The Epidemiology and Trends of Primary Total Ankle Arthroplasty and Revision Procedure in Korea between 2007 and 2017

Background@#The aim of this study was to investigate the surgical trends of primary total ankle arthroplasty (TAA) and revision procedure in Korea from 2007 to 2017 using national population-based data. @*Methods@#We reviewed the National Health Insurance data of Korea from 2007 to 2017. The data included diagnosis codes, procedure codes, prescriptions, medical costs, and other demographic data. Trends of primary diagnosis for primary TAA were evaluated. Annual trends and incidences per 100,000 person-years of primary TAA and revision procedures as well as compound annual growth rate (CAGR) during the study period were analysed. Surgical trends according to patients' age, hospital grades, and insurance systems were also evaluated. @*Results@#Primary diagnosis for primary TAA was mostly degenerative arthritis (6,501 cases; 90.5%). From 2007 to 2017, the total number of cases of primary TAA and revision procedures was 7,183 and 585, respectively. The number of cases in 2007 of primary TAA was 313; there were no cases of revision. The number of cases in 2017 of primary TAA were 986 and of revision were 108. The CAGR during this period was 28.6% for primary TAA and 44.6% for revision procedures. Incidences per 100,000 person-years in 2017 were 1.91 for primary TAA and 0.21 for revision procedures. The average cost paid by patients themselves was USD 813 (19%) and by the National Health Insurance Service was USD 3,480 (81%). @*Conclusion@#The incidence of primary TAA and revision procedures steadily increases in Korea during the 11-year study period.

Does Painful Heels in Ankylosing Spondylitis Demonstrate Distinctive Features on Plain Radiographs: A Study of 104 Cases

OBJECTIVE: To investigate simple radiographic findings on painful heels in ankylosing spondylitis (AS). Heel radiography in most studies was from AS patients' non-painful heel. METHODS: Seventy AS patients (34 bilateral cases) with heel pain at the time digital radiographs were taken were studied. Standing lateral views (104 radiographs) of the heel were reviewed. Associations between radiologic abnormalities and disease duration and among various abnormal findings were analyzed. RESULTS: Ninety-six (93.4%) had radiographic abnormalities (82.7% in soft tissues/61.5% in bone). Abnormalities of bone only were observed in 9.6%, of the soft tissues only in 30.8%, and of both were 51.9%. These included Kager's triangle's blurring (77.9%), posterior soft tissue swellings near the Achilles tendon insertion (65.4%), obliterations of the retrocalcaneal recess (65.4%), erosions of the superior pole of the posterior calcaneus (31.7%), subplantar irregular spurs (20.2%), posterior traction spurs (16.3%), subplantar erosions (14.4%) and cortical thickenings of the inferior calcaneal body (5.8%). There was a significant association between swelling in the posterior soft tissue and obliteration of the retrocalcaneal recess (p<0.001). CONCLUSION: Digital radiography in AS is useful for observing not only bony lesions but also soft tissue abnormalities of the heel, particularly of the posterior heel. For assessing the symptomatic enthesitis of the Achilles, this simple and quick diagnostic tool is valuable when examining for soft tissues' alterations of the posterior heel.

Total Ankle Replacement Arthroplasty / 대한족부족관절학회지

Total ankle replacement has been performed for treatment of end stage arthritis of the ankle, hopefully being an alternative to ankle arthrodesis. However, due to its high failure rates, earlier versions of ankle replacements were not regarded as successful procedures. The latest design has shown increasingly positive results. Total joint replacement of the ankle itself is still regarded as a demanding procedure and much more challenging than that of the hip and knee in many aspects. Several studies, however, have pointed out that it is becoming the viable, accepted alternative for arthrodesis with advanced implants, appropriate patient selection, and proper training experience of procedures. Compared with arthrodesis, it shows equal or better outcomes in pain relief, range of motion, and patient's satisfaction. We are attempting to review its biomechanical characteristics, implant design, indications, complications, clinical outcomes, and survival rate.

Follow-up Testing of Interferon-Gamma Release Assays Are Useful in Ankylosing Spondylitis Patients Receiving Anti-Tumor Necrosis Factor Alpha for Latent Tuberculosis Infection

We evaluated the utility of follow-up interferon-gamma release assays (IGRAs) for the diagnosis of reactivation of latent tuberculosis infection (LTBI) or new tuberculosis in ankylosing spondylitis (AS) patients receiving anti-tumor necrosis factor alpha (anti-TNFalpha). The study participants (n=127) had a negative IGRA screening before receiving anti-TNFalpha and were evaluated by follow-up IGRA. We retrospectively examined data of the subjects according to age, gender, tuberculosis prophylaxis, concomitant medications, IGRA conversion and anti-TNFalpha, including type and treatment duration. The median duration of anti-TNFalpha was 21.5 months, and the median age was 35.3 yr. Of the 127 patients, IGRA conversion was found in 10 patients (7.9%). There was no significant variation between IGRA conversion rate and any risk factors except for age. IGRA conversion rate was not significantly different between AS and rheumatoid arthritis (P=0.12). IGRA conversion was observed in AS patients receiving anti-TNFalpha in Korea. A follow-up IGRA test can be helpful for identifying LTBI or new tuberculosis in AS patients receiving anti-TNFalpha.

Adult flatfoot

Flatfoot deformity in adults is a type of postural deformity of the foot in which the arch collapses. This condition includes a wide spectrum of clinical situations, ranging from asymptomatic to progressive and disabling pathology. The common causes of adult-acquired flatfoot deformity are sustained flexible flatfoot from childhood, posterior tibial tendon insufficiency, tarsal coalition, generalized inflammatory diseases, neuropathic arthropathy, and posttraumatic deformities. The treatment of adult acquired flatfoot deformity should be individualized in each case, depending on the causes, symptoms, severity of deformity, and flexibility of the deformity. Therefore, it is mandatory for physicians to be acquainted with the basic pathomechanics of flatfoot deformity as well as the diagnostic procedures and treatments for each condition. The treatment usually begins with conservative methods and variable surgical procedures could be selectively performed. This article reviews the basic pathoanatomy, the diagnostic procedures for various causes and the treatment of flatfoot deformity in adult.

Comparison of Angle Measurements on Hallux Valgus with Two Different Methods Using Digital Images / 대한족부족관절학회지

PURPOSE: To study inter- and intra-observer reliabilities of computerized measurements of the angular parameters of hallux valgus deformity, using two different kinds of software tools for angle measurement on the digital radiography. MATERIALS AND METHODS: On 35 digital radiographies of standing foot anteroposterior view of hallux valgus, two observers (A, B) independently measured hallux valgus angle (HVA) and 1-2 intermetatarsal angle (IMA1-2) twice, using two methods. In method I, an angle was determined from duplicated lines to longitudinal axes made for bisecting line on the target bones with software tool. In method II, an angle was calculated automatically and directly from bisecting lines (longitudinal axes) made on the target bones. We compared two methods using paired t-test to determine significance of differences. Inter- and intra-observer reliabilities were evaluated using the intraclass correlation coefficients (ICC). RESULTS: There were no significant differences between measurements of method I and II for each observer (p>0.05) and intraobserver reliability were good. (ICC>0.9) Inter-observer reliability for method I and II was good of the HVA (ICCs, 0.912 and 0.905) and moderate of the IMA1-2 (ICCs, 0.505 and 0.537). There were interobserver differences in HVA of method I and II. CONCLUSION: No significant difference was found statistically between measurements of method I and II. Both methods I and II would be acceptable to measure angular parameters of hallux valgus deformity.

Effects of Beraprost Sodium on Subjective Symptoms in Diabetic Patients with Peripheral Arterial Disease

BACKGROUND: This study evaluated the effects of Beraprost sodium (Berasil) on subjective leg symptoms in patients with peripheral arterial disease caused by diabetes mellitus. METHODS: Ninety-four diabetic patients with peripheral arterial disease were treated with Beraprost in a fixed-dose, prospective, multicenter, cohort study. Beraprost (40 microg) was administered orally 3 times daily (120 microg/day) for 12 weeks. We developed a new disease-specific symptom questionnaire, which evaluated the effect of peripheral arterial disease on leg discomfort in daily life and assessed therapeutic responses to treatment. Patients were asked for their subjective assessment of symptoms on a written questionnaire before treatment and after 12 weeks of therapy. RESULTS: There was significant improvement in all estimated subjective symptoms (burning, coldness, edema, exertional pain, stabbing, and paresthesias) in the lower extremities at 12 weeks (p < 0.001). There were 18 patients with neuropathy in whom significant improvement was noted for 6 subjective symptoms at 12 weeks (p < 0.05). Adverse events considered to be drug-related were observed in 4 patients (4.3%), all of which were mild and resolved with discontinuation of the medication. CONCLUSIONS: Beraprost is effective as a treatment for improving various subjective symptoms in the lower extremities, such as burning, coldness, edema, exertional pain, stabbing, and paresthesias, in diabetic patients with peripheral arterial disease.

Computerized Measurement on Angular Parameters for Hallux Valgus: Comparison of 100% and 150% Magnified Digital Radiography / 대한족부족관절학회지

PURPOSE: To study computerized measurements of angular parameters on 100% and 150% resized digital radiography of hallux valgus deformity. MATERIALS AND METHODS: 30 digital radiography of standing foot anteroposterior view of hallux valgus patients were included. Two observers(A, B) independently measured hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) in two times on both 100%-size and 150% magnified images respectively, using computerized measurement software tools. The results were interpreted with the statistical software program, Statistical Analysis System, version 9.2. RESULTS: In repeated measurements of each observer, measurements on 150% magnified image showed no differences of all three parameters and with 100%-size image, there were differences of HVA (observer A) and 1-2 IMA (observer B) (p>0.05). When testing interobserver reliability, both observers showed differences in measurement of HVA and DMAA (p<0.05), but no differences in measurement of 1-2 IMA in both images. Within the 95% confidence interval, limits of error of measurements between two observers on HVA, IMA and DMAA were 2.7degrees 1.4degrees and 5.0degrees respectively in 100%-size images, and 2.6degrees, 1.6degrees and 4.7degrees respectively in 150% magnified images. CONCLUSION: In computerized measurements for angular parameters of hallux valgus with digital radiography, 150% magnified images showed intraobserver reliability. Both 100% and 150% magnified images failed to show interobserver reliability. Measurement of 1-2 IMA in both 100% and 150% images showed less interobserver error.

Ankle Arthrodesis / 대한족부족관절학회지

Ankle arthrodesis has been considered to be the standard operative treatment for end-stage ankle arthritis, nevertheless currently increasing arthroplasty. Indication for arthrodesis is painful ankle from global arthrosis regardless of the etiology. But it is hard to be carried out in the several circumstance such as infection states, poor vascularity, severe diabetes, prematurity, etc. So thorough evaluation should be done before the surgery, including adjacent joints status. The ideal position for fusion is neutral in flexion, functional valgus, and slightly external rotation. Methods of arthrodesis would be largely divided into two categories as in situ fixation and realignment procedure. The lateral and anterior longitudinal approaches are two common procedures, and fixation modalities are also variable. The long-term results of arthrodesis have been reported. Even the close follow-up have shown subsequent degeneration of adjacent joints, benefits such as reliable pain loss, easy correctability for deformity, and improved functional status with considerable durability can be expected in the most patients.

Ankle Lesions, Associated with Anterior Soft Tissue Impingement / 대한족부족관절학회지

PURPOSE: To evaluate clinical features of ankle lesions, associated with anterior soft tissue impingement. MATERIALS AND METHODS: We retrospectively reviewed 21 patients who had chronic anterior ankle pain as initial symptom and associated ankle lesions with anterior soft tissue impingement. Based on preoperative radiologic findings, physical examination intra-operative findings, appropriate procedures were done for lesions by either arthroscopic or minimal open procedure or combined. Clinical evaluation was done using American Orthopedic Foot and Ankle Society, ankle-hind foot score (AOFAS score) and visual analog scale (VAS) on last follow up. RESULTS: Associated lesion(s) to anterior soft tissue impingement of the ankle were 16 cases of osteochondral lesion of talus, 14 cases of bony impingement, 6 cases of ankle lateral instability, 5 cases of loose body, 4 cases of os subfibulare. AOFAS score was 58.9 +/- 5.1 preoperatively and 74 +/- 9.1 on last follow up. Clinical satisfaction score using VAS showed excellent in 3 cases, good in 11, fair in 3, poor in 4. CONCLUSION: The patients who had anterior soft tissue impingement would have various associated lesions on their ankle. In such cases, preoperative counseling for variety of postoperative results would be needed.

The Computerized Measurement for the Radiological Severity of Hallux Valgus / 대한족부족관절학회지

PURPOSE: To study the reliability of intra- and interobserver reliability in angular measurement of hallux valgus deformity by assessing hallux valgus angle (HVA) and the 1st to 2nd intermetatarsal angle (1-2 IMA) through using computerized system. MATERIALS AND METHODS:20 cases of moderate to severe hallux valgus patients were included in this study. With the standing anteroposterior view of foot, the HVA and 1-2 IMA were calculated by computerized measurement system of Infinity cooperation, called phi-view, with its software tools. Using the statistical software program, SPSS (version 12th), we interpreted the results which were measured by two independent observers. RESULTS:In the intraobserver measurement, the HVA of observer A showed reliability (32.5 degrees +/-6.9 and 33.1 degrees +/-6.8)(p005). In the results of observer B, HVAs were measured as 35.7 degrees +/-7.6 and 36.2 degrees +/-7.7, and were not reliable (p>005). 1-2 IMA in observer B was not reliable as well (17.0 degrees +/-0.8 and 20.8 degrees +/-1.5)(p>005). In the interobservers' measurements, the first and the second results of HVA were 3.2 degrees +/-3.6 and 3.1 degrees +/-3.1, reliable within the 95% confidence interval (p005). CONCLUSION: In the angular measurement of the hallux valgus by computerized system, the HVA and 1-2 IMA showed less error range in the interobserver's results, compared with the previous studies about the manual measurement. However, our results failed to show the statistical reliability of intra- and interobserver's measuring. Therefore, even the computerized angular measurements in the severity of hallux valgus require development of the measuring methods and software tools.

The First Metatarsophalangeal Arthrodesis with Screws Fixation / 대한족부족관절학회지

PURPOSE: The aim of this study was to retrospectively evaluate the clinical and radiological results of the first metatarsophalangeal joint arthrodesis with two crossed screws fixation. MATERIALS AND METHODS: We treated 23 patients (24 cases) with arthrodesis of the first metatarsophalangeal joint using two crossed screws fixation between December 2000 and May 2005. There were 3 male patients and 20 female patients. Ages ranged from 28 to 74 years (mean, 50 years). Follow-up ranged from 4.1 to 8.2 years (mean, 6.5 years). The American Orthopaedic Foot and Ankle Society (AOFAS) score and their satisfaction was evaluated clinically, foot anteroposterior and lateral radiograph, radiologically. RESULTS: Of the 24 cases, 6 had surgery for dorsal plate and screws fixation because of failure to acquire firm fixation with two crossed screws fixation. All 6 cases acquired bony union. Fusion of the hallux first metatarsophalangeal joint occurred in 16/18 cases (89%). Nonunion occurred in 2 cases (11%) and was asymptomatic. At last follow-up, hallux valgus angle ranged from 11 to 25 degrees(mean, 17.7 degrees), dorsiflexion ranged from 15 to 25 degrees (mean, 22 degrees).The mean preoperative AOFAS score of 37 points(range, 28 to 45 points) improved to a mean of 77 points (range, 65~90 points) postoperatively. The result of the procedure as rated subjectively by the patient was excellent for 5 cases, good for 11 cases and fair for 2. CONCLUSION: Comparatively, the arthrodesis of the first metatarsophalangeal joint with crossed screws fixation showed a satisfactory clinical results, we thought that require technical attention for firm fixation in operation.

Treatment of Combined Degenerative Lumbar Disease and Adjacent Vertebral Fracture / 대한척추외과학회지

STUDY DESIGN: Retrospective study OBJECTIVE: To analyze the treatment results of vertebroplasty in patients who suffered osteoporotic compression fractures during conservative treatments for pre-existing degenerative lumbar disease. SUMMARY AND LITERATURE REVIEW: Whilst spinal fusion has shown satisfactory clinical results, solid fusion has been reported to accelerate the degenerative changes at the unfused adjacent levels. Therefore, the level of spinal fusion in patients with compression fractures and pre-existing degenerative lumbar disease is controversial. Few studies have evaluated the outcomes of spinal fusion and adjacent segment vertebroplasty. MATERIALS AND METHODS: A retrospective review was carried out on 28 patients who suffered the osteoporotic compression fractures during conservative treatment for pre-existing degenerative lumbar disease. Posterolateral fusion and vertebroplasty were performed for degenerative disease and compression fractures. The average fusion level was 1.82. The mean compressed vertebral bodies were 1.68. The radiology results were evaluated to determine the progression of the compression rate and fractures in the adjacent segment. The clinical results were evaluated using the Denis pain scale for compression fractures and Katz satisfaction scale for degenerative lumbar disease. RESULTS: The average compression rate was 30.2% preoperatively, 21.4% postoperatively, and 24.6% at the final follow-up. There was no fracture in the adjacent segment. Clinically, the preoperative Denis score was P3 and P4 in 8 and 20 patients, respectively. On the other hand, the postoperative Denis score was P1, P2 and P3 in 8, 19 and 1 patients, respectively. In regard to degenerative diseases, the overall satisfaction was 82.1%. CONCLUSION: The stability of fracture sites in vertebroplasty of patients with pre-existing lumbar disease was confirmed. However, further compression of the fractured vertebral body was observed after vertebroplasty in long fusion. Therefore, a followup study of more cases will be necessary to confirm the changes in the vertebroplasty site.

A Radiologic Study of the Reference Line for Measuring Posterior Slope Angle on Lateral View of the Knee / 대한정형외과학회잡지

PURPOSE: This study evaluated the radiological reference line of the posterior slope angle on the lateral view of a plain knee radiograph. MATERIALS AND METHODS: The lateral view of the plain knee and whole tibia radiographs were analyzed from thirty seven patients (fifty-two cases) who had undergone total knee arthroplasty. The posterior slope angle was measured on the lateral view of the tibia. On the lateral view of the knee, the posterior slope angle was measured with reference to the proximal tibial anatomical axis, the proximal tibial anterior cortical line, the proximal tibial posterior cortical line and the proximal fibular anatomical axis. These values were compared with the posterior slope angle measured on the whole tibia lateral view. RESULTS: The posterior slope angle, which was measured by the anterior cortical line as a reference line, was tilted slightly anteriorly to that measured by the whole tibial lateral anatomical axis (0.15 degree in average; anterior slope 3.95- posterior slope 5.57 degree). This difference was smallest among that of the measured angle by the other reference lines (p<0.001). CONCLUSION: The anterior cortical line of the proximal tibia appears to be the most reliable reference line for measuring the posterior slope angle on a knee lateral radiograph after TKA.

A Study of the Decision Status for the Lateral Retinacular Release based on Lateral Patellar Tilt Angle in Total Knee Arthroplasty: Related with Tourniquet Effect

PURPOSE: The pattern of patellar tracking is changed depending upon whether a tourniquet is operating or not. This study was performed to suggest the criteria of lateral retinacular release(LRR) in total knee arthroplasty(TKA) based on the lateral patellar tilt angle(LPTA). MATERIALS AND METHODS: In study 1, the LPTA was compared in 24 bilateral TKAs, one side was required LRR and performed LRR, but not required and not done LRR on the other side according to the patellar tracking status in deflating tourniquet. In the second prospective study, we performed LRR one side and not the other side intentionally in all 11 patients' knees(22 knees) those who were same situations that the patellar tracking was not good under the condition of operating tourniquet but tracking was improved after deflation of tourniquet. We compared LPTA in both studies with paired t-test of SPSS 11.0. RESULTS: The LPTA was average 4.86 degrees on the side of performed LRR and 4.83 degrees on the other side in 24 patients. There was no significant difference of LPTA between them(p=0.952) in study 1. And the LPTA was average 5.18 degrees on the side of underwent LRR based on the condition of operating tourniquet, 5.45 degree on other not LRR side knee. There were also no significant difference between them(p=0.829) in study 2. CONCLUSION: The incidence of LRR will be reduced with no detrimental effect on lateral patellar tilt angle when making decision of LRR based on the patellar tracking status in deflating tourniquet.

Posterior Plating in Distal Fibular Fracture

PURPOSE: To report the technical experience of posterior plating for the distal fibular fracture. MATERIALS AND METHODS: 20 Weber type-B fibular fractures were included in this study, which were treated with the posterior plating. 1/3 semitubular plate was used and orientation of all screws were intended to be perpendicular to the plate as possible. Fixation stability and maintenance of reduction after plating was assessed manually in the operating field. Clinical results were evaluated at least 1 year after operation, using American Orthopaedic Foot and Ankle Society (AFOAS) Ankle-Hindfoot score. RESULTS: 5 cases were firmly stabilized without using any lag screw or fixation of distal fragment. For improving stability or achieving proper reduction, a lag screw was placed posteroanteriorly through the plate in 14 cases. Anteroposterior interfragmentary fixation in 1 case before plating, and contouring of the plate in 3 cases were needed in cases of which the posterior plating impeded reduction of distal fibular fracture. In all cases, fracture was stabilized without fixation through the most distal hole. There were no major postoperative complications. AFOAS score was 95.5±5.2. CONCLUSION: The posterior plating technique for distal fibular fracture is regarded as a recommendable option. Additional fixation with interfragmentary screw or contouring of the plate, however, would be needed in some cases to achieve anatomical reduction or sufficient stability.

Patient Satisfaction Interviews after TKA Successful Rehabilitation Achieved and Functions Still Desired by Respondents

PURPOSE: To determine the priority for the instrumental development of Total knee replacement arthroplasty(TKA) by assessment of patient interviews after TKA in Korea. MATERIALS AND METHODS: We assessed the responses of 168 patients with primary TKA a minimum of one year after surgery. In order not to limit their choices by using a survey, interviewees responded to two open-ended questions, "What was the best result achieved after TKA?" and "What was the result you most wished for but was not achieved after TKA?" RESULTS: All the patients expressed satisfaction with TKA except for 12 patients (7.1%) and for the question of the best result after TKA, 118 patients (70.2%) pointed out that pain relief was the most satisfactory. For the question of the most wished for function still to be restored after TKA, 59 patients (35.1%) answered "No inconvenience and no need" and the greatest proportion among the others who had a wish, 61 patients (36.3%) pointed to discomfort related to the degree of knee flexion with the response "Not easy to stand from the ground and to have deep knee flexion". The average knee flexion degree was 120.7degrees in the group who had a wish related to knee flexion but 127.5degrees in the "No need" group, and the difference was significant (P=0.004). CONCLUSION: Although there was a 93% satisfaction rate after TKA, the remaining function most wished for after TKA was to stand up from the ground easily, which is related to knee flexion degree. Therefore, we propose that the improvement of knee flexion after TKA should be the priority for instrumental development in Korea.

Early change of C-reactive protein level in TKA : Antibiotic-loaded vs Plain bone cement

PURPOSE: To analyse the level of C-reactive protein (CRP) after total knee arthroplasty (TKA) with antibiotic-loaded bone cement (ABLC) and plain bone cement (PBC). MATERIAL AND METHODS: In the 75 primary TKAs, 35 cases with risk factors for infection were fixed with ABLC and 36 cases without risk factors were fixed with PBC. We did comparative analysis of the changing trends of the level of CRP up to 6 months after TKA in the 2 groups. RESULTS: The CRP levels at 5th,7th, 10th, 14th day and 1.5 th, 3 th, 6 th months after TKA were average 3.03, 1.50, 1.00, 0.60, 0.48, 1.04 and 0.60 mg/dl in the ABLC group, and 3.71, 2.16, 1.08, 0.78, 0.58, 0.27 and 0.31 mg/dl in the PBC group. The results were ALBC group, even having some risk factors for infection, showed the lower levels of CRP in early recovery period after TKA than PBC group. But two group has no significant difference statistically (p=0.08). CONCLUSION: Even though some risk factors for infection, statistically same returning patterns of the CRP levels in the ABLC group compare with the PBC group would be informative for observation about infection in TKA.

The Role of Early Routine Manipulation in Total Knee Arthroplasty

PURPOSE: The aim of this study was to determine the role of routine manipulation on increasing angle of great flexion(AGF) after total knee arthroplasty (TKA) in early postoperative period. MATERIALS AND METHODS: We analysed the AGF of the both knees 1 year after total knee arthroplasties in 59 patients who had a bilateral procedures and in whom only one knee was manipulated routinely at 2 weeks after TKA. RESULTS: The average AGF was 124.6 degree (85~145) on routine manipulated knee and 125.3 degree (90~145) on non-manipulated side 1 year after TKAs. Therefore, there was no statistical significance in AGFs between both sides(p=0.384). Among 59 patients, the AGF was same on both knees in 32 patients, greater AGF on manipulated knee in 12 patients and greater AGF on non-manipulated TKA side CONCLUSION: The routine manipulation has no positive role on increasing AGF after total knee arthroplasty in early postoperative period.

The Change of the Coronal Joint Line Level after PCL preserving and substituting Total Knee Arthroplasty

PURPOSE: The change of the joint line is associated not only with bone cutting levels but also balance of soft tissue. The main objective of this study analyze to compare the changes of the coronal joint line levels between PCL retaining total knee arthroplasty and PCL-substituting total knee arthroplasty, using the new method designed by authors. MATERIAL AND METHODS: A total 44 knees of 22 patients who received both TKA, of whom the one side was CR TKA and the other side was PS TKA, were analysed on pre- and post-operative weight-bearing anteroposterior radiopraphy of the knee. The joint line levels were measured two times by one author and one time by different author. RESULTS: The proximal shift of the joint line showed differently in both groups. The average of shifting values were 2.4+/-4.1 mm in CR TKAs, and 5.4+/-5.8 mm in PS TKAs. PS TKAs had significantly larger shifting value than CR TKAs for all times(p<0.05). CONCLUSION: The results of this study showed that the joint line level proximally shifted after TKA, using measured resection technique and gap technique. The shifting level in PS TKA was larger than CR TKA. But it is difficult to predict the change of joint line level after TKA, because of deviation between case by case and the standard deviation of the measured value was 4~6 mm.