Influence of the Rotational Alignment of the Femoral and Patellar Components on Patellar Tilt in Total Knee Arthroplasty

PURPOSE: The purpose of this study was to analyze the influence of rotational alignment of the femoral and patellar components on patellar tilt after total knee arthroplasty (TKA). MATERIALS AND METHODS: A total of 56 patients (76 knees) who underwent TKA using Advance Medial Pivot Knee system between May 2009 and April 2011 and were available for minimum 1-year follow-up were enrolled in this study. Whiteside's line and the transepicondylar line were used to determine the rotational alignment of the femoral component. Patella cut was aimed to be parallel to the anterior patellar cortex during surgery. Radiographic evaluation was performed using plain axial radiographs. The rotational alignment of the femoral component was measured as the angle between the anterior condylar axis and the surgical transepicondylar axis. The patellar resection angle was measured between the patellar resection axis and the anterior cortical line of the patella. Patellar tilt was evaluated to investigate the correlation with the rotation of the femoral component and patellar resection angle. RESULTS: The mean rotation of the femoral component was 0.42degrees+/-3.18degrees of internal rotation. The mean patellar resection angle was 1.82degrees+/-3.44degrees, indicating medial overresection. The mean patellar tilt was 6.12degrees+/-4.31degrees of lateral tilt. The rotational angle of the femoral component showed a negative correlation with patellar tilt in the linear regression analysis (p=0.749), but the patellar resection angle showed a positive correlation with patellar tilt (p<0.001). CONCLUSIONS: Accurate patellar resection is recommended for proper patellar tracking in TKA.

Surgical Outcome of Tuberculous Myelitis, Arachnoiditis and Spondylitis after Brain Meningitis: A Case Report

STUDY DESIGN: A case report. OBJECTIVES: To report a rare case of a surgically treated tuberculous myelitis and arachnoiditis patient with incomplete paraplegia. SUMMARY OF LITERATURE REVIEW: Tuberculous myelitis and arachnoiditis is a rare disease with a high rate of neurologic deficit. This condition is treated using antituberculous medication and high-dose steroid therapy, but surgical treatment has rarely been reported and the outcomes vary. MATERIAL AND METHODS: A 29-year-old female had tuberculous myelitis and arachnoiditis. The patient was treated with antituberculous medication and high-dose steroid therapy, but the treatment failed and the patient could not walk because of incomplete paraplegia. The surgical treatment was performed twice; we decompressed by total laminectomy and debrided the infected arachnoid membrane. Four months after surgery, we performed anterior interbody fusion due to the development of spondylitis with kyphosis. RESULTS: Three years after the first operation, the patient's neurologic state improved and she could walk 90 m without assistance. CONCLUSIONS: Here, we report a very rare case of surgically treated tuberculous myelitis and arachnoiditis and provide a treatment option for this condition to spine surgeons.

Height Restoration after Balloon Kyphoplasty in Rheumatoid Patients with Osteoporotic Vertebral Compression Fracture

STUDY DESIGN: Retrospective study. PURPOSE: This study was conducted to compare vertebral body height restoration rate in rheumatoid arthritis (RA) patients who had undergone percutaneous balloon kyphoplasty (KP) with that of control group who had matched age, sex, body mass index, and bone mineral density. OVERVIEW OF LITERATURE: There is no report on result of KP in RA patients. METHODS: Postoperative height restoration rate of RA group consisting of 15 patients (18 vertebral bodies) who had undergone KP due to osteoporotic vertebral compression fracture with a 30% or higher vertebral compression rate between May 2005 and January 2013 were compared to control group consisting of 38 patients (39 vertebral bodies) who had matched age, sex, body mass index, and bone mineral density. RESULTS: No statically significant difference in age (p=0.846), sex (p=0.366), body mass index (p=0.826), bone mineral density (p=0.349), time to surgery (p=0.528), polymethylmethacrylate injection time (p=0.298), or amount (p=0.830) was found between the RA group and the control group. However, preoperative compression rate in the RA group was significantly (p=0.025) higher compared to that in the control group. In addition, postoperative height restoration rate showed significant correlation with the RA group (p=0.008). Although higher incidence of recollapse occurred in the RA group compared to that in the control group, the difference was not statistically significant (p=0.305). CONCLUSIONS: Compared to the control group, RA patients showed higher compression rate and higher vertebral restoration rate after KP, indirectly indicating weaker bone quality in patients with RA. Higher incidence of recollapse occurred in the RA group compared to that in the control group, although it was not statistically significant.

Management of Tibial Bony Defect with Metal Block in Primary Total Knee Replacement Arthroplasty

PURPOSE: To analyze minimum 2-year clinical and radiological follow-up results of primary total knee replacement arthroplasty (TKRA) with metal block augmentation for tibial bony defect. MATERIALS AND METHODS: We analyzed 67 cases (52 patients) of primary TKRA with metal block augmentation for tibial bony defects from March 1999 and March 2008. Clinical results were evaluated using the Knee Society clinical rating system and the Western Ontario and McMaster University (WOMAC) score. Radiologic results were evaluated using the Knee Society roentgenographic evaluation system. RESULTS: The mean knee score and function score improved from 42.0 and 45.6 preoperatively to 94.5 and 85.4 postoperatively. At last follow-up, the mean WOMAC score was 16.8. The incidence of radiolucent lines was 10% (7 cases) during the follow-up period, but there was no case of progression. There were no statistically significant differences between the groups divided according to the block size (below 5 mm and over 8 mm) and between the stem and no-stem groups for all parameters. CONCLUSIONS: Primary TKRA with a metal block produced satisfactory results for the minimum 2-year follow-up and can be considered as a simple and effective method for the treatment of tibial bony defect in primary TKRA.

The Fate of Neglected Three Column Injuries of the Thoracolumbar Spine / 대한정형외과학회잡지

In a thoracolumbar fracture, accurate diagnosis of spinal stability is necessary in deciding on appropriate treatment options and for prevention of complications that can subsequently occur. In various reports for spinal stability, rupture of the posterior ligament complex is generally accepted as a very important factor of spinal stabiliby. In cases of conservative treatment for unstable thoracolumbar fractures, the progressive kyphotic deformity can cause chronic pain and functional disability, and neurologic deterioration in severe cases. Therefore, the concept of surgical treatment for unstable thoracolumbar fracture has been well established. We report on two cases of neglected three column injury in the thoracolumbar spine, which were treated conservatively due to misdiagnosis at other hospitals, and finally underwent delayed operation in our hospital because of chronic back pain and progressive kyphotic deformity.

Augmentative Locking Plate Fixation for the Treatment of Femoral Nonunion after Intramedullary Nailing

PURPOSE: To evaluate the efficacy of the augmentative locking compression plate fixation in the treatment of femoral shaft nonunion occurring after intramedullary nailing. MATERIALS AND METHODS: Between July 2004 and September 2012, a total of 17 patients (twelve men, five women, average age 52.5 years) who had femoral nonunions after primary intramedullary nailing for femoral shaft fractures were reviewed. The mean period of nonunion after primary nailing was 18.5 months. Leaving the nail in situ, an augmentative locking plate was applied to the nonunion site with simultaneous autogenous bone grafting, except for five hypertrophic nonunions. We followed up all patients with plain radiograph and evaluated clinical status to determine bone union. RESULTS: All patients demonstrated evidence of fracture union with an average follow-up time of 5.0 (range 2 to 9) months. The time of operation was an average of 115 (range 45 to 160) minutes, and mean blood loss was 345.9 (range 150 to 700) ml. Two patients noted discomfort at the distal portion of plate, and one noted discomfort of donor site, but functional limitation was not observed in all patients. CONCLUSION: Augmentative locking plate fixation for diaphyseal femoral nonunion after intramedullary nailing is a reasonable treatment option with increased stability.

Hemodynamic Change in Liver Cirrhosis

The investigation of systolic time intervals and hemodynamics was performed in 42 patients with liver cirrhosis by noninvascive methods. The patients were divided into four groups according to the presence or absence of anemia and/or ascites: i.e. group I; cirrhosis without anemia and ascites, group II; cirrhosis with ascites only, group III; cirrhosis with anemia only, and group IV; cirrhosis with ascites and anemia. In the resting state of the patients, the systolic time intervals and hemodynamic data were measured by the high speed simultaneous recordings of electrocardiogram, phonocardiogram, carotid and femoral arterial pulse tracings, and compared with those obtained from 155 normal adult subjects. 1. The pulse were increased considerably in group IV, and diastolic blood pressure was elevated in group II with significance. 2. The stroke volume and cardiac output were increased significantly in group III. 3. The peripheral resistance was reduced particularly in group III, and the volume elasticit coefficient was decreased in group IV. 4. The QS1 interval was prolonged significantly in group II and IV, but QS1 interval corrected by multiple regression equation proposed by our laboratory (illustrated in the text) did not show significant difference compared with that of normal subjects. 5. The left ventricular ejection time(LVET) and total electromechanical systole(QS 2) appeared to be shortened in group II and IV, but the corrected LVET and QS 2 were not different significantly from those of the normal subjects

Hemodynamic Change in Liver Cirrhosis

The investigation of systolic time intervals and hemodynamics was performed in 42 patients with liver cirrhosis by noninvascive methods. The patients were divided into four groups according to the presence or absence of anemia and/or ascites: i.e. group I; cirrhosis without anemia and ascites, group II; cirrhosis with ascites only, group III; cirrhosis with anemia only, and group IV; cirrhosis with ascites and anemia. In the resting state of the patients, the systolic time intervals and hemodynamic data were measured by the high speed simultaneous recordings of electrocardiogram, phonocardiogram, carotid and femoral arterial pulse tracings, and compared with those obtained from 155 normal adult subjects. 1. The pulse were increased considerably in group IV, and diastolic blood pressure was elevated in group II with significance. 2. The stroke volume and cardiac output were increased significantly in group III. 3. The peripheral resistance was reduced particularly in group III, and the volume elasticit coefficient was decreased in group IV. 4. The QS1 interval was prolonged significantly in group II and IV, but QS1 interval corrected by multiple regression equation proposed by our laboratory (illustrated in the text) did not show significant difference compared with that of normal subjects. 5. The left ventricular ejection time(LVET) and total electromechanical systole(QS 2) appeared to be shortened in group II and IV, but the corrected LVET and QS 2 were not different significantly from those of the normal subjects