Intrapelvic Mass with Calcific Density Wall after Total Hip Arthroplasty : A Report of Two Cases / 대한정형외과학회잡지

We experienced two cases of asymptomatic intrapelvic masses with calcific density walls in failed cementless total hip arthroplasties. The intrapelvic masses communicated with the hip joint along the screw in one case and a medial wall defect in the other case. Instead of excision, the masses were drained and the failed components were revised. Two years after revision arthroplasties, the intrapelvic masses have not increased in size; and there was a thick calcific density wall in the second case. We conclude that the excision of an intrapelvic mass is not always mandatory when it is symptomless.

Early Radiographic Loosening Findings of the Hydrocyapatite-coated Acetabular Cup

Purpose: The purpose of our study is to examine early radiographic findings and clinical signs of failure of the microstructure surface HA-coated acetabular cup. Material and methods: This study included 41 revisions of 204 THA with hydroxyapatite-coated acetabular cup from April 1992 to November 1996. Radiolucent line around cups, change in the cup angle and osteolysis were evaluated in serial radiographs. Acetabular cup was defined as loosening if any movement occurred at the bone and socket interface by manual rotation and extension force intraoperatively or migration of more than 2 mm and change of the cup angle by more than 5 degrees in radiographs. Results: The radiolucent line was observed in 12 of the 41 hips at an average of 55.4 months postoperatively and was most commonly located in zone III. All of the 12 hips showing radiolucent lines were classified as loosening by radiographically in 8 cases and intraoperatively in 4 cases. Radiographic loosening occurred at an average of 28.8 months after the appearance of a radiolucent line. Inguinal pain was noted in 18 of the 19 cases revised for acetabular cup loosening. Conclusion: The most important radiographic finding for the early diagnosis of loosening was progressive radiolucent lines, which occurred most frequently in zone 3.

The Effects of Radiofrequency Energy on Human Articular Cartilage: The Effect of Power Setting and Mode of Treatment on Chondrocyte Viability / 대한정형외과학회잡지

PURPOSE: The objective of this study was to investigate the effects of radiofrequency energy on human chondrocyte viability, and to correlate confocal laser microscopy fluorescence to sulfate uptake and to the histological integrity of articular cartilage. MATERIALS AND METHODS: The chondroplasty procedure for chondromalacic articular cartilage was performed using a 3.0-mm ArthroWand (Arthroscopic Electrosurgery System, ArthroCare Corporation) on fresh human articular cartilage. Radiofrequency energy was applied to the cartilage surface through the probe at a velocity of 10-mm per second in contact and non-contact mode. Three power settings were used. The treated cartilage was analyzed for chondrocyte viability by confocal laser microscopy and (35)S uptake. RESULTS: Confocal laser microscopy demonstrated partial-thickness chondrocyte death irrespective of treatment method. No mode of treatment or radiofrequency energy power setting resulted in full-thickness chondrocyte death. The depth of cartilage ablation was increased in the treated areas in contact mode in proportion to the power level and the time of treatment. No statistically significant difference in radiolabeled sulfate uptake of the specimens was observed with respect to the treatment modes and power settings. CONCLUSION: The extent of chondrocyte death by radiofrequency energy was not as significant as reported previously when the probe was moved at the speed of 10 mm/sec. Radiofrequency energy may be useful to treat chondromalacic cartilage in a contact mode using a proper energy level and delivery time.

Reconstruction of Diabetic Foot Ulcers by Regional Flap Surgery / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the value of regional flap surgery for diabetic foot ulcers combined with infection or bone and tendon exposure. MATERIALS AND METHODS: We reviewed eight patients, nine cases of diabetic foot ulcers, which were treated by regional flap surgery. There were two Wagner's grade 2 ulcers and six Wagner's grade 3 ulcers. We performed four reversed sural artery neurocutaneous flaps, two lateral supramalleolar flaps, two medial plantar artery flaps and one first dorsal metatarsal artery flap. RESULTS: Seven of nine flaps completely survived after regional flap surgery. One partial and one complete flap necrosis occurred. One partially necrotized flap needed an additional skin graft. One completely necrotized flap needed free rectus abdominis myocutaneous flap surgery. There were two new ulcers, which were treated by free flap surgery. No patient needed amputation above the ankle joint. CONCLUSION: Satisfactory results were obtained by regional flap surgery for diabetic foot ulcers. Regional flap surgery is regarded as an effective treatment modality for diabetic foot ulcer combined with bone and tendon exposure with infection.

Relationship between Popliteal Cyst and the Intra-articular Knee Disorders

PURPOSE: To evaluate the clinical symptoms and the associated intra-articular disorders of the polpliteal cyst. MATERIALS AND METHODS: We studied 56 patients, 60 cases of the popliteal cysts which. Had been treated with excision of the cyst after arthroscopy between May 1991 and February 2000. Arthroscopic findings and clinical results of the patients who had popliteal cyst were evaluated. RESULTS: Forty nine patients of the sixty patients of who had popliteal cyst showed intra-articular disorders. Tear of the meniscus and patello-femoral arthrosis with cartilage lesions were the most frequent intra-articular lesions. In 4 cases, recurrence of the popliteal cyst was noted. Two patients had tear of the meniscus and two had no intra-articular disorders. CONCLUSION: This study revealed that popliteal cysts frequently combined with intra-articular disorders. Arthroscopy of the knee joint seems worthwhile method for the patients who had popliteal cyst

Extracellular Matrix, TGF - beta Gene and Ha-ras Oncogene Expression in Type I Neurofibromatosis / 대한피부과학회지

BACKGROUND: Neurofibroma, the hallmark of neurofibromatosis, is a cutaneous or subcutaneous lesion, with a variable clinical presentation. Histologically, neurofibroma consists of proliferation of nerve derived cellular elements, together with an abundant, collagenous extracellular matrix. Specifically, neurofibroma has been shown to contain 30-50% collagen in its matrix. Objective 5. METHODS: We examined the expression of extracellular matrix genes (collagen, fibronectin, laminin), TGF-b mRNA and Ha-ras oncogene mRNA by using Northern and slot-blot hybridization and immunoperoxidase stains. Result: In Northern blot analysis, Ha-ras and TGF-b genes revealed respectively, 8.8kb and 2. 5kb sized mRNA transcripts in neurofibroma. These parameters were normal in the control. The expression of these genes were 1.9, 2.0 fold increased in neurofibroma. In slot-blot analysis, expression of type I collagen showed fibronectin genes to be 2,401+210, 540+43, respectively, in neurofibroma. So there were 3.7 fold, 2.1 fold, differences respectively, compared to the normal control. However, there were no significant changes of type IV collagen and laminin Bl mRNA levels between neurofibroma and normal skin tissues. Irnmunoperoxidase staining by rnonoclonal anti type IV collagen antibody in neurofibroma showed type IV collagen to be diffusely and weakly stained in tissue. On staining by monoclonal anti-laminin antibody, laminin was stained in a matrix and around vessels. CONCLUSION: The increased expression of extracellular matrix genes may suggest that there is a subpopulation of fibroic cells in neurofibroma which are stimulated by TGF-b. Ha-ras genes which might have accumulated with the differentiation of neural tissue may be related to the pathogenesis of neurofibroma tissue formation. Further studies are needed to determine whether the other factors are related to the pathogenesis of neurofibroma.