The Results of Revision Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: Results of revision total knee arthroplasties (TKAs) have provided relatively lower success rates than that of primary TKAs. We tried to evaluate the results and related problems of revision TKAs. MATERIALS AND METHODS: 27 revision total knee arthroplasties were evaluated clinically and roentgenographically with the American Knee Society Clinical Rating System. RESULTS: Pain score, range of motion, and knee score of aseptic and septic failures increased postoperatively after revision TKAs. Success rates of revision TKAs were 68.4% (13/19) for aseptic failure and 62.5% (5/8) for septic failure. We observed 9 complications including deep infections, wound dehiscence and superficial infections, fractures, and limitation of motion. CONCLUSION: Notable improvements were achieved in most of revision TKAs. However, relatively lower rate of success and higher rate of complications of revision TKAs emphasizes the importance of surgical technique handling significant bone loss, aggressive measure for complicated cases, and rehabilitation.

Detection of Mycoplasma pneumoriae in Clinical Samples from Pediatric Patients by Polymerase Chain Reaction

No abstract available.

Experimental Scoliosis Induced by Electrical Stimulation / 대한정형외과학회잡지

Animal experiment was carried out to measure the physiologic changes of thoracic or thoracolumbar spine that occurred as a result of electrical stimulation, and to evaluate the usefulness of electrical stimulation as a possible treatment for scoliosis. Unilateral electrical stimulations were applied to the back muscle of immature rabbits.They were subgrouped into medial, intermediate, and lateral muscle stimulated groups in order to observe the effects of various electrode placements. The radiograms were taken every other week to observe the changes of the spinal curvatures for the period of 12 weeks. The histological studies of the muscles, which were obtained from the stimulated(right) and the nonstimulated(left) sides at the same level, also were carried out to determine the response of the muscles to the electrical stimulation. The results were as follows. l. A significant scoliotic curvature was observed two weeks after electrical stimulation, and those curvatures did not change more for the next six weeks in spite of prolonged stimulation. 2. Scoliotic curvature induced by electrical stimulation for eight weeks remained unchanged for another four weeks after stopping stimulation. 3. There were no statistical differences in the induced scoliotic curvature among the three groups stimulated at different sites of the medial, intermediate, and lateral regions respectively. 4. A prolonged unilateral electrical stimulation could induce the scoliosis, and may be used as a method for treatment of scoliosis.

Anthropological Studies on the Proximal Femur of the Korean / 대한정형외과학회잡지

Anthropological studies of the proximal femur in a given race is a prerequisite step in designing femoral component of the total hip arthroplasty. As these studies and subsequent data are lacking for Korean hips, the author attempted an anthropological measurement of the Korean proximal femur. The results of this study are as following; l. In the orthoscanographic study for 187 subjects, mean of the maximum femoral length was 43.73±2.13cm for male, 40.53±2.03cm for female, The proportion of femoral length to the body height was found to have a constant ratio −26.10% for male, 25.91% for female. 2. In Anthropological measurement of Korean femur for 58 subjects, mean angle of the femoral anteversion was 19.85±6.86 and the neckshaft angle was 129.6±3.09. 3. In the study of the anterior curvature of femur, position index was 51.95±14.5% for male, 52.61±9.25% for female and index of bowing was 2.58±1.01% for male, 3.01±1.25% for female. In comparision with other races the Korean femur was found to have relatively straight curvature and the apex of the maximum curvature was located more distally. 4. External circumferential diameter of the femur-measured at 15cm below the lesser trochanter-showed 8.79±0.59cm for male and 8.42±0.53cm for female. The sexual difference at this level was statistically significant. (P <0.05). 5. In selected cadaeveric femurs, the minimum transverse diameter of internal mold was 1.26±0.30cm and was located at 12.5cm below the lesser trochanter to 20cm can be estimated by the following equation. Y=2.234−0.191X+0.0078X² for male, Y=2.395−0.173X+0.007X² for female.

A Clinical Study on resistance and Antibiotics of Gram Negative Bone and Joint Infection / 대한정형외과학회잡지

Although mortality and incidence rates of pyogenic osteomyelitis and arthritis have been reduced significantly due to development of treatment methods and antibiotics, the resistance of bacterias to antibiotics, especially in gram negative infections which increase rapidly in recent years, posess many difficult problems in the treatment of bone and joint infections. We have analysed 124 patients of gram negative bone and joint infection admitted in Seoul National University Hospital from Jan. 1976 to Dec. 1985. The following results and conclusion were drawn; 1. The ratio of gram negative infections to total pyogenic infections was 39.2% and has been increased annually. 1. The incidence of gram negative infections under 20 years of age was 54.0%, and male was 1.7 times as much affected as female. 3. Involved sites of pyogenic osteomyelitis were femur(32.6%), tibia(25.6%), humerus(6.2%), and those of pyogenic arthritis were hip(12.4%), knee(7.0%), shoulder(2.3%), and ankle(2.3%). 4. Original diseases of gram negative infection were hematogenous osteomyelitis(41.1%), infected nonunion(33.1%), pyogenic osteomyelitis(16.9%), sepsis(4.8%), and infected total hip replacement arthroplasty(4.0%). 5. Incidence rate of gram negative infection, especially mixed gram negative infection rather than pure gram negative infection, was increased annually. 6. Sensitive antibiotics for gram negative organisms were turned out aminoglycosides such as Amikacin and Tobramycin in general, however, the, resistance to that antibiotics increased annually. 7. In the view that resistance rate of gram negative organisms to antibiotics increased annually, it cannot be too much emphasized that the most sensitive antibiotics to be used must be chosen according to the results of antibiotics sensitivity test, and that further advanced effective antibiotics should be developed.

Special Vessel Studies in the Extremities / 대한정형외과학회잡지

Since the first report by Berberich and Hirsch in 1923, conventional angiography had been playing essential roles in diagnosis and treatment in the field of Orthopedic Surgery. Angiography is still the most definitive method for evaluating arterial disease, and is also an invaluable aid in the diagnosis of certain abnormalities which characteristically alter the normal vascular pattern. But the clinical use of conventional angiography as a routine diagnostic study has been limited by the risk associated with arterial catheterization cost, and poor patient acceptance. With improvement of radionuclide angiography and development of the methods for the identification and amplification of signals from small quantities of intravascular administered iodinated contrast agent and their combination with image subtraction (so called digital subtraction angiography, DSA), we have partially substituted the DSA and Radionuclide angiography for conventional angiography in diagnosis and post-operative evaluation of orthopedic patients. We have analyzed and compared the 197 cases who had taken conventional angiography from August, 1981 to July, 1985, and 16 cases who had taken radionuclide angiography from January, 1983 to July, 1985, and 21 cases who had taken DSA from October, 1983 to July, 1985 in Department of Orthopedic Surgery, Seoul National University Hospital. The results were as follow: 1. Conventional angiography is the most reliable and most widely used method in diagnosis of peri pheral arterial disease and evaluating the distribution of peripheral circulation of patient who need arterial reconstruction. But the clinical use of the angiography has been limited by the risk of complications. 2. DSA is simple, relatively non-invasive and can be done in out-patient basis. DSA is particulary useful and can replace the conventional angiography in post-operative assessment of peripheral vascular reconstruction, in the assessment of blunt and penetrating peripheral arterial trauma, and in the evaluation of peripheral aneurysm and vascular malformation. 3. Radionuclide angiography is also simple, and has no morbidity and useful in the patients who may be allergic to the contrast medium. Radionuclide angiography is useful in the evaluation of obstruction of major artery, deep vein thrombosis, and in repeated post-operative evaluation of arterial reconstruction.

Reconstructive Surgery for Old Ligament Injuries of the Knee / 대한정형외과학회잡지

Reconstructive surgeries for old ligament injuries of the knee vary according to the site and nature of injury as well as the age, health, physical demand and cartilage condition of the patients. No single best procedure is present for any old ligament injuries, but the most adaptable technique should be applied according to accurate diagnosis and experiences of surgeon. We reviewed our experiences of several reconstructive surgeries for the 38 cases with chronic ligamentous instabilities and summarized as following. 1) The most prevalent age of the patients was the third decades and males were 5.3 times more common than females. 2) Traffic accidents was the most common cause. 3) Tear of anterior cruciate ligament and medial collateral ligament appeared to be the most common injury. 4) Results at final follow up was not seemed to be affected by severity or location of ligament injury. 5) Intraarticular reconstruction without combined extraarticular reconstruction was not considered to be effective enough for anterior cruciate ligament deficient knee. 6) Although the number of cases was not large enough, we reviewed various reconstructive surgical techniques for comparison and evaluated the effects.

The Changes in Flexibilities of Rabbits' Tibiae in the Growign Period / 대한정형외과학회잡지

In order to define the changes of mechanical properties of bone tissue in the growing period, 90 rabbits' tibiae were loaded in 3-point bending. Emphasis was given to the accurate measurement of maximum angulation degrees within the limit of elastic deformation. Young's modulus of elasticity increased with increasing body weight, and the increments of bending stiffness were more prominent. In rabbits of low body weights, the tibiae absorbed more energy before fracture occurred and plastic deformation after fracture occurred more frequently. The mean values and standard deviations of the maximum angulation were 9.84±1.33 degree in Group 1 (range of body weight: 800–1200g), 7.55±0.85 degrees in Group 2 (range of BW: 1600–2000g), and 5.90±0.78 degrees in Group 3 (range of BW: 2400–2800g), These data may support that the allowable maximum angular deformity in treatment of fracture should be adjusted according to the increase of body weight-in other words, maturation.

Surface Replacement Arthroplasty of the Hip / 대한정형외과학회잡지

The concept of surface replacement arthroplasty of the hip is to replace the diseased joint surface with artificial plastic and metal cup in the acetabular and femoral head respectively, and to restore the normal anatomy and gain biomechanical function. Ten cases of Wagner type's surface replacement arthroplasty performed in Department of Orthopedic Surgery, Seoul National University Hospital since July 1979 are reviewed, and their minimum follow up is two months. In terms of the Pain control and improvement of range of motion in the hip, surface replacement arthroplasty showed about the same result compared with conventional total hip. In our cases there was no one complicatian, even though it is too short to evaluate the result of this operation. Wagner recommends surface replacement arthroplasty to perform through anterior approach, but 2 cases of our ten patients that have relatively good range of motion of the hip could be operated on this surgery by anterolateral approach (oblique skin incision) without trochanteric osteotomy, because of high incedence of myositis ossification with anterior approach. It is our conclusion that surface replacement arthroplasty of the hip may be used as an interim procedure to gain time in young patient who needs conventional total hip replacement which reveals increasing complication with the lapse of time.

Supracondylar Osteotomy in Cubitus Varus and Cubitus Valgus / 대한정형외과학회잡지

Cubitus varus and cubitus valgus is one of late complications of elbow fracture. Tardy ulnar nerve palsy often accompanies with cubitus valgus. The authors reviewed 40 supracondylar osteotomies (on cubitus varus 31, cubitus valgus 9) performed at the Department of Orthopedic Surgery, Seoul National University Hospital, during the period of 15 years, from 1962 till 1976. During long term follow up, correction of elbow deformity and its maintenance is possible even in growing child. So early operation is recommended for the prevention of neurologic compIication and elbow stiffness.