Results of Cruciate-Retaining Total Knee Arthroplasty with Maxim(R) System : More than 5-Year Follow Up

PURPOSE: To evaluate the mid-term (over 5 years) clinical and radiologic results of Maxim(R) (Biomet, Warsaw, USA) Cruciate Retaining total knee replacement arthroplasty (TKRA). MATERIALS AND METHODS: Between Feb. 1997 and Nov. 2000, 103 knees in 65 patients who had been followed up for 5 years after TKRA with Maxim(R) Cruciate Retaining were evaluated retrospectively for clinical and radiologic results. RESULTS: The average range of motion increased from 114degrees (80~130degrees) preoperatively to 128degrees (105~130degrees) at the last follow-up. The average range of flexion contracture decreased from 6.5degrees preoperatively to 0.8degrees (0~15degrees) at the last follow- up. In patients with osteoarthritis, the mean preoperative knee score (59.2) and functional score (40.7) improved to 88.6 and 90.1, respectively. In rheumatoid arthritis patients, the mean knee score and functional score also improved from 47.4 and 39.2 to 80.6 and 88.3. Roentgenographic evaluation revealed a radiolucency rate of 19.5%. Complications were deep infection in 2 cases and periprosthetic fractures in 3 cases. The former had received reimplantations. CONCLUSION: The mid-term results of Maxim(R) Cruciate Retaining total knee replacement arthroplasty were reliable and satisfactory in terms of improvements of range of motion, restoration of function, and rare complications. However, long-term follow-up evaluation is necessary.

Operative Treatment of Lumbosacral Spondylitis Through a Posterior-only Approach / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of this operative method, which includes removal of infected materials, insertion of a bone graft and fixation with pedicle screws through a posterior-only approach in spondylitis with advanced bone destruction and radicular pain. MATERIALS AND METHODS: Ten patients with refractory single level spondylitis of the lumbosacral spine, who underwent the above operation and were followed-up for more than 2 years, were analyzed retrospectively. Six cases were tuberculous and 4 cases were pyogenic in etiology. Radiologically, bone union and restoration of sagittal alignment were assessed. Clinically, Visual Analog Scales (VAS) for back pain, leg pain and resolution of neurologic symptom were analyzed. RESULTS: Bone union was achieved in all cases. Sagittal angle was corrected significantly from -3.6+/-12.5 degrees to -11.4+/-9.3 degrees (p=0.007). However, loss of correction was noted from -16.2+/-10.2 degrees at immediate after surgery to -11.4+/-9.3 degrees at last follow-up (p=0.005). Back pain VAS was improved from 8.3+/-0.7 to 2.6+/-1.6 (p=0.005) and leg pain VAS was improved from 6.8+/-2.1 to 0.5+/-0.9 (p=0.005). There was strong positive correlation between age and final back pain (r=0.79, p=0.011) and leg pain VAS (r=0.75, p=0.020). There was no meaningful correlation between the sagittal angle and back pain (r=0.30, p=0.430) and leg pain VAS (r=0.41, p= 0.274). Implant related complications and deep wound infections did not occur. CONCLUSION: In single level spondylitis of the lumbosacral spine, a posterior-only surgical approach is a useful method in which debridement, bone graft placement and pedicle screw fixation can be performed. This procedure did not provide increased risk with respect to infection control, and it allowed correction of the sagittal angle. The younger the age of the patients, the better the back pain and leg pain VAS results.

The Treatment of Mason Type II Radial Head Fractures using Closed Reduction and K-wire Fixation

PURPOSE: To analyze the clinical results of the treatment of Mason type II radial head fractures using closed reduction and K-wire internal fixation under C-arm guide by radiologically and functionally. MATERIALS AND METHODS: Between March 2001 and October 2003, 7 patients with Mason type II radial head fracture were treated by closed reduction and internal fixation using K-wires under C-arm guide. The average age of the patients was 38 (5 to 57) years old, and average duration of follow up was 20 (5 to 36) months. At last follow up, we evaluated the radiological results and functional results by classifying excellent, good, fair and poor according to functional rating system of Broberg and Morrey. RESULTS: The range of motion of the elbow at last follow up, average flexion contracture was 1.4 (0 to 10) degrees, further average flexion was 146.4 (140 to 150) degrees, average supination was 74.2 (70 to 80) degrees and average pronation was 75 (70 to 80) degrees. In the functional results, 6 cases were excellent and 1 case was good. In the radiological evaluations, the average time of union was 5 (4 to 6) weeks after the operation and no serious complication was occurred in any cases. CONCLUSION: In the treatment of Mason type II radial head fracures, closed reduction and K-wire internal fixation under C-arm guide was an effective method of treatment with satisfactory results and no complications.

Polymorphism and forensic efficiency of 5X-STR loci in Korean / 대한법의학회지

This study intends to examine the polymorphism of 5 STR loci inX-chromosome (GATA172D05, HPRTB, DXS8377, DXS101, HumARA) and to evaluate usefulness of them in forensic identification. 100 unrelated Korean men and women were selected. DNA was extracted from these sample and PCR was performed to amplify it. And using automated DNA sequencer and computer program, the genotype and allele frequency of them were investigated and analyzed. The following results were obtained: 1. The genetic analysis of 5 STR loci inX-chromosome was performed with quadruplex PCR for GATA172D05, HPRTB, DXS8377, HumARA and monoplex PCR for DXS101. 2. Polymorphism information content of 5 loci is higher than 0.5, the high information content is observed. The heterozygosity is higher in DXS8377, DXS101, HumARA than others. 3. The power of discrimination is revealed high in all 5 loci in women, but in men DXS8377 and HumARA is higher than others. 4. The mean exclusion chance is revealed high in DXS8377 and HumARA which have more alleles than others in trio case and motherless case. 5. The difference of allele frequency is observed with other population group in DXS8377, DXS101, HumARA of Korean population group. Based on the results of this study, the allele frequency and population data of 5 STR loci inX-chromosome may be useful in forensic investigation.

Treatment of Femoral Fractures Following Total Knee Arthroplasty

PURPOSE: To analyse the results of the treatment of femoral fractures following total knee arthroplasty (TKA) and to discuss about factors determining operative methods. MATERIALS AND METHODS: Between August 1993 and March 2001, 11 knees in 11 patients were treated for femoral fracture following TKA in Seoul Sacred Heart General Hospital. Only one case was treated with cast immobilization and ten cases were treated with operative method. In operative cases, before choosing the fixation devices, we considered the location, displacement and comminution of fractures and general conditions of patients. We analyzed clinical results according to the tibiofemoral angle, range of motion(ROM), and the knee rating score of Hospital for Special Surgery(HSS). RESULTS: Among 1133 knees in 764 patients with primary TKA, eleven cases underwent femoral fractures following TKA. The incidence was 0.9%. Among ten cases which were treated operatively, four cases had severe displacement without osteoporosis and were treated with dynamic compression plate(DCP) and screws. Three cases had displaced comminuted fractures with ostoporosis and medical problems, so they were treated with Ender nailing. Two cases had mild displacement and comminution and were treated with retrograde interlocking IM nailing. One case was with uncomminuted fracture with cardiopulmonary insufficiency and old age. Because initial closed reduction was failed, open reduction was performed and cancellous screw fixation was done. The average follow up period after fracture was 19 months. Radiologically, tibiofemoral angle was valgus 6.2 degrees on an average before fracture and valgus 8.2 degrees at the last follow up. ROM was 109 degrees on an average before fracture and 98 degrees at the last follow up and HSS knee rating score averaged 84 points before fracture and 78 points at the last follow up. CONCLUSION: Selection of treatment methods and fixation devices according to fracture type was important for satisfactory functional results, patient's general conditions and medical problems must be considered.

The Relationship between Obesity and Functional Status in the Korean Elderly: An Analysis of Korean National Health and Nutrition Examination Survey, 1998

BACKGROUND: Aging and obesity are both positive determinants of chronic disease in the elderly. This study was done to examine the relationship between obesity and functional status and, to examine the relationship between comorbidity and the different levels of BMI among older Koreans. METHODS: A total of 920 community dwelling women and men who completed both the home questionnaire and medical examination that was conducted in 1998 were chosen as subjects. The proportion of subjects with prevalence of obesity-related diseases and functional limitation by NHLBI classifications was determined. Risks for functional limitation associated with comorbidity of obesity-related diseases and fat distribution were examined using multivariate adjusted logistic regression methods. RESULTS: Among 920 subjects studied, 91% were functionally independent. The underweight were one in ten and the overweight were one in four. The overall prevalence of functional limitation in a major activity among underweight was one in ten, but that of overweight or over was one in two. After multivariate adjustment, significant predictors for functional limitation in ADLs and IADLs were vision and hearing impairment, unemployed occupational status, depression, living with spouse, and a history of stroke. Though not significantly shown in the statistics, comorbidity (>or=3) of six obesity-related diseases had odds of 5.4 times and in obese elderly women the odds were 7.9 times. CONCLUSION: We suggest that there is a positive trend between overweight and functional limitation. Although there is no statistical significance, obesity in older Korean women had higher odds for functional limitation in ADLs and IADLs.

Operative Treatment of Chronic Unreduced Dislocation of the Shoulder / 대한정형외과학회잡지

We experienced four patients that had gone unreduced for at least eight weeks and evaluated the results of the operative treatment in these paitents. All four cases were anterior dislocation, and among them three cases were dislocated by direct trauma and one was dislocated during seizure attack. Pain was moderate in one case and mild in three cases. In the preoperative range of motion, the average passive tlexion at the scapular plane was 143 degrees (90 degrees - l70 degrees) and average external rotation at the side was 33 degrees(5 degrees-60 degrees), but the average active flexion was 103 degrees, active external rotation was 16 degrees and the internal rotation at the back was the sacral level except one. All four patients complained of severe limitation of daily living activity due to limitation of motion and weakness and could not occupy their jobs. In all four cases, three dimensional CT scan was performed to evaluate glenoid and humeral bone defect and for preoperative planning. Operation was performed at 8 weeks after initial dislocation in two cases, 1 year later in one case and 2 years later in one case. Open reduction was done and the defect of humeral head was filled with osteochondral allograft in two cases. Fractured humeral head fragment was reduced and fixated with non-ahsorhahle suture in one case and prosthetic head replacement was performed in the other. As a result, three patients had a mild or moderate pain postoperatively and moderate functional restrictions in the activities of daily living, and they were considered to be unsatifactory. Two cases were subluxated during the follow-up. These results show that the overall prognosis for the surgical treatment of the chronic unreduced dislocated shoulder is unpredictable and unacceptable.

CT Arthrographic Finding in Shoulder Instability / 대한정형외과학회잡지

The purpose of this study is to evaluate the morphologic findings of the labrum and capsuloligamentous structures in the normal and unstable shoulders and to compare the effectiveness of double contrast arthrographic findings which were taken with supine and prone position. We reviewed the computerized tomographic arthrogram in 9 cases of normal shoulder and l3 cases of shoulder instability. We evaluated the shape of the labrum, the attachment of anterior capsule and the amount of capsular laxity. Capsular laxity was compared each others in normal, the unidirectional instability and the multidirectional instability. Among these materials, we simultaneously performed CT arthrogram with supine and prone position and evaluated which is more reliable and accurate. Scapular inclination was ahout 25 degrees in the supine position and ahout 60 degrees in the prone position. Normal glenoid labrum varied in size and shape, so its lack of a classic appearance might not indicate a labral tear. Variations existed in the anterior capsular attachment onto the glenoid. The anterior capsule was used to attach far away from the glenoid rim. but it might not indicate an anterior instability. With the prone position, the labral lesion took more excellent visualization due to the contrast coating on the glenoid labrum in both anterior and posterior. Anterior capsular expansion was seen well with prone position in anterior instability. In summary, for proper interpretation of the instability, awareness of the morphologic variations of the labrum and capsuloligamentous structure is important. CT double contrast arthrography with prone position has made a significant contribution to improving and easing the documentation of variety of anatomic abnormalities. Now we recommend the prone position in CT arthrogram for imaging glenoid labrum pathology in shoulder instability.

Conversion Total Hip Arthroplasty for Ankylosed Hip / 대한정형외과학회잡지

Total hip arthroplasty for ankylosed hip has a higher risk of failure due to the poor condition of the hip abductors and the altered configuration of the bone, which lead to poor positioning or fixation of the prosthesis. Fifty-one hips (42 patients) converted to total hip arthroplasty between March 1983 and March 1994 have been reviewed three to thirteen years six months after operation. The average period of follow-up was four years nine months. Twenty six of the patients were men and sixteen were women. The average age at the time of operation was 40 years old (range,19 to 70 years). Among the 51 hips, bony ankylosis were 27 hips and fibrous ankylosis were 24 hips, spontaneous ankylosis were 40 hips and surgical ankylosis were 11 hips. The duration of hip fusion was 13 years six months in the bony ankylosis and 16 years one month in the fibrous ankylosis. Preoperatively 33 cases had low back pain, ipsilateral or contralateral knee or hip pain. In asymptomatic 18 cases, conversion total hip arthroplasty was also performed for the management of functional disabilities due to severe malpositioned ankylosis. At the time of the last follow-up, 25 cases were free from pain and six patients had a mild degree pain on the hip, knee or thigh. In bony ankylosis, the postoperative average hip motion ranged from 1.1 degrees to 93.2 degrees (average arc of motion of 92.1 degrees). In fibrous ankylosis, the postoperative average hip motion ranged from 1.7 degrees to 96.6 degrees (average arc of motion of 94.9 degrees). The average Harris hip score was improved from 66 to 86.9 in bony ankylosis and from 49 to 89.5 in fibrous anklyosis. The postoperative leg length discrepancy was 1.1 cm in average. The postoperative complications included heterotropic ossification in 25 cases (49%), cup loosening in two cases (3.9%) and stem loosening in three cases (5.6%). As for the clinical results, 24 cases (89%) of bony ankylosis and 23 cases (96%) of fibrous ankylosis had satisfactory functional results at the last follow-up. In conclusion, the conversion total hip arthroplasty could provide functional improvement, pain relief and especially correction of leg length discrepancy in most cases of ankylosed hip.

Treatment of Supracondylar Fractures Following Total Knee Arthroplasty

Supracondylar fractures of the femur following total knee arthroplasty are rare complication with reported rates ranging from 0.3% to 2.5%. Union of the fracture in proper alignment, without disruption of prosthetic component fixation and with maintenance of 90 of knee motion, is impotant in treatment of this type of fracture. Modalties of treatment are conservative or operative methods and operative treatment are open reduction 4 internal fixation, intramedullary nailing, revision arthroplasty using a prosthesis with a long stem and closed reduction and external fixation, but there are controversies in the method of treatment. Between Apr. 1989 and Jul. 1994, 10 patients were treated for supracondylar fracture of the ipsilaterai femur following total knee atthroplasty and 2 cases of them had arthrop]asty at other hospital. Average age of patients was 53 years (29-68 years), nine patients were women and one was man. The preoperative diagnosis was rheumatoid arthritis in four, degenerative osteoaithritis in three, posttraumatic osteoarthritis in one and tuberculosis sequelae of the knee in two. In nine cases mechanism of injury were slip down and in one was fall down. The interval hetween arthroplasty and fracture was an average of 22 months (9-79months). Two cases we.re treated with closed reduction and cast immobilization, one case was treated with open eduction and in1ernal fixation and seven patients of' ten cases were treated with closed intramedullay Ender nailing. The average foIlow-up period after fracture was 25 months (3 - 74months). We evaluated the results as the range of motion, bony union at simple radiograph and Knee Rating Score of Hospital for Special Surgery at last follow up. Eight cases of supracondylar fracture occuned among 350 patients, 514 cases of total knee arthroplasty which were operated at Kyung Hee Univcrsity Hospital between Apr. 1989 and Jul. 1994 and incidence was 1.6%. At the last follow up, all 10 cases achieved bony union and 7 cases using Ender naiIing achieved clinical bony union which enabled patients to do weight-bearing without pain at postoperative 6-8 weeks and radiological union was achieved at postoperative 12 weeks. Range of motion were average 105 degrees (80 J.20 degrees) hefore fracture and 86 degrees (6S 120 degrees) at the last follow up and HSS Knee rating score were average 80.3 points (59 94 points) before fracture and average 78.8 points (66-89 points) at the last follow up. At 7 cases using Ender nailing, range of motion were average 106 degrees (90 11S degrees) hefore fracture and 91 degrees (6S-105 degrees) at last follow up and HSS Knee rating score were average 80.6 points (59-94 points) before fracture and average 80.3 points (72-89 poiints) at the last follow up. Closed iintramedullary Ender nailing is a gecommendable operative method in the treatment of supracondylar fracture following total knee arthroplasty considering to good bony union, satisfactory functional result, easy operative technique and less postoperative complication.