Acetabular Revision by Using Femoral Head Allograft and Uncemented Cup / 대한정형외과학회잡지

Acetabular bone deficiencies encountered during the revision hip arthroplasties should be recon- structed to provide the implant stability and to restore the normal center of rotation of hip and the leg length. We revised the loosened acetabular cup by grafting fresh-frozen bulk femoral head and inserting uncemented cup in 17 hips of 15 patients. The average follow-up period was 2 years and 3 months. The acetabular bone deficiencies were type 2A in 6 hips, type 2B in 8, type 3A in 1 and type 3B in 2 by Paprosky's classification. Three blocks of femoral head were grafted in 3 type 3 deficiencies, but only one in type 2 deficiencies. The cup-host bone contact was 41% on the average. However, the cup-host bone contact in the zone I was present only in 12 out of 17 hips and its average was 14%. Incorporation of the allograft into the host bone occurred between 5 months and 1 year and 7 months (average, 8,6 months) after revision surgery. Significant radiographic loosening sign was noted only in 2 hips which had not only type 3B bone deficiencies reconstructed with 3 blocks of femoral head allograft but also no cup-host bone contact in zone I . The bulk allograft of fresh-frozen femoral head demonstrated acceptable results in type 2 acetabular bone deficiencies, although the follow-up period was relatively short. Reconstruction of type 3B acetabular bone deficiencies by using multiple blocks of femoral head allograft had been failed. We presumed that the lack of the graft stability and the intimate contact between the grafts and host bone was the cause of failure.

Pyogenic Arthritis in Renal Transplant Recipients / 대한정형외과학회잡지

Acute pyogenic arthritis in renal transplant patient is one of the serious problem resulting in significant morbidity and mortality. The purpose of this paper is to analyze seven patients in whom acute pyogenic arthritis developed following renal transplantation. Pyogenic arthritis developed in seven (0.7%) out of 958 renal transplant patients whose transplanted kidney functioned well for more than two years. The age of the patients ranged from 37 to 65 years with a mean of 48 years. All patients were male. Pyogenic arthritis developed between the period of one and 12 years (mean: 4.5+/-4.2 years) following transplantation. Causative organisms were Staphylococcus aureus (three), E. coli (two), Salmonella (one) and Acinetobacter bananii (one). Involved joints were four knees, one hip, one elbow and one finger. Two patients improved on a conservative regimen of bed rest and antibiotics and five patients required open drainage. However, pyogenic arthritis recurred in three years, four years and seven years after renal transplant in one patient. Looking at the probable risk factors of age, sex, immunosuppresants, diabetics and acute graft rejection, diabetics and older age (over 40 years old) are highly associated with post renal transplant pyogenic arthritis.