Pre-operative and postoperative radiographs of both hips and pelvis of 160 Malaysian and Australian patients who had undergone Total Hip Replacement (THR) were reviewed. The purpose of the study was to determine morphometric differences in each group that could influence sizing and positioning of cemented total hip implants. In order to measure distances and diameters, we used OSIRIS, a digital radiographic analysis tool provided on the internet by the Department of Medical Imaging, University of Geneva. The known head sizes of the implants were used to calibrate OSIRIS. The patient groups were subdivided into three. We discovered that in general the sizes of the Malaysian population began 1 size below that of the Australian patients. The dimensionally larger 2 groups of the Malaysian patients were similar to the smaller 2 groups of the Australian population leaving a group of small Malaysian femora for whom there were fewer suitable implants We conclude that more work needs to be done to provide suitable implants for South East Asian patients.
Intramedullary devices have been used since 1989 for fractures around the trochanter. Standard PFN has been shown to be one of the stable and successful intramedullary devices for pertrochanteric fractures. In order to minimise the intra-operative complications, small PFN has been designed to fit the Asian femora. Before performing a clinical documentation series, the authors with the computer assisstance performed virtual templating of 60 asian femora. After standardising the magnification of the radiograph with that of the template, best possible fit of the latter was achevied. Various parameters such as:
Width of the remaining neck from the surface of femoral neck screw and hip pin. Height of the proximal end of the nail from the tip of greater trochanter. The distance between the actual and proposed take-off point of medio-lateral angulation. Width of intramedullary canal at distal end of the nail were measured. After analysis of the measurements, we propose to further modify the small PFN in order to get best fit and minimal intra-operative complications.
Postoperative leg swelling after a total knee replacement is common complaint amongst patients. We studied leg swelling by constructing a novel, simple and cost water volumeter. A pilot study was conducted on 15 volunteers by two observers and each observer took a total of three readings. The mean intraobserver variation was 0.2 percent and mean interobserver variation was 0.3 percent, indicating a highly acceptable level of accuracy. The water volumeterwas then used in a randomized prospective study was conducted to determine the relationship between postoperative leg swelling and Fraxiparine, a low molecular weight heparin. From the period of 1st January 2000 till 31th October 2000, a total of 36 patients were enrolled in the study. 18 patients in the study group received fraxiparine and 18 patients in the control group did not. The leg volume was measured preoperatively and on postoperative days 5, 7 and 10. We found that both groups developed maximum swelling at postoperative day 5 and this decreased to almost normal at day 10. However the fraxiparine group was statistically less swollen (4%) than the control group (10%) on day 5 and also on day 7 (−0.2% vs 7%). These findings were independent of whether the patient underwent bilateral or unilateral surgery. We conclude that low molecular weight heparins are effective in reducing postoperative leg swelling in total knee replacement.
