Achromobacter xylosoxidans Infection Following Total Knee Arthroplasty / 대한정형외과학회잡지

Achromobacter xylosoxidans is an opportunistic organism, mainly causing infection in immune compromised hosts, such as patients on dialysis. However, review of the medical literature showed that few cases of A. xylosoxidans infections following total knee arthroplasty have been reported. This organism has not been reported in prosthetic joint infections of patients who are not immune compromised. Here, a case of periprosthetic infection with A. xylosoxidans following total knee arthroplasty in a man with no medical history of immune suppression is reported.

Comparative Study of Osteoporosis Treatment of Elderly Patients with Degenerative Osteoarthritis of the Knee Joints, according to the Korean Health Insurance Review & Assessment Service Criteria versus the FRAX(R) Criteria / 대한정형외과학회잡지

PURPOSE: To compare and evaluate any differences in the osteoporosis treatments of elderly patients with degenerative osteoarthritis of the knee joints, in accordance with the Korean Health Insurance Review & Assessment Service (HIRA) criteria versus the World Health Organization (WHO) fracture risk assessment tool (FRAX(R), http://www.shef.ac.uk/FRAX/) criteria, which is a fracture risk assessment tool developed by the WHO. MATERIALS AND METHODS: From June 2010 to March 2011, we investigated and screened the target populations of osteoporosis treatments among 65-year-old or older patients with degenerative osteoarthritis of the knee joints who scheduled to undergo elective total knee arthroplasty. They were classified in the treatment group only if they met either the HIRA criterion, defined as having a T score of or =20% or > or =3%, respectively. RESULTS: Of a total of 929 patients, the number of patients included in the treatment group as screened according to the HIRA or FRAX(R) criteria was 562 (60.5%) and 372 (40.0%), respectively. The number of patients who met both criteria was 339 (36.5%), and including 334 non-treated patients (36.0%), a total of 673 patients (72.4%) showed low diagnostic concordance (k=0.471). Of 319 patients diagnosing osteopenia, 33 (10.3%) patients were included in the treatment group according to the FRAX(R) criteria. CONCLUSION: A combination of the HIRA and FRAX(R) criteria is required to improve the current guidelines for osteoporosis treatment.

A Comparison of Arthroscopically Assisted Single and Double Bundle Tibial Inlay Reconstruction for Isolated Posterior Cruciate Ligament Injury

BACKGROUND: This study evaluated the clinical results of arthroscopically assisted single and double bundle tibial inlay reconstructions of an isolated posterior cruciate ligament (PCL) injury. METHODS: This study reviewed the data for 14 patients who underwent a single bundle tibial inlay PCL reconstruction (Group A) and 16 patients who underwent a double bundle tibial inlay PCL reconstruction (Group B) between August 1999 and August 2002. The mean follow-up period in groups A and B was 90.5 months and 64 months, respectively. RESULTS: The Lysholm knee scores in groups A and B increased from an average of 43.3 +/- 7.04 and 44.7 +/- 5.02 preoperatively to 88.1 +/- 7.32 and 88.7 +/- 9.11 points at the final follow-up, respectively. In group A, stress radiography using a Telos device showed that the preoperative mean side-to-side differences (SSDs) of 9.5 +/- 1.60 mm at 30degrees of flexion and 9.8 +/- 1.70 mm at 90degrees of flexion were improved to 2.8 +/- 1.19 mm and 3.0 +/- 1.1 mm, respectively. In group B, the preoperative SSDs of 10.4 +/- 1.50 mm at 30degrees of flexion and 10.7 +/- 1.60 mm at 90degrees of flexion improved to 2.7 +/- 1.15 mm and 2.6 +/- 0.49 mm, respectively. There was no significant difference in the clinical scores and radiologic findings between the two groups. CONCLUSIONS: Single bundle and double bundle PCL reconstructions using the tibial inlay technique give satisfactory clinical results in patients with an isolated PCL injury, and there are no significant differences in the clinical and radiological results between the two techniques. These results suggest that it is unnecessary to perform the more technically challenging double bundle reconstruction using the tibial inlay technique in an isolated PCL injury.

The Short-term Follow-up Results of Open Wedge High Tibial Osteotomy with Using an Aescula Open Wedge Plate and an Allogenic Bone Graft: The Minimum 1-Year Follow-up Results

BACKGROUND: This study examined the results of open wedge high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft as a surgical technique for the patients who suffer from osteoarthritis of the knee with a genu varum deformity. METHODS: From March 2007 to August 2007, 33 patients (37 cases) with osteoarthritis of the knee and a genu varum deformity underwent a high tibial osteotomy with using an Aescula open wedge plate and an allogenic bone graft. The patients were followed up for more than 1 year. Before and after surgery, the correction angle of the genu varum was measured by the lower extremity scannogram and the posterior tibial slope, the joint space distance and the time to bone union were evaluated. The functional factors were evaluated using the Knee Society Score. RESULTS: The average knee score and function score improved from 52.19 +/- 11.82 to 92.49 +/- 5.10 and 52.84 +/- 6.23 to 89.05 +/- 5.53, respectively (p < 0.001). According to the lower extremity scannogram, the mean preoperative varus angle was -1.86 +/- 2.76degrees, and the average correction angle at the last follow-up was 10.93 +/- 2.50degrees (p < 0.001). The tibial posterior slope before surgery and at the last follow-up were 8.20 +/- 1.80degrees and 8.04 +/- 1.30degrees, respectively (p = 0.437). The joint space distance increased from 4.05 +/- 1.30 mm to 4.83 +/- 1.33 mm (p < 0.001). The average time to complete bone union was 12.69 +/- 1.5 weeks. CONCLUSIONS: An open wedge high tibial osteotomy using an Aescula open wedge plate and an allogeneic bone graft to treat osteoarthritis of the knee with a genu varum deformity showed good results for the precision of the correction angle, the time to bone union and the functional improvement.

Perioperative Changes in C-Reactive Protein Levels after Unilateral and Simultaneous Bilateral Total Knee Replacement / 대한정형외과학회잡지

PURPOSE: The objective of this study was to determine the patterns of C-reactive protein (CRP) changes during the postoperative period after total knee replacement (TKR), and to determine the CRP changes associated with infection after TKR. MATERIALS AND METHODS: A retrospective analysis of the pattern of CRP changes during the first 6 postoperative months was conducted on 2,315 patients who underwent unilateral or simultaneous bilateral TKR. This data was also compared with the pattern of CRP changes which occurred in 19 patients with a deep prosthesis infection who were not enrolled in the main study. RESULTS: The CRP levels peaked 3 days postoperatively, and then decreased to baseline levels at 15-28 days postoperatively. Within 14 days postoperatively, the CRP levels were significantly higher in the simultaneous bilateral TKA group than in the unilateral group (p<0.01). Thereafter, no significant difference in CRP levels existed between two groups. After the 8th postoperative day, a significant difference in CRP level existed between patients with and without deep prosthesis infections. CONCLUSION: CRP changes post-TKR provide an effective means of monitoring of infections. In cases of non-inflammatory arthritis in which the CRP levels are significantly difference after the 8th postoperative day or are elevated after the 4th postoperative week, an infection should be suspected.

Changes of KSR and CRP after Total Knee and Hip Arthroplasty

PURPOSE: To study the changes of ESR and CRP after total hip arthroplasty(THA) and total knee arthroplasty(TKA). MATERIALS AND METHODS: We tested the values of ESR and CRP of total 61 patients, who received THA or TKA. The levels of ESR and CRP were compared before operation, on the 2nd, 4th post-op. Day, 1st, 2nd, 3rd week after operations. RESULTS: The peak level of ESR was reached on the 4th post-op day(70.7mm/hr) in unilateral TKA group, but on the 7th day(53.2em/hr) in bilateral group. The peak level of ESR was reached on the 4th day in unilateral THA group(71.5mm/hr), as was in bilateral group(50.6em/hr). The values of ESR were declined to the normal range until the 3rd week except 9 cases(15%). The peak level of the CRP of TKA(14.0mg/dL, 15.0mg/dL) and THA(12.7mg/dL, 17.7mg/dL) in unilateral and bilateral group were reached on the 2nd day after operations. After the peak level, the values of CRP were abruptly declined to the normal and pre-op level until the 3rd week. CONCLUSION: The highest value of the CRP revealed on the 2nd post op day in bilateral group and declined to the normal range at 2nd week. The peak value of the ESR showed on the 4th post-op day, but the peak value of the bilateral group was low and the range of increase was narrow when compared with the unilateral group. The value of CRP after post-op 2 weeks could be used as the index of normal and infection in TKA or THA.

Isokinetic Muscle Strength and Clinical Evaluation of the Knee Following Arthroscopic Menisectomy / 대한정형외과학회잡지

PURPOSE: Postoperative strength of knee flexor and extensor, and functional evaluation after arthroscopic menisectomy of the knee was evaluated objectively at the time of returning to daily life. MATERIALS AND METHODS: The 31 knees (29 patients) had meniscal injuries without associated ligament injury. The muscle strength was tested with Cybex 340 isokinetic dynamometer preoperatively and at 2, 4, 6, 10 weeks postoperatively. Clinical evaluation by Lysholm scoring system was also done simultaneously. The statistical analysis was evaluated by repeated measures of ANOVA. RESULTS: Muscle strength of extensor (quadriceps) was abruptly decreased to about 45% torque of the preoperative level at postop 2 weeks, but slowly increased to about 90% torque at 10 weeks in 90 degree/sec and 180 degree/sec exercise. The flexor strength was also a little bit decreased at post-op 2 weeks, slowly increased to about 120%-150% torque of preoperative level in 90 degree/sec and 180 degree/sec exercise at post-op 10 weeks. The clinical evaluation by Lysholm scale showed 45 points at postop 2 weeks and slowly improved to 80 points at post-op 10 weeks. CONCLUSIONS: Muscle weakness of knee extensor and flexor remained in isokinetic test at post-op 4-6 weeks. The recovery rate for weakness of hamstrings was faster than quadriceps. The rehabilitation of quadriceps should be accentuated in the prevention of knee injury due to muscle weakness.