Minimum Five-Year Results of Arthroscopic Management with Labral Preservation in Borderline Hip Dysplasia / 대한정형외과학회잡지

Purpose@#This study examined the patient-reported outcome scores at mid-term follow-up after arthroscopic labral preservation in patients with borderline hip dysplasia. @*Materials and Methods@#Data were collected retrospectively from patients who underwent arthroscopic labral preservation. Among the 61 patients classified with hip dysplasia, patients with arthritis beyond Tönnis grade II were excluded, Patients with subchondral bony exposure were excluded even if they had arthritis of Tönnis grade I. Forty-two patients with borderline hip dysplasia were enrolled among patients whose lateral center edge angle (LCEA) was between 18° and 25°. The PRO scores including the modified Harris hip score (mHHS), hip outcome score activities of daily living (HOS-ADL), hip outcome score sport-specific subscale (HOS-SSS) and visual analog scale (VAS), were collected and compared preoperatively, and then at one year and a minimum of five years after surgery. @*Results@#The mean preoperative LCEA and Tönnis angle were 20.9° (range, 18° to 25°) and 6.3° (range, 0° to 18°), respectively. The mean follow-up was 64.8 (range, 60 to 84) months. The mean mHHS increased from 73.5 before surgery to 86.2 in the fifth year after surgery (p<0.01), the mean HOS-ADL from 70.5% before surgery to 84.9% in the fifth year after surgery (p<0.01), and the mean HOS-SSS from 51.4 before surgery to 69.4 in the fifth year after surgery (p<0.01). The mean VAS score improved from 6.3 before surgery to 1.5 in the fifth year after surgery (p<0.01). @*Conclusion@#Arthroscopic labral preservation performed in appropriately selected patients with borderline dysplasia showed good results at mid-term follow-up. In borderline hip dysplasia without the progress of osteoarthritis and subchondral bone exposure, arthroscopic labral preservation may be considered a good and less invasive option.

Treatment Outcomes at Skeletal Maturity after Calcaneo-Cuboid-Cuneiform Osteotomy for Symptomatic Flatfoot Deformity in Children

Background@#The purpose of this study was to evaluate clinical and radiological outcomes at skeletal maturity after a calcaneo-cuboid-cuneiform osteotomy (triple C osteotomy) for symptomatic flatfoot deformity compared with healthy young adult controls. @*Methods@#Nineteen patients (30 feet) who undergone a triple C osteotomy for idiopathic symptomatic flatfeet from July 2006 to April 2013 were compared with 19 controls (38 feet). Radiographic measurements at preoperative examination, 1-year postoperative follow-up, and follow-up at skeletal maturity were evaluated. Functional outcomes were assessed by using the validated visual analog scale foot and ankle (VAS-FA) and the modified American Orthopaedic Foot and Ankle Surgery (AOFAS) score. @*Results@#In the triple C osteotomy group, 11 of 12 radiographic measurements were significantly improved at 1 year postoperatively and the last follow-up (p 0.05). There were no significant differences in nine of 12 radiographic measurements between the triple C osteotomy group at maturity and the control group (p > 0.05). Average VAS-FA and AOFAS scores were significantly improved at the time of skeletal maturity (p < 0.001). @*Conclusions@#Surgical correction of symptomatic flatfoot deformity in childhood resulted in favorable outcomes after the triple C osteotomy. Deformity correction was also maintained during follow-up at skeletal maturity.

Learning Curve of the Direct Anterior Approach for Hip Arthroplasty / 대한정형외과학회잡지

Purpose@#To evaluate the timing of the improvement in surgical skills of the direct anterior approach for hip arthroplasty through an analysis of the clinical features and learning curve in 58 cases. @*Materials and Methods@#From November 2016 to November 2018, 58 patients, who were divided into an early half and late half, and underwent hip arthroplasty by the direct anterior approach, were enrolled in this retrospective study. The operation time and complications (fracture, lateral femoral cutaneous nerve injury, heterotopic ossification, infection, and dislocation) were assessed using a chi-square test, paired t-test, and cumulative sum (CUSUM) test. @*Results@#The mean operation times in total hip arthroplasty (26 cases) and bipolar hemi-arthroplasty were 132.1 minutes and 79.7 minutes, respectively, demonstrating a significant difference between the two groups. CUSUM analysis based on the results revealed breakthrough points of the operation time, decreasing to less than the mean operation time because of the 16th case in total hip arthroplasty and 14th case in bipolar hemiarthroplasty. Complications were encountered in the early phase and late phase: five cases of fractures in the early phase, no case in the late phase; eight and two cases of lateral femoral cutaneous nerve injury, respectively; three and two cases of heterotopic ossification, respectively; and one case of dislocation, one case of infection and three cases of others in the early phase. The CUSUM chart for the fracture rate during operation in the early phase revealed the following: five cases fracture (17.2%) in the early phase and no case in the late phase (0%). This highlights the learning curve and the need for monitoring the inadequacy of operation based on the complications. @*Conclusion@#Hip arthroplasty performed by the direct anterior approach based on an anatomical understanding makes it difficult to observe the surgical field and requires a learning curve of at least 30 cases.

Effectiveness of Endoscopic Sciatic Nerve Decompression for the Treatment of Deep Gluteal Syndrome / 대한고관절학회지

PURPOSE: The purpose of this retrospective study was to evaluate clinical outcomes of endoscopic nerve decompression in patients with deep gluteal syndromes (DGS). MATERIALS AND METHODS: Between October 2013 and March 2015, 24 patients who underwent surgical treatment of DGS were retrospectively included in this study. The mean age was 47 years (range, 35 to 76 years), and there were 11 males and 13 females. The mean duration of pain was 12 months (range, 5 to 35 months) and the mean follow-up period was 32 months (range, 26 to 45 months). Clinical evaluations included the visual analog scale (VAS) pain score, modified Harris hip score (mHHS), and the symptom-rating scale. RESULTS: Significant improvement in symptoms following endoscopic decompression were achieved as measured using the VAS score (decrease in the mean from 7.1±0.9 to 2.5±1.5; P < 0.001) and mHHS (increase from 59.4±6.5 to 85.0±8.3; P < 0.001). CONCLUSION: Endoscopic sciatic nerve decompression was satisfactory for treating recalcitrant DGS, making it an effective treatment option to improve symptoms of DGS.

The Effectiveness of Arthroscopy in Borderline Hip Dysplasia / 대한정형외과학회잡지

PURPOSE: The outcome of hip arthroscopy as a treatment of patients with hip dysplasia is variable. In patients with severe hip dysplasia, arthroscopy has the potential to exacerbate instability and unfavorable outcome. To the best of out knowledge, there has not been a report regarding arthroscopic treatment in patients with borderline hip dysplasia in Korea. We favorable outcome with using arthroscopy to treat symptomatic borderline hip dysplasia. MATERIALS AND METHODS: Between August 2010 and February 2015, 143 patients undergoing hip arthroscopy for intra-articular hip disorder were retrospectively enrolled. From this cohort, a borderline dysplasia group compromising 29 patient with lateral center edge angle (LCEA) >18° and <25° and a minimum of 1 years follow-up, was identified. Patient-reported outcome scores, including modified Harris hip score, the hip outcome score-activity of daily living, the sport-specific subscale, visual analogue scale (VAS) and satisfaction survey were obtained preoperatively and at postoperative 3 months, 6 months, 1 year, 2 years, and 3 years. Revision surgery and complications were recorded for each group. RESULTS: The mean age was 35.7 years (range, 16–63 years) years respectively. There were 16 females (55.2%) and 13 males (44.8%). The mean LCEA was 22.0° (range, 18°–25°) and the mean Tönnis angle was 6.1° (range, 0°–18°). The mean follow-up was 20.2 months (range, 12–39 months), and at the 1 year follow-up, there was significant improvement (p<0.001) in all patient reported outcome scores and VAS. Satisfaction survey showed an average score of 7.7. CONCLUSION: In patients with borderline hip dysplasia, if there is an occurrence of symptomatic labral tear, arthroscopic labral refixation has a good short-term result. Therefore, if patients have no response to conservative treatment or have severe pain, arthroscopic labral refixation is a useful treatment options to relieve symptom.

Stress Fracture of the Anterior Atlas Arch Following C1 Posterior Arch Resection for Cervical Myelopathy with Retro-Odontoid Pseudotumor / 대한정형외과학회잡지

Atlas fracture accounts for 1% to 3% of all spinal column injuries and 10% of cervical spine fractures, and is most frequently caused by motor vehicle accidents and falls. Only a few cases involving complications after surgical treatment have been reported. We present a case of anterior atlas arch stress fracture accompanied by worsening neurologic symptoms following atlas posterior arch resection for cervical myelopathy with retro-odontoid pseudotumor.

Efficacy of Posterior Lumbar Interbody Fusion using PEEK Cage and Pedicle Screw Stabilization in Degenerative Lumbar Spinal Disorders: Minimum 3 Years Follow up Results

STUDY DESIGN: A retrospective study. OBJECTIVES: To evaluate the three-plus year follow-up results of patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease. SUMMARY OF LITERATURE REVIEW: There are few previous reports addressing posterior lumbar interbody fusion using PEEK cage with mid-term follow up periods. MATERIALS AND METHODS: 260 patients who underwent posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation for lumbar degenerative disease were enrolled. We classified patients into three groups according to their fusion level: group A (n=151) had one-level fusion, and group B (n=91) had two-level fusion, and group C (n=18) had three-level fusion. Clinical outcomes were evaluated by pre- and post-operative Visual analogue scale (VAS) scores, the Oswestry Disability Index (ODI), and complication and reoperation rates. Radiologic outcomes were measured by the fusion rate, sagittal alignment, disc height and changes. RESULTS: VAS (pre-operative to final follow-up) changed from 7.62+/-2.03 (5-10) to 3.19+/-1.94 (1-8) in group A, from 6.83+/-2.28(4-9) to 4.51+/-2.18(2-9) in group B and from 7.17+/-2.46 (5-10) to 4.63+/-1.97(1-9) in group C. Final follow-up ODI also decreased in group A (17.6+/-8.56%), group B (15.4+/-5.46%) and group C (24.7+/-7.46%). This corresponds to scores of 94.7% in group A, 92.3% in group B and 94.4% in group C. There were significant differences between preoperative, post-operative and final follow-up lumbar lordosis [p=0.042(group A), 0.036(group B), 0.045(group C)], segmental lordosis [p=0.036(group A), 0.039(group B), 0.047(group C)]. Reoperation was performed in patients 8 group A, 4 group B, and 1 group C, and there is no significant diffrence between groups. Adjacent segmental change was found in all reoperation patients, but showed no correlation with clinical results. CONCLUSIONS: Posterior lumbar interbody fusion with PEEK cage and pedicle screw fixation in lumbar degenerative disease showed excellent clinical results and fusion rates, regardless of patient fusion levels.

Analysis of Treatment Outcomes for Open Fractures of the Tibia in Children / 대한정형외과학회잡지

PURPOSE: Our objective was to analyze outcomes of treatment for open fractures of the tibia in children according to the classification of Gustilo-Anderson type. MATERIALS AND METHODS: We reviewed thirty five pediatric patients who underwent surgery for open fractures of the tibia between June 1998 and June 2007. We followed up over more than 1 year. Fractures were grouped into three types according to Gustilo-Anderson classification (Types I, II, and III). External fixation or flexible intramedullary nailing was used as the surgical method. We analyzed the period required to achieve radiologic bony union, tibial alignment, leg length discrepancy and complications. Clinical outcomes were assessed using the Karlstrom-Olerud method. RESULTS: Radiologically, bony union was achieved in 11.35+/-3.08 weeks, 10.50+/-2.20 weeks, and 21.62+/-7.19 weeks for types I, II, and III, respectively. Delayed union occurred in one case of type II and 3 cases of type III fractures. Complications such as nonunion, malunion and osteomyelitis were seen only in type III. Clinical outcomes showed excellent or good results in all cases except one (type III). CONCLUSION: Excellent outcomes for open fractures of the tibia in children can be obtained regardless of Gustilo-Anderson type when adequate procedures are performed.

Perioperative Complications in Elderly Patients Undergoing Lumbar Arthrodesis with Pedicle Screw Instrumentation in the Degenerative Lumbar Disorders: A Comparative Study between Posterolateral Fusion and Posterior Lumbar Interbody Fusion / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study that focused on the perioperative complications when performing posterior arthrodesis for treating degenerative lumbar disorders in elderly patients. OBJECTIVES: We wanted to analyze the perioperative risk factors and the complications associated with posterior lumbar decompression and arthrodesis in patients who were sixty-five years of age or older. SUMMARY OF LITERATURE REVIEW: Lumbar arthrodesis is commonly done in elderly patients to treat degenerative spine problems. These patients may be at an increased risk for complications because of their age and their associated medical conditions. MATERIALS AND METHODS: We studied 111 patients who were over 65 years old and they were able to be followed up for more than 3 months after performing posterior arthrodesis during the recent 5 years. Sixty-one patients who had undergone posterolateral fusion (PLF) were classified as group A, and 50 patients who had undergone posterior lumbar interbody fusion (PLIF) using a PEEK cage were classified as group B. We analyzed their rates of complications and the causative factors, according to operative methods and age, and these complications occurred within 12 weeks after the operations. RESULTS: Complications occurred for 43 patients of group A, and for 26 patients of group B. The differences in the rates of complications were statistically significant, and group A had a more complications than did group B. The relations between medical problems and the incidence of perioperative complications were statistically significant for both groups. CONCLUSIONS: Elderly patients with medical problems should be made aware that they are at an increased risk for surgical complications, and attention hould be paid to controlling the blood loss and limiting the operative time. The PLIF using a PEEK cage was identified as a procedure that could reduce the perioperative complications.