Spinopelvic Alignment and Low Back Pain before and after Total Knee Arthroplasty

Methods@#Sagittal spinopelvic alignment was evaluated in 110 subjects using radiographs of the whole spine. Parameters measured in this study included sagittal vertical axis (SVA), LL, sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI). The distribution of sagittal plane modifier grade was evaluated according to the Scoliosis Research Society-Schwab classification of adult spinal deformity (ASD). Consequently, personal history related to LBP was obtained, and the association of pre- and postoperative LBP and spinopelvic alignment was investigated. @*Results@#Preoperatively, 66% of all subjects showed LBP and mostly exhibited anteriorly shifted global imbalance associated with a decrease in LL and knee flexion contractures, and the subject who had severe flexion contracture of the knee joint showed more forwardly shifted global balance with backward PT and decrease in LL. After TKAs, the knee flexion contractures were eliminated in most cases, and one-third of subjects experienced decrease in LBP. However, SVA increased more and associated with slight decrease of PT and increase of SS. No significant differences were confirmed between pre- and postoperative values of LL and PI. In addition, there were no significant differences in postoperative values of spinopelvic parameters between subjects with and without relieved LBP. @*Conclusions@#Although one-third of subjects experienced decrease of LBP after TKAs, the sagittal global imbalance was not restored through the removal of knee flexion contracture.

Aortic Root Replacement for Destructive Aortic Valve Endocarditis or Aortitis / 日本心臓血管外科学会雑誌

Destructive aortic valve endocarditis or poor controlled aortitis cause the development of left ventricular-aortic discontinuity. We reported our experience with aortic root replacement for cases of severe aortic annular destruction. Between 1999 and 2006, 9 patients with severe aortic annular destruction underwent aortic root replacement at our institute. There were 8 men and one women with a mean age of 55 years. Seven patients were in New York Heart Association functional class III. Four of 9 patients had native valve endocarditis, 4 had prosthetic valve endocarditis (previous aortic valve replacements in 2, aortic root replacements in 2) and one had active aortitis with a detached mechanical valve. Radical debridement of the infected cavity and necrotic tissue was performed in all cases, followed by reconstruction of the aortic annulus using autologous or xenogenic pericardium in 3 cases. Antibiotic-saturated fibrin glue was applied to the cavity. Aortic root replacement was achieved with a pulmonary autograft (Ross procedure) in 4 and stentless aortic root xenograft in 4. One patient who had advanced liver cirrhosis underwent aortic valve replacement with a stentless xenograft by subcoronary implantation method. No mortality was observed during hospitalization and follow-up. Reoperation within 5 years was not necessary in 66.7% of the patients. Excellent outcome can be achieved by radical exclusion of the abscess cavity and viable pulmonary autograft or stentless aortic root xenograft in patients with severe aortic annular destruction.