Extramedullary Tibial Bone Cutting Using Medial Cortical Line in Total Knee Arthroplasty

PURPOSE: This study aims to identify the effectiveness of the medial cortical line for attaining a more accurate tibial component alignment in proximal tibial resection using an extramedullary alignment rod. MATERIALS AND METHODS: The study examined 100 cases of total knee arthroplasty performed from December 2013 to February 2014 in a retrospective manner. On a preoperative anteroposterior (AP) radiograph of the entire tibia, we identified the medial cortical line that runs parallel to the tibial anatomical axis and passes the medial tibial spine, and measured the point where the medial cortical line crosses between the medial malleolus and the lateral malleolus in the ankle joint. RESULTS: The preoperative AP radiograph of the tibia showed the medial cortical line passing the point 40.4%±0.8% medial to the distance from the medial malleolus to the lateral malleolus including the skin thickness in the ankle joint. When the proximal tibial resection was performed with the extramedullary tibial cutting guide aligned with the medial cortical line, the tibial component angle averaged 0.7°±0.3° varus and the alignment accuracy of the tibial component within 0°±3° varus amounted to 97.0%. CONCLUSIONS: The use of the medial cortical line in proximal tibial resection with an extramedullary tibial cutting guide allowed for relatively accurate alignment of the tibial component.

Radiologic Outcomes According to Varus Deformity in Minimally Invasive Surgery Total Knee Arthroplasty

PURPOSE: To identify the accuracy of postoperative implant alignment in minimally invasive surgery total knee arthroplasty (MIS-TKA), based on the degree of varus deformity. MATERIALS AND METHODS: The research examined 627 cases of MIS-TKA from November 2005 to December 2007. The cases were categorized according to the preoperative degree of varus deformity in the knee joint in order to compare the postoperative alignment of the implant: less than 5degrees varus (Group 1, 351 cases), 5degrees to less than 10degrees varus (Group 2, 189 cases), 10degrees to less than 15degrees varus (Group 3, 59 cases), and 15degrees varus or more (Group 4, 28 cases). RESULTS: On average, the alignment of the tibial implant was 0.2+/-1.4degrees, 0.1+/-1.3degrees, 0.1+/-1.6degrees, and 0.3+/-1.7degrees varus, and the tibiofemoral alignment was 5.2+/-1.9degrees, 4.7+/-1.9degrees, 4.9+/-1.9degrees, and 5.1+/-2.0degrees valgus for Groups 1, 2, 3, and 4, respectively, in the preoperative stage, indicating no difference between the groups (p>0.05). With respect to the accuracy of the tibial implant alignment, 98.1%, 97.6%, 87.5%, and 86.7% of Groups 1, 2, 3, and 4, respectively, had 0+/-3degrees varus angulation, demonstrating a reduced level of accuracy in Groups 3 and 4 (p0.05). CONCLUSION: Satisfactory component alignment was achieved in minimally invasive surgery in total knee arthroplasty, regardless of the degree of varus deformity.

The Results of Long-term Follow-up of Total Hip Arthroplasty Using Hydroxyapatite-coated Cups / 대한고관절학회지

PURPOSE: The aim of this study was to report the long-term outcome and the failure mechanism of cementless total hip arthroplasty (THA) using hydroxyapatite (HA)-coated acetabular cup. MATERIALS AND METHODS: From January 1992 to May 1994, a total of 123 consecutive cementless primary THAs were performed using a HA-coated acetabular cup with metal-on-polyethylene articulation. We retrospectively evaluated 66 hips available for follow-up at a mean 18.3 years (range, 10.4-23.6 years). The survival analysis was performed by the Kaplan-Meier method. We defined end point as any failure that required a reoperation of acetabular component. RESULTS: Thirty-nine of 66 hips (59.1%) were defined as a failure for progressive acetabular osteolysis or aseptic loosening of the cup. Acetabular osteolysis was observed in 47 hips (71.2%) and 33 hips (50.0%) were revised because of cup loosening. The Kaplan-Meier method showed the survival rate of the acetabular cup to be 46.3% at 15 years and 34.8% at 20 years for any failure that required a reoperation of acetabular component. CONCLUSION: The long-term survival rate of THA using HA-coated acetabular cup was unsatisfactory, and it was attributed to vulnerable property of HA coating and progressive osteolysis.

Minimum 5-year Follow-up Results of Minimally Invasive Total Knee Arthroplasty Using Mini-Keel Modular Tibial Implant

PURPOSE: To evaluate the minimum 5-year mid-term clinical and radiological results of minimally invasive surgery total knee arthroplasty (MIS-TKA) using a mini-keel modular tibia component. MATERIALS AND METHODS: We retrospectively evaluated 254 patients (361 cases) who underwent MIS-TKA between 2005 and 2006. The latest clinical and radiological assessments were done in 168 cases that had been followed on an outpatient basis for more than 5 postoperative years. Clinical results were assessed using the Hospital for Special Surgery (HSS) score and Knee Society score. Radiological evaluation included measurements of knee alignment. RESULTS: The average postoperative knee range of motion and HSS score were 134.3degrees+/-12.4degrees and 92.7degrees+/-7.0degrees, respectively. The average postoperative femorotibial angle and tibial component alignment angle were 5.2degrees+/-1.7degrees valgus and 90.2degrees+/-1.6degrees, respectively. The average tibial component posterior inclination was 4.8degrees+/-2.1degrees. The percentage of cases with tibial component alignment angle of 90degrees+/-3degrees was 96.1%, and that with the femorotibial angle of 6degrees+/-3degrees valgus was 94.0%. Radiolucent lines were observed in 20 cases (12.0%): around the femur, tibia, and patella in 14 cases, 10 cases, and 1 case, respectively. However, they were less than 2 mm and non-progressive in all cases. The survival rate was 99.4% and there was no implant-related revision. CONCLUSIONS: MIS-TKA using a mini-keel modular tibial plate showed satisfactory results, a high survival rate, and excellent clinical and radiological results in the mid-term follow-up.

Periarticular Injection with Corticosteroid Has an Additional Pain Management Effect in Total Knee Arthroplasty

PURPOSE: Although the analgesic effects of corticosteroids have been well documented, little information is available on periarticular injection (PI) containing corticosteroids for early postoperative pain management after total knee arthroplasty (TKA). We performed a prospective double-blind randomized trial to evaluate the efficacy and safety of an intraoperative corticosteroid PI in patients undergoing TKA. MATERIALS AND METHODS: Seventy-six consecutive female patients undergoing bilateral staged TKA were randomized to receive steroid or non-steroid PI, with 3 months separating the procedures. The steroid group received PI with a mixture containing triamcinolone acetonide (40 mg). The non-steroid group received the same injection mixture without corticosteroid. During the postoperative period, nighttime pain, functional recovery [straight leg raising (SLR) ability and maximal flexion], patient satisfaction, and complications were recorded. Short-term postoperative clinical scores and patient satisfaction were evaluated at 6 months. RESULTS: The pain level was significantly lower in the PI steroid than the non-steroid group on the night of the operation (VAS, 1.2 vs. 2.3; p=0.021). Rebound pain was observed in both groups at POD1 (VAS, 3.2 vs. 3.8; p=0.248), but pain remained at a low level thereafter. No significant differences were seen in maximal flexion, frequency of acute rescuer, clinical scores, and patient satisfaction. The steroid group was able to perform SLR earlier than the non-steroid group (p=0.013). The incidence of complications was similar between the groups. CONCLUSION: PI containing a corticosteroid provided an additional pain-relieving effect on the night of the operation. In addition, corticosteroid PI did not increase the perioperative complications of TKA.

Bilateral Insufficiency Fracture of Medial Subtrochanteric Area of the Femur: A Case Report / 대한고관절학회지

A non-traumatic, incomplete insufficiency fracture commonly involves the lateral side of the femoral cortex; whereas a non-traumatic, incomplete stress fracture commonly involves the medial side of the femoral cortex. Here, we describe a case of a 66-year-old woman with a two-month history of bilateral thigh pain without trauma or medication usage who was diagnosed with bilateral subtrochanteric insufficiency fractures involving the medial side of the femoral cortex.

Long-Term Follow-Up Results of a Second-Generation Cementless Femoral Prosthesis with a Collar and Straight Distal Fixation Channels

PURPOSE: We evaluated the results of more than 10 years of follow-up of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels. MATERIALS AND METHODS: One hundred five patients (129 hips) who underwent surgery between 1991 and 1996 for primary total hip arthroplasty using cementless straight distal fluted femoral stems were followed for more than 10 years. Ninety-four hips in 80 patients were available for clinical and radiologic analysis. The mean age at the time of surgery was 47 years, and the mean duration of follow-up was 14.3 years. RESULTS: The mean Harris hip scores had improved from 58 points to 88 points at the time of the 10-year follow-up. Activity-related thigh pain was reported in nine hips (10%). At the last follow-up, 93 stems (99%) were biologically stable and one stem (1%) was revised because of loosening. No hip had distal diaphyseal osteolysis. Proximal femoral stress-shielding was reported in 86 hips (91%). We found no significant relationship between collar-calcar contact and thigh pain, stem fixation status, or stress-shielding. The cumulative survival of the femoral stem was 99% (95% confidence interval, 98-100%) after 10 years. CONCLUSION: The long-term results of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels were satisfactory; however, the high rate of proximal stress-shielding and the minimal effect of the collar indicate the need for some changes in the stem design.

Evaluation of Postoperative Range of Motion and Functional Outcomes after Cruciate-Retaining and Posterior-Stabilized High-Flexion Total Knee Arthroplasty

PURPOSE: The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. MATERIALS AND METHODS: Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. RESULTS: After the 2-year postoperative period, the mean range of motion was 131degrees in the CR-Flex group and 133degrees in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2+/-9.1 points) than in the PS-Flex group (11.9+/-9.6 points); however, this difference was not statistically significant (p=non-significant). CONCLUSION: The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty.

Postoperative Safety of Sequential Bilateral Total Knee Arthroplasty in Low Risk Patients / 대한정형외과학회잡지

PURPOSE: To study the safety of sequential bilateral total knee arthroplasty in low risk patients. MATERIALS AND METHODS: Those who had received the surgery all at once were grouped as the first group, those who had received the surgery over two weeks interval were the second group and the last group, third group were those who had received the first surgery on only one knee and they were gotten re-hospitalized for the second surgery on the rest of the knee. These groups were compared on the aspects of complication, postoperative bleeding amount, average transfusion amount, operation time and admission period. RESULTS: There were no major complications found in all groups and the minor complication rate of occurrence was 3%, 4%, 6% in each, which did not constitute a significance difference. Each of the total blood loss was 1442.9 mL, 1567.4 mL, 1616.6 mL and which did not constitute a significance difference, either. Each of the average volume of blood transfused was 1220.3 mL, 680.1 mL, 692.2 mL, and the first group had the largest volume transfused (p<0.05). The operation time was 186, 196, 211 minutes in each and the first group had the shortest duration (p<0.05). The average admission periods were 16.8, 28.6, 29.8 days and the first group had the shortest period (p<0.05). CONCLUSION: We suggest that when there are no medical diseases contracted on patients, the sequential bilateral total knee arthroplasty can be performed safely without definite increase in perioperative complications.

Prescription Pattern of NSAIDs and the Prevalence of NSAID-induced Gastrointestinal Risk Factors of Orthopaedic Patients in Clinical Practice in Korea

This is a cross-sectional observational study undertaken to explore the current prescription pattern of non-steroidal anti-inflammatory drugs (NSAIDs) and the prevalence of NSAID-induced gastrointestinal (GI) risk factors of orthopaedic patients in real clinical practice in Korea. Study cohort included 3,140 orthopaedic outpatients at 131 hospitals and clinics between January 2008 and August 2008. A self-administered questionnaire was completed by each patient and physician. A simplified risk scoring scale (the Standardized Calculator of Risk for Events; SCORE) was used to measure patients' risk for GI complications. The pattern of NSAIDs prescription was identified from medical recordings. Forty-five percents of the patients belonged to high risk or very high risk groups for GI complications. The cyclooxygenase-2 enzyme (COX-2) selective NSAID showed a propensity to be prescribed more commonly for high/very high GI risk groups, but the rate was still as low as 51%. In conclusion, physician's considerate prescription of NSAIDs with well-understanding of each patient's GI risk factors is strongly encouraged in order to maximize cost effectiveness and to prevent serious GI complications in Korea. Other strategic efforts such as medical association-led education programs and application of Korean electronic SCORE system to hospital order communication system (OCS) should also be accompanied in a way to promote physician's attention.

Cementless Total Hip Arthroplasty Using VerSys Fiber Metal Midcoat Stem: a Minimum 3-Years Follow-up

PURPOSE: The purpose of this study was to retrospectively evaluate the results of cementless total hip arthroplasties that used a Versys fiber metal midcoat femoral stem. MATERIALS AND METHODS: From March 2000 to June 2005, 28 cases in 23 patients were followed up for a minimum of three years. The average follow up period was 5.1 years. Clinical results were evaluated by Harris hip scores. Radiographic analysis was done by evaluating fixation stability, osteolysis, stress shielding, and cortical hypertrophy. RESULTS: The mean Harris hip score improved from 43.1 to 93.8 at the last follow up. In radiographic analyses of the stem, there was no evidence of positional changes or vertical subsidence. There was heterotopic ossification in four, distal cortical hypertrophy in two, proximal stress shielding in twenty, and femoral osteolysis in five cases. The femoral stem revealed a stable bony ingrowth in all. The acetabular cup revealed a stable bony ingrowth in all. There was no evidence of horizontal or vertical migration or of a change of inclination angle of the acetabular cup. CONCLUSION: Cementless total hip arthroplasty using a Versys fiber metal midcoat femoral stem showed good clinical and radiologic results, but long term follow up is needed.

The Mid to Long Term Results of PCL Substitution Type Total Knee Arthroplasty with Using a Scorpio(R) system (Comparison with or without Patella Resurfacing)

PURPOSE: The purposes of this study were to evaluate the clinical results of performing total knee arthroplasty (TKA) with using the posterior substitution (PS) type Scorpio(R) system and to compare the clinical results of the patellar resurfacing group with those of the patellar non-resurfacing group. MATERIALS AND METHODS: 72 TKAs in 51 patients with minimum 7 years' follow-up were evaluated in terms of flexion contracture, the range of motion, the Hospital for Specific Surgery (HSS) knee score and the radiologic findings. We compared the clinical results of 42 cases in 31 patients with patellar resurfacing with those of 30 cases in 20 patients without patellar resurfacing. RESULTS: Flexion contracture, the range of motion and the HSS knee scores were significantly improved after the TKAs. Radiolucencies were found in 14% of the cases on the anteroposterior views of the tibia and in 11% on the lateral views of the femur. One case of aseptic loosening was observed during the follow-up period. There were no significant differences of clinical results between the patellar resurfacing TYAs and the without patellar resurfacing TKAs. CONCLUSION: We achieved favorable results when performing TKAs with the PS type Scorpio(R) system during mid to long term follow-up. There was no significant difference of clinical results between the patellar resurfacing and non resurfacing groups in our study.

Short Term Result of Minimally Invasive Total Knee Arthroplasty with Mini-Midvastus Approach / 대한정형외과학회잡지

PURPOSE: To investigate the effectiveness of minimally invasive total knee arthroplasty using the mini-midvastus approach through analyzing the short-term clinical outcomes. MATERIALS AND METHODS: Seventy-seven consecutive total knee arthroplasties were performed with the mini-midvastus surgical technique from August 2005 to February 2006 and were followed for more than 1 year after the procedure. All operations were performed with the Nexgen LPS-flex total knee system using a MIS quad-sparing instrument. The evaluation included preoperative and postoperative clinical data, surgical and radiological outcomes. RESULTS: The length of skin incision was average 8.4+/-0.6 cm and the operation time was average 95.5+/-15.7 minutes. The blood loss was average 727.5+/-315.5 cc. The tibial component alignment angles averaged 0.2+/-1.3degrees varus and the tibiofemoral angles averaged 5.8+/-1.8degrees. The mean ROM and the mean HSS score was 117+/-10degrees and 120+/-11degrees, 88.9+/-7.1 and 96.2+/-4.5 at eight weeks and one year after surgery respectively. CONCLUSION: If proper surgical procedures are performed using the appropriate surgical instruments, minimally invasive total knee arthroplasty with the assistance of the mini-midvastus approach, can result in good clinical outcomes and alignment of the implants.

Cementless Total Hip Arthroplasty using Ceramic-on-ceramic Osteonics(R) System: Minimum 8-year Follow up Results / 대한정형외과학회잡지

PURPOSE: To evaluate the 8-year follow up results of the clinical and radiographic of the cementless total hip arthroplasty using the Osteonics(R) system with ceramic-on-ceramic articulation on a retrospective basis. MATERIALS AND METHODS: Between March 1999 and February 2000, 31 primary total hip arthroplasties were performed in 27 patients using the cementless Osteonics(R) system. The mean follow-up period was 101 months (96-107 months). The mean age at surgery was 56.5 years of age (28-62 years). Preoperative diagnoses were the following in the 27 patients: 5 cases of primary osteoarthritis, 15 cases of avascular necrosis, and 7 cases of secondary osteoarthritis. The clinical results were evaluated using the Harris hip score and radiographic evaluation was done in terms of the fixation of components, the prevalence of osteolysis, and wear of ceramics. RESULTS: The mean preoperative Harris hip score at was the most recent follow-up was 91. Complications were calcar fracture in 8 cases, posterior dislocation in 2 cases, continuous thigh pain in 2 cases, squeaking sound in 3 cases, and limping gait lasting at least 1-year post operation in 6 cases. All cases had fixation by bony ingrowth was and there was no migration of acetabular cups nor osteolysis. There was no loosening of the femoral stem. It was not possible to measure ceramic wear and there were no ceramic fractures. CONCLUSION: At the 8-year follow-up, results of the cementless total hip arthroplasty using the Osteonics(R) system with ceramic-on-ceramic articulation demonstrated favorable results of osseointegration of the components and unmeasurable ceramic wear. However, longer-term-follow up was necessary. We believe that further study is required to determine the high incidence of squeaking.

The Influence of Obesity on Clinical Outcomes after Total Knee Arthroplasty: A Five-year Minimum Follow-up

PURPOSE: To evaluate the effects of obesity on clinical outcomes following total knee arthroplasty in osteoarthritis patients. MATERIALS AND METHODS: Between June 1999 and February 2002, 239 osteoarthritis patients underwent total knee arthroplasty, and 118 knees of 94 patients treated during this period were followed for a minimum of 5 years. Seventy knees belonged to 56 obese patients (body mass index, BMI>25 kg/m2), while 48 knees belonged to 38 non-obese patients (BMI80 points at final follow-up) (p>0.05). With regard to revision, 4 liner exchanges took place in the obese group due to liner dislodgement, and no liner exchanges took place in the non-obese group. However, there was no significant difference in the incidence of liner exchange between the two groups (p>0.05). CONCLUSION: Obesity (BMI>25 kg/m2) has no effect on total knee arthroplasty outcomes in osteoarthritis patients at 5 years follow-up.

Behcet's Arthritis / 대한정형외과학회잡지

PURPOSE: The clinical manifestations of Behcet's arthritis are similar to those of rheumatoid arthritis, and they need to be differentiated. The objective of this study was to evaluate the past history, diagnosis, treatments and clinical findings of Behcet's arthritis. MATERIALS AND METHODS: Among 1,602 cases with Behcet's disease, 87 cases with Behcet's arthritis were enrolled in this study between January 1990 and December 2000. A thorough review of each case was done by examining the patients' medical charts and personal interview. The clinical manifestation, the existence of morning stiffness and laboratory studies including ESR, CRP, AS, and RF were investigated. The Shimizu classification was used as diagnostic criteria. RESULTS: There was no preponderance of gender and the most prevalent age group was in their 3rd and 4th decades. The most common involved site was the knee joint (60 of 87 cases), and multiple site involvement was common (56.0%). Clinically, symptoms such as pain, tenderness and joint swelling were common. According to the Shimizu classification, the incomplete type was the most common (67.8%). The symptoms improved after conservative treatment, but 12 cases (21.0%) recurred within one year. Arthroscopic synovectomy was performed in 2 cases, but these cases showed no improvement. CONCLUSION: Behcet's arthritis should be differentiated from rheumatoid arthritis, and conservative treatment showed good clinical results.

Factors Affecting Outcome after Total Knee Arthroplasty in Patients with Diabetes Mellitus

PURPOSE: To compare the clinical outcome and complications following total knee arthroplasty (TKA) in diabetic and non-diabetic patients, and to identify diabetes-related risk factors for negative outcomes. MATERIALS AND METHODS: 222 primary TKAs in patients with diabetes were evaluated using Knee Society scores and Hospital for Special Surgery score. Postoperative complications were reviewed retrospectively. The mean follow-up was 53.2 months. The effect of diabetes-related factors and comparison with a matched control group were analyzed statistically. RESULTS: Significant improvements were noted in all the scores after TKA (p < 0.05). There was no statistical difference in clinical sores between the diabetic and non-diabetic patients. In multivariate analysis associating age, gender and body mass index with pain and knee score at the latest follow-up, the average knee scores in normal and overweight group were found to be significantly higher than those in the obese group. The diabetic patients had an increased overall incidence of postoperative complications (17.6%) compared with the control group (8.1%) (p < 0.05). Particularly, the rate of wound complications such as skin necrosis, bulla formation or erythema with drainage was higher in the diabetic group (p < 0.05). Diabetes-related factors did not influence the incidence of complications. Associated diseases were the only significant risk factors correlated with wound complications and meniscal bearing dislodgement. CONCLUSION: Patients with diabetes can benefit from TKA, even though diabetic patients are at an increased risk for overall postoperative and wound complications. Preoperative factors such as obesity and associated diseases may adversely affect the clinical outcome of TKA in diabetic patients.

Obesity and Perioperative Morbidity after Total Hip Arthroplasty in Osteoarthritis Patients

PURPOSE: To evaluate the effect of obesity on perioperative morbidity following total hip arthroplasty in patients with severe osteoarthritis. MATERIALS AND METHODS: Between April 1987 and April 2007, 272 patients with severe osteoarthritis underwent total hip arthroplasty. One hundred seventeen patients were obese (body mass index, BMI> or =25 kg/m2), and 155 were not obese (BMI0.05). However, the medical complication rate was significantly higher in the obese group compared to the non-obese group (4.3% vs. 0.6%, p or =25 kg/m2) has no observable effect on perioperative morbidity in terms of length of hospital stay, operation time, total blood loss and replacement, or surgical complication rate, but is associated with a higher medical complication rate.

Results of Screw Fixation for Displaced Femoral Neck Fracture / 대한정형외과학회잡지

PURPOSE: This study retrospectively reviewed the results of a closed reduction and internal fixation with cannulated screws for a displaced femoral neck fracture. MATERIALS AND METHODS: Among 631 patients between January 1991 and December 2000, 27 patients classified as Garden stage III or IV were treated with a closed reduction and internal fixation with cannulated screws. The mean follow-up duration was 4.5 years. The mean age of the patients was 56.5 years. RESULTS: Union and the restoration of function was observed in 15 cases (55.6%), and failure occurred in 12 cases (44.4%). The cause of failure was early stage reduction loss due to a failure to obtain anatomical reduction on the surgical field in 4 cases, reduction loss and displacement during the follow up period after an appropriate reduction at surgery in 4 cases and avascular necrosis in 4 cases. Seven cases were converted to a total hip arthroplasty, 4 cases were converted to bipolar hemiarthroplasty and 1 case is currently being followed up. CONCLUSION: A closed reduction and internal fixation for displaced femoral neck fracture showed a high failure rate. Therefore, an accurate anatomical reduction, firm internal fixation and efforts to prevent further unnecessary vascular injury will be needed to reduce the high failure rate and complications.

Comparison between the Results of Minimally Invasive Total Knee Arthroplasty Performed with Mini-Midvastus Technique and Quadriceps-Sparing Technique

PURPOSE: To compare the short-term clinical results of mini-midvatus minimally invasive total knee arthroplasty(TKA) with quadriceps-sparing minimally invasive TKA. MATERIALS AND METHODS: Between August 2005 and February 2006, 23 bilateral (46 knees) minimally invasive total knee arthroplasties were performed simultaneously using quadriceps-sparing surgical technique at one side and mini- midvastus minimally invasive technique at the contralateral side. The same surgeon performed all the operations with the same type of prosthesis(Nexgen LPS-flex Total Knee System) using MIS quadriceps-sparing instrument. The pos- toperative clinical and radiological results were analyzed in each group. RESULTS: There were no significant differences between the two groups in the operating time, total blood loss, length of skin incision, radiological results and postoperative HSS scores at 8 weeks and 1 year follow-up(p>0.05). Also, there were no differences in the postoperative range of motion and pain score assessed by visual analog scale at 1 day, 3 days, 7 days, 14 days, 8 weeks and 1 year follow-up(p>0.05). Conclusions: Compared to quadriceps-sparing TKA, mini-midvastus minimally invasive TKA revealed no significant differences in the short-term clinical and radiological results. Therefore, it can be considered as an effective, alternative minimally invasive technique.