Thompson Quadricepsplasty in Ankylosis of the Knee Joint / 대한정형외과학회잡지

PURPOSE: To evaluate the results of Thompson quadricepsplasty in ankylosis of the knee joint by a comparison of the patients'ages, the causes, the duration of the ankylosis and the preoperative range of motion (ROM). MATERIALS AND METHODS: We reviewed 17 patients who received Thompson quadricepsplasty for knee ankylosis between 1991 and 1998, and who could be followed up for more than one year. We compared the results according to the patients'ages, the causes and degree of ankylosis and the duration. Since onset, the postoperative ROM, the final degree of the flexion, the flexion gain (difference between the preoperative and the postoperative ROM), and the loss of ROM (difference between the intraoperative ROM and the postoperative ROM) were also assessed. RESULTS: The preoperative mean arc of motion (26.2degrees, range 0degrees-80degrees) and the mean flexion (30degrees, range 5degrees-90degrees) were significantly increased up to a mean of 98.8degrees (75-100degrees) and 102.1degrees (80-130degrees) respectively. In the severe ankylosis group, the flexion gain was significantly increased. However, the correlation according to the patients'ages, causes and duration of the ankylosis were not statistically significant. The mean loss of ROM was 14.7degrees (-20-30degrees), and it occurred within the postoperative 2 month period in most patients. CONCLUSION: The Thompson quadricepsplasty procedure can be considered to be an acceptable technique for the treatment of ankylosis of the knee joint. Rehabilitation in the postoperative 2 month period is very important for a good outcome.

Analysis of 1,000 Cases of Total Knee Arthroplasty: Preliminary Report / 대한정형외과학회잡지

PURPOSE: To analyze the results and complications arising from 1,000 cases of primary total knee arthroplasty (TKRA), as performed by one surgeon. MATERIALS AND METHODS: From February, 1992 to June, 2000, 1,000 cases of primary TKRA were performed by a single surgeon. Among the 1,000 cases, 573 cases followed up for more than one year (average 2.9 years) were evaluated try allocating special surgery (HSS) scores and by determining the range of motion (ROM), and presence of complications retrospectively. RESULTS: There were 872 cases of primary osteoarthritis, 70 cases of rheumatoid arthritis, 32 cases of osteonecrosis, and 26 cases of miscellaneous diseases. The HSS score increased from 57.8 preoperatively to 90.4 postoperatively, ROM increased from 111degrees to 113degrees and flexion contracture decreased from 9degrees to 2degrees, but no statistical differences in results were observed between diseases. Common causes of complications were superficial infection (3.6%), deep infection (2.4%) and deep vein thrombosis (1.8%). Two patients died, one due to myocardial infarct and the other due to an unknown etiology. Revision arthroplasties were performed in 19 cases. CONCLUSION: After primary TKRA, ROM and functional score improved satisfactorily. No statistical differences were apparent between diseases. Infection was the most common complication.

Treatment of Infected TKRA / 대한정형외과학회잡지

PURPOSE: To investigate the causes and to determine the most useful test for the early diagnosis of infected TKRA, and to present the treatment modality and its possible complications. MATERIALS AND METHODS: We reviewed 17 cases, with follow up, among the 18 infected TKRA cases registered from March 1992 to June 2000. Diagnosis of deep infection after TKRA was made by assessing clinical symptoms, laboratory and radiological findings, nuclear scan studies and aspirate culture results. Data were analyzed clinically by HSS score, recurrence of infection and postoperative complications. RESULTS: The overall incidence of deep infection after TKRA was 1.4%. In fourteen of the 17 cases TKRA was revised. In 13 cases, excluding 1 case of infection recurrence after 2-stage TKRA revision, the mean ROM increased from 55o to 86o and the mean HSS score increased from 53 points to 84. Knee fusion was performed in 4 cases, including one case of infection recurrence after 2-stage TKRA revision. CONCLUSION: The most reliable clinical results were achieved after a 2-stage TKRA revision. Knee joint fusion should be considered when the general condition is poor, with an initial diagnosis of infection, and in the presence of skin problems.

Interleukin-6 and Soluble Interleukin-6 Receptor in Degenerative Arthrits / 대한류마티스학회지

Unlike other soluble receptors, the soluble interleukin-6 receptor (sIL-6R) cooperates with IL-6 to activate gp130 of effector cell. As the IL-6 and sIL-6R are important in the rheumatoid disease, this study was designed to measure concentration of IL-6 and sIL-6R in synovium and synovial fluid of the degenerative arthritis. The synovium and synovial fluid were obtained during total knee replacement arthroplasty. The synovium was taken from eleven patients, and synovial fluid taken from sixteen patients. Same patients between two groups were seven. Tissue cultures of the synovial tissues were done with 10% FBS for 72 hours. After irrigation, thery were incubated for 48 hours without FBS, and the culture media and the synovial fluid were collected after centrifuged at 2500rpm for 10 minutes. The level of IL-6 and sIL-6R were measured by quantitative sandwich enzyme immunoassay technique. RESULTS: In the synovium, the IL-6 level was 5.1+/-0.12ng/ml, and the sIL-6R level was 0.41+/-0.25ng/ml. In the synovial fluid, the IL-6 level was 0.09+/- 0.15ng/ml, and the sIL-6R level was 10.37+/-3.28ng/ml. These results show that IL-6 concentration was measured highly in two groups, especially in synovium (sixty times), and the sIL-6R concentration was measured significantly high in synovial fluid (twenty-five times). CONCLUSION: The IL-6 and sIL-6R were elevated in degenerative arthrits. We confirmed the source of IL-6 was synovium (very high in synovial tissue culture media), but we need further study for the source of sIL-6R as it was remarkably elevated as IL-6 and its level was lower than serum.

Percutaneous Iliosacral Screw Fixation in Unstable Pelvic Ring Injury / 대한정형외과학회잡지

PURPOSE: To evaluate and analyse the operative results of percutaneous iliosacral screw fixation in displaced posterior pelvic ring injuries. MATERIALS AND METHODS: Fourteen consecutive patients with displaced posterior pelvic ring injuries (August 1995-June 1998) treated by percutaneous iliosacral screw fixation were reviewed. We analysed the pattern of fracture, associated injury and method of operation including patient's position, complication and functional result. RESULTS: Seventeen iliosacral screws under fluoroscopic guidance were applied in fourteen patients. During the operations various positions of patients were possible, and all cases were treated with closed reduction and percutaneous iliosacral screw fixation except in one case (open reduction and percutaneous screw fixation). Fixation of associated anterior pelvic ring injury was undertakes in eight cases. Screw-related neurovascular injury and other complications such as breakage, loosening, misplacement and redisplacement, nonunion and screw site infection during follow-up period were not found. Satisfactory clinical and radiologic results were achieved during follow-up period except in one case (limping due to leg length discrepancy, malreduction) in this study. CONCLUSION: Precise understanding of iliosacral anatomy and its variants, proper patient positioning and appropriate intraoperative interpretation of fluoroscopic iliosacral image are mandatory. We believe percutaneous iliosacral screw fixation is a useful addition to treatment options for unstable posterior pelvic ring injury.

Discoid Meniscus: Arthroscopic Classification , Pattern of the Tear and Treatment / 대한정형외과학회잡지

Discoid meniscus has been defined as a morphological anomaly, and several clinical classification has been proposed. Commonly used classification is Watanabes classification; complete, incomplete and Wrisberg ligament type discoid meniscus. It is a relatively more common disease of the knee in Korea and Japan than western countries. Eighty-one discoid meniscal tears which were operated arthroscopically between the period of June, 1991 and August, 1996 were reviewed retrospectively. The purpose of this study is to analyze the pattern of the tear and the extent of arthroscopic resection according to the arthroscopic classification of the discoid meniscus. Thirty-three cases were classified as complete and forty-five cases as incomplete and three cases were Wrisberg ligament type. The major pattern of the tear in the complete type lesions was horizon- tal(in twenty-three) and complex(in seven) tear. Of the knees that had an incomplete type lesion, longitudinal(in ten including six bucket-handle tear) and degenerative tear(in eight) were observed more frequently, and horizontal tear(in ten) less frequently than that of the complete type. The extent of arthroscopic resection of the discoid meniscus was related to the pattern of tear and type of the discoid meniscus. For the majority of the horizontal tear, arthroscopic partial meniscectomy (twentyeight of thirty-four) was performed, but arthroscopic subtotal and total meniscectomy was performed more frequently for longitudinal tear, complex tear, and Wrisberg ligament type.

Plate Designed for Wiring ( CHO Plate ) / 대한정형외과학회잡지

Although intramedullary nailing is mostly used in the management of fractures in the long bone shaft, plate fixation is still alternative option in periprosthetic or metaphyseal fractures. For the rigid fixation during plating, sometimes we need wiring. Many surgeons experience slippage of wire resulting in loss of rigid fixation because plate and wire is so slippery and the diameter of bone is changing by level especially in the metaphyseal area. Wiring plate(CHO plate) was designed to prevent slippage. This plate has transverse holes for wires between screw holes on traditionally used dynamic compression plate. Sixteen fractures of long bone shaft were fixed with wiring plate and 11 cases which were followed up for more than one year were evaluated. There were periprosthetic fractures(4 cases), spiral or butterfly fractures(4 cases) and fractures of poor bone quality(two cases of malignancy and one case of osteoporosis). Nine cases were successfully reduced and the healed without loss of fixation. In two cases, delayed union and nonunion were observed due to wire breakage with plate loosening. Preliminarily, wiring plate fixation can be used for the periprosthetic fracture and one of alternative option in butterfly or spiral fracture and fracture in osteoporotic bone or pathologic fracture.