Results of Cruciate-Retaining Total Knee Arthroplasty with Maxim(R) System : More than 5-Year Follow Up

PURPOSE: To evaluate the mid-term (over 5 years) clinical and radiologic results of Maxim(R) (Biomet, Warsaw, USA) Cruciate Retaining total knee replacement arthroplasty (TKRA). MATERIALS AND METHODS: Between Feb. 1997 and Nov. 2000, 103 knees in 65 patients who had been followed up for 5 years after TKRA with Maxim(R) Cruciate Retaining were evaluated retrospectively for clinical and radiologic results. RESULTS: The average range of motion increased from 114degrees (80~130degrees) preoperatively to 128degrees (105~130degrees) at the last follow-up. The average range of flexion contracture decreased from 6.5degrees preoperatively to 0.8degrees (0~15degrees) at the last follow- up. In patients with osteoarthritis, the mean preoperative knee score (59.2) and functional score (40.7) improved to 88.6 and 90.1, respectively. In rheumatoid arthritis patients, the mean knee score and functional score also improved from 47.4 and 39.2 to 80.6 and 88.3. Roentgenographic evaluation revealed a radiolucency rate of 19.5%. Complications were deep infection in 2 cases and periprosthetic fractures in 3 cases. The former had received reimplantations. CONCLUSION: The mid-term results of Maxim(R) Cruciate Retaining total knee replacement arthroplasty were reliable and satisfactory in terms of improvements of range of motion, restoration of function, and rare complications. However, long-term follow-up evaluation is necessary.

Acute Compartment Syndrome of the Thigh Caused by the Pseudoaneurysm of the Femoral Artery: A Case Report / 대한정형외과학회잡지

A pseudoaneurysm occurs as a late complication of an arterial wall injury after a surgical procedure or injuries such as a fracture, stab injury and penetrating trauma. Acute compartment syndrome as an elevation of the pressure in a closed compartment results in vascular compromise and a dysfunction. However, its occurrence in the thigh is quite rare. We report a case of a patient treated with an excision of a pseusoaneurysm and an artificial vessel graft who had compartment syndrome of the thigh caused by a pseudoaneurysm of the femoral artery that had developed after a blunt injury.

Degenerative Change of Adjacent Segments according to the Fusion Method after L4-5 Segmental Fusion: Comparative Study of Posterolateral Fusion and Posterior Lumbar Interbody Fusion / 대한정형외과학회잡지

PURPOSE: We wanted to investigate the difference in the incidence of post-fusion adjacent segment degeneration between performing posterolateral fusion and posterior lumbar interbody fusion. MATERIALS AND METHODS: One hundred fifty seven patients who underwent L4-5 fusion using pedicle screws for degenerative lumbar disease and followed up more than three years were analyzed retrospectively. Eighty-six cases of posterolateral fusion (group I) and 71 cases of posterior lumbar interbody fusion (group II) were compared. Sampling bias was evaluated by comparing gender, age, the preoperative degeneration of adjacent segments, the sagittal angle of fusion segments on the last follow up and the follow-up period. The differences of adjacent segments degeneration and the revision rate between the two groups were investigated multilaterally. The actual risk factors for such degeneration were investigated by performing multiple logistic regression test, which contrasted the degeneration group with the non-degeneration group for all the above factors, including whether interbody fusion was done or not. RESULTS: Sampling bias was excluded except for the preoperative proximal adjacent segments degeneration (p=0.036). There was no statistical difference in the final proximal degeneration (31/86, 36% in group I, 26/71, 37% in group II, p=0.536) and revision (8/86, 9% in group I, 6/71, 8% in group II, p=0.536). There was no statistical difference in the final distal degeneration (9/86, 10% in group I, 8/71, 11% in group II, p=0.536) and revision (4/86, 5% in group I, 2/71, 3% in group II, p=0.435). When comparing those cases who developed degeneration on either side with the non-degeneration cases, the odds ratio of old age and an insufficient sagittal angle of the fusion segments reached statistical significance (p=0.024, 0.001). CONCLUSION: There were no differences in adjacent segments degeneration between the posterolateral fusion group and the posterior lumbar interbody fusion group. Rather than the operation methods, old age and insufficient sagittal angle of the fusion segments were the actual risk factors of such degeneration.

Adjacent Segment failure after Lumbar Spine Fusion: Controlled Study for Risk Factors / 대한정형외과학회잡지

PURPOSE: To verify the risk factors associated with adjacent segment failure after lumbar spine fusion using pedicle screws. MATERIALS AND METHODS: The study group consisted of 35 patients who underwent lumbar spine fusion using pedicle screws and required revision surgery due to adjacent segment failure. These were compared with 73 control patients who were stratified according to the aspect of the surgical method and period. Gender, age, surgical procedures, the number of fusion segments, the fixation of the sacrum, initial instability and degeneration of the adjacent segments, lumbar lordosis, whole lumbar spondylosis, placement of most proximal screws, habitat, the demand of physical work, physical exercise, smoking, life style and BMI were reviewed retrospectively. RESULTS: Multivariate logistic regression showed that insufficient lumbar lordosis (odds ratio=3.041), instability of the distal adjacent segment (odds ratio=17.196), physically demanding jobs (odds ratio=2.462), delinquent exercise (odds ratio=2.534) and rural habitat (odds ratio=46.729) were associated with an increased incidence of adjacent segment failure. CONCLUSION: Insufficient lordosis, instability of the distal adjacent segment, physically demanding jobs, delinquent exercise and rural habitat were found to be risk factors. The postoperative life style has a large impact on adjacent segment failure. The extension of fusion to an unstable distal segment should be deliberated even though it is not attributable to the current symptoms. A reconstruction of the proper lordosis far outweights the other methodological factors.

Operative Treatment of Lumbosacral Spondylitis Through a Posterior-only Approach / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of this operative method, which includes removal of infected materials, insertion of a bone graft and fixation with pedicle screws through a posterior-only approach in spondylitis with advanced bone destruction and radicular pain. MATERIALS AND METHODS: Ten patients with refractory single level spondylitis of the lumbosacral spine, who underwent the above operation and were followed-up for more than 2 years, were analyzed retrospectively. Six cases were tuberculous and 4 cases were pyogenic in etiology. Radiologically, bone union and restoration of sagittal alignment were assessed. Clinically, Visual Analog Scales (VAS) for back pain, leg pain and resolution of neurologic symptom were analyzed. RESULTS: Bone union was achieved in all cases. Sagittal angle was corrected significantly from -3.6+/-12.5 degrees to -11.4+/-9.3 degrees (p=0.007). However, loss of correction was noted from -16.2+/-10.2 degrees at immediate after surgery to -11.4+/-9.3 degrees at last follow-up (p=0.005). Back pain VAS was improved from 8.3+/-0.7 to 2.6+/-1.6 (p=0.005) and leg pain VAS was improved from 6.8+/-2.1 to 0.5+/-0.9 (p=0.005). There was strong positive correlation between age and final back pain (r=0.79, p=0.011) and leg pain VAS (r=0.75, p=0.020). There was no meaningful correlation between the sagittal angle and back pain (r=0.30, p=0.430) and leg pain VAS (r=0.41, p= 0.274). Implant related complications and deep wound infections did not occur. CONCLUSION: In single level spondylitis of the lumbosacral spine, a posterior-only surgical approach is a useful method in which debridement, bone graft placement and pedicle screw fixation can be performed. This procedure did not provide increased risk with respect to infection control, and it allowed correction of the sagittal angle. The younger the age of the patients, the better the back pain and leg pain VAS results.

The Treatment of Mason Type II Radial Head Fractures using Closed Reduction and K-wire Fixation

PURPOSE: To analyze the clinical results of the treatment of Mason type II radial head fractures using closed reduction and K-wire internal fixation under C-arm guide by radiologically and functionally. MATERIALS AND METHODS: Between March 2001 and October 2003, 7 patients with Mason type II radial head fracture were treated by closed reduction and internal fixation using K-wires under C-arm guide. The average age of the patients was 38 (5 to 57) years old, and average duration of follow up was 20 (5 to 36) months. At last follow up, we evaluated the radiological results and functional results by classifying excellent, good, fair and poor according to functional rating system of Broberg and Morrey. RESULTS: The range of motion of the elbow at last follow up, average flexion contracture was 1.4 (0 to 10) degrees, further average flexion was 146.4 (140 to 150) degrees, average supination was 74.2 (70 to 80) degrees and average pronation was 75 (70 to 80) degrees. In the functional results, 6 cases were excellent and 1 case was good. In the radiological evaluations, the average time of union was 5 (4 to 6) weeks after the operation and no serious complication was occurred in any cases. CONCLUSION: In the treatment of Mason type II radial head fracures, closed reduction and K-wire internal fixation under C-arm guide was an effective method of treatment with satisfactory results and no complications.

Posterior Lumbar Interbody Fusion with Chip Bone and Pedicle Screw Fixation: Comparative Study between Local Chip Bone Graft and Autoiliac Chip Bone Graft / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of posterior lumbar interbody fusion utilizing pedicle screw fixation and chip bone graft, and to compare the radiologic and clinical results in two group which use local chip bone and autoiliac chip bone respectively. MATERIALS AND METHODS: We analyzed 58 cases of single segment chip bone posterior lumbar interbody fusion which were followed up for more than 1 year. Group I was operated with local chip bone and group II with autoiliac chip bone. Radiologic union was assessed, based on Brantigan & Steffee method and functional outcome by Kirkaldy-Willis criteria. Student t-test and Fisher's exact test were used for statistical analysis. RESULTS: Clinical satisfaction of group I and II were 81.3% and 88.1% respectively (p>0.05). Though 12% of group II complained about pain on the donor site, no one among them were assessed as unsatisfactory. Radiological union was confirmed in 75% in group I and 90% in group II (p>0.05). Twenty five percent of group I and nineteen percent of group II showed collapsed union without significant differences. There were no significant differences between group I and II in loss of disc height, segmental lordosis, operation time and blood loss. CONCLUSION: Both local and autoiliac chip bone posterior lumbar interbody fusion are useful methods in the aspect of radiologic union and functional outcome and there are no significant differences between two groups. However, considerable collapsed unions were observed in both groups. It is necessary to investigate long term influence of collapsed union on the adjacent segment and functional outcome.