The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: The purpose of this study was to compare the outcomes of osteosynthesis using compression hip screw fixation versus bipolar hemiarthroplasty in AO type A2 intertrochanteric fractures. MATERIALS AND METHODS: From March 2003 to December 2009, 89 patients were included in this study. They were treated using compression hip screws (43 cases) or bipolar hemiarthroplasty (46 cases). The mean age of patients was 77.7 years (65-94 years) and the mean follow-up period was 5.9 years (1-8.3 years). For comparison of the outcomes in the two groups, statistical analyses were performed with parameters including anesthesia time, operation time, amount of transfusion, hospital stay, general complications, clinical outcome, time of partial weight-bearing using a walker, and radiological failure rate. RESULTS: Differences in the amount of transfusion, general complications, and clinical outcome (Merle d'Aubigne and Postel score) were not statistically significant between the two groups. The bipolar hemiarthroplasty group showed better results than the compression hip screw group for anesthesia time and the time of partial weight-bearing using a walker. Radiological failures were observed in hips in one case (2.2%) of bipolar hemiarthroplasty, and in four cases (9.3%) of compression hip screw fixation. CONCLUSION: Among elderly individuals with AO type A2 intertrochanteric fractures, patients treated with bipolar hemiarthroplasty were able to perform early ambulation. However, no significant difference in operation time, amount of postoperative transfusion, clinical results, hospital stay, and radiological failure rate was observed between the bipolar hemiarthroplasty and compression hip screw fixation groups.

Consideration about Bearing Surfaces of Total Hip Arthroplasty / 대한고관절학회지

No abstract available.

Cementless Total Hip Arthroplasty Using the ABG I Hydroxyapatite-coated Prosthesis: Minimum 10 Year Follow-up / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the outcomes of total hip arthroplasty (THA) with an ABG I hip prosthesis after a minimum ten-year follow up. MATERIALS AND METHODS: From January 1996 to March 2001, 121 hips in 104 patients, whi were followed up for a minimum of ten-years, were enrolled in this study. The clinical and radiographic outcomes were evaluated and Kaplan-Meier survival analysis was performed. RESULTS: The mean Harris hip score at the last follow-up was 84 points. A radiolucent line around the cup, osteolysis, and cup loosening were observed in 5 hips(4.1%), 53 hips(43.8%), and 5 hips(4.1%), respectively. In the femoral side, osteolysis and stem loosening were observed in 11 hips(9.1%) and 2 hips(1.7%), respectively. The mean linear wear rate of the polyethylene liner was 0.23 mm/yr. Forty four revisions(36.3%) were performed. The outcomes were similar regardless of the cause of primary THA. The survival rate with the end point of revision due to cup loosening was 56.3%, and revision due to stem loosening was 98.1% after a 16 year follow-up. CONCLUSION: High polyethylene wear and the disappointing survival rate of the ABGI cup were observed after a minimum ten year follow-up. Therefore, close observation of patients who have received an ABG I prosthesis is necessary.

The Third Generation Alumina-on-Alumina Bearing Total Hip Arthroplasty in Patients Under the Age of Forty: A Minimum Five-Year Follow Up Study / 대한정형외과학회잡지

PURPOSE: We investigated the results of the third generation alumina on alumina bearing total hip arthroplasty in patients under the age of forty. MATERIALS AND METHODS: Fifty patients (57 hips) under the age of forty, who had uncemented total hip arthroplasty using third generation alumina bearing, between April 2000 and March 2006 were observed. The group consisted of 24 men and 26 women. The average age at the operation was 30.3 years (18-39 years). The average follow up period was 8.0 years (5-11 years). The most common cause for surgery was rheumatoid arthritis. We assessed the clinical and radiological results and postoperative complications. RESULTS: The mean Harris hip score at the last follow-up was 96 points on average. There was no inguinal pain. However, there were two hips of which the patient was experiencing thigh pain. One hip with squeaking was observed. We could observe the stable bony fixation of implants in all hips. There were no aseptic loosening and no osteolysis around the implants. Postoperative complications included one hip with nonunion of trochanteric osteotomy and one hip with dislocation. There were no ceramic fractures, no postoperative infections and no revisions. CONCLUSION: We observed the favorable clinical and radiographic outcomes of the third generation alumina on alumina total hip arthroplasty in patients under the age of forty. However, in the case of squeaking, a longer term follow-up is needed.

Persistency and Change of the Bone Mineral Density with Alendronate Treatment after Hip Fracture

PURPOSE: The purpose of this study was to evaluate the effects of alendronate on bone mineral density (BMD) and to determine the persistency and side effects of alendronate treatment after hip fractures. MATERIALS AND METHODS: 452 patients who underwent surgery for hip fractures from March 2000 to February 2007 were retrospectively included. The hip fractures consisted of 218 cases of femur neck fractures and 234 cases of intertrochanteric fractures. There were 254 women and 198 men with a mean age of 73.4 years (range: 60~95 years) at the time of surgery. The BMD was assessed in 398 patients and 348 were diagnosed with osteoporosis, while 102 received alendronate for treatment. The persistency with alendronate treatment and change of the BMD were evaluated annually. We also evaluated the side effects and reasons for discontinuation. RESULTS: The prescription rate of alendronate was 29.3% and the persistency rate over 1 year was 33%. The annual BMD of the lumbar spine showed a 9.11% increase the first year, a 4.5% increase the second year and a 3.5% increase the third year, while negative changes were noted in the proximal femur as a 1.89% decrease the first year, a 1.38% decrease the second year and a 0.97% decrease the third year. The BMD changes were 11%(L: Lumbar spine) and 1.1%(F: Femur) for the T-scores -3.0, respectively. The BMD changes in the patients with femur neck fractures and who were treated with hemiarthroplasty were 15.6%(L) and -3.9%(F). The BMD changes in the patients with intertrochanteric hip fractures and who were treated with compression hip screws or hemiarthroplasty were 18.7%(L), 0.77%(F), 24.2%(L) and 1.19%(F), respectively. Gastrointestinal problems(19.1%) were the most common cause for discontinuation of alendronate. CONCLUSION: It is important for doctors to approach osteoporosis more carefully and educate patients to follow the prescriptions in order to improve the low prescription and persistency rates for the management of osteoporotic hip fractures. Administration of alendronate may have a positive influence on the BMD of the proximal femur by lowering the rate of decreased BMD more than would be expected.

Risk Factors for Dislocation after Primary Total Hip Arthroplasty with the Transtrochanteric Approach

PURPOSE: We wanted to evaluate the risk factors that predispose a patient to dislocation after undergoing primary total hip arthroplasty with the transtrochanteric approach. MATERIALS AND METHODS: Between July 1995 and May 2007, 593 consecutive total hip arthroplasties using the trantrochanteric approach were performed. A matched comparative study was performed for the dislocated group(18 hips) and the non-dislocated control group(18 hips). The patient-related factors and mechanical factors were retrospectively reviewed to evaluate the risk factors for dislocation. RESULTS: Dislocation occurred in 18 hips(3.04%). The mean age was 57.1 years in the dislocated group and 55.2 years for all of the patients (p>0.05). Statistical analyses of the BMI, inclination and anteversion of the cup, lowering of the hip center, a leg length discrepancy, the size of the femoral head and nonunion of the greater trochanter revealed no significant differences between the two groups. Nonunion of the greater trochanter was observed in 16 hips(2.84%). The risk of dislocation was 8.5 times higher in the patients with excessive alcohol intake (p<0.05). The combination of more than 3 risk factors significantly affected the incidence of dislocation after total hip arthroplasty (p<0.05). CONCLUSION: After primary total hip arthroplasty with the transtrochanteric approach, in the cohort of this study, excessive alcohol intake was the main risk factor for dislocation and a combination of risk factors contributed to dislocation.

Revision Total Hip Arthroplasty Using a Wagner Revision Stem

PURPOSE: We evaluated the results of revision total hip arthroplasty using a Wagner revision femoral stem. MATERIALS AND METHODS: We enrolled 54 patients who underwent hip arthroplasty using a Wagner revision stem between 1996 and 2004. The mean age at revision surgery was 65.4 years and the mean follow up period was 7.2 years. There were 42 aseptic loosenings and 12 periprosthetic fractures. The pre-operative femoral defects were classified according to the Paprosky classification system. Clinical and radiological results were evaluated. RESULTS: The mean Harris hip score improved from 43 preoperatively to 89 at the latest follow up. There were 2 cases with inguinal pain and 1 with thigh pain; in each case pain was reduced by medications. All cases showed endosteal bone formation around the stem. Five cases showed radiolucency in Gruen zones 1 and 7. Six cases had hips that showed subsidence (average=3.1 mm). There was 1 dislocation (1.8%) and 1 intraoperative periprosthetic fracture (1.8%). There were no re-revisions. CONCLUSION: Use of a Wagner revision femoral stem for revision total hip arthroplasty elicits satisfactory results including stable fixation of the stem, a low rate of subsidence, and a low rate of dislocation.

Acetabular Revision Using Uncemented Acetabular Cup

PURPOSE: The purpose of this study is to evaluate the clinical and radiological results of revision total hip arthroplasty with using impacted bone grafts and uncemented acetabular cups on the acetabulum with bone defects. MATERIALS AND METHODS: From June 1990 to March 2006, 131 revision total hip arthroplasties using an uncemented acetabular cup and impacted bone graft, were performed in 124 patients. The average follow-up period was 66 months. The clinical results were evaluated with the Harris hip score. The radiological results included the period of graft incorporation, the rate of resorption, the migration and the change of inclination of the cup. The failure rate and 13 year survival rate were analyzed. RESULTS: The Harris hip scores were 51.8 preoperatively and 82.5 postoperatively. The period of incorporation was a mean of 6.38 month. Most cases showed a resorption rate below 10%. The mean migrations of the acetabular cup were 1.37 mm superiorly and 1.20 mm medially. The mean change of inclination was 1.24 degrees. There were 5 re-revision surgeries. The failure rate was 3.8%. The survival rate of the revision that was done due to loosening was 94.9% at 13 years. CONCLUSION: Acetabular revision arthroplasty with bone grafts, and an uncemented cup is recommendable as it achieves favorable outcomes in terms of rapid incorporation of the grafted bone and stable fixation of the cup.

Treatment of Vancouver B2 and B3 Periprosthetic Femoral Fractures

Purpose: To evaluate respectively the clinical results after femoral stem exchange or retention in the treatment of Vancouver B2, B3 periprosthetic femoral fractures. Materials and Methods: Nineteen cases of Vancouver B2 fractures and 8 cases of B3 fractures that were treated surgically between January 1992 to October 2004 were reviewed. There were 15 retained stems (group A) and 12 exchanged stems (group B). Firm fixation of a fracture and stem with a plate, screw and cable was performed in both groups. The HHS and criteria of Beals and Tower was used for the clinical and radiological evaluation. Results: The mean HHS was 84 in group A and 85 in group B. Unsatisfactory (<80 HHS) results were obtained in 2 cases from each group. The radiological results were excellent in both groups with the exception of one case of femoral stem loosening in group A and one case of non-union in group B. The complications encountered were 1 case of femoral stem loosening, 1 case of non-union, 1 case of a superficial infection, 1 case of dislocation, and 1 case of cup loosening. Conclusion: Stable fixation of the fracture and stem with a sufficient bone graft in the treatment of Vancouver B2, B3 periprosthetic femoral fractures can produce favorable clinical results regardless of the level of femoral exchange.

Uncemented Bipolar Hemiarthroplasty for Femoral Neck Fracture in Patients Older Than 75 Years of Age

Purpose: This study examined the clinical and radiographic outcomes of uncemented bipolar hemiarthroplasty for femoral neck fractures in elderly patients with osteoporosis Materials and Methods: Between March 2002 and July 2004, 48 uncemented bipolar hemiarthroplasty procedures (Zweymuller, Plus Orthopedics AG, Rotkreuz, Switzerland) for femoral neck fractures were performed in 47 patients older than 75 years of age. Of the 48 patients, 1 patient died during the follow-up period. There were 11 men and 36 women. The mean age of the patients at the time of surgery was 81 years (range, 75 ~ 94 years), and the mean follow up period was 42 months(range, 24 ~ 58 months). The bone mineral density and canal flare index of the proximal femur were measured in all patients. Results: The mean bone mineral density (T score) was -3.9 points (range, -2.9 ~ -5.3) and the proximal femoral morphology showed stove pipe shapes in 33 hips. At the last follow up, the mean Harris hip scores and visual analogue scale score was 85 (range, 75~93) and 2.7 (range, 1 ~ 6)points, respectively. Inguinal pain was observed in thirteen hips, among which the degree of pain was moderate in 1 and mild in 12. Radiologically, none of the stems showed evidence of osteolysis and aseptic loosening, and remained well osseointegrated without subsidence. Conclusion: Uncemented bipolar hemiarthroplasty using a Zweymuller stem in elderly patients associated with osteoporosis can provide favorable clinical and radiographic results because the stem imparts good primary stability due to its rectangular tapered shape and long-term secondary stability due to excellent osseointegration on the gritblasted surface.

Treatment of Periprosthetic Femoral Fractureaccording to the Vancouver Classification / 대한정형외과학회잡지

PURPOSE: To determine the treatment results according to the guideline of the Vancouver classification in periprosthetic femoral fractures. MATERIALS AND METHODS: Thirty-five periprosthetic femoral fractures treated between May 1981 and February 2003 were assessed. The mean age of the patients was 56 years (30-83 years). The outcomes were estimated according to the Beals and Tower's criteria. RESULTS: The overall incidence of postoperative periprosthetic femoral fracture was 0.91%. The frequency of the fracture types in decreasing order was B1, B2, B3, C, AG and AL. The treatment outcomes according to the Vancouver guidelines were excellent in 27 hips, good in 5 hips and poor in 3 hips. Suspicious risk factors of periprosthetic fractures were found in 6 hips (osteoporosis in 4 hips, osteolysis in 1 hip and loosening of femoral stem in 1 hip). Complications related to the treatment included a bony defect in 1 hip and an infection with non-union in 1 hip. The complications related to treatment for an implant were loosening in 2 hips and subsidence of stem in 1 hip. CONCLUSION: In order to obtain favorable results, in addition to following the Vancouver treatment guideline, consideration should be made to the basic principles such as the stability of the fractures, the stability of the implant and restoration of the bone stock.

Failure of Repaired Short External Rotator Muscles after Total Hip Arthroplasty

Purpose: To determine the incidence and the time to failure of repaired short external rotator muscles through aposterolateral approach in total hip arthroplasties; and to describe the correlation between failure of the repaired short external rotator muscles and the hip dislocation rate. Materials and Methods: Between January 2003 and October 2003, 51 patients (55 cases) were treated with primary, uncemented total hip arthroplasties. The average patient`s age was 51 years (33 men, 19 women). After the short external rotator muscles were repaired, two 26-gauge wires were stitched as a marker to the abductor tendons and short external rotator tendons. The distance between the two opposing reference points was less than 1.2 cm. The distance between the markers was determined on radiographs that were obtained 1 day, 2 weeks, and 3 months post-operatively. A distance of more than 2.5 cm, or an invisible one, indicated failure. Results: Of a total of 52 repaired short external rotator muscles, 45 (86.5%) failed. Twenty-five(48.1%) failed within the first day, 15 (28.8%) within 2 weeks, and 5 (9.6%) within 3 months post-operatively. Regardless of the time of failure of the repaired short external rotator muscles, postoperative hip dislocations did not occur. Conclusion: The repair of short external rotator muscles after total hip arthroplasties has a high failure rate and contributes little to the prevention of hip dislocations.

Comparison of Monoblock and Modular Femoral Stem on Isolated Acetabular Revision with Use of Uncemented Cup

Purpose: The purpose of our study was to assess the clinical and radiological results of isolated acetabular revision and the differences in the results between monoblock and modular femoral stems. Materials and Methods: Between October 1991 and June 2002, 39 patients (39 hips) underwent isolated acetabular revisions with use of uncemented cups and bone grafts. The mean period of follow-up was 5 years 3 months (range, 2 years 1 month to 9 years 8 months). The mean age of the patients at the time of the surgery was 51 years old (range, 26 to 75 years old). The monoblock femoral stems were used in 19 hips and the modular femoral stems were used in 20 hips. The monoblock stems were retained without exchange provided that there was no gross scratch on the femoral head and the femoral stem was confirmed to be stable and fixed intraoperatively. In the modular stems, the femoral heads were always exchanged with new ones. Results: The mean Harris hip score improved from 57 to 87 points. Radiologically, all the stems retained at surgery remained well osseointegrated without osteolysis. Re-revisions of the acetabular components were performed in 5 hips using monoblock stems due to periacetabular osteolysis caused by excessive wear of polyethylene and subsequent loosening of the cups in 3 hips and mechanically unstable acetabular cups without osteolysis in 2 hips. The mean wear rate of polyethylene coupled with the monoblock stem was 0.27 mm/year which was greater than the 0.11 mm/year in the cases with modular stems. Conclusion: To prevent failure of acetabular cups that may occur later by excessive wear of polyethylene, we recommend revision of the well-fixed monoblock femoral stems even though there is no gross scratch on the femoral heads of the monoblock stems.

Polyethylene Wear and Osteolysis in Uncemented Acetabular Component / 대한정형외과학회잡지

PURPOSE: To investigate the influence of the linear wear rate of polyethylene, the osteolysis threshold of the linear wear rate, and the related factors on polyethylene wear in an uncemented metal-backed-cup of a primary total hip arthroplasty. MATERIALS AND METHODS: This study examined 87 hips from 75 patients (57 men and 18 women) who had undergone a primary total hip arthroplasty with a minimum follow-up of five years. The mean age was 47.3 years (range, 25-68 years). The mean follow up period was 90 months (range, 60-148 months). The most frequent diagnosis was avascular necrosis of the femoral head. 18 Harris-Galante I and 69 Harris-Galante II cups, were used on the acetabular side, and 66 Anatomic and 21 Harris-Galantestems were used on the femoral side. Radiographic polyethylene wear was estimated using the method reported by Livermore, and the above mentioned factors that influence polyethylene wear were investigated and analyzed statistically. RESULTS: The overall mean linear wear rate of polyethylene was 0.21 mm/year. The linear wear rate of 22 hips with osteolysis and 65 hips without osteolysis was 0.29 mm/year and 0.12 mm/year respectively, showing a significant difference (p=0.001). The patients with high activity had a significantly higher mean linear wear rate (0.28 mm/year) than that those patients with low activity (0.16 mm/year) (p=0.048). Patients younger than 40 year-old had a significantly higher mean linear wear rate (0.23 mm/year) than the patients older than 40 year-old (0.19 mm/year) (p=0.049). However, there were no correlations between the mean linear wear rate and gender, weight, diagnosis, the type of cup and the thickness of the polyethylene. CONCLUSION: The polyethylene wear rate in an uncemented metal-backed-cup was significantly affected by age and the activity of the patients, which strongly influenced the development of osteolysis. Therefore, in order to reduce the incidence of aseptic loosening due to osteolysis in young patients with high activity, a bearing surface with mean linear wear rate of 0.12 mm/year or less is recommended.

Hydroxyapatite Coated CLS Femoral Stem in Patients with Rheumatoid Arthritis: Minimum 5 Year Results / 대한정형외과학회잡지

PURPOSE: The study was undertaken in order to characterize the clinical and radiological results of total hip arthroplasty using a fully rough blasted stem with proximal hydroxyapatite coating in rheumatoid arthritis patients. MATERIALS AND METHODS: Twenty three total hip arthroplasties were performed using CLS stems in rheumatoid arthritis patients. Mean patient age of the patients and follow-up period were 53 and 6.8 years, respectively. Both clinical and radiographical parameters were evaluated. RESULTS: Chronological change of Harris hip score showed good results after 1 year. Harris hip score and the incidence of thigh pain at the last follow-up were 94 and one case, respectively. The mean time weight bearing without support was 12.5 weeks. Most endosteal bone formations around the stem appeared in the first 3 to 6 months. This was present in more than 80% of cases in zones 1, 2, 6, 7 and from 50 to 70% of cases even in zones 3, 4, 5 at the final follow-up. Loosening or implant failure was not found. Incomplete calcar fracture occurred in three cases, liner fracture around the femoral stem in one, heterotrophic ossification in one and superficial infection in one. CONCLUSION: The total hip arthroplasty using a CLS stem with a proximal HA coating may be a good choice in rheumatoid arthritis patients requiring hip arthroplasty.

Cementless Total Hip Arthroplasty in Bony Ankylosed Hip / 대한정형외과학회잡지

PURPOSE: The purpose of the present retrospective study was to report the clinical and radiological results of 31 total hip arthroplasties of 28 patients with bony ankylosed hip. MATERIALS AND METHODS: Conversions to cementless total hip arthroplasty between August 1983 and May 1999 were reviewed after followups ranging from 3 years 1 month to 18 years. The mean age of the patients at the time of operation was 35.0 years. The mean duration of the ankylosis was 15 years 7 months. RESULTS: At the time of the last follow-up, the mean arc of flexion was 84.6 degrees. The mean Harris hip score improved from 47.7 to 84.9. There were no significant differences in clinical results according to the type and duration of ankylosis. Radiographs showed one acetabular loosening, six acetabular osteolysis and five femoral osteolysis. In cases of osteolysis, the average wear rate was 0.28 mm/year. CONCLUSION: The conversion of bony ankylosed hip to a cementless total hip arthroplasty revealed a favorable outcome, and the risk of failure was found to be unrelated to the type and the duration of ankylosis. However, since some patients show excessive wear with osteolysis, polyethylene liner wear will be of critical importance in terms of long-term results.

Reverse Hybrid Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to report the long-term clinical and radiological results of reverse hybrid total hip arthroplasty. MATERIALS AND METHODS: Between Oct. 1984 and Dec. 1987, reverse hybrid total hip replacements were performed using cemented all-polyethylene acetabular cup and porous coated tri-lock femoral stem. 26 cases in 25 patients were followed up more than 10 years. RESULTS: The average Harris hip score was 50 points preoperatively, 88 points at last follow-up. Two patients (7.7%) complained thigh pain at POD 1 years and 4 patients (15.4%) complained inguinal pain at last follow-up. On the radiologic findings, endosteal bone formation were observed with bone apposition mainly on the Gruen zone 2 and 6. Osteolysis developed in the proximal portion of the femoral stem, respectively. Definite loosening were found in 9 cases (34.6%) in the acetabulum and none in the femur. The mean rate of linear wear of polyethylene was 0.14 mm/year and the mean rate of volumetric wear was 108.75 mm3/year. CONCLUSION: The high incidence of acetabular loosening, presumably because of poor bone stock and great volumetric wear associated with use of the thirty-two-millimeter head. The result of tri-lock component can provide satisfactory clinical and radiological result.

An Immunoelectron Microscopic Study on Localization of Fibronectin by 17-beta Estradiol Effects in Rat Tibia / 대한정형외과연구학회지

Fibronectin(FN) is a multifunctional glycoprotein with ARG-GLY-ASP(RGD) sequences that has been known as an important constituent of extracellular matrix in bone. 17-beta estradiol, bone active hormone has been reported to stimulate the in vitro production of several extracellular matrix proteins. Though it is known that estrogen withdrawal causes a significant diminition in PTH induced FN production, the hormonal regulation of FN production in bone has not been thoroughly studied. Especially the study using immunoelectron microscopy about FN production is rare. So, the author undertook tile present study to pursue the effect of estrogen on the distribution of fibronectin in the process of bone matrix formation with immunoelectron microscopy. Four to five weeks old female Sprague-Dawley rats, weighing about 150 gm, were used as experimental animals. It was grouped as ovariectomy group, sham operation group, ovarectomy with estrogen injection group, and normal control group. Each group was sacrificed at 1 week, 3 weeks and 5 weeks postoperatively. Ovaries were removed under the pentobarbital anesthesia, and for the estrogen injection group, 0.25 mg/kg of 17-beta estradiol was injected subcutaneously after oophorectomy. Immunoelectromicroscopic findings were as follows. 1 At the one week after operation, the distributions of gold particles, show the fibronectin reaction in osteoid, are similar in the control group, sham operation group, and ovariectomy with estrogen injection group at intermediate reactions, but it is severely decreased in the ovariectomy group as a weak reaction. 2. At there weeks after operation, the distributions of gold particle are similar in the control group, sham operation group and ovariectomy with estrogen injection group as intermediate reactions, but it is also decreased in the ovariectomy group as a weak reaction. 3 At the five weeks after operation, all the groups have similar distributions of gold particles as intermediate reaction. It is suggested that the estrogen secreted in ovary, partially effects on the fibronectin formation in the matrix of developing bone, and other factors stimulate and compensate the fibronectin formation with removal of ovaries.

Hydroxyapatite coated Total Hip Arthroplasty in Rheumatoid Arthritis / 대한정형외과학회잡지

Rheumatoid patients have poor bone quality and also have an increased incidence of sepsis, delayed wound healing, and general overall complications. It is the purpose of this paper to assess the clinical and roentgenographic results of ABG total hip replacement in rheumatoid arthritis. Twenty-six total hip arthroplasties done in seventeen patients with rheumatoid arthritis were studied prospectively. The average follow-up was 3 years and 4 months, with a minimum follow-up of 2 years and 7 months. The average age of the patients was 49.7 years (range 36-63) and there were sixteen females and one male. All patients fulfilled the 1987 revised criteria and there were eleven cases of protrusio acetabuli. All patients except two were taking oral steroids, nineteen cases were classed as Singhs index 1, five cases as Singhs index 2, and two cases as Singhs index 3. The Charnley approach with a trochanteric osteotomy was employed in all patients. Cup fixation was achieved with two spikes in twenty-one cases, two spikes and one screw in five cases, and in all cases the acetabular cup was angled at less than 45 from the horizontal. There was a gap between the acetabular cup and the acetabulum at DeLee and Charnley zone 1 in three cases, and at zone 2 in six cases. At 2 years, there was no radiolucency, reactive line or any sign of bone resorption. The development of cancellous and cortical densification was seen in Gruen's zone 2 and 6 for the first time in the 1 year radiographs. It became more prominent in the 2 year radiographs. The reactive bone line first became visible at the 6 month follow-up in the Gruen's zone 3 and 5. These lines extended more proximally, but it did not involve the proximal HA coated portion. Cortical hypertrophy of diaphysis was seen at Gruen's zone 3 and 5 in five cases. Rounding off of calcar was visible at zone 7 in six cases. There were no radiological changes of the femoral side in fourteen cases and the acetabular side in seven cases. There was one case of wire breakage, one case of trochanteric separation, and one case of intraoperative splitting of calcar. The result of the study indicated that the development of osseointegration in rheumatoid arthritis might be slow, but the clinical and radiological results were satisfactory. Further prospective follow up is necessary to determine whether the favorable early result of HA coated implant are maintained over longer periods.

Diagnostic Signification of Antiperinuclear Factor(APF) in Rheumatoid Arthritis / 대한정형외과학회잡지

In systemic rheumatic disease, marker antibodies such as anti-Sm, anti Scl-70 and anti Jo-1 are helpful in the diagnosis of disease, but in rheumatoid arthritis, the diagnosis is difficult due to the low sensitivity and specificity of the rheumatoid factor(RF). So, a new maker antibody with high sensitivity and specificity was needed. Recently, the antiperi- nuclear factor(APF) has gained particular attention. The results of the APF and RF test in 165 patients with rheumatoid arthritis, 77 patients with osteoarthritis, and 109 normal healthy persons, which were taken between January, 1994 through December 1994 were as follows; 1. The sensitivity, specificity, and predictive value of positivity of the RF test in patients with rheumatoid arthritis were 58.2%, 93.5%, and 95.0%, and that of the APF test were 72.1%, 94.6% and 92.2%, respectively. 2. The sensitivity, specificity and predictive value of positivity when combining the APF with the RF were 83.0%, 85.7%, and 92.6%, respectively. 3. The disease status of the patients correlated with intensity of the APF test, that is, the more severe the disease status, the higher intensity. In conclusion, the APF was useful in the diagnosis of rheumatoid arthritis, and may be used as an indicator of disease status. When combining test the APF with RF, the incidence of sero-negative rheumatoid arthritis decreased.