Effects of Intravenous and Epidural Patient-Controlled Analgesia on Postoperative Pain and Knee Rehabilitation after a Unilateral Total Knee Replacement / 대한마취과학회지

BACKGROUND: Postoperative pain is a major concern after a total knee replacement (TKR). It hinders early intense physical therapy, the most influential factor for good postoperative knee rehabilitation. The purpose of this study was to compare intravenous patient-controlled analgesia (IV-PCA) using morphine and continuous ketorolac IV infusion with patient-controlled epidural analgesia (PCEA) using morphine and continuous bupivacaine infusion in terms of analgesic efficacy and postoperative knee rehabilitation after a unilateral TKR. METHODS: Eighteen patients undergoing a unilateral total knee replacement were randomly allocated to one of the two groups. In group IV-PCA (n = 9), 30 min before the end of surgery, patients received ketorolac 30 mg IV bolus followed by continuous infusion with ketorolac (5 mg/h) and IV-PCA with morphine (20microgram/kg, lockout 10 min). In group PCEA (n = 9), 30 min before the end of surgery, patients received 2 mg morphine bolus followed by continuous infusion with 0.1% bupivacaine (2 ml/h) and PCEA with morphine (1 mg, lockout 15 min). RESULTS: There were significant differences in visual analogue scale scores at the first 2-hours after the unilateral TKR, cumulative morphine consumption and number of postoperative days required to obtain 90o knee flexion. CONCLUSIONS: PCEA using a morphine-bupivacaine combination provided better pain relief and faci litated the continuous passive motion more than IV-PCA using a morphine-ketorolac combination. This results in possible faster postoperative knee rehabilitation.

Revisional Reconstruction of Anterior Cruciate Ligament using Modified One Incision Technique with Autogenous Hamstring Tendon Composite Graft / 대한정형외과학회잡지

PURPOSE: Evaluation of anterior cruciate ligament (ACL) reconstruction using autogenous hamstring tendon composite grafts and the modified one incision technique for the revisional ACL reconstruction. MATERIALS AND METHODS: Eight cases that had undertaken revisional ACL reconstruction were evaluated. Follow-up period was 17.5 months on the average (12-41) . All cases were evaluated using the Lysholm knee score, KT-2000 arthrometer (Medmetrics) and one leg hop test. RESULTS: Lysholm knee score increased from 67.8 to 80.6 by an average of 13 points. When comparing with normal side, the average differences of anterior translation was 2 mm and the average functional activity was 77.1% of the healthy side. All cases returned to the normal activities of daily living. CONCLUSION: New femoral and tibial tunnel can be made regardless of pre-existing tunnels with modified one incision technique and hamstring tendon composite graft. Allogeneous bone grafts were used to fill the enlarged tunnels caused by overlapping with pre-constructed tunnels.

Cardiovascular Responses to Isometric Handgrip Exercise

Isometric contractions of muscles in upper extremities occur frequently during ordinary daily activities. The isometric handgrip exercise can be one of the best methods for the evaluation and treatment of patients with disability of upper extremity. However these isometric contractions can impose sudden and significant high stresses to the cardiovascular system. The purpose of this study was to document the torque patterns and cardiovascular responses of subjects by the isometric handgrip exercises and hopefully to provide a guidance for the safe evaluations and prescriptions of isometric exercises. Eighty healthy male subjects from 21 to 60 years of age performed isometric handgrip exercises using a Baltimore therapeutic equipment work simulator. The peak torque, time to peak torque, and torque at each second were measured by a six-second isometric strength trial program. The blood pressure and heart rate were measured simultaneously at rest and at each minute during isometric exercises at 30%, 50%, and 70% of the peak torque. There were no differences in the peak torque, time to peak torque, and torque at each second between age groups(p>0.05). After the onset of peak torque, the torque gradually decreased and recorded 72.8% of the peak torque at 6 seconds. The mean arterial pressure and heart rate increased significantly during exercise(p<0.001), but returned to the resting state immediately when the exercise stopped. The mean arterial pressures were significantly different when the duration of exercise prolonged at 50% and 70% of the peak torque(p<0.05). And also the mean arterial pressures increased significantly when the strength of exercise increased as well(p<0.001). We have concluded that attentions should be given to patient's cardiovascular state, and duration and strengh of exercise when the isometric handgrip exercises are prescribed for the evaluation and treatment of patients.

Association of osteoarthritis and bone mineral density in women: The health and nutritional examination survey in Kuri / 예방의학회지

Previous studies, reporting the inverse relationship between osteoarthritis and osteoporosis suggest the existence of possible pathophysiologic mechanisms between them. To examine the hypothessis that "bone mineral densities of women with osteoarthritis are significantly higher than that of women without osteoarthritis in Korea", subjects from the health and nutritional examination survey in Kuri city were sampled. Samples were selected through multi-stage sampling frame using established clusters in Kuri city. From August 18 to September 10, 1997, the survey was conducted. Among the total number of selected sample population(1,656 people), response rate was 52.4 percent(348 men and 519 women). 420 women who took BMD measurement, radiologic exam, and anthropometric exam were selected for the analysis. The analysis results are as follows. 1. General characteristics : Mean BMD was 0.493 g/cm2, mean age was 43.0, mean BMI was 23.9 kg/m(3). The number of women who experienced menopause was 106, hysterectomy was 19. There were 0 case of osteoarthritis of hip, 64 cases of osteoarthritis of knee, and 2 cases of osteoarthritis of hand. 2. Univariate analysis results : Mean BMD of women with the osteoarthritis of knee was significantly lower than that of women without the osteoarthritis of knee(0.4296 vs. 0.5057 g/cm2). But, there were to few cases of osteoarthritis of hip and hand, so comparative studies of BMD in ostearthritis of hip and hand could not be conducted. There were significant differences of BMD among pre-menopause group(0.5204), post-menopause group(0.4206), and hysterectomy group(0.4881). Additionally, there were significant differences of BMD among diabetes group(0.4297), impaired glucose tolerance group(0.4874), and normal group(0.5057). Furthermore, age, parity, BMI, bioimpedance wer significantly related with BMD. 3. Multivariate analysis results : To examine the relationship between osteoarthritis and BMD while controlling the other variables' effects which were significant in the univariate analyses, multiple linear regression analysis was done. But, it was found that osteoarthritis of knee was not a significant variable to BMD anymore. While age and menopause had significant negative relationship with BMD. Diabetes, parity, BMI, and bioimpedance did not have significant relationships with BMD. After stratification of subjects according to menopause, multiple linear regression analyses were done to each strata. Consequently, age in post-menopause group, age and osteoarthritis of knee in hysterectomy group showed significant negative relationship with BMD. The results did not support the many results of other previous studies done with white men and women. Further studies of biological plausibility to Korean women are recommended. Also it is suggested that longitudinal study to verify the relationship between osteoarthritis and BMD will be valuable.