The Usefulness of Three-dimensional Computed Tomography as an Assessment of Periacetabular Osteolysis in Revision Total Hip Arthroplasty / 대한고관절학회지

PURPOSE: This study was performed to determine the usefulness of three-dimensional computed tomography (3D-CT) in measuring periacetabular osteolysis by comparing the real volume of osteolysis in revision surgery. MATERIALS AND METHODS: Twnety-three patients who had undergone revision surgery due to periacetabular osteolysis but not included septic osteolysis and implant loosening. The mean age of patients at the time of surgery was 55.2 years. And the mean time interval between the primary total hip arthroplasty and revision surgery was 13.3 years. We measured the polyethylene wear in plain radiographs using computer assisted vector wear analysis program, the volume of acetabular osteolytic lesions in high-resolution spiral CT scans using Rapidia 3D software version 2.8 algorithms before the revision surgery were performed. Intraoperative real osteolytic volume was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume. RESULTS: Strong correlation was found between the volume of acetabular osteolytic lesions measured on 3D-CT and intraoperative real osteolytic volume which was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume. CONCLUSION: 3D-CT is considered a useful method for assessing and measuring the volume of periacetabular osteolysis before revision surgery.

Long-Term Clinical Outcome of Two Stage Revision Surgery for Infected Hip Arthroplasty Using Cement Spacer / 대한정형외과학회잡지

PURPOSE: We retrospectively analyzed long-term clinical results after two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for infected total hip arthroplasty. MATERIALS AND METHODS: Twenty-six hips (group 1: cup exchanged, group 2: cup and stem exchanged) were enrolled in this study. The mean follow-up period was 7.4 years (5 to 11 years). We analyzed the laboratory findings, the time interval between antibiotic-impregnated cement spacer insertion and revision arthroplasty, Harris hip score, Oxford hip score, radiologic changes, and recurrence of infection. RESULTS: Revision hip arthroplasty was performed at 7.5 weeks on average (group 1: 7.2 weeks, group 2: 7.7 weeks) after implant removal and cement spacer insertion. In group 1, Harris hip score was 51.1 points preoperatively, 84.4 points at six months, 89.3 points in at one year, 91.8 points at three years, and 89.8 points at five years. In group 2, the Harris hip score was 49.8 points preoperatively, 78.1 points at six months, 83.7 points at one year, 90.3 points at three years, and 88.7 points at five years. Recurrence of infection developed in one hip in each group. CONCLUSION: Ninety-two percent of infected hips were eradicated with two-stage revision arthroplasty using an antibiotic-impregnated cement spacer for infected hip arthroplasty at minimum five-year follow-up. When the infection was limited to the hip joint and the stem was fixed well, two-stage revision with stem retained could be a good treatment option.

Effectiveness of Tranexamic Acid in Reducing Blood Loss after Spinal Fusion / 대한정형외과학회잡지

PURPOSE: Spinal fusion surgery can be associated with significant blood loss, often requiring blood transfusion. The objective of this retrospective study was to evaluate the efficacy of tranexamic acid in reducing blood loss and transfusion after lumbar spinal fusion. MATERIALS AND METHODS: A total of 75 consecutive patients undergoing spinal fusion surgery for spinal stenosis were included in this study. Thirty-five patients who were administered tranexamic acid were compared with 40 patients who did not receive the drug. Blood loss through drain, amount of blood transfusion, and hematological laboratory findings were evaluated. RESULTS: Blood loss through drain for the first 24 hours after surgery was 548.6+/-192.1 ml in the tranexamic acid group and 1,089.8+/-368.3 ml in the control group with a significant difference (p=0.001). Total blood loss through drain was 1,010.5+/-452.5 ml in the tranexamic acid group and 1,512.7+/-427.8 ml in the control group with a significant difference (p=0.005). Time to removal of drains after surgery was not different, 2.6+/-0.8 days in the tranexamic acid group and 2.5+/-1.1 days in the control group (p=0.885). Packed red blood cell (RBC) transfusion for the postoperative period and the number of patients requiring transfusion was significantly lower in the tranexamic acid group than in the control group. A prolongation of protrombin time was observed in the control group on first postoperative day. There were no complications related to the use of tranexamic acid. CONCLUSION: Tranexamic acid had an effect on reducing blood loss through drain for the first 24 hours and total blood loss after spinal fusion surgery. As a result, there was less of a requirement for RBC transfusion after surgery.