Prophylaxis for Venous Thromboembolism Following Total Knee Arthroplasty: A Survey of Korean Knee Surgeons

PURPOSE: The purpose of this study is to provide information on the actual status and prevailing trend of prophylaxis for venous thromboembolism (VTE) following total knee arthroplasty (TKA) in South Korea. MATERIALS AND METHODS: The Korean Knee Society (KKS) developed a questionnaire with 6 clinical questions on VTE. The questionnaire was distributed to all members of KKS by both postal and online mail. Participants were asked to supply details on their specialty and to select methods of prophylaxis they employ. Of the total members of KKS, 27.9% participated in the survey. RESULTS: The percentage of surgeons who routinely performed prophylaxis for VTE was 60.4%; 19.4% performed prophylaxis depending on the patient's health condition; and the remaining 20.2% never implemented prophylaxis after surgery. The common prophylactic methods among the responders were compression stocking (72.9%), pneumatic leg compression (63.3%), perioral direct factor Xa inhibitor (46.9%), and low-molecular-weight heparin (39.5%). For the respondents who did not perform prophylaxis, the main reason (51.5%) was the low risk of postoperative VTE considering the low incidences in Asians. CONCLUSIONS: The present study involving members of the KKS will help to comprehend the actual status of VTE prevention in South Korea. The results of this study may be useful to design VTE guidelines appropriate for Koreans in the future.

Periprosthetic Fractures Following Total Knee Arthroplasty

Periprosthetic fractures after total knee arthroplasty may occur in any part of the femur, tibia and patella, and the most common pattern involves the supracondylar area of the distal femur. Supracondylar periprosthetic fractures frequently occur above a well-fixed prosthesis, and risk factors include anterior femoral cortical notching and use of the rotational constrained implant. Periprosthetic tibial fractures are frequently associated with loose components and malalignment or malposition of implants. Fractures of the patella are much less common and associated with rheumatoid arthritis, use of steroid, osteonecrosis and malalignment of implants. Most patients with periprosthetic fractures around the knee are the elderly with poor bone quality. There are many difficulties and increased risk of nonunion after treatment because reduction and internal fixation is interfered with by preexisting prosthesis and bone cement. Additionally, previous soft tissue injury is another disadvantageous condition for bone healing. Many authors reported good clinical outcomes after non-operative treatment of undisplaced or minimally displaced periprosthetic fractures; however, open reduction or revision arthroplasty was required in displaced fractures or fractures with unstable prosthesis. Periprosthetic fractures around the knee should be prevented by appropriate technique during total knee arthroplasty. Nevertheless, if a periprosthetic fracture occurs, an appropriate treatment method should be selected considering the stability of the prosthesis, displacement of fracture and bone quality.

Distal Femoral Varization Osteotomy / 대한정형외과학회잡지

Distal femoral varization osteotomy is performed for treatment of lateral compartment osteoarthritis of the knee associated with valgus deformity for relief of pain and improvement of functional status. Careful selection of patients is the key to the success of this procedure. Distal femoral varus osteotomy is indicated for patients with isolated lateral compartment knee arthritis with a valgus deformity; candidates must have a range of motion arc of at least 90 degrees and less than 20 degrees of flexion-contracture. The indications of distal femoral varization osteotomy must be considered before surgery. Contraindications include patients with diffuse and nonspecific knee pain, primary complaint of patellofemoral pain, history of medial meniscectomy, and bicompartmental degeneratvie osteoarthritis. The success of an osteotomy is dependent on adequate correction of limb malalignment; therefore, accurate determination of the desired angle of correction is essential during preoperative planning. In recent years with the advent of new anatomical locking plate designs, medial closed wedge osteotomy has become popular. Compared to lateral opening wedge osteotomy, with medial closing wedge osteotomy, earlier union is expected and it provides stable fixation even with poor bone quality. Nevertheless, arthroplasty offers rapid pain relief and short-term rehabilitation period; however, risk of wear, difficulty and poor outcome of revision surgery, possible complication of infection or prosthetic failure in young and active patients, demanding high functional loading, is a cause for concern. Because this joint preserving procedure is not associated with prosthesis-related complication, it can be a good alternative option for young and active patients.

Primary Cementless Total Hip Arthroplasty with a Ceramic Sandwich Liner and a Third Zweymuller Stem: Minimum 8-Year Follow up Results / 대한고관절학회지

PURPOSE: The purpose of this study is to evaluate the minimum eight-year follow up results of primary total hip arthroplasty (THA) performed using an alumina sandwich liner and the third Zweymuller stem. MATERIALS AND METHODS: A total of 86 patients (107 hips) who underwent a THA with alumina sandwich liners and the third Zweymuller stems from July 2001 to December 2003 were analyzed. Mean age of patients at the time of THA was 50.8 years (range, 17-77 years) and the mean follow-up period was 112 months (range, 98-127 months). Clinical evaluation was performed using the Harris hip score and level of thigh pain. The radiographic evaluation was performed in terms of the radiolucent line, subsidence of the stem, migration of the acetabular cup, and proof of loosening. RESULTS: At the final follow-up, mean Harris hip score had improved from 57.8 points to 91.9 points. Radiolucent line was observed at Gruen zone 1 in 40 cases (37%) and at zone 7 in 35 cases (33%); however, no detectable loosening was observed. There were six cases (5.6%) of fracture of the ceramic liner, one case of ceramic liner dissociation, and one case of stem loosening due to infection. CONCLUSION: At the minimum eight-year follow up, survival rate of the third Zweymuller stem was 99.1%. However, owing to the high rate of fractures of the ceramic sandwich liners, the survival rate of the ceramic liner was 93.5%.

Outcome of Surgical Treatment of AO Type C Pelvic Ring Injury / 대한고관절학회지

PURPOSE: To evaluate the radiologic and clinical outcomes of AO type C pelvic ring injury and identify the prognostic factors. MATERIALS AND METHODS: We studied 53 patients who were treated for AO type C pelvic ring injury from January 2002 to February 2010. Mean age and mean follow-up duration were 42.4 years and 14 months, respectively. We had 8 cases of AO type C1-1, 19 cases of C1-2, 11 cases of C1-3, 6 cases of C2 and 9 cases of C3 injury. We analyzed type of fracture, displacement, method of fixation and associated injuries. Radiologic outcome was evaluated with Matta and Saucedo criteria and clinical outcome was evaluated using Majeed score. RESULTS: The average Majeed score was 86.2 distributing as 36 excellent cases, 15 good cases and 2 fair cases. Using radiologic Matta and Saucedo criteria, patients were divided as 31 excellent cases, 17 good cases and 5 fair cases. There was no significant difference between the outcomes of anterior, posterior and antero-posterior fixation. Neurologic injury was the reason for an unsatisfactory functional outcome. We identified two cases with complication, one with postoperative infection and the other with nonunion following anterior-posterior fixation. CONCLUSION: Satisfactory radiologic and clinical outcomes were obtained with open reduction and internal fixation in the management of AO type C pelvic ring injuries. Neurologic injuries affected the clinical outcome.

Relationship between Tibial Bone Defect and Extent of Medial Release in Total Knee Arthroplasty

PURPOSE: To understand the relationship between tibial bone defect and extent of medial release in total knee arthroplasty. MATERIALS AND METHODS: We evaluated 32 knees in 22 patients with variable degrees of tibial bone defect on medial plateau has undergone total knee arthroplasty. In this study, 31 cases had been diagnosed as degenerative osteoarthritis and 1 case was osteonecrosis. We excluded cases with infection, traumatic arthritis, or neuropathic joints. With regard to gender, 29 cases were female and 3 cases were male. The following relationships were analyzed: preoperative degrees of tibial bone defect and varus deformity; the femorotibial angle of both weight-bearing whole extremity radiogram, distractive stress radiogram, and the extent of medial release. RESULTS: Average tibial bone defect was 9.8+/-4.1 mm. Average femorotibial angle on weight-bearing whole extremity radiograph was varus 10.0degrees+/-6.2degrees. Average femorotibial angle on distractive stress radiograph was varus 0.7degrees+/-4.6degrees. Statistically the extent of medial release showed no significant relationship with the degree of tibial bone defect and femoro-tibial angle of whole extremity radiogram. However, it revealed a statistically significant relationship with the femorotibial angle on distractive radiogram (r=0.465, p=0.007). CONCLUSIONS: Preoperative distractive stress radiograph might be a useful method to predict the extent of intraoperative medial release during total knee arthroplasty.

A Comparison of the Clinical and Radiographic Results of Press Fit Condylar Rotating-Platform High-Flexion and Low Contact Stress Mobile Bearing Prosthesis in Total Knee Arthroplasty: Short term Results

PURPOSE: This study compared the results of rotating-platform high-flexion (RP-F) total knee arthroplasty with low contact stress (LCS) for clinical and radiographical assessment after a short-term period. MATERIALS AND METHODS: 68 total knee arthroplasties using a RP-F and LCS system were analyzed retrospectively. Thirty-five of the 68 were osteoarthritic knees and were followed-up for more than 2 years. The clinical evaluation included range of motion (ROM), Knee Society Knee Score and Function Score (KSKS and KSFS), tailor position and kneeling. The radiographic evaluation included femorotibial angle, position of implants, radiolucent line and position of patella. RESULTS: The postoperative ROM, KSKS, and KSFS improved statistically in both implants. Comparing RP-F with LCS there were statistically no differences in ROM (p=0.863), KSKS (p=0.835), KSFS (p=0.535) and tailor position (p=0.489). There were no significant radiographic differences. CONCLUSIONS: Total knee arthroplasty with RP-F and LCS showed similar clinical and radiographic results; it also showed excellent and predictable results at the short-term follow up. However, in RP-F there was 1 case of early osteolysis, 1 case of patella clunk syndrome and 1 case of painful patella crepitus; therefore, further case studies and follow-up are needed.

Survival Analysis of Conservative Treatement in Osteoporotic Vertebral Fracture

STUDY DESIGN: Prospective study. OBJECTIVES: To define the prognostic factors by analyzing the survival rates of osteoporotic vertebral fracture treated by conservative management. SUMMARY OF THE LITERATURE REVIEW: Due to an increasing elder population, many recent studies of osteoporosis have been done; pointing out that osteoporotic vertebral fracture may produce serious complications. However, there is nothing obviously demonstrated in both the management and prognosis of the osteoporotic vertebral fracture. MATERIALS AND METHODS: Survival analysis was done for 130 patients who had undergone conservative management for a single level vertebral fracture. Univariant and multivariant survival analysis was done for age at trauma, sex, body mass index (BMI), bone mineral density (BMD), smoking, diabetic history, fracture level, fracture type, vertebral compression ratio and regional Cobb's angle. RESULTS: Survival rate for conservative management was 70.7%. Univariant analysis for survival rate revealed significantly inferior results for age over 78 (p=0.008), T score< -3.5 (p=0.047), and crush or biconcave type than wedge type (p=0.021). Only the age factor showed significance in multivariant analysis (p=0.025, Hazard ratio=2.08). CONCLUSION: Conservative management in a single level osteoporotic vertebral fracture, showed a survival rate of 70.7% and age was the most important factor in conservative management. We should notice that age of more than 78 years is at high risk for failure in conservative management of vertebral fracture.

The Availability of Autogenous Bicortical Iliac Bone Graft in Anterior Cervical Interbody Fusion

STUDY DESIGN: Retrospective study. OBJECTIVES: To demonstrate the fusion rate, degree of subsidence and donor site morbidity of anterior cervical interbody fusion with autogenous bicortical iliac bone graft and anterior cervical locking plate. SUMMARY OF THE LITERATURE REVIEW: In anterior cervical discectomy and fusion with autogenous tricortical iliac bone graft, a large percentage of patients report chronic donor site pain. MATERIALS AND METHODS: Retrospective research was done for 39 patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft, from January 2006 to July 2011, with a follow up period of longer than 1 year. Fusion rates and subsidece of the graft is estimated with radiographs. Neck pain and donor site pain was estimated with visual analogue scale (VAS) and dysfunction was estimated with the neck disability index (NDI). RESULTS: A 95% of patients who underwent anterior cervical interbody fusion with autogenous bicortical iliac bone graft revealed definitive fusion with little amount of subsidence. The mean VAS score was 0.7 on the donor site and the mean NDI score was 3.8 at the final visit. There was excellent clinical outcome without complication at the donor site or the recipient site. CONCLUSIONS: Anterior cervical interbody fusion with autogenous bicortical iliac bone graft showed high fusion rates and minimal subsidence with excellent clinical outcomes. Therefore, bicortical iliac bone graft is an effective operational procedure in anterior cervical interbody fusion.

Comparison between Single and Dual Femoral Fixation for Anterior Cruciate Ligament Reconstruction with a Hamstring Autograft

PURPOSE: The purpose of this study was to evaluate dual fixation with different fixation mechanisms, determine the advantages, and compare the outcomes between single and dual femoral fixation. MATERIALS AND METHODS: From April 2004 to September 2007, 19 patients who received single femoral fixation and 22 patients who received dual femoral fixation were enrolled in the study. Single femoral fixation was performed using a cross-pin expansion mechanism. Dual femoral fixation was performed using a cross-pin expansion mechanism and an EndoButton CL loop suspensory mechanism. RESULTS: No significant differences were found in the incidence of cross-pin problems between the two groups (p=0.35-0.83) or in the stability assessment using a KT-2000 arthrometer and pivot shift test preoperatively (p=0.79 and 0.77, respectively) or postoperatively (p=0.89 and 0.75, respectively). In addition, no significant differences were detected between the two groups in the Lysholm, Tegner activity, or International Knee Documentation Committee knee scores preoperatively (p=0.07-0.47) or postoperatively (p=0.15-0.89). CONCLUSIONS: This study showed that dual fixation with different fixation mechanisms was not advantageous over the single fixation mechanism. Outcomes using the dual femoral fixation mechanism were not superior to those using the single femoral fixation mechanism.

Surgical Treatment of Habitual Patella Dislocation with Genu Valgum

Habitual dislocation of patella is a rare disorder. Sometimes it is associated with angular deformity such as genu valgum. We experienced habitual patella dislocation associated with genu valgum that was treated with corrective osteotomy of distal femur and soft tissue realignment procedure including lateral release and medial reefing.

Comparison of anticancer drug efficacy using the short-term microplate culture and MTT dye reduction assay

Individual tumors, even those of the same histologic type, show varying sensitivity to specific cytotoxic agent. Therefore, sensitivity testing assume an increasingly important as an orientational aid in planning chemotherapy. In the past decade there have been many attempts to develop a chemosensitivity test that would predict the clinical effectiveness of various chemostherapeutic agents against human neoplasms. In the United States National Institue's anticancer drug screening program, a colorimetric assey based on the ability of live cells to reduce a tetrazolium-base compound(MTT) to a blue formazan product was used. There has been an increase in reports of a chemosensitivity assay that use tetrazolium dyes and current the assay is in use in our country. The efficacy of several anticancer drug (vincristine sulfate, Etoposide, doxorubicin CDDP) were evaluated using the in vitro chemosensitivity of MTT assay with two cancer cell lines (MOLT-4, KHOS/NP). The follows obtained. 1) CI50 on MOLT-4 are 0.55ng/ml and 0.81ng/ml for vincristine and oncovin, 142.30ng/ml and 78.75ng/ml for lastet and vepesid, and 19.75ng/ml, 20.43ng/ml and 8.66ng/ml for ADR, ADM and adriblastin, respectively. 2) CI50 on KHOS/NP are 691.35ng/ml, 873.73ng/ml, 1,205.22ng/ml, 768.81ng/ml and 672.19ng/ml for cisplan, cisplatin, cispatin, platinol and cisplatin G, and 9.22ng/ml, 11.46ng/ml and 4.28ng/ml for ADR, ADM and adriblastin, respectively. In conclusion the MTT dye reduction assay to anticancer drug sensitivity using short-term microplate culture might serve as a reliable tool for the selection of effective chemotherapeutic agents in patients with cancers.

A case of right pulmonary artery arising from ascending aorta

No abstract available.