(JOINTS) Journal Orthopaedi and Traumatology Surabaya

Comparison of Oxford Knee Score in Knee Osteoarthritis Patients Before and After Total Knee Replacement at Dr. Mohamad Soewandhie Hospital

Sharlene Joy Santosa — 2025-10-30

Background: One of the most common degenerative joint diseases is knee osteoarthritis. This condition leads to pain and reduces functionality of the knee joints, which can negatively impact a patient’s quality of life. Total knee replacement (TKR) has become the standard procedure to treat end-stage osteoarthritis. Evaluating the success of TKR procedures is very important. One instrument that can be used for this purpose is the Oxford Knee Score (OKS).

Methods: This observational analytic comparative study involved 40 patients. The data were collected by interviewing patients who had undergone TKR at Dr. Mohamad Soewandhie General Hospital between 2019 and 2024. The data were analyzed using Wilcoxon signed-ranks test, independent samples t-test, and Kruskal-Wallis test.

Results: The majority of the sample in this study was aged over 60 years (62.5%), female (87.5%), and had an overweight BMI (47.5%). The analysis showed a significant increase in the OKS after surgery, with a p-value of <0.05. The independent samples t-test showed a significant difference in the improvement of the OKS between males and females. Meanwhile, the Kruskal-Wallis test showed no significant difference in OKS improvement across BMI categories.

Conclusions: There is a significant difference in the OKS before and after TKR surgery, which indicates an improvement in knee functionality and quality of life after surgery. Differences in patient gender may affect the outcome of the surgery, including post-surgery recovery rate and knee functionality. Meanwhile, BMI showed no significant difference in the outcome of TKR surgery.

Functional Outcomes After Total Knee Replacement in Kupang: A Retrospective Cohort Study

Su Dji To Rante — 2025-10-30

Background: Total knee replacement (TKR) is effective for advanced knee osteoarthritis, but its access can be limited by implant and perioperative costs. Our tertiary center in Kupang, Indonesia, adopted a single implant system to support service delivery. This study quantified early functional change using the Oxford Knee Score (OKS) three months after TKR.
Methods: We conducted a retrospective single-centre cohort at Siloam Hospital in Kupang, from December 2022 to May 2024. Consecutive adults with Kellgren–Lawrence grade IV knee osteoarthritis who underwent primary TKR with one implant system (Fixamet) were included. The OKS (0–48; higher scores indicate better function) was collected preoperatively and at three months in Bahasa Indonesia using a standardized protocol. Pre–post change was analyzed as paired data.
Results: Forty-seven patients were analyzed (mean age 65.77 ± 7.44 years; 80.9% women). The mean OKS improved from 12.53 ± 3.69 preoperatively to 41.02 ± 2.17 at three months, a mean change of 28.48 points (95% CI 27.24–29.70; p < 0.001). One early complication was documented (arthrofibrosis, 2.1%).
Conclusions: In this single-centre cohort, TKR was associated with large early improvements in patient-reported knee function at three months. These findings describe early recovery within our service and do not establish comparative effectiveness versus other implant systems. Future studies should follow patients for a longer period, directly compare Fixamet with other implant systems, and include cost-effectiveness analyses to assess both clinical and economic value.

Early Application of Neuromuscular Electrical Stimulation Prevents Excessive Muscle Wasting in Critically Ill Patients in the Intensive Care Unit

Johannes Diandra Indra Utama Hutapea — 2025-10-30

Background: Intensive Care Unit-Acquired Weakness (ICU-AW) is a common neuromuscular complication in critically ill patients, leading to muscle atrophy, prolonged mechanical ventilation and impaired functional recovery. Effective rehabilitation strategies play crucial role in maintaining muscle strength. Neuromuscular electrical stimulation (NMES) had shown potential in preserving quadriceps femoris muscle thickness. This study aimed to examine the effect of NMES to quadriceps femoris muscle thickness in patient with ICU-AW.
Methods: Patients that stayed in ICU more than 48 hours and used mechanical ventilation for at least 24 hours enrolled in one-group pretest-posttest design. Neuromuscular electrical stimulation applied to bilateral quadriceps femoris for 30 minutes daily over five consecutive days. Bilateral quadriceps femoris muscle thickness were assessed with USG day before and after therapy.
Results: Twenty ICU-AW patients were enrolled from December 2023 to June 2024, and 13 of them completed the study. There were no significant changes in the thickness of the right and left quadriceps femoris muscle before and after 5-days of NMES therapy (p = 0.910 and p = 0.519, respectively). However, we preserved less than 5% decreased of muscle thickness.
Conclusions: Early 5-days of NMES therapy did not increase quadriceps femoris muscle thickness but effectively prevented further muscle degradation in ICU-AW patients. The potential benefits of rehabilitation therapy in ICU-AW patients should be further explored in future studies with controlled indicators and larger sample sizes.

Anticipatory Balance in Athletes Cerebral Palsy After 6-Month Intervention of Proprioceptive Neuromuscular Facilitation Stretching Techniques

Nieko Caesar Agung Martino — 2025-10-30

Background: The effect of Proprioceptive Neuromuscular Facilitation (PNF) stretching, in addition to standard stretching, improves anticipatory balance in athletes with Cerebral Palsy (CP). We aimed to analyze the effects of PNF stretching to standard training over 4 weeks on anticipatory balance in Cerebral Palsy athletes at 6-month post-intervention evaluation.
Methods: The subjects of this study are 24 athletes with Cerebral Palsy at the Indonesian National Paralympic Committee (NPC) training facility. Subjects divided into the treatment group (n = 12) received standard stretching exercises along with PNF stretching, and the control group (n = 12) performed only standard stretching exercises. Both groups received intervention 3 times per week for 4 weeks and evaluation 6 months post-intervention. Y balance tests (YBT) were measured in three directions: anterior (A), posterolateral (PL), and posteromedial (PM), pre- and post-intervention.
Results: There was significant improvement of YBT in the treatment group after 4 weeks of intervention. For the right and left limbs, marked increases were observed in all directions (p < 0.05). No significant improvements in YBT were observed at 6 months post-intervention in all directions (p > 0.05).
Conclusions: Significant improvements in the Y Balance Test were observed after 4 weeks, but no differences between the two groups at the 6-month evaluation. These findings suggest that while short-term gains in dynamic stability are achievable with PNF, sustained benefits require ongoing reinforcement to maintain neuromuscular adaptations over time.

Diagnostic Value of Magnetic Resonance Imaging Based Coracoid Morphology in Patients with Subscapularis Tears

Barış Acar — 2025-10-30

Background: This study investigates the association between subscapularis tendon tears and the anatomical characteristics of the coracoid process, as assessed by magnetic resonance imaging (MRI) and to determine the predictive cut-off values for significant measurements.
Methods: Patients who underwent surgery for rotator cuff injury between 2020 and 2024 were retrospectively reviewed. Those with a subscapularis tear were classified as Group 1, while those with an intact subscapularis were classified as Group 2. MRI images were analyzed to measure axial and sagittal coracohumeral distance (axCHD, sagCHD), coracoid overlap (CO), and coracoid angle (CA). The diagnostic utility of these parameters was assessed using receiver operating characteristic (ROC) curve analysis.
Results: A significant association was found between subscapularis tear and axCHD, sagCHD, and CO measurements. Among these, sagCHD demonstrated the strongest predictive power, with an optimal threshold of 9.5 mm, a sensitivity of 77.8% and a specificity of 80.4%.
Conclusion: Our study demonstrated that decreased axCHD and sagCHD, and increased CO, are associated with subscapularis tears. The intracoracoid angle, however, does not appear to influence the incidence of subscapularis tears.

Hypertonic Dextrose Prolotherapy Injection Improves Clinical Outcomes in Shoulder Impingement Syndrome with Diabetes Mellitus: A Quasi-Experimental Study

Rita Vivera Pane — 2025-10-30

Background: Shoulder impingement syndrome (SIS) is the most common cause of shoulder pain. Current conservative management approaches often require years for patients to achieve pain relief. This study aimed to identify the effects of hypertonic dextrose prolotherapy (HDP) injections on pain levels and shoulder functionality in SIS patients with diabetes mellitus.
Methods: A quasi-experimental study was conducted recruiting SIS patients at Hajj Regional Hospital, Surabaya, Indonesia, from January 2022 to December 2023. The study group was divided into two: the HDP group, which received a 5 mL injection of HDP at a concentration of 20%, and the control group, which received pharmacotherapy and regular rehabilitation therapy. While the control group received regular pharmacotherapy and rehabilitation therapy only. The study outcomes assessed were the Numeric Rating Scale (NRS) and shoulder Active Range of Motion (AROM). The evaluation was conducted three times: before the intervention, immediately after the intervention, and two weeks after the intervention.
Results: A total of 20 study participants were divided into two groups: 10 in the HDP group and 10 in the control group. Inter- and intragroup analyses showed significant differences in NRS mean values between the HDP and control groups (p < 0.05). Similarly, AROM analysis showed significant differences in mean values between the HDP and control groups, both inter- and intra-group (p < 0.05). Conclusions: HDP injection reduces pain intensity and improves shoulder AROM within two weeks after injection.

Solitary Neurofibroma Mimicking Giant Cell Tumor of The Upper Cervical Spine: A Case Report

Rieva Ermawan — 2025-10-30

Background: Spinal neurofibromas are benign peripheral nerve sheath tumors typically occurring in the thoracic region. Involvement of the C2 vertebra is particularly rare. Atypical presentations of solitary neurofibromas can pose diagnostic challenges when their radiological features resemble other neoplastic entities.
Case Report: A 35-year-old male presented with a 3-month history of neck pain and no history of trauma. Physical examination revealed mild bulging and localized tenderness in the posterior neck, with restricted neck extension to 30 degrees. Plain radiography showed a round, expansile lytic lesion with well-defined, nonsclerotic borders on the C2 spinous process, while MRI confirmed enhancing solid components and extensive bone involvement, indicative of a giant cell tumor. The histopathology from the core needle biopsy was inconclusive, showing few inflammatory cells and no evidence of malignancy. The lesion was marginally resected from a posterior approach, achieving only subtotal resection to preserve the vertebral artery. Histopathological analysis from the open biopsy confirmed the diagnosis of neurofibroma. At the 3-month follow-up, postoperative imaging showed the residual tumor. Despite this, the patient reported significant neck pain relief.
Discussion: Radiography is insufficient for differentiating spinal tumors; therefore, histopathological biopsy is necessary for an accurate diagnosis. Open biopsy offers higher diagnostic accuracy than core needle biopsy.
Conclusion: Neurofibroma should be considered in differential diagnosis for patients initially suspected of giant cell tumors based on radiological findings.

Complicated Calcaneal Fracture with Displacement Following Osteosynthesis and Successful Reoperation: A Case Report

Tobias Bak Skov — 2025-10-30

Background: Calcaneal fractures are relatively uncommon but account for a significant proportion of tarsal injuries. Often resulting from high-energy trauma, they carry a high risk of complications and remain a clinical challenge. Although open reduction and internal fixation (ORIF) is often successful, certain risk factors may predispose to failure and unexpected complications.
Case Presentation: A 49-year-old female sustained a closed, displaced tongue-type calcaneal fracture after a fall from height and underwent acute screw fixation. At four weeks, radiographs revealed fracture recurrence and hardware failure, necessitating urgent reoperation with realignment and re-fixation, followed by a restrictive postoperative regimen. At 14 weeks post-reoperation, radiographs confirmed fracture healing. Upon completion of the treatment course, the patient was referred for continued physiotherapy to support ongoing functional recovery. Despite slight residual limitations, the patient reported minimal discomfort and regained mobility, reflected in an American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score of 81.
Discussion: Calcaneal fractures are complex injuries with a high complication rate. Initial fixation of tongue-type calcaneal fractures may fail due to factors such as obesity, age, gender, surgical technique, or inadequate aftercare. A good functional outcome was ultimately achieved through timely reoperation, strict rehabilitation protocols, and close follow-up.
Conclusion: This case underscores the importance of early surgical intervention, mitigating risk factors, and structured rehabilitation in managing complex calcaneal fractures. Risk factors should guide both surgical planning and aftercare. Early recognition of fixation failure and reoperation within four to six weeks can still result in favourable outcomes, even in high-risk patients.

Front Matter

JOINTS — 2025-10-30

Front Matter