Comparison of Results of Total Knee Arthroplasty Performed Using the Navigation System and the Conventional Technique: Minimal Follow-Up of 5 Years / 대한정형외과학회잡지

PURPOSE: Authors compared the laxity, radiologic and clinical outcomes of total knee arthroplasty (TKA) performed using the navigation system and using the conventional technique at least 5-year follow-up. MATERIALS AND METHODS: Total of 92 TKAs were included for this study. Forty seven TKAs were performed by the navigation group and 45 TKAs were performed by the conventional surgery. At the final follow up, to evaluate knee joint laxity, varus-valgus laxities were measured on the stress radiographs taken with varus or valgus loads at 90degrees of flexion. The radiologic measurements and the clinical evaluations were compared between two groups. RESULTS: At the final follow-up, the mean of valgus laxities were 3.9degrees in the navigation group and 4.0degrees in the conventional group, and the corresponding mean of varus laxities were 4.0degrees and 4.3degrees (p=0.19, p=0.22) at 90degrees flexion state. Although there was no significant difference in the total laxities (7.8degrees in the navigation group and 8.1degrees in the conventional group, p=0.35). However, more than 10degrees of total laxity was significantly reduced in the navigation group (1 knee in the navigation group and 6 knees in the conventional group, p=0.04). The outlier numbers at mechanical axis, the mean of coronal inclination of the femoral and tibial component and the mean of sagittal inclination of the femoral and tibial component in the two groups were significantly different. Stiffness of WOMAC score was significantly better in the navigation than in the conventional group (p<0.001). CONCLUSION: Varus-valgus laxity was significantly different in the two groups as were the outlier numbers. The navigation system could provide good, improved alignment accuracy of the lower extremity and better result in stiffness of knee compared with conventional technique.

The Efficacy and Persistence of Selective Nerve Root Block under Fluoroscopic Guidance for Cervical Radiculopathy

STUDY DESIGN: Retrospective study. OBJECTIVES: To investigate the outcomes of fluoroscopically guided selective nerve root block as a nonsurgical treatment for cervical radiculopathy. OVERVIEW OF LITERATURE: Only a few studies have addressed the efficacy and persistence of cervical nerve root block. METHODS: This retrospective study was conducted on 28 consecutive patients with radicular pain due to cervical disc disease or cervical spondylosis. Myelopathy was excluded. Cervical nerve root blocks were administered every 2 weeks, up to 3 times. Outcomes were measured by comparing visual analogue scale (VAS) scores, patient satisfaction, and medication usage before the procedure and at 1 week and 3, 6, and 12 months after the procedure. In addition, complications associated with the procedure and need for other treatments were evaluated. RESULTS: The average preoperative VAS score was 7.8 (range, 5 to 10), and this changed to 2.9 (range, 1 to 7) at 3 months and 4.6 (range, 2 to 7) at 12 months. Patient satisfaction was 71% at 3 months and 50% at 12 months. Five patients used medication at 3 months, whereas 13 used medication at 12 months. Average symptom free duration after the procedure was 7.8 months (range, 1 to 12 months). Two patients were treated surgically. Only two minor complications were noted; transient ptosis with Horner's syndrome and transient causalgia. CONCLUSIONS: Although selective nerve root block for cervical radiculopathy is limited as a definitive treatment, it appears to be useful in terms of providing relief from radicular pain in about 50% of patients at 12 months.

Incidentally Detected Concurrent Lower Thoracic Lesions in Extended Lumbar Spine MRI

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the prevalence and associated factors of the concurrent lower thoracic lesions in patients who have a lumbar spine disease, using the extended lumbar MRI. SUMMARY OF LITERATURE REVIEW: There are no studies regarding the concurrent thoracic lesions with lumbar disease. MATERIALS AND METHODS: All the patients, who had visited the out-patient department (OPD) of orthopaedic surgery in our hospital and underwent lumbar spine MRI, were studied during 1 year. Totally, 750 patients were included. The extended lumbar spine MRI contained additional extended T2-weighted sagittal images that cover the lower thoracic vertebrae with 35 centimeters long. We analyzed the highest observable level, characteristics of detected thoracic lesions. Those lesions were classified according to the severity of compression of the spinal cord and investigation for associated factors of patients. Also, the times for additional tests were measured. RESULTS: Additional tests were able to observe up to the 7th thoracic vertebrae. In 257 cases (34.3%), the lower thoracic lesions were detected and increased with aging (p<0.001). A total of 48 patients (6%) had the lesion compressing the spinal cord and 28 patients needed further evaluation for the lower thoracic lesion. Further, 2 cases were treated surgically for lower thoracic lesions. Scanning extra time for additional test were 3 minutes. CONCLUSIONS: The prevalence of lower thoracic lesions accompanied with the lumbar disease was 34% in this study. Therefore, additional extended lumbar spine MRI is needed to check possible concurrent lesions in the lower thoracic spine.

The Effect of Sacral Alar Screw on Long-level Fusion Including Lumbosacral Segment

STUDY DESIGN: This is a retrospective study. OBJECTIVES: To evaluated the clinical and radiological effectiveness of sacral alar screws for augmentation of S1 pedicle screws in long-level fusion including L5-S1 segment. SUMMARY OF LITERATURE REVIEW: The fusion rates of lumbosacral junction in long-level fusion are various when S1 pedicle screws are used without augmentation. But, reports of sacral alar screw augmentation are rare. MATERIAL AND METHODS: From 1996 to 2005, 63 patients performed more than two-level fusion including lumbosacral junction were reviewed. 47 patients underwent lumbosacral fusion with S1 pedicle screws only (S1 group), and 16 patients with sacral alar screws augmentation in addition to S1 pedicle screws (S1-2 group). Radiologically, bony union, halo sign, and breakage of implants were evaluated. Clinically, complications associated with screw placement and general complications were evaluated. RESULTS: Bony union was obtained in 56 cases(89%) at postoperative 4.3 months. Nonunion was observed in 7 cases(11%, S1 group:5, S1-2 group:2). Loosening of S1 pedicle screw was observed in 32 cases(89%) of S1 group and in 4 cases(25%) of S1-2 group. It showed statistical significance between two groups. Sacral alar screw loosening occurred in 8 cases(50%) of S1-2 group. Metal breakage was developed in 2 cases of S1 group without nonunion or loosening. Postoperative infection occurred in 7 cases(11%, S1 group:5, S1-2 group:2). CONCLUSIONS: Sacral alar screw augmentation was effective on protecting the loosening of S1 pedicle screw. Additional sacral alar screw can improve the rate of fusion for lumbosacral junction despite no statistical significance.

A Comparative Study of the Anterior Cervical Fusion with Harms Cage versus Iliac Bone Block: Clinical and Radiological Outcomes

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the clinical and radiological outcomes of anterior cervical fusion within Harms cage versus an iliac bone block graft. SUMMARY OF LITERATURE REVIEW: There is no current consensus regarding the optimal material for anterior cervical fusion. MATERIALS AND METHODS: This was a single-center study of 107 patients who either underwent anterior cervical fusion with an iliac bone block graft (n=56; group A) or a cancellous bone graft within the cervical Harms titanium cage (n=51; group B). Anterior plating occurred in all cases. Clinical outcomes and complications were evaluated using Visual Analogue Scale (VAS) scores and Odom's Criteria. Radiological outcomes were evaluated by the height of vertebral bodies, sagittal lordosis, the rate of bony union, and the subsidence of cage. RESULTS: The VAS of donor site pain was significantly higher in group A than in group B at the final follow-up. Sagittal lordosis was increased in both groups, but was significantly higher in group B than group A. The rate of bony union was 95% and 91% for both groups 6 months after surgery and reached 100% for both groups at the final follow-up. In terms of cage subsidence, the highest point of subsidence was at the inferior and posterior aspect of the cage and the average amount of subsidence was approximately 1.3 mm at final follow-up. CONCLUSIONS: Anterior cervical fusion using a cancellous bone graft within Harms titanium cage is a good method for anterior cervical fusion with iliac bone block.

Minimally Invasive Two-Incision Total Hip Arthroplasty for Treating Acute Displaced Femoral Neck Fractures in Active Elderly Patients / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the short term follow-up results of minimally invasive (MI) two-incision total hip arthroplasty (THA) for treating acute displaced femoral neck fractures in active elderly patients. MATERIALS AND METHODS: We performed a retrospective review of 39 cases (average age: 72 years old, range: 60 years and above) of elderly patients who underwent MI two-incision THA within 30 days of their injury for treating displaced acute femoral neck fractures. They were followed up for a minimum of 12 months. Clinical evaluation was done by comparing the pre-injury and postoperative daily activities, the Harris Hip score (HSS) and the Western Ontario and McMaster University (WOMAC) score. The radiographs were checked to evaluate for implant alignment and periprosthetic abnormalities. The postoperative complications were analyzed. RESULTS: The average postoperative HSS was 88.3 and the average WOMAC score was 28.8. All the patients were able to walk without any assistive device. One patient had a HHS of less than 70. There were 2 dislocations but there was no recurrence. Radiographically, there was no case with a limb length discrepancy of more than 5mm. The femoral stems did not reveal any subsidence of more than 5mm. Other complications such as osteolysis, infection, neurologic injury and intraoperative periprosthetic fracture were not noted. Especially, no patient complained of any groin pain, which often occurs after bipolar hemiarthroplasty. CONCLUSION: The short term follow-up results were good for MI two-incision THA to treat acute displaced femoral neck fractures in active elderly patients, and these procedures were done by an experienced hip surgeon.

Avascular Necrosis of Femoral Head Treated by Total Hip Replacement in AIDS Patients: A Case Report

The incidence of osteonecrosis of the femoral head is increasing in patients infected with the human immunodeficiency virus (HIV). The etiology of osteonecrosis in HIV positive patients is multifactorial. The factors considered responsible include antiretroviral therapy, corticosteroid use and resultant hyperlipidemia, hypercoagulability, immune reconstitution, the increased prevalence of alcoholism in this population and megesterol acetate. The emergence of the HIV has highlighted the need for surgeons to understand the epidemiology of percutaneous injuries and other blood exposure in a surgical setting. We report a case of avascular necrosis of the hip treated with a total hip replacement, with particular focus on the etio-pathology of the disease and preventive measures for its transmission in an orthopedic surgery setting.

Cementless Total Hip Arthroplasty using Cone Prosthesis for Childhood Septic Hip Sequelae / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiographic results of cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae. MATERIALS AND METHODS: Thirty-seven patients of childhood septic hip sequelae that were treated with total hip arthroplasty using cone prosthesis, were evaluated after at least 2 years of follow-up. The average age at the time of the operation was 44 years. The cause of hip infection was pyogenic in 34 cases and tuberculous in 3. The average duration of follow-up was 51 months. RESULTS: The average Harris hip score improved from 45 points preoperatively to 90 points postoperatively. The mean leg length discrepancy decreased from 3.1 cm preoperatively to 0.7cm postoperatively. There was one case of stem subsidence over 5 mm, which didn't progress further. One patient underwent revision for migration of acetabular cup at postoperative 53 months. Postoperative infection occurred in 2 patients at postoperative 6 and 9 months respectively, which were treated by prosthesis removal. Radiolucent line over 2 mm was observed between the bone and stem in 1 case, without any evidence of loosening. CONCLUSION: Cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae resulted in excellent clinical and radiographic outcome.

Osteoarthritis after Ten Year Follow-Up of ACL Reconstruction Using Patellar Tendon Autograft / 대한정형외과학회잡지

PURPOSE: To evaluate the incidence and risk factors associated with osteoarthritis after a reconstruction of the anterior cruciate ligament (ACL) using a patellar tendon autograft after an average follow-up period of more than 10 years. MATERIALS AND METHODS: The study examined 56 cases that were selected from 118 cases who underwent an arthroscopic reconstruction of the ACL using a patella tendon autograft a minimum of 8 years ago and were available for follow up. The mean age at the time of the reconstruction was 31.3 years (19-58 years), and the average follow up period was 10.6 years (8.6-13.8 years). At the last follow up, the presence of osteoarthritis on the weight-bearing antero-posterior and lateral, and Merchant's radiographs, was assessed using the Kellgren and Laurence classification. The correlation between the development of osteoarthritis and the clinical results (Lysholm knee score, Lachman test, Pivot-shift test, return to preinjury activity), the radiological results (anterior laxity, persistent anterior subluxation), the interval from injury to the reconstruction, the patient age at the time of the reconstruction, the presence of an accompanying meniscal injury, and the patient's gender were examined. RESULTS: Among the 56 cases, osteoarthritis was detected in 23 (41%) (grade II, 18 cases; grade III, 5 cases), and in regard to the lesion sites, the medial compartment was detected in all cases, the lateral compartment in 12 cases and the patello-femoral compartment in 11 cases. Among them, 19 cases were accompanied with a meniscal injury (OR, 10.336; p = 0.001), and a significant increase in osteoarthritis was detected in those cases with a interval from the injury to the reconstruction of more than 6 months (OR, 4.611; p=0.030), and in those aged more than 26 years at the time of the reconstruction (OR, 5.038; p=0.023). However, there was no correlation between the development of osteoarthritis and the clinical outcome, radiological anterior laxity and continuous anterior subluxation, and genders (p>0.05). CONCLUSION: Osteoarthritis developed in 41% of cases, and developed more frequently in those cases with an accompanying meniscal injury, older patients at the time of the reconstruction, or in those with a longer interval from the injury to reconstruction.