Eight to Eighteen Years Follow Up Study of Primary Hybrid Total Hip Arthroplasty Using a Precoat Femoral Stem / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the 15.5 year long term survival rate of the Precoat femoral stem. MATERIALS AND METHODS: We reviewed the results of 105 primary hybrid total hip replacements (98 patients) that were performed by one surgeon between October 1990 and August 1995 using a cemented polymethyl-methacrylate coated femoral prosthesis (Precoat) and contemporary cementing techniques. Thirty four patients (34 hips) died and seventeen patients (17 hips) were lost to follow-up. Forty seven patients (54 hips) were available for clinical follow-up, with an average follow-up period of 15.5 years (range: 8.4 to 18.3 years). The average age of the patients at the time of the index operation was 46 years (range: 22 to 67 years). There were 32 male patients (37 hips) and 15 female patients (17 hips). RESULTS: For the acetabular component, 15 hips (27.8%) were revised for cup loosening and isolated liner exchange was performed in 12 hips (22.2%) for liner wear and osteolysis. For the femoral component, 12 hips (22.2%) were revised due to aseptic loosening. Of these twelve hips, 3 hips had Grade B cement mantles and 9 had Grade C cement mantles. The clinical results of the 54 retained hips were good or excellent in 52 hips (96.3%) with the average Harris hip score being 88 points (range: 72 to 96 points). CONCLUSION: The mean 15.5 years' survival rate of the Precoat cemented femoral stem was 78%. We think that there were several factors for the failure of femoral stem fixation, including age, physical activity and the body weight, as well as the stem design and the surgical technique had an influence on the stem's survival.

A Case of Medial Rectus Muscle Injury after Functional Endoscopic Sinus Polypectomy and Ethmoidectomy

PURPOSE: To report appropriate treatment of medial rectus muscle injury after functional endoscopic sinus polypectomy and ethmoidectomy METHODS: The author experienced the right medial rectus muscle injury after functional endoscopic polypectomy and ethmoidectomy in a 42-year-old man who complained of decreased visual acuity, ocular pain, binocular diplopia, and exophthalmos in the right eye at the first postoperative day. His best corrected visual acuity of right eye was 0.3, Intraocular pressure was 26 mmHg, and pupillary light reflex was decreased. On exophthalmometry, the right eye was more exophthalmic by 3 mm than the left eye. After steroid therapy and befunolol eyedrops instillation, the visual acuity was improved to 0.8 and intraocular pressure was decreased to 18 mmHg. There was severe limitation of medial gaze and about 65 prism diopters of right exodeviation in red filter test. In computerized tomography, bony defect in the right orbital medial wall and defect in the right medial rectus muscle were confirmed. On the third postoperative day, silastic sheet was applied in dehiscent medial wall under endoscopic examination in otorhinolaryngologic outpatient department. Because exodeviation and diplopia had not improved, on the 61th postoperative day, right lateral rectus muscle recession 12 mm was carried out, and then, on the 88th postoperative day, Hummelsheim operation on right eye was done. RESULTS: Right exodeviation was decreased by about 40 prism diopters after right lateral rectus muscle recession 12 mm. and then, after Hummelsheim operation, he had right exodeviation 20 prism diopters of and less binocular diplopia. We prescribed 10 prism diopters of prism lens in each eye, but he complained of decreased visual acuity and cosmetic problem. So, we prescribed 5 prism diopters of prism lens in each eye. At the last follow-up he is satisfied with his visual acuity and cosmetic aspect.