Synovial Impingement after Total Knee Replacement Arthroplasty: A Case Report

A thickened soft tissue impingement after total knee replacement arthroplastyis a complication that causes pain and is usually developed between patella and femoral component such as patellar clunk syndrome. But we experienced a case that medial and lateral synovial tissues were impinged between femoral component and polyethylene liner after total knee replacement arthroplasty with medial pivot prosthesis for degenerative arthritis and were treated with arthroscopic excision. We report this case with literature review.

Lateral Retinacular Release in Total Knee Arthroplasty; Patella Resurfacing versus Retaining

PURPOSE: To investigate the rate of lateral retinacular release and the contributing factors between the patellar resur- faced total knee arthroplasty(TKA) and patellar retained TKA. MATERIAL AND METHODS: From Jan. 2003 to Jan. 2006, 179 cases(90 patella retained, PR; 89 patellar resurfaced, PS) were enrolled in this study. To investigate the contributing factors on the lateral retinacular release along the patellar replacement, the preoperative and postoperative radiographic evaluation was done. Patellar height, congruence angle and medial displacement was measured with the Merchant view. Anterior-posterior knee distance was measured at a lateral film. The statistical significance between two groups was analyzed using the student's t-test. RESULTS: Lateral retinacular release was done in 59 of 179 cases. Thirty-six cases of PR group and 23 cases of PS group were undertaken. The rate of lateral retinacular release was higher in PR group(p<0.05). The difference between preoperative and postoperative patellar height at a Merchant was 2.5, 0.5mm reduction in PS and PR group respectively. PS group showed more medial displacement(mean 2.5mm) than PR group(mean 1.2mm)(p<0.05). CONCLUSION: In PR group, higher rate of a lateral retinacular release was shown than PS group. Less reduction of patellar height and less medial displacement of patella might be related with the high rate of a lateral retinacular release in PR group.

Clinical Efficiency after Fixation with Cable in Patellar Fracture

PURPOSE: To evaluate the clinical results of cable fixation in patellar fractures followed by early ROM exercise and early weight bearing. MATERIALS AND METHODS: We analyzed 46 patients who had operation for transverse or comminuted patellar fractures with cable fixation from April 1995 to January 2003. Mean term of follow up was 15 months (range, 15~24 months). We reviewed the clinical and radiologic bony unions, ROM, time of weight bearings retrospectively. All cases were fixed with Dall-Miles' cable, and additional fixation was done with K-wires in 25 cases and with screws in 11 cases. At next day after surgery, all patients started CPM, except 3 cases who had severly comminuted fractures. Full weight bearing was started 2-3 days after surgery with LMB in full extended state. RESULTS: We gained bony union in all cases, Average ROM was 115 degree(80-130 degree) at postoperative 2nd week, all patients showed more than 130 degree at 8th week and final results showed normal ROM compared with opposite knee. During follow up, K-wires were migrated in 2 cases, but there was no difference in ROM or bony union compared with other patients. CONCLUSION: Fixations using Dall-Miles' cable for transverse or comminuted patellar fractures are considered to be enough stable for early ROM exercise and early weight bearing without major complications.

Role of Matrix Metalloproteinase-3 in Degenerative Lumbar Scoliosis / 대한척추외과학회지

PURPOSE: This study was performed to investigate the differences in the expression of matrix metalloproteinase-3 in degenerative scoliosis compared with other degenerative disc disease of the spine. MATERIALS AND METHODS: The intervertebral disc materials were obtained during discectomies. Six, 13 and 12 cases of herniated nucleus pulposus, spinal stenosis and degenerative lumbar scoliosis, respectively, were included in the experimental group. The expression of MMP-3 was evaluated three times that of the means, in the immunohistochemical staining, western blotting using anti human MMP-3 antibody and RT-PCR with MMP-3 primer, respectively. RESULTS: On the immunohistochemical stains, extensive and strong staining was noted in the discs of degenerative lumbar scoliosis compared to those with spinal stenosis and HNP. In the western blotting, greater expression of MMP-3 was noted in the discs of degenerative lumbar scoliosis (mean optical density: 20.68) than in other degenerative disc diseases (SS: 6.24, HNP: 2.0). In the RT-PCR, a similar result was shown (DLS: 62.1, SS: 27.4 and HNP: 10.4). There were statistically significant differences between degenerative lumbar scoliosis and degenerative disc disease (p<0.05). CONCLUSION: Rapid degeneration of the intervertebral disc might be an important factor in the pathogenesis of degenerative lumbar scoliosis. MMP-3 could be a key enzyme for the rapid degeneration of the intervertebral discs, especially in degenerative lumbar scoliosis.

Comparison of the Activities of NF-kappa B and I kappa B alpha in Patients with Rheumatoid Arthritis and Osteoarthritis / 대한정형외과연구학회지

PURPOSE: The nuclear factor-kappa B (NF-kappa B) has been known to regulate the inflammatory and immune process by transcription of inflammatory intermediates. The purpose of the present study is to show the difference in activity of NF-kappa B and its inhibitory factor-I kappa B alpha in patients with rheumatoid arthritis, osteoarthritis and normal control subjects. MATERIALS AND METHODS: Synovial membrane samples were obtained at the time of orthopedic surgery from the knees of 7 patients with RA and 7 patients with OA. Two control samples were obtained from an amputee with no history of arthritis. We designed the primer of the subunit p65 of NF-kappa B and I kappa B alpha, measured the activity of them by RT-PCR, and analyzed the expression of NF-kappa B by immunohistochemical staining. RESULTS: From the results of RT-PCR, the expression levels of NF-kappa B was found to be higher in synovial tissues obtained from patients with RA than from synovial tissue obtained from patients with OA, and the least from the control group. The expression levels of I kappa B alpha were not different statistically among the three groups. Immunohistochemical staining for the NF-kappa B was dominant in synovial tissue from patients with RA. The result of immunohistochemical staining was similar to the results of RT-PCR for NF-kappa B. The localization of the staining was predominantly nuclear. CONCLUSION: In this study, activity of NF-kappa B of rheumatoid arthritis was higher than the other group, but expressions of I kappa B alpha were no different between the diseases. Further studies about specific inhibitors of NF-kappa B will benefit the development of rheumatoid arthritis regimens with greater efficacy.

Propofol-N2O versus Seveflurane-N2O during Outpatient Knee Arthroscopic Surgery Using the Laryngeal Mask Airway: Hemodynamic Responses and Recovery Profiles / 대한마취과학회지

BACKGROUND: The increasing number of outpatient surgery which requiring the rapid, smooth induction of anesthesia with rapid recovery may lead to the use propofol or sevoflurane. Our objective was to compare the hemodynamic responses and recovery profiles obtained by sevoflurane inhalation with propofol infusion using a laryngeal mask airway (LMA) in an ambulatory setting. METHODS: Forty patients undergoing knee arthroscopic surgery were randomized into two groups. The laryngeal mask airway insertion was accomplished by using the voluntary maximal vital capacity breathing method (VCB) with sevoflurane 7% in nitrous oxide 50% (sevoflurane group) or by the infusion of propofol (target: 7microgram/ml) (propofol group). Under BIS monitoring (40-60), anesthesia was maintained by sevoflurane (2-3%) or propofol (range of 3.7-4.2microgram/ml) with spontaneous respiration. Time to loss of consciousness (LOC) and LMA insertion from induction of anesthesia, hemodynamic responses, end tidal CO2, and recovery profiles were evaluated. RESULTS: The mean time to LOC and to successful LMA insertion were similar in the groups. Hemodynamic responses in the sevoflurane group were not significantly different from those of the propofol group. However, in both groups, systolic and diastolic blood pressure were lower at the time of loss of consciousness and 5 min of after LMA insertion versus preinduction and LMA insertion values (P<0.05). Heart rate was significantly lower in the propofol group (P<0.05). After cessation of anesthesia, hemodynamic responses and to the time for LMA removal or to the time for responding to a verbal command were similar in both groups. CONCLUSIONS: Sevoflurane inhalation and propofol infusion anesthesia with spontaneous respiration provided comparable conditions for outpatient surgery.

Relationship between meniscal injury & articular cartilage defect in arthroscopy

PURPOSE: We studied to know the relationship between meniscal injury & defect of articular cartilage and its clinical importance. MATERIALS AND METHODS: 252 patients were selected, who undergone arthroscopic surgery for meniscal injury from May 1997 to December 2001. We excluded patients with severely progressed osteoarthritis or degenerative changes in simple X-ray. Physical examinations, simple X-rays, MRI & arthroscopic photographs were taken for all patients. And the results were analyzed according to age, duration from accident to operation and type of meniscal injury RESULTS: 40 cases (15.9%) showed defects of articular cartilage with meniscal injury. Among them, 18 cases (45%) in femur, 10 cases (25%) in tibia, and 12 cases (30%) in both. Incidence of articular cartilage defect was significantly higher in patients over the age of forty (p<0.01) and in those with a history longer than six months (p<0.05). Posterior horn tears were associated with the highest incidence of articular cartilage defect, but were also associated with a longer history and with older patients. CONCLUSION: In patients with meniscal injury, older age, long duration of symptom and tear at posterior horn have higher incidence of articular cartilage defect, especially femoral condyle. The reason for this is not entirely clear but these patients need close attention and early treatment.

Surgical Treatment for the Neglected Non-union of the Lateral Humeral Condyle / 대한정형외과학회잡지

PURPOSE: To assess the clinical results of surgical treatment for established nonunion of the lateral humeral condyle and to determine the factors necessary for successful outcome. MATERIALS AND METHODS: 12 patients with nonunion of the lateral humeral condyle underwent open reduction, autogenous iliac bone graft and internal fixation with two smooth or treated K-wires between 1994 and 1999. Mean age was 16 years and the mean follow-up period was 2 years and 8 months. RESULTS: All of the patients achieved solid union at the nonunion site and were free of pain in the elbow upon strenuous activities. Average union time was 7.2 weeks after the surgery. Aggressive anatomical reduction of the fragment must not be undertaken because it may disturb a well adapted joint congruity in adults. Rigid internal fixation with iliac bone graft and preservation of the blood supply of the distal fragment are important factors for a successful outcome. The range of motion of the elbow joint decreased 10.5 degrees on average after surgery. Valgus deformity improved in four of six patients. CONCLUSION: The patients with symptomatic established nonunion are good candidates for surgery, even adults.

Comparison of Results Between Internal Fixation of Both Bones and Internal Fixation of the Only Tibia for Distal Tibial and Fibular Fractures / 대한정형외과학회잡지

PURPOSE: This study undertaken to evaluate the clinical results between the fixation of both bones and the fixation of the only tibia for extra-articular distal tibial and fibular fracture, and to know if the fixation of both bones could be needed. MATERIALS AND METHODS: In a retrospective study from 1994 to 1999, thirty-seven patients who underwent internal fixation with plate and screws for both bones (Group I : 17 cases) and only tibia (Group II : 20 cases) for extra-articular distal 1/3 tibial and distal 1/4 fibular fractures, which were above distal tibio-fibular syndesmosis, were evaluated the period of union, range of motion and operative time. RESULTS: The union period of tibia was 124 days (Group I) and 126 days (Group II) and the cases of full ROM were 16 / 17 cases (94.1%) in Group I and 18 / 20 cases (90.0%) in Group II. The mean score was 94.6 points in Group I and 91.3 points in Group II by Baird scoring system (P>0.05), and the operative time was 147 minutes (Group I) and 106 minutes (Group II) (P<0.05). CONCLUSION: The clinical results in extra-articular distal tibial and fibular fractures, which were distal 1/4 and above distal tibio-fibular syndemosis, treated with internal fixation of the only tibia were as good as internal fixation of both bones. We thought that there is no need to fix distal fibular fracture in these cases.

Comparison of results between conservative treatment and operative treatment for clavicle fractures in adults / 대한정형외과학회잡지

PURPOSE: The conservative treatment in the clavicular fractures is the gold standard. However, we found that there were some complications including angulation of clavicle and shortening of clavicular length, long-period immobilization, and nonunion in conservative treatment. This study was undertaken to evaluate union period, nonunion rate, and clinical results between conservative treatment and surgical treatment in clavicular fractures. MATERIALS AND METHODS: We evaluated 67 clavicular fractures in adults with conservative treatment (42 cases) and operative treatment (25 cases) from 1991 to 1996 and followed up for at least 1 year. RESULTS: Nonunion occurred in 4 cases (9.5%) in conservative treatment and 1 case (4.0%) in operative treatment (p>0.05) . The excellent results were 12 cases (28.6%) in conservative treatment and 12 cases (48.0%) in operative treatment (p>0.05) . CONCLUSION: We concluded that the early surgical treatment of displaced, low contact area of fracture segments of the clavicle fracture with internal fixation, even though not statistically significant, provides clinical results that are superior to those obtained with conservative care in view of early exercise of the shoulder joint, union period, rate of nonunion, correction of angular deformity and cosmetic problem. We thought that it leaves much room for consideration about the early surgical treatment for these fractures.

Solitary Osteochondroma of the Clavicle associated with Congenital Muscular Torticollis: A Case Report / 대한정형외과학회잡지

Congenital torticollis, or wryneck, is caused by fibromatosis within the sternocleidomastoid muscle. It may invlove the muscle diffusely, but more often it is localized near the clavicular attachment of the muscle. An osteochondroma is a benign lesion that is often considered to be the most common type of bone tumor and this lesion rarely occurs in the clavicle. We report a case who had congenital muscular torticollis with solitary osteochondroma on the clavicular attachment site of sternocleidomastoid muscle of medial clavicle.

Arthroscopic Surgery of the Knee Through Ambulatory Care Unit Under General Anesthesia

PURPOSE: Though many patients who visit ambulatory care unit are performed arthroscopic surgery under local anesthesia, it is difficult to do it in some patients. By selecting the anesthetic agents, educating the patients preoperatively and controlling the pain carefully, we gained the good results in arthroscopic surgery of knee through ambulatory care unit under general anesthesia without complications. MATERIALS AND METHODS: From May 1998 to December 1999, arthroscapic surgery of the knee(menis-cectomy, synovectomy, debridement, loose body removal, bursa excision) was carried out under general anesthesia in 91 patients through ambulatory care unit. The anesthetic agents used in operation were propofol(52 cases) and ethrane(39 cases), 10cc of 0,25% bupivacaine with 1% lidocaine was injected in1o knee joint after arthroscopic surgery for pain control. RESULTS: The pain scores were improved from 12.5 points to 14.7 points at rest, from 9.5 points to 13 point at walking. Postoperatively, there were nausea(2 cases), chest pain(1 case), elevated blood pressure(2 case), redness(3 cases), pain(18 cases), effusion(27 cases). But these symptoms were improved without other complications. CONCLUSION: It is considered one of the comfortable, safe end reliable methods to perform arthroscopic surgery of knee through ambulatory care unit under general anesthesia.

Bilateral apophysitis of ischial tuberosity in a Taekwondo practitioner: A Case Report / 대한정형외과학회잡지

Ischial tuberosity pain in athletes may be caused by bony avulsions or apophysitis. Apophysitis of the ischial tuberosity is a rare condition observed in adolescents who participate in sports, it causes gradual increasing functional and palpable pain at the ischial tuberosity without any major trauma at the beginning of the symptoms. Bilateral apophysitis is very rare, and the reason that Taekwondo practitioners may develop it is due to stretching exercises of both lower extremities. Repeated traction can cause an apophysitis at 15-17 ages when the ossification process of the apophysis is ongoing. Conservative treatment is adequate for apophysitis. We report the clinical and radiologic findings in detail.

Chiari Pelvic Osteotomy in Children and Adolescent / 대한정형외과학회잡지

Twenty five patients (twenty seven hips) who had Chiari osteotomy at Kang Nam St. Marys Hospital between 1980 and 1995 were reviewed to evaluate the factors in the operative technique that contribute to successful outcome and assess the clinical results in various conditions. The length of follow-up ranged from one to fourteen years and the age of at operation ranged from four to twentythree years. Eighteen patients had developmental dysplasia of the hip: four, septic hip: three had another disorders, Prior to the Chiari osteotomy, fourteen hips had an femoral osteotomy and four, trochanteric arthroplasty. We used to the standard osteotomy as described by Chiari with certain modification. A pneumatic saw and osteotome are used instead of Gigli saw. This technique is simple procedure to make the correct level and angle. Bone graft was not performed in all cases even the osteotomy was displaced more than 50 percent of the iliac width. The overall results were 12 excellent, eight good, five fair, and two poor. In eleven patients, the osteotomy had to be displaced more than 50 percent to provide good coverage of the femoral head. Their results were good or excellent. A good result will be obtained if enough attention is paid to displacing the osteotomy. The osteotomy using the pneumatic saw provides accurate level and direction of osteotomy and it is an simple procedure also.

A Case of Ipsilateral Neglected DDH Combined with Contralateral LCPD: A Case Report / 대한정형외과학회잡지

Although many reports have been published about Legg-Calve-Perthes disease, developmental dysplasia of hip, it is difficult to gain a satisfactory results in treatment. We experienced 9 year-old girl with ipsilateral neglected DDH combined with contralateral LCPD, and treated with Klisic operation for DDH and femoral valgus osteotomy for hinged abduction of LCPD. We gained satisfactory results and report this rare case.

Dysplasia Epiphysealis Captitis Femoris (Meyer's Dysplasia) / 대한정형외과학회잡지

Dysplasia epiphysealis captitis femoris is a rare syndrome which after the hip joing in childhood. Pedersen(1960) was the first to differentiate dysplasia epiphysealis capitis femoris(DECF) from Perthes' disease. Scattered reports of this entity have appeared, and in 1964 Meyer defined the syndrome through explanation of its clinical and radiological characteristics. There is a clinical significance that DECF is clinical-radiologic syndrome which resemble Perthes' disease but has important differences, especially in its treatment and prognosis, We experienced two cases of DECF which are misdiagnosed as Perthes' disease. Therefore, pediatricians should keep in mind the possibility of the DECR among the Perthes' disease of younger children.