menggunakan SEM-EDX dan XRD. Terbentuk 4 fasa pada pola XRD yang didapatkan dari karakterisasi, yaitu α-Al2O3, MgAl2O4 (spinel), α-Al2TiO5, dan cubic zirconia. Tingkat kekerasan sampel meningkat seiring dengan penambahan fraksi TiO2, Nilai kekerasan pin batch 1, 2, 3, 4, 5 sebesar 1041 HV; 1042 HV; 1062,67 HV; 1065,5 HV; dan 1073,67 HV. Berdasarkan analisis morfologi permukaan disk UHMWPE, nilai kekasaran batch 3 memiliki tingkat kekasaran paling tinggi sebesar (Sk = 0.2 µm); alumina batch 5 sebesar (Sk = 0.15 µm); sementara yang paling rendah batch 1 sebesar(Sk = 0.13 µm). Nilai Sk(Core roughness depth) yang tinggi menandakan bahwa permukaan suatu sampel semakin kasar, sehingga dan menyebabkan gesekan yang lebih tinggi. Perbedaan antara tinggi puncak dan kedalaman lembah yang tereduksi oleh pin alumina juga dapat memperkuat pernyataan, dimana nilai selisih batch 3 adalah 0.258 µm, 2 kali lebih besar dari 2 batch lainnya yaitu sebesar 0.087 µm dan 0.12 µm. hasil pengujian tribologi untuk ketiga jarak putar sebanyak 5000, 15000 dan 30000 siklus didapatkan nilai koefisien gesek untuk masing-masing pin alumina yang diuji. Koefisien gesek pada batch 1, 2, 3, 4,dan 5 sebesar 0,07; 0,14; 0,07333; 0,13667; 0,10067. Terdapat nilai koefisien gesek tertinggi sebesar 0.22 karena pembentukan serpihan permukaan, yang dapat menyebabkan peningkatan koefisien gesek. Di sisi lain, nilai koefisien gesek minimum sebesar 0,01 disebabkan oleh terbentuknya lapisan oksida pelindung pada permukaan material keramik. Tingkat ketahanan aus yang didapatkan pada batch 3 memiliki nilai yang terendah dikarenakan nilai volume peak dengan volume hole-nya yang tinggi serta dimensi fraktal yang tinggi. ......Total hip arthroplasty (THA), or hip joint replacement surgery with an artificial prosthesis, is the last reconstructive procedure performed when other conventional medical treatments and therapies cannot cure/improve hip joint function caused by a hip joint disease. Zirconia-Toughened Alumina (ZTA) is a ceramic material that is widely used for commercial femoral head components. This research aims to obtain a femoral head component material that meets the standards, so the addition of TiO2 material fraction of 4,6,8,10,12 wt% to the variation of Al2O3, YSZ, and MgO mixed ceramic composition is carried out. The Vickers hardness and friction coefficient obtained from ZTA-MgO-TiO2 were evaluated as a function of different TiO2 additions. In the sample fabrication, each sample was mixed by ball milling method, molded uniaxially and sintered at 1500 °C for 10 hours under unstressed conditions. Tribological properties were observed using a tribometer with the pin on disk method and microstructure morphology and elemental composition were characterized using SEM-EDX and XRD. Four phases were formed in the XRD pattern obtained from the characterization, namely α-Al2O3, MgAl2O4 (spinel), α-Al2TiO5, and cubic zirconia. The hardness of the samples increased with the addition of TiO2 fraction, the hardness values of batch 1, 2, 3, 4, 5 pins were 1041 HV; 1042 HV; 1062.67 HV; 1065.5 HV; and 1073.67 HV. Based on the surface morphology analysis of UHMWPE disks, the roughness value of batch 3 has the highest roughness level of (Sk = 0.2 µm); alumina batch 5 of (Sk = 0.15 µm); while the lowest batch 1 of (Sk = 0.13 µm). A high Sk (Core roughness depth) value indicates that the surface of a sample is rougher, leading to higher friction. The difference between the peak height and valley depth reduced by the alumina pin can also strengthen the statement, where the difference value of batch 3 is 0.258 µm, 2 times greater than the other 2 batches of 0.087 µm and 0.12 µm. tribological testing results for the three rotating distances of 5000, 15000 and 30000 cycles obtained friction coefficient values for each alumina pin tested. The coefficient of friction in batches 1, 2, 3, 4, and 5 was 0.07; 0.14; 0.07333; 0.13667; 0.10067. There is the highest friction coefficient value of 0.22 due to the formation of surface debris, which may lead to an increase in the friction coefficient. On the other hand, the minimum friction coefficient value of 0.01 is due to the formation of a protective oxide layer on the surface of the ceramic material. The wear resistance level obtained in batch 3 has the lowest value due to its high peak volume to hole volume value and high fractal dimension.

Abstrak :
A case of unilateral bony ankylosis of the temporomandibular joint (TMJ) in a thirteen year old girl was reported. Maximum opening was minimal (4 mm) with hypoplastic mandible and also facial and dental asymmetry. There was no palpable movement over the left TMJ and only slight rotation on the right side. It may be caused by trauma, but the parents didn't notice. She had a problem with sleep apneu and sometimes felt sleepy during school time. She was refered to Oral Surgery Department Hasan Sadikin Hospital in Bandung from a private dental practitioner in Jakarta. Treatment for this patient is divided into three operations. The first operation was gap arthroplasty, second operation is osteodistraction and followed by orthognatic surgery. This paper discusses only gap arthoplasty with temporoparietalis muscle interposition. Twenty days after surgery maximum opening was 26 mm.

Abstrak :
Geriatric hip fractures are common; however, surgery on a 100-year-old patient is rare in Indonesia. We report arthroplasty in 100-year-old woman with right hip fracture and right Colles fracture; which benefits her a three year of active and qualified life. Despite her age, the patient was quite independent, active, and mobile beforehand. Hence a meticulous preoperative planning and post-operative rehabilitation were structured by a comprehensive medic and non-medic geriatric team. Cementless bipolar hemiarthroplasty was perfectly sufficient for the hip fracture under regional anesthesia while the Colles fracture was managed with a close reduction and plastering. Rehabilitation was started on Day-2 and continued weeks after discharge. The patient is still alive and well 3 years after the surgery. Surgery is beneficial for the 100-year-old patient; it is in the best interests of the patient’s mobility and quality of life. Age alone should not limit a surgical decision as long as all comorbidities are controlled by a comprehensive medic and non-medic geriatric team.

Abstrak :
Persentase penduduk usia lanjut di Indonesia meningkat sekitar dua kali lipat dalam lima dekade terakhir. Pasien usia lanjut yang akan menjalani pembedahan mempunyai risiko mengalami komplikasi pascabedah. Pengkajian Paripurna Pasien Geriatri (P3G) dan klasifikasi ASA dapat digunakan untuk mengevaluasi kesehatan pasien geriatri. Program prehabilitasi yang direkomendasikan oleh berbagai guideline perioperatif untuk memperbaiki kesehatan fisik dan status fungsional preoperatif dapat meningkatkan pemulihan pascabedah dan luaran klinis. Penelitian ini bertujuan untuk mengetahui hubungan komponen P3G, status ASA dan prehabilitasi preoperatif terhadap komplikasi pascabedah 30 hari pasien usia lanjut yang menjalani pembedahan artroplasti panggul dan lutut elektif dan untuk mengembangkan model prediksi komplikasi pascabedah 30 hari berdasarkan faktor prediktor tersebut. Penelitian ini adalah penelitian kohort retrospektif yang menggunakan data sekunder dari rekam medis pasien usia lanjut yang menjalani pembedahan artroplasti panggul dan lutut elektif di RSUPN Dr. Cipto Mangunkusumo periode Januari 2017 – Oktober 2022. Performa pengembangan model prediksi komplikasi pascabedah 30 hari dilakukan dengan menentukan nilai kalibrasi (uji Hosmer-Lemeshow) dan diskriminasi (Area Under the Curve [AUC]). Didapatkan 144 pasien yang telah memenuhi kriteria dan dapat dianalisis. Angka komplikasi pascabedah 30 hari sebesar 29,2%. Faktor yang dianalisis sebagai prediktor komplikasi di antaranya status depresi (HR=5,11; IK95% 2,549-10,244), status frailty (HR=2,44; IK95% 1,329-4,473), komorbiditas (HR=1,53; IK95% 0,786-2,982) serta prehabilitasi preoperatif (HR=1,77; IK95% 0,906-3,459). Model prediksi komplikasi pascabedah 30 hari memiliki kualitas kalibrasi dan diskriminasi yang baik dan cukup kuat [AUC 0,690 (p<0,001; IK 95% 0,586-0,794)]. Status depresi, status frailty, komorbiditas dan prehabilitasi preoperatif berhubungan dengan komplikasi pascabedah 30 hari  pada pasien usia lanjut yang menjalani pembedahan artroplasti panggul dan lutut elektif. Model prediksi komplikasi pascabedah 30 hari memiliki kualitas kalibrasi dan diskriminasi yang baik dan cukup kuat. ......The percentage of the geriatric population in Indonesia has roughly doubled in the last five decades. Elderly patients who will undergo surgery are at risk of experiencing postoperative complications. The Comprehensive Geriatric Assessment (CGA) and ASA Classification can be used to evaluate the health of geriatric patients. Prehabilitation programs that various preoperative guidelines suggest to improve physical health and preoperative functional status may increase the rate of postoperative recovery and clinical outcomes. This study aims at determining the relationship between the CGA components, ASA status, and preoperative prehabilitation on complications within 30 days after the surgery in elderly patients undergoing elective hip and knee arthroplasty, as well as developing a prediction model for 30-day postoperative complications. This research is a retrospective cohort study using secondary data from medical records and interviews with elderly patients who underwent elective hip and knee arthroplasty at Cipto Mangunkusumo Hospital between January 2017 and October 2022. The performance of the 30-day postoperative complication predictor model was measured by determining the calibration (Hosmer-Lemeshow test) and discrimination (Area Under the Curve [AUCC]) value. 144 patients who met the criteria were analyzed. The 30-day postoperative complication rate was 29.9%. The factors analyzed as complication predictors including depression status (HR=5.11; 95%CI 2.549-10.244), frailty status (HR=2.44; 95%CI 1.329-4.473), comorbidity (HR=1.53; 95%CI 0.786-2.982) and preoperative prehabilitation (HR=1.77; 95%CI 0.906-3.459). The 30-day postoperative complication prediction model has good and strong enough calibration and discrimination qualities [AUC 0.690 (p<0.001; 95% CI 0.586-0.794)]. Depressive status, frailty status, comorbidity, and preoperative prehabilitation were significantly associated with 30-day postoperative complications in elderly patients undergoing elective hip and knee arthroplasty surgery. The 30-day postoperative complication prediction model has good and strong enough calibration and discrimination qualities.

Abstrak :
ABSTRAK
Pendahuluan: Keluhan nyeri paska total knee arthroplasty dilaporkan cukup tinggi sehingga meningkatkan penggunaan morfin paska operasi, memperlambat mobilisasi, meningkatkan biaya dan menurunkan angka kepuasan dari pasien. Preemptif analgesia Celecoxib dan Pregabalin dilaporkan memberikan hasil yang menjanjikan, namun belum banyak studi yang melaporkannya. Metode: Penelitian ini merupakan uji klinis acak tersamar ganda. Sebanyak 30 pasien dibagi secara acak kedalam 3 kelompok. Kelompok pertama mendapatkan preemptif analgesia kombinasi Celecoxib 400 mg dan Pregabalin 150 mg, Kelompok 2 mendapatkan Celecoxib 200 mg dan pregabalin 75 mg dan kelompok 3 diberikan placebo. Efektifitas dinilai dengan menghitung total konsumsi morfin paska operasi, penilaian VAS Score, latihan fungsional lutut dengan range of motion ROM dan mobilisasi.. Hasil: Terdapat perbedaan bermakna total konsumsi morfin paska operasi pada kelompok preemptif analgesia, dibandingkan placebo, Terdapat perbedaan bermakna derajat VAS antara kelompok preemptif analgesia dibanding placebo, namun tidak terdapat perbedaan bermakna antara kedua kelompok preemptif analgesia. Keluhan mual ditemukan pada 2 subjek di kelompok 1, 1 subjek di kelompok 2 dan 3. Kesimpulan: Pemberian preemptif analgesia celecoxib dan pregabalin efektif mengurangi nyeri akut paska operasi dan menurunkan penggunaan morfin paska operasi, Dianjurkan untuk menggunakan kombinasi celecoxib dan pregabalin sebagai preemptif analgesia pada total knee arthroplasty.

---

ABSTRACT
Introduction Pain after Total Knee Arthroplasty reported high, therefore increase the use of morphine after surgery, slow mobilization, increase cost and decrease patient satisfactory. Preemptive analgesia celecoxib and pregabalin reported give the promising result, but not many studies have reported it. Method This study was double disordered clinical study. 30 patients divide randomly into 3 groups. The first group receive preemptive analgesia combination of celecoxib 400 mg and pregabalin 150 mg. The second receive celecoxib 200 mg and pregabalin 75 mg and third group receive placebo. Effectiveness in this study assessed with count total consumption of morphine after surgery, VAS Scoring, functional exercise of knee with ROM and mobilization. Result There was significant differences in count of total consumption of morphine after surgery in preemptive analgesia group, compared to placebo. There was significant difference in VAS degree between preemptive group and placebo, but no significant difference between two preemptive groups. Nausea found on 2 subjects in first group, 1 subject in second and third respectively. Conclusion Administration of preemptive analgesia celecoxib and pregabalin effective to decrease acute pain and reduce use of morphine after surgery. It is advisable to use a combination of celecoxib and pregabalin in total knee arthroplasty.

Abstrak :
Total hip arthroplasty, the most commonly performed orthopedic procedure, is used to replace or reconstruct the hip with an artificial joint. Perspectives in Total Hip Arthroplasty outlines developments in technologies and biomaterials used for this procedure, with a focus on the tribological interactions of the materials used. Part one outlines the history of total hip arthroplasty and goes on to explore advances in techniques and biomaterials. Part two focuses on the tribology of materials used to perform this procedure, explaining the impact of wear on the load-bearing surface, a major cause of failure in hip prostheses. Chapters review a range of materials, including modern biomaterials, hybrid materials, metal, ceramic, and polyethylene. The book also discusses the tribological interactions of these materials when used in total hip arthroplasty.