Minimally Invasive Two-Incision Total Hip Arthroplasty for Treating Acute Displaced Femoral Neck Fractures in Active Elderly Patients / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the short term follow-up results of minimally invasive (MI) two-incision total hip arthroplasty (THA) for treating acute displaced femoral neck fractures in active elderly patients. MATERIALS AND METHODS: We performed a retrospective review of 39 cases (average age: 72 years old, range: 60 years and above) of elderly patients who underwent MI two-incision THA within 30 days of their injury for treating displaced acute femoral neck fractures. They were followed up for a minimum of 12 months. Clinical evaluation was done by comparing the pre-injury and postoperative daily activities, the Harris Hip score (HSS) and the Western Ontario and McMaster University (WOMAC) score. The radiographs were checked to evaluate for implant alignment and periprosthetic abnormalities. The postoperative complications were analyzed. RESULTS: The average postoperative HSS was 88.3 and the average WOMAC score was 28.8. All the patients were able to walk without any assistive device. One patient had a HHS of less than 70. There were 2 dislocations but there was no recurrence. Radiographically, there was no case with a limb length discrepancy of more than 5mm. The femoral stems did not reveal any subsidence of more than 5mm. Other complications such as osteolysis, infection, neurologic injury and intraoperative periprosthetic fracture were not noted. Especially, no patient complained of any groin pain, which often occurs after bipolar hemiarthroplasty. CONCLUSION: The short term follow-up results were good for MI two-incision THA to treat acute displaced femoral neck fractures in active elderly patients, and these procedures were done by an experienced hip surgeon.

Cementless Total Hip Arthroplasty using Cone Prosthesis for Childhood Septic Hip Sequelae / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiographic results of cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae. MATERIALS AND METHODS: Thirty-seven patients of childhood septic hip sequelae that were treated with total hip arthroplasty using cone prosthesis, were evaluated after at least 2 years of follow-up. The average age at the time of the operation was 44 years. The cause of hip infection was pyogenic in 34 cases and tuberculous in 3. The average duration of follow-up was 51 months. RESULTS: The average Harris hip score improved from 45 points preoperatively to 90 points postoperatively. The mean leg length discrepancy decreased from 3.1 cm preoperatively to 0.7cm postoperatively. There was one case of stem subsidence over 5 mm, which didn't progress further. One patient underwent revision for migration of acetabular cup at postoperative 53 months. Postoperative infection occurred in 2 patients at postoperative 6 and 9 months respectively, which were treated by prosthesis removal. Radiolucent line over 2 mm was observed between the bone and stem in 1 case, without any evidence of loosening. CONCLUSION: Cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae resulted in excellent clinical and radiographic outcome.

The Early Results of a Cementless Total Hip Arthroplasty in Femoral Head Necrosis in Renal Transplant Recipients / 대한정형외과학회잡지

Purpose: To analyze the clinical results of cementless total hip arthroplasty (THA) for the treatment for osteonecrosis of the femoral head in renal transplant recipients. Materials and Methods: Twenty-one cementless THA were performed in 15 renal transplant recipients with advanced osteonecrosis of the hip. The average interval from the transplant to arthroplasty was 43 months (range, 7-122 months). The mean age at the time of arthroplasty was 35 years (range, 25-58 years). The average preoperative Harris hip score was 40 points (range, 31-57 points). The mean follow-up period was 45 months (range, 24-101 months).The articulations were metal-on-polyethylene bearing in 1 case, metal-on-metal in 6 cases, and ceramic-on ceramic in 14 cases. Results: The average postoperative Harris hip score was 91 points (range, 82-94 points), and there were no problems such as wound healing or infections despite the immunosuppressed state. Radiographically, there was one case of femoral and acetabular osteolysis, which had used metal on polyethylene articulation, 80 months after surgery. There was neither aseptic loosening nor dislocation after an average 45 months. Heterotopic ossification was detected in 1 case. Conclusion: The early results of a cementless THA in this young group of renal transplant recipients is encouraging.

A New Innominate Osteotomy in Legg-Calve-Perthes' Disease / 대한정형외과학회잡지

Purpose: To evaluate the clinical and radiological results of a new innominate osteotomy in Legg-Calve-Perthes' disease (LCPD). Materials and Methods: This study examined 25 hips that were treated with a new innominate osteotomy for LCPD. The treatment involved the anterior half of the ilium being osteomized in a direction of 45degrees to the coronal plane and 30degrees to 45degrees to the sagittal plane, and the posterior half of the ilium being cut using a Gigli saw according to the conventional method. The mean follow-up duration was 5.5 years. Stable interposition of the bone block was achieved using a single biodegradable screw in 8 hips, and without any fixation device in 17 hips. Results: The clinical results according to the criteria of Robinson were good in 20 hips. Twelve hips was graded as good by the Mose method, according to the criteria of Stulberg, 8 hips were included in class I, 6 hips in class II, 8 hips in class III, and 3 hips in class IV. The mean center-edge angle improved from 19.4degrees to 30.2degrees. Conclusion: The new innominate osteotomy is simpler and easier to perform than a routine Salter osteotomy, and satisfactory clinical results can be obtained without fixing the Kirschner wire.

Total Ankle Arthroplasty for the Post-traumatic Osteoarthritis / 대한족부족관절학회지

PURPOSE: To evaluate the short-term clinical outcomes of total ankle arthroplasty for the post-traumatic osteoarthritis. MATERIALS AND METHODS: Fourteen patients who had undergone total ankle arthroplasty from February 2005 to June 2006 were reviewed. Eleven patients were male and three patients were female. The mean age was 52.8 years (range, 33 to 69 years). The mean follow-up duration was 15.9 months (range, 12 to 24 months). Primary injuries were pilon fractures in eight cases, malleolar fractures in three, ankle syndesmotic injury in one, talus fracture and dislocation in one, and distal tibial physeal injury in one. Visual analogue scale (VAS), Range of motion (ROM), American Orthopaedic Foot and Ankle Society (AOFAS) score and complications were evaluated. RESULTS: The mean VAS improved from 8.6 preoperatively to 2.6 at last follow-up. The mean ROM improved from 24.6 degrees preoperatively to 33.1 degrees postoperatively. The mean AOFAS score improved from 44.5 points preoperatively to 75.1 points postoperatively. Radiographically, all components were stable, but there were component malpositions in two cases, including one varus malposition of tibial component and one increased anterior translation of talar component. Complications were deep infection in one case, intraoperative malleolar fracture in three, marginal wound necrosis in two, and heterotopic ossification in one. One prosthesis was revised because of deep infection. CONCLUSION: Total ankle arthroplasty for the post-traumatic osteoarthritis is believed to be an useful method for preservation of the motion, relief of the pain and high satisfaction of patients in short-term results.

Avascular Necrosis of Femoral Head Treated by Total Hip Replacement in AIDS Patients: A Case Report

The incidence of osteonecrosis of the femoral head is increasing in patients infected with the human immunodeficiency virus (HIV). The etiology of osteonecrosis in HIV positive patients is multifactorial. The factors considered responsible include antiretroviral therapy, corticosteroid use and resultant hyperlipidemia, hypercoagulability, immune reconstitution, the increased prevalence of alcoholism in this population and megesterol acetate. The emergence of the HIV has highlighted the need for surgeons to understand the epidemiology of percutaneous injuries and other blood exposure in a surgical setting. We report a case of avascular necrosis of the hip treated with a total hip replacement, with particular focus on the etio-pathology of the disease and preventive measures for its transmission in an orthopedic surgery setting.

Pathologic Fracture of Proximal Femur with Benign Bone Tumor / 대한정형외과학회잡지

PURPOSE: The treatment results for a proximal femur fracture caused by a benign bone lesion were evaluated. MATERIALS AND METHODS: Nineteen patients (23 cases) who had been treated for proximal femur pathologic fracture from 1987 to 2002 were enrolled in this study. The mean follow-up duration was 40 months. The causes and treatments of the pathologic fractures and complications such as nonunion, deformity and recurrence were evaluated. RESULTS: The benign bone lesions treated were fibrous dysplasia (15), simple bone cyst (3), aneurysmal bone cyst (2), giant cell tumor (2) and eosinophilic granuloma (1). An autograft (3), allograft (2), and both autograft and allograft (3) was performed after adjuvant curettage with a high-speed burr. There was no recurrence in these 8 cases. At the final course, internal fixation was performed in 18 cases (intramedullary nail (10), compressive hip screw (6), plate (1), screw (1)), a hip spica cast 3 cases and a THR 2 cases. Three cases where a hip spica cast had been performed showed a varus deformity. A refracture and deformity were prevented in 10 cases who underwent intramedullary nailing. CONCLUSION: The IM nail is very effective in preventing complications such as a deformity, refracture after a treatment for polyostotic fibrous dysplasia. However, in a solitary benign bone lesion, bone graft and internal fixation is effective after thorough curettage.

Modified Chiari Pelvic Osteotomy for Dysplastic Hip / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical, radiographic results of a modified Chiari osteotomy for dysplastic hips associated with early osteoarthritis. MATERIALS AND METHODS: 17 dysplastic hip patients were examined, and treated with modified Chiari osteotomy, which is dome-shaped pelvic osteotomy. Their mean age at surgery was 33.5 years old (range: 14-53 years), and the mean follow-up period was 28.2 months (range: 12-73 months). In the clinical evaluation, limping, range of motion and Harris Hip Score (HHS) were used and in the radiographic evaluation, center edge angle, acetabular angle, head coverage, weight bearing joint space and minimal joint space were evaluated. RESULTS: Six out of 13 patients who had an antalgic gait improved, and the level of abduction, internal rotation and external rotation showed significant improvement at the final follow-up. The radiographic results showed that the acetabular angle improved significantly from 47.5degrees preoperatively to 40.0degrees at the last follow-up. The center edge angle showed significant improvement from 9.9degrees preoperatively to 38.5degrees at the last follow-up and the head coverage also showed significant improvement from 57.9% preoperatively to 82.4% at the last follow-up. CONCLUSION: A modified Chiari osteotomy is an effective method for a dysplastic hip with a mild and moderate grade of osteoarthritis, and shows improved clinical and radiographic results.

Comparison of Results of Total Knee Arthroplasty Performed using a Navigation System and the Conventional Technique / 대한정형외과학회잡지

PURPOSE: To compare the radiologic and clinical outcomes of total knee arthroplasty (TKA) performed using a navigation system with those obtained using the conventional technique. MATERIALS AND METHODS: Forty-one TKAs were performed using a navigation system (navigation group) and forty-eight by conventional surgery (conventional group). Radiologic results outside the range defined by +/-3degrees of optimum were classified as outliers. Range of motion and HSS scores at final follow-up were also compared. RESULTS: Mean mechanical axes were 0.3degrees valgus for navigation and 0.5degrees varus for the conventional group, which were not statistically different. However, two outliers occurred in the navigation group, which was significantly less than the 14 that occurred in the conventional group. Mean coronal inclination of the femoral component was significantly different in the two groups as were the outlier numbers. Although outlier numbers significantly differed in sagittal inclination of the femoral or tibial components or coronal inclination of the tibial component, there were no statistical differences in terms of mean values. Differences in ROM and HSS scores were also not observed between the two groups. CONCLUSION: The navigation system helped increase alignment accuracy of the lower extremity, but no significant difference was observed in clinical results between the two study groups.

Comparative Study of Acute and Chronic Reconstruction of Anterior Cruciate Ligament?

PURPOSE: To compare the clinical? results and stability of acute and chronic reconstruction of anterior cruciate ligament (ACL). MATERIALS AND METHODS: Patients who had ACL reconstruction with a quadruple hamstring tendon and ligament anchor (LA) screw with a minimum 2-year follow-up were included in this study. Acute (within 4 weeks) reconstruction group was composed of 27 knees and chronic (over 3 months) group was 44 knees. We compared the two groups with regard to Lysholm knee score, range of motion, thigh circumference, Lachman test, Tegner activity scale, associated meniscal injuries, and anterior laxity difference by Telos stress arthrometer. RESULTS: At last follow-up, no significant differences were found between the acute and chronic groups for Lysholm score, range of motion, Lachman test, Tegner activity scale, and instrumental laxity. 16 cases (59%) of acute and 33 cases (75%) of chronic patients had a meniscal injuries of which were reparable in 5 cases (28%) and 7 cases (17%). CONCLUSIONS: Acute reconstruction of ACL had excellent clinical and radiologic results as good as the chronic group without motion problem.