Treatment of Infected Total Hip Arthroplasty

Deep infection after total hip arthroplasty is one of the most serious post operative complications. Treatment of infection of the hip joint can be made very difficult by poor response to antibiotic therapy. Infection rates of total hip arthroplasty have decreased due to prophylactic antibiotics, sterilization of surgical instruments, cleaner operation environments, Improvement of surgical methods and proper patient selection. Recently, post operative infection rates of primary or revision arthroplasties were reported to still be as high as 1% to 2%. Therefore, the aim of this article is to review the recent literature and to evaluate the cause, environment diagnosis and treatment of infection after total hip arthroplasty.

Treatment of Posterolateral Rotatory Instability of the Knee

Injury of posterolateral corner is unusual, but it can cause disability due to severe instability and cartilage damage. However, the anatomical structures, diagnosis and treatment have not defined clearly yet. Posterolateral corner injury is regarded as the one of main factor to the results of failure in cruciate ligament reconstcution if it was undiagnosed and untreated. Diagnosis of postetolateral corner injury is consists of physical exam, radiographic finding, MRI, and arthroscopic findings. The treatment method of of postetolateral corner injury depends on the time and severity of injury. Anatomical reconstruction of posterolateral corner shows the better clinical outcome than non anatomical reconstructions, but the clinical results of long term follow up is still needed. Therefore, the aim of this article is to review the recent literature and to organize diagnosis and treatment of posterolateral corner injury

Short-term Results of Medial Displacement Calcaneal Osteotomy for Flexible Flatfoot / 대한족부족관절학회지

PURPOSE: To evaluate the short-term results of medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot deformity. MATERIALS AND METHODS: Twenty four patients (25 feet) who had undergone medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot between July 2004 and May 2007 were included. The mean age was 43.6 years (16~78 years). The mean follow-up was 26 months (14~50 months). Clinical outcomes were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Six radiographic parameters were measured from weightbearing radiographs to assess the difference between preoperative and postoperative radiographs. RESULTS: The mean AOFAS score improved from 57.9 points preoperatively to 89.2 points at latest follow-up (p=0.000). The mean VAS improved from 62 points preoperatively to 23 points at latest follow-up (p=0.000). The mean talonavicular coverage angle on anteroposterior (AP) view changed from 20.2 degrees to 16.0 degrees (p=0.002). The mean calcaneal pitch angle on lateral view changed from 12.6 degrees preoperatively to 14.5 degrees at latest follow-up (p=0.001). Regarding these radiographic parameters, the difference between interobserver measurements was larger than that between pre- and post-operative measurements. The calcaneus was transferred medially by average 11.8 mm (p=0.003), which was 27.9% of the width of calcaneal tuberosity (p=0.000). The mean talo-first metatarsal angle on AP and lateral views, and navicular height on lateral view were not significantly changed. CONCLUSION: Medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot could lead to improve the clinical outcomes, although the restoration of medial longitudinal arch was not clinically significant.

Clinical Results of the Subtalar Arthroereisis for the Flat Foot / 대한족부족관절학회지

PURPOSE: To determine the clinical and radiographic results of arthroereisis using the Kalix(R) implant (Newdeal, Lyon, France) for the treatment of flexible flatfoot deformity. MATERIALS AND METHODS: From February 2005 to February 2007, we performed the subtalar arthroereisis on 8 patients (9 feet) of symptomatic flexible flat feet after more than 6 months of conservative treatment. Average age was 14.5 years (11~29 years) old. We checked the functional status with AOFAS functional score pre-operatively and at final follow-up. Radiologically, we took weight bearing anterior to posterior and lateral view of the feet, and measured the talo-first metatarsal angle, calcaneal pitch angle in pre-operatively and at final follow-up. RESULTS: Mean follow up period was 34.4 months. Average AOFAS score improved from preoperatively 65.6 to postoperatively 94.8. Average lateral talo-first metatarsal angle reduced from 12.8degrees preoperatively to 1.6degrees at final follow-up. Average anterior to posterior talo-first metatarsal angle was reduced from 15.1degrees preoperatively to 8.3degrees at final follow-up. Average calcaneal pitch angle was increased from 9.5degrees preoperatively to 12.0degrees at final follow-up. CONCLUSIONS: Subtalar arthroereisis with Kalix(R) implant can be considered to be one of treatment options symptomatic flatfoot deformity patients.