Publications by authors named "P Sa-Ngasoongsong"

30 Publications

Reliability of Imageless Computer-Assisted Navigation for Femoral Rotational Alignment in Total Knee Arthroplasty.

Malays Orthop J 2021 Mar;15(1):79-84

Department of Orthopaedic Surgery, Bhumibol Adulyadej Hospital, Bangkok, Thailand.

Introduction: The aim of this study was to evaluate the reliability of the femoral component rotation on intra-operative data recorded in a computer-assisted navigation system (CAN-FRA) compared with the post-operative femoral component rotation observed on computed tomography (CT-FRA).

Material And Method: Computer-assisted total knee arthroplasty (TKA) or primary osteoarthritis of the knee was performed in 51 knees in 36 patients with a mean age of 69.51 years. All procedures were performed by a single surgeon using the same implant design. The intraclass correlation coefficient (ICC) was used to compare the intra-operative CAN-FRA with the post-operative CT-FRA. The angle between the anatomical epicondylar axis and the posterior condylar axis of the implant (CT-FRA) was measured at two separate timepoints by three observers who were blinded to the intra-operative CAN-FRA. Internal rotation was defined as rotation in the negative direction, while external rotation was defined as positive.

Results: The mean intra-operative CAN-FRA was 0.1° ± 2.8° (range -5.0° to 5.5°). The mean post-operative CT-FRA was -1.3° ± 2.1° (range -4.6° to 4.4°). The mean difference between the CAN-FRA and the CT-FRA was -1.3° ± 2.2° (range -7.9° to 2.4°). The respective ICC values for the three observers were 0.92, 0.94, and 0.93, while the respective intra-observer coefficients were 0.91, 0.85, and 0.90. The ICC for the intra-operative CAN-FRA versus the post-operative CT-FRA was 0.71.

Conclusion: This study shows that using a computer-assisted navigation system in TKA achieves reliable results and helps to achieve optimal positioning of the femoral component and rotation alignment correction.
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March 2021

Is continuous locking suture with braided suture sufficient for arthrotomy repair in the conventional TKR? A randomized controlled trial study.

J Orthop 2021 Mar-Apr;24:47-53. Epub 2021 Feb 12.

Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270, Rama VI Road, Thung Phaya Thai, Ratchathewi District, Bangkok, 10400, Thailand.

Introduction: Medial-parapatellar-arthrotomy is the standard approach for total knee replacement(TKR). No studies have clarified the outcomes as quadriceps-strength-recovery (QS) and safety of Continuous-locking-suture-technique(CLS) for the arthrotomy-repair.

Methods: Patients were randomly assigned into a CLS(n = 40) and an interrupted-horizontal-mattress(IHM, n = 40). QS, visual-analog-scale(VAS), modified-timed-up-and-go(TUGT) test, Western-Ontario-and McMasters-Universities-Osteoarthritis-Index[WOMAC] and Knee-Society-Score[KSS] were followed for 6 months'.

Results: A significantly-shorter capsular-closure-time in CLS(233 ± 40 VS 388 ± 47 sec)(p < 0.0001). There were insignificant difference in QS, VAS, TUGT, WOMAC and KSS during the 6-month follow-up period(p > 0.05 all). No wound complications were found.

Conclusion: CLS with braided-suture is safe and effective as demonstrated a recovery of the QS and knee function outcome comparable to IHM.

Trial Registration: This study was registered in Thai Clinical Trials Registry on December 2015 ( The registration number was TCTR20151208003.
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February 2021

Efficacy of Periarticular Multimodal Drug Injection Without NSAIDs in Elderly Patients With Displaced Femoral Neck Fractures Undergoing Bipolar Hemiarthroplasty: A Prospective Triple-Blinded RCT.

Cureus 2020 Sep 6;12(9):e10271. Epub 2020 Sep 6.

Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, THA.

Introduction Recently, periarticular multimodal drug injection (PMDI) has demonstrated the ability to significantly reduce early postoperative pain with hip fractures in the elderly. Nonetheless, data on PMDI without non-steroidal anti-inflammatory drugs (NSAIDs) in these patients are still doubtful. The current study has evaluated the effect of PMDI with NSAIDs in elderly femoral neck fractures (FNFs) underlying bipolar hip arthroplasty (BHA). Materials and methods A prospective triple-blinded randomized controlled trial (RCT) was conducted in 28 elderly FNFs undergoing BHA. They were randomized into two groups: PMDI group (n=14), which received intraoperative PMDI (50-mL solution of 100-mg bupivacaine, 10-mg morphine, 300-mcg epinephrine, and 750-mg cefuroxime), and a placebo group (n=14), which received only saline solution. The primary outcome was a 10-point visual analog scale (VAS). Secondary outcomes were morphine consumption and cumulative ambulatory score (CAS), postoperative complications, and functional outcomes as a timed up-and-go (TUG) test and Harris hip score (HHS) at two, six, and 12 weeks postoperatively. Results The PMDI group demonstrated a significant reduction in the median VAS at the 48 hour postoperatively as compared to the placebo group (P = 0.019), and a non-significant reduction in the median VAS at the 36 and 60 hours (P = 0.058 and 0.110, respectively) and in a median dosage of morphine consumption on the second postoperative day (P = 0.140). There was no significant difference in postoperative ambulation and functional outcome between both groups (P > 0.05, all). Conclusion The PMDI regimen without NSAIDs is effective for postoperative analgesia on the second postoperative day in elderly FNFs undergoing BHA without any significant difference in functional outcome or postoperative complications.
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September 2020

Effectiveness of a Simple Auditory Feedback Insole (Sim-Insole) for Touchdown Weight-Bearing Training in At-Risk Volunteers with Poor Compliance: A Crossover Study.

Surg Technol Int 2020 Nov;37:313-320

Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Introduction: Recent studies have shown that biofeedback devices are effective for weight-bearing (WB) training. However, these devices have limitations due to high costs and inadequate evidence of their effectiveness among poor-compliance individuals. This study aimed to assess WB compliance after touchdown weight-bearing (TDWB) training by the standard bathroom scale (BS) method and to evaluate the efficacy of our innovative simple auditory feedback device (Sim-Insole).

Methods: In this crossover study, healthy volunteers were trained for TDWB (targeting 20% of bodyweight [BW]) with the BS method and assessed with the Sim-Insole without feedback (phase 1), and then completed a 30-min wash-out period and underwent re-assessment with Sim-Insole with feedback (phase 2). Satisfaction was evaluated with a self-assessment questionnaire. Those who had and had not experienced a weight-bearing force (WBF) >25% of BW were classified as high-risk and low-risk groups, respectively. Steps with percentage of WB &15%, 15%-25%, and >25% were defined as under-zone, in-zone, and over-zone, respectively.

Results: Fourteen volunteers (70%) were classified as high-risk after the BS method. Without auditory feedback, the high-risk group demonstrated a significantly higher average percentage of WB and higher average lowest WBF compared to the low-risk group (18.8% vs. 13.7% and 74.3N vs. 60.2N, respectively, p=0.002 for both). With the use of auditory feedback with Sim-Insole in the high-risk group, the cadence, percentage of WB, highest absolute WBF, proportion of over-zone step, and confidence for TDWB improved significantly compared to those with the BS method (p&0.05 for all). However, the low-risk group showed only a significant improvement in cadence (p=0.047) and a non-significant trend for improvement in the percentage of WB (p=0.089), compared to the BS method.

Conclusion: Sim-Insole is effective for TDWB training. This device significantly improved WB compliance with regard to excessive WB, walking speed, and the confidence of volunteers in the high-risk group with poor compliance.
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November 2020

Reliability and Correlation of the Force-PRO Device and Computer-Assisted Navigation System for Measurement of Acetabular Cup Position in Total Hip Arthroplasty.

Surg Technol Int 2020 05;36:438-442

Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Introduction: Acetabular cup malposition is very common in total hip arthroplasty (THA) and is significantly associated with many serious postoperative complications, such as dislocation, wear and loosening, and decreased range of motion. To improve the accuracy of intraoperative assessment, we recently developed an innovative sensor-based navigation system (Force-PRO device) using an inertial measurement unit and a 3D-printed liner for acetabular cup measurement, and aimed to evaluate its reliability and correlate its accuracy with that of a computer-assisted navigation system (CANS).

Design: Method-comparison study between the Force-PRO device and a standard CANS in a 1:1 pelvic bone model.

Methods: The test-retest reliability of both the Force-PRO device and CANS, and agreement between the Force-PRO device and CANS, for the measurement of acetabular inclination and anteversion angles, were examined using 40 random acetabular cup positions. Statistical analysis was performed by using limits of agreement and intraclass correlation coefficient (ICC).

Results: The mean differences in the inclination angle and anteversion angle in test-retest of the Force-PRO device were -0.43°±1.03° and -0.40°±0.78°, respectively. The mean differences in the inclination angle and anteversion angle between the Force-PRO device and CANS were 0.70°±0.94° and -0.10°±0.44°, respectively. Excellent reliability in the inclination and anteversion angles of the Force-PRO device and excellent agreement between the Force-PRO device and CANS were demonstrated, with ICC values of 0.994 and 0.997, and 0.993 and 0.999, respectively.

Conclusion: The Force-PRO device showed excellent reliability equivalent to CANS with excellent agreement in acetabular cup position measurement comparable to that with CANS. Future clinical studies will be needed to evaluate the efficacy of this device.
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May 2020