The Extended Trochanteric Osteotomythrough the Lateral Approachin Revision Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: To review the results and discuss the technique for an extended trochanteric osteotomy through the lateral approach in revision total hip arthroplasty. MATERIALS AND METHODS: Twenty patients were reviewed after an average follow-up of 30.4 months (range, 24-56 months) between 1999 and 2003. The indications for the extended trochanteric osteotomy included the removal of a well-fixed cemented or cementless stem in 12 hips, varus remodeling of the femur in 3 hips and trochanteric malposition in 5 hips. The length of the osteotomy, the proximal migration of the osteotomized fragment, the fixation status of the femoral stem, the union status of the osteotomy site and complications were evaluated at the last follow-up. RESULTS: The mean length of the osteotomy was 12 cm (range, 8-20 cm). Radiographic union of the osteotomy site was noted in all cases after an average of 3.8 months (range, 2.5-6.0 months). The mean migration of the osteotomized fragment was 2.4 mm (range, 0-8 mm). The complications included postoperative dislocation in 3 hips and fractures of the osteotomy fragment in 2 hips, which were treated at the last follow up. Fixation of the stem with bone ingrowth was noted in all patients. CONCLUSION: An extended trochanteric osteotomy through the lateral approach can be performed safely in complex revision total hip arthroplasty.

Comparative Analysis of Image-free Navigation System-Assisted TKA and Conventional TKA

PURPOSE: To compare the roentgenographic results between Image-free navigation system-assisted total knee arthroplasty (TKA) using the OrthoPilot(R) and conventional TKA. MATERIALS AND METHODS: Of 120 primary TKA that operated by one surgeon, 60 cases were operated with a Image-free navigation system (OrthoPilot(R) 4.0, Aesculap, Tuttlingen, Germany) (group A) and 60 cases were operated with conventional method (manual alignment system) (group B). The alignment of the lower extremity and the position of the components were determined on postoperative long-leg standing anteroposterior radiogram and lateral radiogram. RESULTS: Mechanical axis was significantly more accurate in group A than group B(95% compared with 80%). The coronal inclination of femoral component to mechanical axis (theta) was significantly more accurate in group A than group B(96.7% compared with 80%). There were no significant differences between two groups in the sagittal inclination of femoral component(gamma), the coronal inclination of tibial component (beta) and the sagittal inclination of tibial component(delta). In all five measurements being excellently implanted, a significantly higher number was in group A(60% compared with 40%). CONCLUSION: Image-free navigation system-assisted TKA using the OrthoPilot(R) led to significantly increased precision of restoration of the alignment of the lower extremity and the position of the components compared with the conventional method. Potential benefits in long-term outcome and functional improvement require further investigation.

Autogenous Bone Graft for Medial Tibial Bone Defect in Total Knee Arthroplasty

PURPOSE: To evaluate clinical and radiographic results associated with the use of autogenous bone graft with preservation of cortical bone in the patients with severe bone defect of the proximal medial tibia in total knee arthroplasty. MATERIALS AND METHODS: From January 2000 to June 2003, thirty three primary total knee arthroplasty were performed with autogenous bone graft for severe peripheral defect of the proximal medial tibia. After sclerotic bone of defect site was removed by the burr, reconstruction of medial wall was done by use of resected bone, which was fixed by wedge-shaped bone. Autogenous cancellous bone was grafted in the central type bone defect area. We reviewed the result using the HSS knee rating scores and observed the radiographic changes. RESULTS: The mean HSS knee rating score was 43.5 preoperatively and was 91.3 at last follow-up. Radiologically, union of the tibial bone grafts were impossible to determine, but there were no evidence of the displacement of grafted bone, osteolysis and loosening of the inserted implants. CONCLUSION: The method of autogenous bone graft applied with preservation of cortical bone and wedge bone graft could be supposed as useful in the reconstruction of the tibial bone defects as well as in the stability of the tibial component.

Operative Treatment of Acetabular Fractures through the Ilioinguinal Approach / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy and the result of the ilioinguinal approach in the operative treatment of acetabular fractures. MATERIALS AND METHODS: A retrospective analysis was performed on 22 patients who were available for follow-up over one year. The reduction quality, clinical results, and radiographic results were analyzed based on the criteria of Matta. Complications were recorded as well. RESULTS: Anatomical reduction (0-1 mm displacement) was achieved in 18 cases (81.9%) and imperfect reduction (2-3 mm displacement) was achieved in 4 cases (18.1%). Excellent clinical and radiographic results were graded in all of the 18 anatomically reduced fractures. The clinical results were excellent in 1 case, good in 2, and poor in 1; although radiographic results were good in 4 cases with imperfect reductions. Complications included 5 cases with a transient lateral femoral cutaneous nerve injury, which resolved during the follow-up period and 1 case with a partial femoral nerve palsy. CONCLUSION: The ilioinguinal approach is effective for anterior wall, anterior column, and associated anterior and posterior hemitransverse fractures; as well as both column, transverse fracture, and T-shaped fractures. The risk of iatrogenic lateral femoral cutaneous nerve damage is relatively high, but there were no residual symptoms at the time of latest follow-up evaluation.

The Effect of Stem Alignment on Clinical and Radiographic Results of a Tapered CLS Stem / 대한정형외과학회잡지

PURPOSE: To examine the effects of the stem alignment on the clinical and radiographic results of a tapered wedge femoral prosthesis. MATERIALS AND METHODS: Ninety-one consecutive primary total hip arthroplasties were performed with an implantation of a CLS cementless femoral prosthesis between 1995 and 1998. Among them, 75 hips were retrospectively examined after a minimum duration of five years. The hips were divided into three groups based on the stem alignment; neutral stem alignment in 50 hips (67%), valgus in 15 hips (20%), and varus in 10 hips (13%). The clinical and radiographic results of the three groups were compared. RESULTS: There were no differences in the Harris hip scores and the incidence of thigh pain between the groups. Radiographic analysis revealed no difference in the fixation status at the latest follow up, nor was there any difference in the level of endosteal bone formation, the incidence of radiolucent lines, stressshielding, or osteolytic lesions. No loosening of the femoral stems was observed in any of the cases. CONCLUSION: Stem alignment of a tapered CLS femoral component does not compromise the clinical and radiographic results after a minimum follow-up of five years.

Rotational Acetabular Osteotomy for the Dysplastic Hip: A Follow-up for 5 to 18 years / 대한정형외과학회잡지

PURPOSE: To evaluate the midterm result of patients who underwent rotational acetabular osteotomy for the treatment of acetabular dysplasia. MATERIALS AND METHODS: The clinical and radiographic outcomes of 36 patients, who underwent rotational acetabular osteotomy between January 1987 and September 1998, were evaluated after a minimum followup of five years. The mean follow-up period was 8.6 years. The clinical evaluation included recording the level of pain, the ambulation status and range of motion according to the d'Aubigne and Postel system. Radiographic analysis included the C-E angle of Wiberg, the acetabular roof obliquity, and arthritis grade of Tonnis. RESULTS: The average Postel score increased from 12.5 points preoperatively to 15.7 points at the final follow up. All the radiologic indices improved after surgery. In five hips (13.1%), there was a progression of arthritis prior to surgery. CONCLUSION: Rotational acetabular osteotomy is a valuable procedure for preventing the progression of early osteoarthritis in patients with a dysplastic hip. However the results were unsatisfactory for hips with more advanced osteoarthritis.

Failure Mode of Polyethylene Liner in Total Hip Arthroplasty with Harris-Galante II Acetabular Cup / 대한정형외과학회잡지

PURPOSE: To assess the mode of a polyethylene liner failure in total hip replacement using a Harris-Galante II acetabular component. MATERIALS AND METHODS: A retrospective review was performed and 128 consecutive primary total hip arthroplasties were analyzed in 111 patients who had a second-generation Harris-Galante cup. All patients were followed up for a minimum of five years, with a mean follow up of 7.4 years (range, 5 to 12.9 years). A total of 26 cups (20.2%) were revised at the time of the latest follow up. The medical records, radiographs, surgical notes, and retrieved components were analyzed in order to determine the precise causes of the revision. RESULTS: Twenty-two cases (17.3%) were found to have experienced problems with the polyethylene liner. Three types of liner failure were identified; metallosis associated with polyethylene liner wear (14 cases), excessive wear without metallosis necessitating a revision (6 cases), and polyethylene liner dissociation without gross evidence of wear (2 cases). CONCLUSION: This study find that polyethylene liner failure is the main cause of the revision of this component. Early surgical intervention needs to be performed before fatal metal damage occurs in order to avoid metallosis, and severe bone stock damage in cases of excessive polyethylene wear.

Type III Monteggia Equivalent Fracture with Ipsilateral Distal Radial Epiphyseal and Ulnar Metaphyseal Fracture in a Child: Case Report / 대한정형외과학회잡지

This paper present a rare case of a Type III Monteggia equivalent fracture with an ipsilateral distal radial epiphyseal (Salter-Harris type II) and an ulnar metaphyseal fracture in a child. An 8-year-old boy sustained a closed bipolar fracture of his forearm after a fall from a height. The closed reduction was unsuccessful. Therefore, an open reduction and plate fixation was performed for a diaphyseal fracture of the ulna, and the unstable radial fractures and the distal ulnar metaphyseal fracture were treated with a closed reduction and internal fixation using Kirschner wires (K-wires). Two years after surgery, the joint motion including the forearm, wrist and elbow were completely normal. Radiologically, the bone was well united without any residual deformity.

Treatment of the Difficult Fractures of the Femur Using the Ilizarov External Fixator / 대한정형외과학회잡지

There are many difficult problems and various methods in the treatment of difficult fractures of the femur. We reviewed the records of twelve patients who had been managed with circular external fixation using the llizarov apparatus for difficult fractures of the femur at Keimyung University. Dongsan rnedical center from October 1993 to April l996. There were ten males and two females with an average age of 42 years (range, 16-74 years). Si.x of twelve patients were severely comminuted supracondylar and intercondylar fractures of the femur associated with severe soft tissue injury (including four open fractures). These patients were treated initially by closed reduction with Ilizarov external fixator and followed by compression-distraction techniques. Four of the remaining six ptients developed infected non-unions after internal fixation of the femur without shortening or bone defect. These infected non-unions were treated by curettage, irrigation and Ilizarov application. After the control of infection, compression - distraction techniques were applied. One of the remaining two patients had severe open comminuted fracture of the supra-intercondyle region of femur associated with diaphyseal segmental bone defect (5cm in length). This patient was treated with closed reduction and internal bone transportation usipg llizarov external fixator. One patient with varus deformity (20 degree) was treated by correction of the deformity and simple compression technique. In three patients, additional autogenous cancellous iliac bone graft was done. The union of the fracture site was obtained in ten patients and the duration of llizarov external fixation was an average of 10 months (range 6-14 months). We experienced several complications; there were twelve patients of limitation of motion of knee, ten patients of pin tract infection, one patient of fracture site non-union, one patient of re-fracture and one patient of femoral artery injury. We concluded that the Ilizarov external fixation technique is one of the effective methods for the treatment of difficult fractures of the femur in spite of its complexity and high incidence of complications.