Factors Affecting Range of Motion after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Restoration of range of motion (ROM) after total knee arthroplasty (TKA) greatly affects post-operative results. We analyzed various actors, including implant systems, to identify those factors affecting ROM in TKA. MATERIALS AND METHODS: 645 knees of 418 patients who received TKA from the same operator between June 1990 and May 1999 were analyzed. Knees were sorted according to patient (age, sex, body mass index, symptom duration, pre-operative ROM, and deformity), disease (osteoarthritis, rheumatoid arthritis, and osteonecrosis), implant (implant system, and thickness of spacer), operation (preservation or resection of the posterior cruciate ligament (PCL), and lateral release or not). Post-operative ROM was evaluated with a minimum 3 years of follow-up. RESULTS: Within 1 year after TKA, BMI, symptom duration, pre-opeative deformity, pre-operative ROM, and lateral release were found to significantly (p-value<0.05) affect post-operative ROM. At 2 years after TKA, BMI, pre-operative deformity, and pre-operative ROM were found to significantly affect post-operative ROM. At 3 years after TKA, post-operative ROM was significantly better for a wider pre-op. (p<0.0001), and in patients without lateral release (p<0.018). Underlying disease, the implant system used, and PCL treatment showed no significant difference. CONCLUSION: A better pre-operative ROM and no lateral release of the retinacular ligament showed a better post-operative ROM at 3 years after TKRA.

Mobile bearing joint in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To assess the clinical and radiological results of mobile bearing total knee arthroplasty using the LCS system and to analyse complications arising. MATERIALS AND METHODS: From Oct. 1992 to Dec. 1998, 135 cases of total knee arthroplasty was performed using the LCS mobile bearing system. Among those are evaluated 108 cases which were followed up for a mean of 4.8 years (3-9.2 years). Retrospective analysis was done by the clinical and radiological evaluations usinga ROM, tibio-femoral alignment, HSS score and radiological loosening. RESULTS: The preoperative mean HSS score (58.6) was improved to 89.5 at final follow up. Tibio-femoral angle changed from a varus of 3 degrees to a valgus of 5 degrees. Arc of motion was reduced from 121 degrees to 116 degrees in osteoarthritis and increased from 111 degrees to 118 degrees in rheumatoid arthritis. There were 16 cases of osteolysis, but no case provoked clinical problems or more than 4 points in the radiolucent score. Complications were one polyethylene dislocation and one intraoperative tibia plateau fracture. CONCLUSION: Mobile bearing knee system showed excellent and predictable clinical and radiological results at a mean 4.8 years follow-up.

Modified Elmslie-Trillat Operation in Recurrent and Habitual Patella Dislocation

PURPOSE: To evaluate the effectiveness of the modified Elmslie-Trillat operation on recurrent and habitual patella dislocation. MATERIALS AND METHODS: From November 1993 to December 2000, 16 cases of modified Elmslie-Tril-lat operation were performed in 13 patients. Recurrent dislocation were 10 cases, habitual were 6 cases. Mean age was 26 years old(15~46) and male was 1 patient, female were 12 patients. We checked the Q angle and congruence angle to compare the postoperative state with the preoperative result by radiologic finding. Crosby and Insall's criteria was used to evaluate the clinical results. RESULTS: The congruence angle and Q angle were improved from average 46 degrees (10 degrees ~ 77 degrees) and 20.2 degrees(16 degrees ~35 degrees) in preoperative state to average -5 degrees (-10 degrees ~4 degrees) and 9.5 degrees(4 degrees~15 degrees) in postoperative state. Patella alta were 2 cases and patella baja was none in preoperative measurement. There was no change of patella alta in postoperative measurement. In Crosby and Insall 's criteria, 5 cases showed excellent, 10 cases good, l case poor result. At final follow-up, there were no postoperative complications such as degeneratve arthritis, nonunion, ROM limitation except 1 case of patellar redislocation. CONCLUSION: Modified Elmslie-Trillat operation is good alternatives to the recurrent and habitual patella dislocation.

Lateral Retinacular Release in Primary Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To determine the effect of lateral retinacular release on patellofemoral alignment in primary total knee arthroplasty (TKA). MATERIALS AND METHODS: From June 1990 to December 1998, 351 cases of TKA, which were followed up more than 3 years, were divided into two groups, 147 cases (group I) with lateral retinacular release and 204 cases (group II) were without release. We compared the two groups in terms of the range of motion, patellofemoral alignment and clinical results using a Hospital for Special Surgery score. RESULTS: Average range of motion in group I (112 degrees preoperatively and 113 degrees on final follow-up) and group II (114 degrees preoperatively and 113 degrees on final follow-up) showed no statistical difference. The average functional knee score in group I (58 preoperatively and 88 on final follow-up) and group II (59 and 85 respectively) also showed no statistical difference. Patellar maltracking occurred in 4 cases (2.7%) in group I and 31 cases (15.2%) in group II. Patellar tilting (4.5 degrees in group I and 7.7 degrees in group II) and patellar translation (3.7 mm in group I and 7.8 mm in group II) showed significant statistical difference between the two groups at the final follow-up. CONCLUSION: Patellar tracking was better in the lateral retinacular release group, although there was no clinically significant difference at the short term follow-up period.

Analysis of 1,000 Cases of Total Knee Arthroplasty: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To analyze the results and complications arising from 1,000 cases of primary total knee arthroplasty (TKRA), as performed by one surgeon. MATERIALS AND METHODS: From February, 1992 to June, 2000, 1,000 cases of primary TKRA were performed by a single surgeon. Among the 1,000 cases, 573 cases followed up for more than one year (average 2.9 years) were evaluated try allocating special surgery (HSS) scores and by determining the range of motion (ROM), and presence of complications retrospectively. RESULTS: There were 872 cases of primary osteoarthritis, 70 cases of rheumatoid arthritis, 32 cases of osteonecrosis, and 26 cases of miscellaneous diseases. The HSS score increased from 57.8 preoperatively to 90.4 postoperatively, ROM increased from 111degrees to 113degrees and flexion contracture decreased from 9degrees to 2degrees, but no statistical differences in results were observed between diseases. Common causes of complications were superficial infection (3.6%), deep infection (2.4%) and deep vein thrombosis (1.8%). Two patients died, one due to myocardial infarct and the other due to an unknown etiology. Revision arthroplasties were performed in 19 cases. CONCLUSION: After primary TKRA, ROM and functional score improved satisfactorily. No statistical differences were apparent between diseases. Infection was the most common complication.

Treatment of Infected TKRA / 대한정형외과학회잡지

PURPOSE: To investigate the causes and to determine the most useful test for the early diagnosis of infected TKRA, and to present the treatment modality and its possible complications. MATERIALS AND METHODS: We reviewed 17 cases, with follow up, among the 18 infected TKRA cases registered from March 1992 to June 2000. Diagnosis of deep infection after TKRA was made by assessing clinical symptoms, laboratory and radiological findings, nuclear scan studies and aspirate culture results. Data were analyzed clinically by HSS score, recurrence of infection and postoperative complications. RESULTS: The overall incidence of deep infection after TKRA was 1.4%. In fourteen of the 17 cases TKRA was revised. In 13 cases, excluding 1 case of infection recurrence after 2-stage TKRA revision, the mean ROM increased from 55o to 86o and the mean HSS score increased from 53 points to 84. Knee fusion was performed in 4 cases, including one case of infection recurrence after 2-stage TKRA revision. CONCLUSION: The most reliable clinical results were achieved after a 2-stage TKRA revision. Knee joint fusion should be considered when the general condition is poor, with an initial diagnosis of infection, and in the presence of skin problems.

Arthrocopic Reconstruction of the Posterior Cruciate Ligment: The Effects of femoral attachment points and knee flexion angles at the time of graft fixation on posterior stability / 대한정형외과학회잡지

The purpose of this study is to compare the effects of the femoral attachment points of the graft and knee flexion angles at the time of graft fixation on stability of posterior cruciate ligament reconstruction. We analyzed the posterior stability of the knee on 23 patients(24 knees) with posterior cruciate ligament injury whose posterior cruciate ligament had been reconstructed arthroscopically and followed for minimum 1 year period at Asan Medical Center from May 1992 to June 1994. The patients were divided into the two groups according to femoral attachment points of the graft and knee flexion angles at the time of graft fixation. The distance from the junction of the intercondylar notch with trochlear groove of the femoral attachment points and knee flexion angles were 11mm and 0°-30° in group A and 7mm and 70°-90° in group B, respectively. 11 knees were included in group A and 13 knees in group B. Posterior stability was determined by difference in posterior tibial translation between the injured and the opposite knee with Telos device. In group A, 5 cases were at the range of 0-2mm, 3 cases 3-5 mm, 3 cases 6-10mm. In group B, 10 cases were at the range of 0-2mm and 3 cases 3-5mm, respectively. Differences in posterior tibial translation on average were 3.6mm and 1.7mm in group A and B, respectively. Conclusively, arthroscopic postrior cruciate ligament reconstruction with femoral attachment point at 7mm from the junction of interconlylar notch with trochlear groove and 70°