The difficult situation of the coronavirus disease (COVID)-19 pandemic may affect to hip and knee arthroplasty service. Retrospective study was performed to patients who received elective total hip/total knee arthroplasty (THA/TKA) from January to September 2020 at Prof. Dr. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia. There were a total of 64 THA and 227 TKA from January to September of 2020. There was an extreme decrease in the number of TKA surgery during April, May, and June in 2020. The effect of coronavirus disease-19 pandemic to the decrease of arthroplasty service was mainly in the first 3 months period.

Introduction and importance Limb length discrepancy can be occurred as residual problems after bone cyst treatment. Distraction osteogenesis is one of surgical option to treat this problem. Case presentation A male 27 years old came with 3 cm residual lower limb discrepancy after treatment of femoral aneurismal bone cyst (ABC). Distraction osteogenesis has been successfully performed to treat this case at the site of previously cystic bone lesion. Conclusion Good quality of callus could be expected at the site of distraction osteogenesis that previously a cystic bone lesion.

Background The distraction osteogenesis procedure has a high potential to treat bone defect problems. The alternative technique to treat nonunion associated with a bone defect is the acute shortening and re-lengthening (ASRL) procedure. This study aimed to evaluate the outcome of ASRL procedure with a monorail fixator to treat femur/tibia nonunion associated with the bone defect. Method Retrospective analysis was performed to patients who received ASRL procedure with monorail fixator for femur or tibia nonunion from October 2018 to October 2020 at Prof. Dr. R. Soeharso Orthopaedic hospital. One case was loss to follow-up and excluded from the study. The rest of 16 cases were included for further analysis. The evaluation was performed to the demographic, intraoperative procedure, problems/complications, additional procedure, and final outcome. Results There were 13 male and three female patients with age ranged from 16 to 64 years old. The follow-up period ranges 9–31 months. ASRL procedures performed to 6 femur and 10 tibias. The problems/complications: two cases with problems associated with callus formation, two cases of fracture at corticotomy site, one case of skin necrosis, one case of osteomyelitis, one case of malrotation. Additional surgical procedures were needed 5/16 (31.2%) cases. Evaluation at the final follow-up period showed 14/16 (87.5%) cases had a complete bone union. Conclusions Acute shortening and re-lengthening (ASRL) could be reliable as a method of treatment for femur/tibia nonunion associated with the bone defect. Several possible complications need to be considered prior to perform this procedure.

Background: Broken bones in a severe lower motion device, especially those associated with a bone defect, often fail or are slow to fuse. The possibility of non-union in patients triggering clinicians to use bone-grafting as part of a procedure aims at achieving the union. The Gold Standard is to use autogenous bone graft, but it actually has some disadvantages. To overcome this, there are alternative measures of bone grafting. Hydroxyapatite is known to be synthetic bonegraft which has good osteoconductive properties. For hydroxyapatite, it has been widely used and easily available. Bone morphogenetic proteins (BMPs) are the family of osteo-inductive proteins in the bone matrix. This study aims to evaluate the effectiveness of synthetic bone graft and BMP-2 as a bonegraft in the process of bone healing with "bone defect" in long bones by evaluating the process of radiological closure of defects and clinical bone healing process. Subjects and Method: This was a cross sectional study. A sample of 20 patients with bone defect in the tibia and femur was selected for this study. An evaluation of radiological defect closure was evaluated using a calculation system using the FDA-determined radiological evaluation method and a periodic lower function of the LEFS (Lower Extremity Functional Scale) every 2 months up to the 6th month. The statistical tests were performed using linear regression. Results: There is a negative relationship between the radiological value and the functional scale of the lower motion device (b = -1.26; p = 0.001). There is an improvement in bone defect closure and clinical functional improvement in patients who performed a synthetic bonegraft closure action added by BMP-2 as well. The evaluation is carried out through radiological calculations that show a periodically reduced size of the defect which affects the increase in the value of the functional scale of the lower motion device. Conclusions: There is a negative relationship between radiological values and functional scale of lower motion devices in patients with bone defect in the tibia bone or femur given synthetic bone graft and Bmp2.

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