Osteogenic Induction of Periosteum-Derived Stem Cells Transplanted into Rabbit Long-Bone Defects / 대한정형외과학회잡지

PURPOSE: To determine if stem cells transplanted directly into a bone defect of rabbit tibias have osteogenic induction potential. MATERIALS AND METHODS: Immature white New Zealand rabbits underwent tibial osteotomies, and were divided into three groups according to the implant material used: stem cells embedded in agar (group 1); agar alone (group 2); nothing (group 3). For all rabbits, radiographs were taken weekly for 8 weeks, and histological studies of the newly formed-bone were performed. CM-Dil was used to label the stem cells prior to transplantation to ascertain whether or not the newly formed bone was derived from the transplanted stem cells. RESULTS: Fibroblasts and osteoblasts (osteoid matrix-forming cells) derived from the stem cells were identified by electron microscopy. Interspersed enchondral ossification (probably induced by osteogenic cells from the remaining periosteum and marrow) and pure osteoids (created directly from the osteoblasts originating from the transplanted stem cells) were identified. Fluorescent-labeled cells were conspicuous in the new bones until 6 weeks after surgery, which indicates that the new bones were induced by the stem cells. CONCLUSION: The osteogenic induction potential of the undifferentiated stem cell has promise for therapeutic application, which may be used for the treatment of bone defects in the future.

Colonna Greater Trochanteric Arthroplasty for Septic Hip Sequelae: Long-term Follow-up of Two Cases / 대한정형외과학회잡지

Hip dislocation and associated instability in septic hip arthritis, caused by destruction of the femoral head and neck and damage of the proximal femoral epiphysis, is difficult to treat. Colonna greater trochanteric arthroplasty, which places the greater trochanter into the acetabulum, can provide stability and increased function in the hip joint. The greater trochanter can be remodelled to act as a femoral head. We report 2 cases of Colonna greater trochanteric arthroplasty, which were observed twelve and twenty years after surgery. Although the patient had limited motion of the hip joint, which was accompanied by pain and limping, the overall results were satisfactory. In summary, we believe that Colonna greater trochanteric arthroplasty is an effective way of achieving a stable hip joint in a difficult septic hip sequelae. Limb length discrepancy can be corrected by a limb lengthening procedure at a later stage. In addition, conversion to a total hip arthroplasty is much easier than in unreduced high dislocation.

Prognostic Indices in Surgical Treatments of Legg - Calve - Perthes Disease / 대한정형외과학회잡지

Methods of management of Legg-Calve-Perthes Disease (LCPD) are at present controversial. Some practical prognostic indices were imperative for proper management of the disease. .We followed up on twenty LCPD patients-14 who underwent varization osteotomy of proximal femur and 6 who underwent pelvic innominate osteotomy or shelf procedure-for more than 3 years and analyzed the results using the Stulberg classification. There were three requirements for the hip to be included in this study: follow-up until residual stage occurred, Catterall group III or IV and complete clinical and radiological data. The purpose of this study-was to determine the validity of radiological and clinical factors in predicting prognosis in surgical treatments. Results of the evaluation were as follows; 1.Age was found to be an important prognostic index. Older children aged > 9 years tended to do worse than younger children (P<0.05). Other prognostic indices were not found to be statistically significant. 2. When Stulberg classification IV atients were considered, there were common factors in the children who were more than 9 years old, were of Catterall group IV, and late fragmentation stage disease with more than 1.5 of the lateral subluxation index, regardless of treatment. 3. Although Catterall's classification had been widely accepted, Catterall group III or IV seemed to be difficult to be distinguished. Many cases that had been regarded as Catterall group IV were proved to have intact posteromedial portion of femoral head later in residual stage. 4. Even though well-known prognostic indices were important in anticipating the results, we considered additional unknown biomechanical factors. In some cases continuous deformation of femoral head would not be prevented even though necrotic portion of femoral head was well contained by surgical treatment.