Purpose Patients undergoing major orthopedic surgeries, such as total hip replacement (THR), total knee replacement (TKR), and trauma surgery, are at an elevated risk of venous thromboembolism (VTE), causing significant morbidity and mortality. Previous studies have investigated aspirin as a thromboprophylactic agent for arthroplasty, besides trauma surgery. Therefore, we sought to analyze the efficacy of aspirin compared to that of other anticoagulants for VTE prophylaxis in patients undergoing major orthopedic surgeries. Methods This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study protocol was registered with the PROSPERO register. Randomized controlled trials that investigated the use of aspirin for thromboprophylaxis in major orthopedic lower limb surgeries were included and analyzed. Quality analysis of the literature and level of evidence were assessed. The primary clinical outcome was VTE. Secondary clinical outcomes included mortality, bleeding events, and wound complications. Results Eight high-quality studies with level 2 evidence (published within 2006–2021) were included, comprising 6220 patients. The incidence of VTE with aspirin was not found to be more significant than other anticoagulants (risk ratio (RR) = 1.18, 95% CI: 0.89–1.58, P = 0.25). Regarding secondary outcomes, there were no significant differences between aspirin and other anticoagulants (mortality (RR = 1.40, 95% CI: 0.27–7.23, P = 0.69), bleeding events (RR = 0.89, 95% CI: 0.57–1.39, P = 0.61), or wound complications (RR = 0.64, 95% CI: 0.30–1.35, P = 0.24)). Conclusion The current meta-analysis did not show any difference between aspirin and other anticoagulants as thromboprophylactic agents in preventing VTE in patients who underwent major orthopedic surgeries.

Background: The purposes of this study were (1) to describe the characteristics of patients underwent TKR during COVID-19 Pandemic and (2) to compare the demographic of patients underwent TKR before and after COVID-19 Pandemic in St. Carolus Hospital, Jakarta, Indonesia.Methods: Data were extracted from January 2016 to December 2020 from the annual reports of arthroplasty registry (single surgeon). Patient demographic data were collected (Gender, age, comorbidity). Post-operative characteristics were defined as: (1) Length of hospitalization (days); (2) Complication rate (%); (3) Revision event (%). The complication rate included: (1) Deep vein thrombosis; (2) Prosthetic joint infection; (3) Periprosthetic fracture. The above parameters were compared before and after the COVID-19 Pandemic.Result: A total of 730 primary TKR procedures (12.3 cases per month) were performed from January 2016 to February 2020, meanwhile there were 54 primary TKR (6 cases per month) done in 9 months after COVID-19 Pandemic from March 2020 to December 2020. The lowest case monthly after the COVID-19 Pandemic was found on April 2020 (1 case per month), on the other hand, the highest case monthly was found on December 2020 (14 cases per month). The complication rate decreased from the Pre COVID-19 Pandemic (8.6% to 1.8%).Conclusion: The number of cases was reduced during Indonesia large-scale social restriction (40 %) and returned to the Pre-Pandemic period on December 2020.Level of Evidence : Descriptive study, level III

Peroneal tendon injury is one of the pathological ankle conditions which causes pain and is frequently misdiagnosed as ankle sprain. There is a variety of peroneal tendon injuries, depending on the mechanism of injury. We report a series of three peroneal injuries in our institution. Case Presentation: All three of the patients presented with ankle pain and instability following injuries. There was a presence of peroneus quartus in one of the patients. Retromalleolar pain was revealed in all of the patients, in addition to instability. All of the three patients received open peroneal tendon repair with groove tubular deepening for the 1 st patient. Following the surgery, the patients could partially weight-bear after 3-4 weeks. Full range of motion was restored 6 weeks after surgery. Discussion: The peroneal muscle functions as a dynamic stabilizer of the ankle, which is vital to control the dynamic stability of the lateral ankle. There is a variety of peroneal injuries ranging from split tear to chronic dislocation. The treatment for peroneal tendon subluxation can be conservative or surgical. There are several surgical techniques for peroneal tendon subluxation repair, such as: 1) direct repair of retinaculum; 2) retromalleolar groove deepening; 3) tendon graft reconstruction; 4) bone block procedure; 5) tendon rerouting procedure. Conclusion:Peroneal tendon injury should always be considered following inversion ankle trauma, especially in case of chronic lateral retromalleolar pain. Surgeries are often required after failure of conservative treatment which can cause impaired walking, decreased sports performance, or chronic pain and muscle strain.

Background. The purpose of this study was to evaluate the feasibility of the virtual clinic for outpatient follow-up care after TKR surgery. Methods. A total of 546 TKR surgeries were performed from January 2017 to December 2019. 30 patients were not able to go the hospital for routine follow-up. The data collections were taken for age, gender, year of surgery, functional score (Oxford Knee Score (OKS)), and active range of motion (ROM). The virtual clinic was conducted with the physician assistant and the operating surgeon via WhatsApp video call (WhatsApp Inc., Mountain View, California, USA) or Zoom (Zoom Video Communications, Inc., San Jose, California, USA). Result. The average follow-up period was 39.1 months. The earliest follow-up was 20 months, while the longest follow-up was 97 months. The average OKS score was 45. The average consultation time for the virtual clinic is 9 minutes 21 seconds. Most of the patients were satisfied with the online consultation, with only two patients having a satisfaction score below 80%. Conclusion. The virtual clinic for TKR surgery showed a high satisfaction rate during the COVID-19 pandemic, which has the potential to extend to the postpandemic era.

Background. Computer-assisted navigation TKA has just been adapted in Indonesia for the last decade. The method is aiming to achieve more precise mechanical alignment in TKA. However, controversies still exist especially in terms of functional outcome and radiological outcome.Method. Fifty elderly patients aged more than 50 years old with severe knee osteoarthritis (Kellgren Lawrence stage III or IV) who scheduled for TKA surgery in the first half of 2019 were consecutively sampled. All patients were measured for objective functional status with Western Ontario Mac Master University Index (WOMAC) and Oxford Knee Score (OKS). Weight-bearing, long-leg follow-up radiographs of both lower limbs were taken, and coronal tibiofemoral angle (CTFA), coronal femoral component angle (CFCA) and coronal tibial component angle (CTCA) were measured.Results. Group of computer-assisted navigation TKA surgery was found to have significantly lower WOMAC score (p0.05) and higher OKS score (p0.05). Although not statistically significant, greater angle of deviation is observed in the conventional TKA surgery group. Proportions with deviation of less than 3º were found more in the group using computer navigation.Discussion. The results of this study indicate the advantage of using a computer assisted  system in TKA procedure, in terms of better functional outcome. However, our study only measures mechanical alignment from coronal plane and short term follow up time. Other parameter measurement, such as mechanical alignment on sagittal plane, rotational alignment, and soft tissue balance are also important to determine the success rate of TKA procedure.Conclusion. Patients who had TKA surgery under computer-assisted navigation would benefit a better functional outcome if compared with conventional TKA surgery, as measured with WOMAC and OKS. However, there is no significant difference in terms of radiographic value of coronal-plane mechanical deviation on both methods.