Press Fit Condylar Total Knee Arthroplasty

The PFC (Press Fit Condylar) knee was first implanted clinically in 1984 with retention of posterior cruciate ligament. Thereafter PFC modular version had been developed at 1988 with option of posterior cruciate ligament substitution and minor design changes. We classified the 170 patients, 252 knees which underwent the PFC total knee arthroplasty in the period from January 1988 to May 1995 into three groups. In group I, 62 patient. Had 93 total knee arthroplasties with insertion of the original PFC total knee prosthesis with retention of posterior cruciate ligament from January 1988 to October 1991. In group Iia, 51 patients had 74 total knee arthroplasties with insertion of the modular PFC total knee prosthesis with retention of posterior cruciate ligawient from November 1991 to May 1995. In group III, 57 patients had 85 total knee arthroplasties with insert.ion of the modular PFC total knee prosthesis with substitution of posterior cruciate ligament from November 1991 to May l995. Average follow-up periods were 7 years 5 months in group I and 3 years 2 months in group Iia and Ilb. Clinical and radiographic results were similar among the group I, Iia and llb except slight better scores in group Iia and Iib than group I, even though group IlI and IlI had short follow-up periods, Postoperative implant wear was developed at 5 knees in group I, 1 knee in group Iia and not developed in group Ilb. Implant loosening was developed at 1 knee only in group 1. Revisional arthroplasty was performed to 7 knees in group I, 1 knee in group Iia and not in group 1Ib. In conclusion, posterior cruciate ligament substitution group had no difference in functional results with the retention group. In the problem of implant wear, posterior cruciate ligament substitution group was superior to the retention group but similar in loosening.

More than 10 year Follow-up Study of Insall-Burstein Posterior Stabilized Knee / 대한정형외과학회잡지

Insall-Burstein Posterior stabilized knee prosthesis is a variant of total condylar prosthesis. It is designed to get more wide range of flexion and stability with the transverse cam. We analyze with modified HSS knee rating score clinically and scoring system of AKS(American Knee Society) radiologically. We report the operative results in 34 cases of 25 patients whom we operated with Insall-Burstein PSP from August, 1982 to May, 1985 and the long term follow-up result of 24 cases of 16 patients, excluding three death and 7 cases of 6 patients who were lost to follow up. Follow-up period is average 11 years and 5 months. The average preoperative flexion contracture improved markedly. The average preoperative flexion arc was 95° and preoperative flexion contracture was 14°. The postoperative ROM and flexion contracture improved markedly. The average preoperative modified HSS knee rating scoring was 52 points and improved to 91 points at last follow-up. Patients with rheumatoid arthritis had progression of other joints involvement which limited the activity of daily living. At the last follow up, loosening signs were not observed radiologically but three cases of radiolucent zone were observed in the zone I, II, III, IV, VII of tibial components and zone III, VI of femoral components. There were two deep infections.

Posterolateral Fusion in Spondylolisthesis / 대한정형외과학회잡지

After Kilian first described apondylolisthesis in 1854, there has been diverse opinions over the surgical treatment of the spondylolisthesis: in situ fusion vs. reduction and fusion, PLIF vs. PLF, and instrumentation vs. non-instrumentation. The advantages of the instrumentation are rigid fixation, better union rate of grafted bone and early rehabilitation after surgery. The disadvantages are long operation time and increased chance of the wound infection. The purpose of this retrospective study is to review the clinical results and fusion rate of 41 patients who were treated with decompression and posterolateral fusion in situ with autograft with or without instrumentation from January 1986 to June 1992. 1. Among 41 patients, 20 patients were degenerative type and 21 were isthmic type, and most commonly involved level was L4-5(46.4%). 2. Fusion was obtained in all patients. 3. Clinically 11 of 15 patients(73.4%) showed excellent or good results in instrumentation group, and 19 of 26 patients(73.0%) showed excellent or good results in non-instrumentation group. 4. Postoperative complications developed in two cases(13.3%) with instrumentation and five cases(19.2%) without instrumentation. Comparing with the non-instrumentation, we could not find great advantage of the instrumentation on the clinical results or union rate, although instrumentation showed a little better result.

Pronator Quadratus Pedicled Bone Graft for the Kienbock's disease: Three cases report / 대한정형외과학회잡지

Pedicled bone flap raised from the volar aspect of lower end of the radius, pedicled by the pronator quadratus has been used for the treatment of scaphoid nonunion and Kienbock's disease. From July 1991 to Jan. 1992, authors performed this procedures for 3 cases of Kienbock's disease. Patients were 2 cases in the left hand, l case in the right hand. There was no critial trauma history. Age at operation were 25, 37 and 57 years. All patients were in Stage I in 2 cases and stage II-A in 1 case of Lichtman's radiologic classification. Preoperative grip powers were 11%, 38%, 63% and pinch powers were 20%, 41%, 61% of that of normal opposite hand. Follow up periods were 28, 31 and 33 months. At last follow up roentgenographic finding shows no progression of necrosis of lunate, new bone formation, decreased sclerosis, and joint space were preserved in all cases. The fuctional results at the last follow up were as follows. Pain during motion was markedly diminished in all patients. Grip power were 57%, 89% and 96% and pinch powers were 68%, 83% and 100% of that of normal opposite hand with use of calibrated Jamar dynamometer which showes significant increase than preoperative state. The ranges of motion of wrist were as follows. Volar flexion were 40, 45 and 80 degree. Dorsiflexion were 10, 20 and 45 degree. Ulnar deviation were 10, 20 and 30 degree. Radial deviation were 10, 25 and 30 degree. This viable bone graft with blood supply gives very satisfactory clinical results.