The Philippine Journal of Orthopaedics, the official journal of the Philippine Orthopaedic Association, Inc. is an open-access, English language, web-based, medical science journal published by the Association. The Journal is guided by the International Committee of Medical Journal Editors (ICMJE) “Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals.” The Philippine Journal of Orthopaedics shall advance the art and science of orthopaedics in the country by publishing high quality original clinical investigations, epidemiological studies, case reports, review articles, evaluations of diagnostic and surgical techniques, and the latest updates on management guidelines. The journal’s target audience are local and international practitioners, clinicians, and other scientists, researchers. It shall accept manuscript submissions from consultants, fellows, residents, and other allied medical professions and specialties, not only from the Philippines but also from Asia and the rest of the world as long as these are within scope and relevant to the practice. Non-members of the Association may submit scientific manuscripts to the journal.
Philippine Orthopaedic Association, Inc.
A Systematic Review and Meta-Analysis of Surgical Site Infections in Older Adults Undergoing Total Knee Arthroplasty
Background. Total knee arthroplasty (TKA), effectively improves joint function and quality of life, but carries the risk of surgical site infection (SSI). SSIs most affect older adult patients with comorbidities. Thus, we evaluated the incidence of SSIs following TKA in older adult populations (≥65 years) and explored the association of SSIs with male sex, morbid obesity, and other comorbidities. Methodology. A systematic review and meta-analysis were conducted according to PRISMA guidelines. Data were extracted from prospective and retrospective studies evaluating the incidence and risk factors for SSIs following TKA in older adults aged ≥65 years. Studies were found through MEDLINE/PubMed, Cochrane Library, and other databases up to 31 July 2024. Risk factors included male sex, morbid obesity, type 2 diabetes, rheumatologic disease, peripheral vascular disease, heart failure, and anaemia. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I² statistic. Results. Twenty studies with a total population of 29,20,681 patients were included. The pooled prevalence of SSIs following TKA was estimated at 1.19% (95% CI: 0.84–1.68%). Male sex was associated with a higher SSI risk (OR: 1.79, 95% CI: 1.45–2.21%). Morbid obesity showed the strongest association with SSIs (OR: 1.47, 95% CI: 1.16–1.86%), followed by type 2 diabetes (OR: 1.28, 95% CI: 1.05–1.56%), and rheumatologic disease (OR: 1.72, 95% CI: 1.09–2.69%). Significant heterogeneity was observed across studies (I² >50%). Conclusion. This meta-analysis highlights the burden of SSIs among older adult patients following TKA, particularly male patients and those with comorbidities. These results indicate the need for individualized risk assessment and preventive strategies to optimize surgical outcomes in this population. Future research should focus on developing tailored interventions for this vulnerable population.
Copyright (c) 2024 Chaitanya Halder, MBBS, MS (Orthopedics), Banamali Samanta, MBBS, MS (Orthopedics), Prasun Sanyal, MBBS, MS (Orthopedics), FNB (Arthroplasty) https://creativecommons.org/licenses/by/4.0
Correlation of WOMAC Score with Functional Recovery in Patients with Osteoarthritis Following Total Knee Replacement
Background. Total knee replacement (TKR) is an established procedure for advanced knee osteoarthritis, offering pain relief and improved mobility. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) is widely applied to measure pain, stiffness, and functional limitation. Objective. This study investigated the relationship between WOMAC scores and overall functional recovery in patients after TKR. Methodology. A prospective observational study was performed in patients who underwent primary TKR at the Government Medical College and Hospital, Kallakurichi, Tamil Nadu, India, between January 2023 and June 2025. WOMAC scores were documented preoperatively, at six weeks, three months, and six months postoperatively. Recovery was further assessed using the Timed Up-and-Go (TUG) test, range of motion (ROM), and patient satisfaction levels. Statistical analysis included paired t-tests and Pearson correlation. Results. Eighty patients (52 females, 28 males; mean age 64.2 ± 6.8 years) were enrolled. The average baseline WOMAC score was 72.4 ± 9.6, decreasing to 34.8 ± 7.2 at 3 months and 21.5 ± 5.6 at 6 months (p < 0.001). Improvements in TUG and ROM correlated significantly with WOMAC changes (r = 0.68 and –0.55, respectively; p < 0.01). Patient satisfaction also showed a strong positive association with WOMAC outcomes (r = 0.72, p < 0.001). Conclusion. This study concludes that significant WOMAC improvements within six months are correlated with high patient satisfaction and functional gains. Clinicians should consider early interventions if scores plateau. Longerterm studies are needed to confirm sustained benefits. The key take-home message is that WOMAC monitoring after TKR can enhance personalized recovery strategies.
Copyright (c) 2026 Ramaraj Rathnasamy, MBBS, MD, Balasubramaniyan P, MBBS, MD, Dineshkumar S, MBBS, MD https://creativecommons.org/licenses/by/4.0
Lateral Tibial Plateau Reconstruction using a Pedicled Patellar Transplant in a Male Patient with a Recurrent Fungating Giant Cell Tumor
Reported here is a surgical approach to a recurrent fungating giant cell tumor in a 35-year-old male. The patient presented with a lytic lesion on the epiphysis extending to the metaphyseal area of the lateral tibial plateau. Reconstruction was done using a pedicled patellar transplant following an extended curettage of the affected area. This was augmented with a suture anchor, a non-vascularized fibular strut graft, synthetic bone grafts, and soft tissue reconstruction.
Copyright (c) 2026 Francine Germaine S. Sy, MD, Valleden L. Bancod MD, Melito Antonio P. Ramos, MD, FPOA https://creativecommons.org/licenses/by/4.0
Reliability of the Filipino Translated Disabilities of the Arm, Shoulder and Hand (FIL-DASH) Questionnaire Among Hiligaynon Patients with Forearm Fractures
Background. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a validated scoring system for distal and diaphyseal forearm fractures. The Filipino translated version (FIL-DASH) is reliable and valid as an outcome measure for adult Filipino patients with brachial plexus injury. However, there is still a paucity of published literature on the reliability of FIL-DASH among Filipinos; hence, this study was conducted to determine its reliability among native Hiligaynon speakers. Objective. The primary aim of this study was to determine the reliability of the Filipino translated DASH questionnaire (FIL-DASH) among Hiligaynon patients with forearm fractures managed in a public tertiary hospital in Iloilo City, Philippines. Methodology. A descriptive study was conducted in a public tertiary hospital in Iloilo City, Philippines, from November 2022 to May 2024. Thirty patients with forearm fractures, selected through convenience sampling, were given the FIL-DASH questionnaire twice within 7 to 14 days (mean: 10 ± 3.11 days). Internal consistency was determined using Cronbach’s alpha, and test-retest reliability was determined using the intraclass correlation coefficient (ICC). Results. Internal consistency was high with Cronbach’s alpha exceeding 0.8 for all sections: 0.9562 for the overall questionnaire, 0.9469 for the disability/symptom section, 0.8545 for the work module, and 0.9752 for the sport/instrument module. For the test-retest reliability, the intraclass correlation coefficients for each module were: 0.953 for the disability/symptom section, 0.919 for the work module, and 0.982 for the sport/instrument module. Most items within the disability/symptom section of the questionnaire exhibited coefficients exceeding 0.5, with the exceptions of questions 3 and 22 (correlations of 0.472 and 0.471, respectively). Conclusion. These results showed that the FIL-DASH questionnaire is generally a reliable functional outcome measure for Hiligaynon patients.
Copyright (c) 2026 Kutch V. Yasa, MD, FPOA, Lucille P. Detoyato, MD, FPOA https://creativecommons.org/licenses/by/4.0
Demographic Profile, Clinical Characteristics, and Short-Term Outcomes of Tuberculosis Spondylitis in a Tertiary Medical Center in Southern Philippines
Background. Tuberculous spondylitis remains a significant cause of morbidity in the Philippines, with limited local outcome data. Objective. To describe the demographic profile, clinical characteristics, management, and outcomes of patients with tuberculous spondylitis treated at a tertiary-level medical center from 2015 to 2024. Methodology. This was a 10-year retrospective chart review of patients diagnosed with tuberculous spondylitis. Demographic, clinical, radiographic, and management data were collected and analyzed. Results. A total of 69 patients were included. Most patients were male (63.6%) and unemployed (63.6%). The mean age was 40 years (range, 19–59). Thoracic involvement was reported in 59% of cases. Back pain was reported at 48.5%, and neurologic deficits were reported at 27.3%. On neurologic assessment at presentation, 50% had incomplete neurologic deficits and 10.6% had complete deficits. Management consisted of anti-tuberculous therapy alone in 59.1% and anti-tuberculous therapy with bracing in 21.2%. Thirteen patients (19.7%) underwent surgery, performed via a posterior approach. In the surgical cohort, the mean preoperative kyphosis angle was 47.7 degrees (range, 39–79 degrees), and the mean postoperative kyphosis angle was 40.8 degrees (range, 27–55 degrees). Neurologic recovery was documented among patients with incomplete deficits. The mean interval from surgery to discharge was 51 days. At two years, more than 90% of patients were lost to follow-up. Conclusion. Tuberculous spondylitis in this cohort was observed predominantly among unemployed young to middle-aged males, involving the thoracic spine, with a substantial proportion presenting with neurologic compromise. Among surgically treated patients, posterior surgery was associated with modest deformity correction and neurologic improvement during the early postoperative period. Long-term outcomes could not be reliably assessed due to >90% loss to follow-up at two years. Strengthened early detection, improved continuity of care, and inclusion of functional outcomes in future studies are recommended.
Copyright (c) 2026 Ralph Daniel V. Delgado, MD , Ma. Ramona Reyes-Diyco, MD https://creativecommons.org/licenses/by/4.0
Clinical and Patient-Reported Outcomes of Braganza-Tan (BT) Pass-Through Stump Incision, Stump-Sparing, and Stump-Sacrificing ACL Reconstruction Techniques Among Filipino Patients
*]:pointer-events-auto scroll-mt-(--header-height)" dir="auto" tabindex="-1" data-turn-id="f5309b42-738f-48e1-a802-be6e609dcf13" data-testid="conversation-turn-1" data-scroll-anchor="false" data-turn="user"> *]:pointer-events-auto scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" tabindex="-1" data-turn-id="request-WEB:950672bc-079e-4160-9009-1053312313f4-0" data-testid="conversation-turn-2" data-scroll-anchor="true" data-turn="assistant"> Background. Anterior cruciate ligament reconstruction (ACLR) aims to restore knee stability and function following ligament injury. Remnant-preserving techniques have gained interest due to their potential benefits in proprioception, graft healing, and early functional recovery. Objective. To compare the clinical and patient-reported outcomes, knee stability, and complication rates of the Braganza-Tan (BT) pass-through stump incision, the stump-sparing, and the stump-sacrificing techniques in ACLR using hamstring grafts among Filipino patients at the University of Santo Tomas Hospital. Methodology. A prospective, randomized controlled trial was conducted among 90 Filipino patients aged 18–35 years diagnosed with acute primary ACL tear (<6 weeks from injury) confirmed by MRI. Participants were block-randomized into three groups: BT pass-through stump incision, stump-sparing, and stump-sacrificing (n = 30 each). All underwent hamstring autograft reconstruction and a standardized rehabilitation protocol. Outcomes were assessed preoperatively and at three, six, nine, and 12 months using the International Knee Documentation Committee (IKDC) Scale, Tegner Activity Scale, Lysholm Score, and Hospital for Special Surgery (HSS) Score. Knee stability was evaluated through the Lachman, pivot shift, and anterior drawer tests, and an instrumented arthrometer. One-way ANOVA, Kruskal-Wallis tests, repeated-measures ANOVA, and mixed-effects models were used for analysis. Results. All groups showed significant improvement from baseline across all functional scores (p <0.001). However, both the BT and stump-sparing groups consistently demonstrated higher IKDC, Lysholm, HSS, and Tegner scores from three to 12 months compared with the stump-sacrificing group (p <0.01). Knee stability tests showed significantly better early and midterm anterior and rotational control in the BT and stump-sparing groups (p <0.05). Complications were lowest in the BT group, with no graft failures recorded, though this difference did not reach statistical significance. By 12 months, stability outcomes became comparable across all groups, although functional scores remained highest in the BT and stump-sparing groups. Conclusion. The BT pass-through stump incision and conventional remnant-preserving techniques demonstrated superior early clinical outcomes and improved knee stability within the first 12 months compared with stump-sacrificing reconstruction in acute ACL tears. Longer-term follow-up is required to determine sustained graft durability and functional superiority.
Copyright (c) 2026 Diovince S. Tan, MD, Carmelo L. Braganza MD, FPOA, Byron S. Angeles MD, FPOA, Carlo F. Fernandez, MD, DPBO https://creativecommons.org/licenses/by/4.0
Long Term Outcomes of Nerve Transfers in Adult Patients with C5–C7 and C5–C8 Brachial Plexus Injuries
Background. Nerve reconstructions for C5 to C8 brachial plexus injuries are challenging due to the extent of injury and paucity of nerve donors. Objective. The objective of this paper was to determine the long-term clinical outcomes of nerve transfers for shoulder and elbow function in patients with C5–C7 or C5–C8 brachial plexus injuries. Methodology. We retrospectively reviewed the charts of all patients with C5–C7 or C5–C8 brachial plexus injuries treated with nerve transfers from January 1, 2005, to December 31, 2022, with at least 24 months follow-up. Filipino Version of the Disability of the Arm, Shoulder and Hand (FIL-DASH) scores, range of motion (ROM), and muscle strength were compared between single and double nerve transfers, and between early (within six months of injury) and delayed (more than six months) surgery. Results. A total of 21 patients with a mean age of 29.9 years old were included. The mean surgical delay was 6.4 ± 3.0 months, while the mean follow-up was 58.5 ± 29.7 months. There were 11 patients with C5–C7 injuries, and 10 patients with C5–C8 injuries. FIL-DASH scores were available for eight patients, with a mean postoperative improvement of 25 points. There were no significant differences between single (SNT) and double nerve transfers (DNT) in terms of elbow flexion and shoulder function. Early surgery (within six months of injury) resulted in higher mean shoulder abduction range (110º vs 51º) compared to delayed surgery (more than six months). Conclusion. Good elbow flexion and shoulder abduction recovery can be expected in nerve transfers for patients with C5–C7 or C5–C8 brachial plexus injuries. A higher ROM for shoulder abduction can be expected if surgery is done within six months of injury.
Copyright (c) 2026 Emmanuel P. Estrella, MD, MSc, PhD, Eduard Frank D. Delos Reyes, MD https://creativecommons.org/licenses/by/4.0
Comparison of Sinus Tarsi Approach with screws vs Lateral Extensile Approach with plates in Sanders Type Two and Three Calcaneal Fractures: A Non-Randomized Study
Background. Intra-articular calcaneal fractures, particularly of the joint depression type, present significant surgical challenges. The traditional lateral extensile approach (LEA), although providing excellent exposure, is associated with notable soft tissue complications, such as wound necrosis and infection. The sinus tarsi approach (STA), a minimally invasive technique, aims to minimize these complications while maintaining comparable outcomes. This study aimed to compare the functional, radiological outcomes, and complications of STA with cannulated cancellous (CC) screw fixation versus LEA with plating in the management of joint depression-type intra-articular Sanders Type 2 and 3 calcaneal fractures. Methodology. A prospective, non-randomized comparative study was conducted at a tertiary care center (BSTRH and MIMER Medical College, Talegaon Dabhade), involving 56 adult patients (aged >18 years) with acute (<three weeks) intra-articular joint depression (Sanders Type 2 and 3) calcaneal fractures, diagnosed via radiographs and CT scan. All surgeries were performed by a senior orthopaedic trauma surgeon with more than 10 years of experience. Patients were allocated into two groups of 28 each: Group A underwent STA with CC screw fixation, while Group B received LEA with plate fixation. Surgical intervention was performed after soft tissue readiness, followed by standard postoperative care. Patients were evaluated at one, three, six, nine, and 12 months postoperatively using the American Orthopaedic Foot and Ankle Society hindfoot score (AOFAS), Visual Analogue Scale (VAS), and radiological parameters including Bohler’s angle, Gissane angle, and calcaneal height and width. Complication rates, operative time, and hospital stay were also analyzed. Results. STA resulted in significantly shorter operative times (59.1 vs. 98.4 minutes, p < 0.001) and hospital stays (4.7 vs. 7.42 days, p < 0.001). AOFAS scores at 12 months were comparable between STA (mean 80.57) and LEA (mean 77.33). Postoperative VAS scores were significantly better in the STA group (1.67 vs. 2.04; p = 0.044). Radiographic outcomes were similar between groups. STA demonstrated fewer complications, including superficial infection (3 vs. 5), deep infection (0 vs. 2), and sural nerve injury (0 vs. 1). Conclusion. The sinus tarsi approach with cannulated screw fixation offers equivalent functional and radiological outcomes to the lateral
Copyright (c) 2026 Santosh Borkar, MD, Rajiv Munde, MD, Shrirang Godbole, MD, Suraj Doshi, MD, Rhythm Tahilramaney, MD,, Bhushan Adhari, MD, Sameed Ahmed, MD https://creativecommons.org/licenses/by/4.0
As President of the Philippine Orthopaedic Association (POA), it is with great pride and enthusiasm that I welcome you to the first issue of the Philippine Journal of Orthopaedics for 2026. This marks another milestone in our shared commitment to advancing the art and science of orthopaedic surgery in the Philippines. As the official publication of the POA, the Journal serves as a vital platform for Filipino orthopaedic surgeons, researchers, residents, and allied specialists to share original research, clinical experiences, case studies, and innovations that address the unique musculoskeletal challenges faced by our patients—from trauma and degenerative conditions to pediatric and oncologic orthopedics. In this era of rapid advancements in surgical techniques, biomaterials, rehabilitation, and evidence-based practice, the Philippine Journal of Orthopaedics stands as an open-access, peer-reviewed resource dedicated to elevating the quality of care nationwide. I encourage our members and the wider orthopaedic community to continue submitting high-quality manuscripts and engaging actively with the content published here. To our readers, contributors, reviewers, and editorial team—thank you for your dedication and support. Together, let us strive to make this Journal a beacon of excellence that strengthens orthopaedic practice, fosters collaboration, and ultimately improves patient outcomes across the archipelago. Mabuhay ang Philippine Orthopaedic Association! Mabuhay ang Philippine Journal of Orthopaedics!
Copyright (c) 2026 Marcelino T. Cadag, MD, FPOA https://creativecommons.org/licenses/by/4.0
Medical practice in the last few decades has increasingly moved toward evidence-based care. However, evidence is only as relevant as the context in which it is generated.¹ Much of current orthopedic literature originates from healthcare systems and patient populations different from those encountered in the Philippines.² For Filipino clinicians, locally produced research ensures that clinical decisions align with the realities of our patients, disease patterns, and healthcare environment. I was fortunate to learn this important lesson directly from the late Dr. Antonio Montalban, the first Editor-in-Chief of the Philippine Journal of Orthopaedics and a pioneer of orthopedic research in the country. Dr. Montalban emphasized that advancing orthopedic care in the Philippines requires the systematic documentation and sharing of our own clinical experience. At a time when access to international publications was limited, he recognized the need for a platform where Filipino surgeons could publish local disease patterns, evaluate treatment outcomes, and contribute to knowledge directly relevant to Philippine practice. While access to international journals has expanded considerably over time, the need for local publications remains. Differences in epidemiology, healthcare resources, and patient expectations mean that findings from other regions cannot always be directly applied to our setting. Local research therefore continues to ensure that clinical practice is guided by evidence that reflects the realities of Filipino patients. Alongside this expansion in the use of local data, orthopedic research has also increasingly embraced patient-reported outcome measures (PROMs). Traditional clinical outcomes such as radiographic healing, range of motion, and complication rates remain important, but they do not always capture how patients themselves perceive recovery. These PROMs offer direct insight into function and quality of life from the patient’s perspective, helping clinicians understand the real impact of treatment on daily activities and well-being.³ For PROMs to be meaningful, however, outcome instruments must be culturally and linguistically appropriate for the populations in which they are used.⁴ Validating and applying these tools locally allows clinicians to measure recovery in ways that reflect patients’ social roles, tendencies, and expectations. As patient-centered care continues to grow in importance, the integration of PROMs into local orthopedic research allows us to evaluate outcomes that matter most to the people we serve. This latest issue showcases the range of contemporary orthopedic research, from epidemiologic observations and clinical outcomes to systematic reviews and complex reconstructive techniques. Together, these studies highlight the ongoing efforts of Filipino orthopedic surgeons and regional collaborators to generate evidence that informs both clinical decision-making and future research. More importantly, these studies reflect a shared commitment to strengthening the evidence base that supports orthopedic care in our setting. As the volume of global literature expands, maintaining venues for locally generated scholarship becomes essential. Supporting and sustaining the Philippine Journal of Orthopaedics ensures that valuable clinical insights from our own institutions remain visible, accessible, and relevant to practitioners across the country.
Copyright (c) 2026 Nathaniel S. Orillaza, Jr., MD https://creativecommons.org/licenses/by/4.0