Early Experience of Direct Anterior Approach Total Hip Arthroplasty: Analysis of the First 53 Cases / 대한고관절학회지

Purpose@#To determine if it is feasible and safe for a surgeon to transition from using the posterolateral approach to direct anterior approach (DAA) by evaluating the first 53 cases of total hip arthroplasty using a DAA. @*Materials and Methods@#A retrospective review of 52 patients who underwent THA using a DAA between July 2017 and December 2018. Reasons for THA were: femoral neck fracture (n=34), avascular necrosis (n=13), and arthritis (n=6). The mean age was 70 years old. An assessment of feasibility was made by analyzing mean operative time and blood loss. Cup inclination, anteversion, and leg length discrepancy (LLD) were measured using postoperative radiology. Safety of the DAA was judged using the incidence and nature of all complications. @*Results@#The mean operative time was 112 minutes. 135 minutes for the 1st 10 cases, 100 minutes for 2nd 10 cases, 113 minutes for 3rd 10 cases, 119 minutes for 4th 10 cases, and 91 minutes for the final 13 cases. The mean blood loss was 724 mL. Average cup inclination was 40.27。; 2 cases were out of safety angle. Mean anteversion was 16.18。. No intraoperative fractures or infections were observed. LLD was detected in 3 cases, one of which underwent revision due to walking difficulty. Dislocation occurred in 3 cases, all within the first 20 cases, however, there was no recurrent dislocation. @*Conclusion@#DAA for THA was deemed to be feasible and safe based on an assessment of operative time, blood loss and complications.

Prognostic Factors Related with Surgical Outcome of Vitrectomy in Myopic Traction Maculopathy

Homonymous Hemianopia as the Initial Sign of Posterior Cortical Atrophy

No abstract available.

Effect of Sequential Intrastromal Corneal Ring Segment Implantation and Corneal Collagen Crosslinking in Corneal Ectasia

PURPOSE: To assess the clinical efficacy of sequential intrastromal corneal ring segment (ICRS) implantation and corneal crosslinking (CXL) in corneal ectasia.METHODS: To assess the clinical efficacy of sequential intrastromal corneal ring segment (ICRS) implantation and corneal crosslinking (CXL) in corneal ectasia.RESULTS: Greater improvement in uncorrected visual acuity was observed in the ICRS + CXL group than in the ICRS or CXL alone groups at both 6 (p = 0.008) and 12 months (p = 0.028). Refractive errors of sphere and spherical equivalent were significantly reduced in both the ICRS (p = 0.002 at 6 months, p = 0.004 at 12 months) and ICRS + CXL groups (p < 0.001 at both 6 and 12 months). Keratometric values including the maximum, minimum, and average were significantly reduced in all 3 groups at postoperative 6 and 12 months; however, the greatest reductions were observed in the ICRS + CXL group (all p < 0.001).CONCLUSIONS: ICRS implantation followed by CXL within 1 month seems to be effective, and may be superior to ICRS or CXL alone in improving visual acuity and reducing refractive errors and keratometric values.

Hemiarthroplasty for Hip Fractures in Elderly Patients over 80 Years Old - Comparative Analysis between Femoral Neck Fracture and Intertrochanteric Fracture - / 대한고관절학회지

PURPOSE: The purpose of this study is to investigate the relative surgical risk and problems in hip hemiarthroplasty for treatment of an unstable intertrochanteric fracture in elderly patients over 80 years old. MATERIALS AND METHODS: Between April 2005 and May 2010, 58 patients whose age was over 80 years were available for inclusion in this study. They were divided into two groups: group 1 included 30 patients with femoral neck fracture and group 2 included 28 patients with intertrochanteric fracture. No significant differences in average age, concomitant disease, and walking ability before development of fracture were noted between the two groups. The following factors, including interval from development of fracture to operation, operation time, amount of blood loss, start time of walking after operation, duration of hospital stay, complications, revision rate, and walking ability were compared between the two groups. RESULTS: Operation time was an average of 85.2 minutes in group 1 and 97.5 minutes in group 2(P=0.03). The amount of bleeding was an average of 483 cc in group 1 and 695 cc in group 2(P=0.006). Similar results for walking start and recovery of walking ability after operation were observed in the two groups. No significant differences were observed in duration of hospital stay, complications, and revision rate. While 25 patients in group 1(83.3%) showed restoration of walking ability after operation to the same level of walking before injury, 19 patients in group 2(67.8%) showed restoration of walking ability postoperatively. CONCLUSION: Even though patients in group 2 showed a longer operation time and a higher amount of blood loss, compared with those in group 1, patients in group 2 had similar surgical risk and complications, compared with those in group 1. Therefore, primary hip hemiarthropalsty could be a good treatment option for intertrochanteric fracture in elderly.

Revision Hip Arthroplasty with a Cementless Femoral Stem / 대한고관절학회지

PURPOSE: To evaluate the clinical and radiographic results of patients who received revision total hip arthroplasty using cementless femoral stems. MATERIALS AND METHODS: This study included 26 patients who underwent revision total hip arthroplasty using a cementless femoral stems in our hospital, between Jan 2000 and May 2010, and were able to be evaluated in the final follow-up. The mean age was 63.8 years at the time of the revision surgery, and the follow up period was an average of 45 months. The causes of revision were aseptic loosening in 11 cases, periprosthetic fracture in 6 cases, femoral osteolysis in 6 cases, and infection in 3 cases. The radiologic results were evaluated in term of subsidence, loosening, and the stress shielding. The clinical results were evaluated by the Harris hip score and thigh pain. RESULTS: Harris hip score improved from 41.2 points preoperatively to 85.8 points at the final follow-up. There were 5 cases that complained of thigh pain at the last follow-up. Subsidence of femoral stem of more than 10 mm was observed in 3 cases. Stress shielding was noticed in 6 hips. The 3 grafted strut allografts were completely fused with the host bone. Complications included 2 cases of intraoperative periprosthetic fracture and 3 cases of dislocation. CONCLUSION: We obtained favorable clinical and radiologic outcomes in revision total hip arthroplasty using a cementless femoral stems. However, thigh pain and stress shielding resulted from the diameter of femoral stem being too large.

Clinical Characteristics of Korean Hereditary Nonpolyposis Colorectal Cancer

Hereditary nonpolyposis colon cancer(HNPCC) accounts for 1~6% of colorectal cancer. Mutations in the DNA mismatch repair genes(hMSH2, hMLH1 and hPMS1, hPMS2 and hMSH6) are responsible for HNPCC. To evaluate the clinical characteristics of Korean HNPCC patients, analysis were performed on the 176 patients from 40 HNPCC families registered in the Korean Hereditary Tumor Registry. All the families in this study fulfilled the ICG-HNPCC criteria. The control group consisted of 1,204 patients of nonhereditary colorectal cancer operated at SNUH between 1991 and 1995. The mean age of patients at diagnosis was significantly lower than the control group (44.5 vs 56.1 years old). Thirty three percent of cancers were located proximal to splenic flexure compared to 23% in control group. Among the 71 patients whose pathological reports were available, 14 patients(20%) had synchronous colorectal cancer compared to 4% in control. Also 15 patients(21%) had synchronous adenomatous polyp and 3 patients had both the synchronous cancer and polyp. Thus, overall 26 patients (36%) had multiple colorectal cancer including polyp. The cancers in HNPCC patients were detected at significantly earlier stage than control(67% of HNPCC patients were Dukes A or B compared to 48% in control). Statis tically significant difference was not observed in tumor differentiation between HNPCC and control group. In terms of treatment, 64% of patients received an extensive surgery over subtotal colectomy between 1995~1997 compared to 31% in the period of 1991~1994. In this series, we confirmed that Korean HNPCC patients have similar characteristics with western countries in that an early age of onset, a proclivity for the proximal colon and excess of synchronous colorectal cancers. However, relatively low incidence of proximal colonic involvement and low rate of mucinous or poorly differentiated carcinoma differed from the reports from the western countries.