Association between the Total Homocysteine Concentration and the Bone Marrow Density and Bone Turnover Rate in Postmenopausal Women / 대한폐경학회지

OBJECTIVES: Hyperhomocysteinemia is related to fractures in the elderlies. We assessed the relationship between serum homocysteine and bone mass, size, and bone turnover rate. METHODS: This study included 2,670 postmenopausal women who underwent periodic health examinations in Ajou University Health Promotion Center, between January 2002 and December 2003. Serum homocysteine, bone turnover markers and bone mineral density were measured RESULTS: Patient age, osteocalcin, 25-vit D, total lumbar BMD, total lumbar T-score, the lowest lumbar BMD, the lowest lumbar T-score, femur neck BMD, femur neck T-score, femur trochanteric BMD and femur trochanteric T-score showed a significant correlation with the serum total homocysteine. However, after adjusting for age, the only osteocalcin was significantly correlated with the serum total homocysteine, At the 3rd lumbar vertebra, the BMC, volumetric BMD and areal BMD had a significant correlation with the serum total homocysteine but the bony size and the volume were not significant. After adjusting for age, the 3rd lumbar BMD was significantly correlated with the serum total homocysteine. CONCLUSION: Serum homocysteine level is correlated significantly with bone turnover rate, less with bone mass but not with bone size.

Revision of the Femoral Stem

There is an increasing need for revision of the femoral stem due to a high frequency of total hip arthroplasty. Recently, many orthopedic professionals are paying particular attention to the durability of revision arthroplasty. This review article includes the most recent information and published studies about revision of the femoral stem. It is ordered as follows: preoperative evaluation, surgical planning, surgical approaches, implant removal, reimplantation, perioperative complications and clinical results according to implant type.

Osteochondral Autograft Using Head of Proximal Phalanx of Toe for Partial Osteochondral Defect of Proximal Interphalangeal Joint: A Case Report

Osteochondral injury due to the trauma of the hand is relatively common. If the size of the osteochondral fracture fragment is large, open reduction and internal fixation are often feasible in treating these problems. However, arthroplasty using osteochondral graft is more preferred when the particle is small and articular surface is comminuted or fully defected. There are many reports of osteochondral graft using the costal osteochondral graft but the osteochondral graft using the interphalangeal joint of the toe is rarely reported. Thoroughly reviewed with relevant articles, this report presents a case of a 33 year old male who was successfully treated with osteochondral autograft using the proximal interphalangeal joint of the toe due to the traumatic osteochondral defect in the head of the second proximal phalanx.

The Efficacy of Core Decompression for Treating Avascular Necrosis of the Femoral Head

PURPOSE: We evaluated the efficacy of core decompression (CD) for treating early avascular necrosis of the femoral head (ANFH), as well as the effect of an autogeneous bone graft and an DBM graft on the results of CD. MATERIALS AND METHODS: This study included 37 patients (40 cases) who were initially diagnosed as suffering with early ANFH, and they were treated with CD and followed up for a minimum of two years. The average patient age was 47.8 years and the average follow up period was 62.4 months., The Ficat & Arlet (F&A) stage and the ARCO stage were used for the radiological staging. RESULTS: The failure rate was 65% (26 case), and 32.5% (13 cases) underwent THA due to clinical and radiological failure. According to the F&A stage, there were 10 stage I hips, 22 stage IIA hips and 8 stage IIB hips, and the success rate (SR) of core decompression was 60%, 36.4% and 0%, respectively. The differences were statistically significant. The cases of ARCO stage II were divided into subgroups: A 2 hips, B 13 hips and C 12 hips and the SR of each were 50%, 46%, and 33.3%, respectively. The differences were statistically significant. CONCLUSION: CD should be carefully considered for treating the advanced stages above F&A stage IIA and ARCO stage IIB.

M. chelonae Soft Tissue Infection Spreading to Osteomyelitis

A previously healthy, 54-year-old woman presented with Mycobacterium chelonae soft tissue infection and osteomyelitis of her left lower leg. The infection had started from soft tissue emerging at the medial aspect of the distal femur and had spread through the bone because of delayed diagnosis. The largely indolent, 8-month course to diagnosis was attributable to unremarkable clinical manifestations combined with a low index of suspicion such as immunocompetent patient and/or inadequate finding of acid-fast bacilli in a lesion smear, characteristic histopathological features, and culture techniques. Soft tissue infection and osteomyelitis were successfully treated without surgical intervention and with a 6-month course of chemotherapy.

A Comparative Study of the in vivo Wear of Zirconia and Metal Heads Articulating with Polyethylene Liners in Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purposes of this paper was to determine the wear rates and volumetric wears of ceramic (Zirconia) and metal (Cobalt-chrome) femoral heads, and to differentiate creep from true wear. Another purpose was to determine the extent of wear and volumetric wear per annum. MATERIALS AND METHODS: We examined 86 patients (111 hips) who were continuously followed up from 180 patients (225 hips) who received THRA with AVN of stage III or above at our hospital. Patients were followed until December 1999 for more than a minimum of 3 years from June for 1996. The hip joint AP radiographs that had been taken immediately after the operations, six weeks postoperatively and annually thereafter were compared. We used the computer assisted vector wear analysis program of Martell to measure the wear rate, volumetric wear and vector wear. RESULTS: The wear rate and the volumetric wear in the zirconia ceramic head group (1.443 mm/year, 665.433 mm3/year) and metal head group (2.161 mm/year, 1271.831 mm3/year) were high immediately after operation and six weeks postoperatively, and this was significantly more than during all for other periods, giving a wear rate and volumetric wear in the ceramic head group of 0.180 mm/year and 81.101 mm3/year, and in the metal head group of 0.219 mm/year and 124.149 mm3/year. Moreover, the average wear rates and volumetric wear rates of these two groups were significantly different, and annual wear and volumetric wears showed a trend to decrease with time. CONCLUSION: Wear rate and volumetric wear six weeks after operation were remarkably high compared with the other periods. This is interpreted as the result of a creep phenomenon, which occurred mainly during the six weeks following the operation. The Zirconia ceramic head group showed little wear, which confirms the theoretical advantage of the zirconia ceramic head in vivo.

Change of Periprosthetic Bone Mineral Density after Cementless Total Hip Arthroplasty: Using Extensively Porous Coated Femoral Stem / 대한정형외과학회잡지

PURPOSE: To investigate the annual change of bone mineral density (BMD) around the femoral stem and identified the factors that influence the stress shielding effect in patients who have received extensively porous coated cementless stem. MATERIALS AND METHODS: We reviewed seventy-four patients who were followed up for longer than three years after unilateral primary total hip replacement arthroplasty. The BMD was measured annually using a DEXA QDR 4500(R) on the proximal femur according at the Gruen zone. We analyzed the relationship between the results and the possible variates of periprosthetic bone remodeling. RESULTS: In first year after operation, the BMDs of all Gruen zone decreased significantly. From the second year, the BMDs in Gruen zones 1, 2, and 7 were decreased significantly, but those in Gruen zones 3, 5, and 6 were increased. After three years, the BMD showed no significant change. Among the examined variables including sex, patient's age, stem size, and preoperative Singh's index, stem size and age were found to have strong predictive value. CONCLUSION: Our findings suggest that periprosthetic BMD decreased in all areas over first postsurgical year. From the third year, the BMD stabilized.