Lordoplasty: An Alternative Technique for the Treatment of Osteoporotic Compression Fracture

We report here on a new technique using polymethylmethacrylate to manage vertebral osteoporotic compression fractures in three patients. These patients presented with acute back pain that manifested itself after minor trauma. Osteoporotic compression fractures were diagnosed via plain X-ray and magnetic resonance imaging studies. The patients were treated with absolute bed rest and non-steroidal anti-inflammatory drugs. Despite of the conservative treatment, the patients experienced severe, recalcitrant and progressive pain. The vertebrae were collapsed over 50% or kyphotic deformity was seen on the radiologic materials. We performed a new technique called lordoplasty, which is derived from percutaneous vertebroplasty. The patients experienced a reduction in pain after the procedure. The wedge and kyphotic angles of the fractured vertebrae were significantly restored.

Cementless Total Hip Arthroplasty Using a Ceramic on Ceramic Bearing Surfaces in Patients 60 or More Years Old

PURPOSE: To investigate clinical and radiographic results for cementless total hip arthroplasty (THA) using ceramic-on-ceramic articulation in patients over 60 years old. MATERIALS AND METHODS: Between May 2000 and February 2007, we analyzed 44 THAs that used ceramic-on-ceramic articulation in 34 patients aged 60 or older. The mean follow-up duration was 3.2 years; the mean age was 66.8 years. Clinical and radiographic evaluations were carried out. Risk factors for dislocation were evaluated. RESULTS: Final Harris hip scores increased to an average of 90 points from an average of 51 points preoperatively. Radiographic findings demonstrated that fixations around the stems and the acetabular cups were stable. There was no aseptic loosening and osteolysis around the implants. There were 10 cases of posterior dislocation within 3 months postoperatively. Two revisions were done, one due to a recurrent dislocation and one to a ceramic head fracture. Risk factors for dislocation were ASA score, cup anteversion angle and total anteversion angle. CONCLUSION: Cementless THAs using ceramic-on-ceramic articulation for patients aged sixty or more elicits good clinical and radiographic results. Because of the high rate of early dislocation and damage to the ceramic, we call attention to the position of the implants and postoperative management in elderly, debilitated patients.

Chronic Post-traumatic Inflammatory Tenosynovitis of the Finger Joint

PURPOSE: Chronic inflammatory tenosynovitis (CITS) involving the finger joint after trauma has been rarely reported. This study reports the surgical results of ten patients with CITS. MATERIALS AND METHODS: From March 2007 to June 2009, ten patients with pain, swelling and limitation of motion of the finger were diagnosed as CITS. All patients had a history of direct injury. The operation was performed at a mean of 6.6 months after the onset of symptom. Average range of motion was 54 degrees in five patients with CITS of the metacarpophalangeal joint and was 44 degrees in five patients with that of the proximal interphalangeal joint. The mean follow-up duration was 15 months. Two of ten patints showed the involvement of the bone. Tenosynovectomy was performed and four patients required volar and dorsal double incisions. In cases of the bony invasion, multiple drilling and curettage was done. RESULTS: Postoperatively, all patients showed improvement of pain and swelling and did not show recurrence. The magnetic resonance image was carried out in all patients and showed the inflammatory changes of the tendosynovium and joint capsule. Culture and PCR test for tuberculosis showed negative findings in all cases. However, anti-tuberculosis chemotheraphy for nine months was applied to three patients who showed caseous necrosis or rice body in biopsy. The mean range of motion was 66 degrees in metacarpophalangeal joint and 53 degrees in proximal interphalangeal joint. CONCLUSIONS: Magnetic resonance image appears helpful in the diagnosis and the treatment of CITS which involved the joint of hand and the operative treatment can improve the symptoms and clinical outcomes.

Comparison of Kyphoplasty and Lordoplasty in the Treatment of Osteoporotic Vertebral Compression Fracture

STUDY DESIGN: A retrospective study. PURPOSE: To compare the level of restoration of the vertebral height, improvement in the wedge and kyphotic angles, and the incidence of complications in osteoporotic compression fracture in patients treated with either kyphoplasty or lordoplasty. OVERVIEW OF LITERATURE: Kyphoplasty involves recompression of the vertebral bodies. Recently, a more effective method known as lordoplasty was introduced. METHODS: Between 2004 and 2009, patients with osteoporotic thoracolumbar vertebral compression fractures were treated by either kyphoplasty (n = 24) or lordoplasty (n = 12) using polymethylmethacrylate (PMMA) cement, and the results of the two interventions were compared. A visual analogue scale was used to measure the pain status. Preoperative and postoperative radiographs were analyzed to quantify the anterior vertebral height restoration and the wedge and kyphotic alignment correction. RESULTS: All patients in both groups reported a significant decrease in pain. The anterior heights increased 24.2% and 17.5% after the lordoplasty and kyphoplasty procedures, respectively (p < 0.05). Three months after the procedures, there was a larger decrease in the loss of anterior vertebral height in the kyphoplasty group (12.8%) than in the lordoplasty group (6.3%, p < 0.05). The wedge angles decreased after both procedures. The wedge angle in the lordoplasty group maintained its value after 3 months (p < 0.05). The kyphotic angular correction was 11.4 and 7.0degrees in the lordoplasty and kyphoplasty groups, respectively (p < 0.05). Both kyphotic deformities worsened to a similar degree of 5degrees after 3 months. CONCLUSIONS: Lordoplasty is more useful than kyphoplasty in terms of the improved anatomic restoration and postoperative maintenance.

Transforaminal Selective Nerve Root Blocks for Treating Single Lumbosacral Radiculopathy: The Short-term Outcome and Efficiency / 대한정형외과학회잡지

PURPOSE: We wanted to determine the clinic usefulness of selective nerve root block for treating lumbosacral radiculopathy that's due to a herniated nucleus pulposus (HNP) or foraminal stenosis (FS) by analyzing the short-term results after the selective nerve root block (SNRB) procedure. MATERIALS AND METHODS: Sixty-five patients were investigated in our research. Sixty-five patients were divided into two groups: thirty-seven patients of group one were the HNP patients and twenty-eight patients of group two were the FS patients. The effect of SNRB treatment was assessed by the degree of radiating pain in lower legs with using the visual analogue scale (VAS) and patients' subjective satisfaction. The average overall follow-up period was eleven months: that of the first group was 13.5 months and that of the group was 7.6 months. RESULTS: For the 65 patients, the average VAS was 7.8 before a SNRB procedure and this decreased to 2.9 and 3.4 after one to three SNRB procedures, respectively. For group one, the VAS was 7.4 before the procedure and it decreased to 3.3 at one month and 3.7 at three months after the procedure. For group two, the VAS was 8.3 before the SNRB procedure and this favorably changed to 2.3 at one month and 3.0 at three months after the procedure. An operation was carried out due to no response for 8 patients (12%) and due to aggravation for 4 patients (6%) after the SNRB procedures. Three patients (8%) of group one and two patients (11%) of group two obtained pain relief at one month and aggravation at three months, respectively. On comparing the two groups, a better treatment effect was observed for the FS group after one month (p=0.002) and three months (p=0.01). Complications related to the SNRB procedure haaves not been observed in both groups. CONCLUSION: The SNRB procedure is a very effective and safe procedure, after the appearance of symptoms, as a non-operative treatment for single lumbosacral radiculopathy due to a herniated nucleus pulposus or foraminal stenosis. This treatment appears to be more effective for the FS group than for the HNP group and it should be considered before carrying out an operative treatment.

The Expression of Extracellular Matrix mRNA in the Chondrocytes of the Femoral Head Affected by Avascular Necrosis

PURPOSE: The aim of this study was to evaluate the expression of type II collagen, aggrecan, VEGF-A and PEDF mRNAs in the human chondrocytes derived from the articular cartilage of the femoral heads with avacular necrosis (AVN). MATERIALS AND METHODS: We cultured human chondrocytes that were primarily derived from the articular cartilage of femoral heads with AVN. We evaluated the mRNA expression of type II collagen, aggrecan, VEGF-A and PEDF. RESULTS: The chondrocytes of the AVN group showed decreased expressions of type II collagen mRNA and aggrecan mRNA (p0.05). CONCLUSION: The cartilage matrix's formation ability was found to be decreased in the chondrocytes of the femoral heads affected by AVN.