The Effect of Autotransfusion System in Minimally Invasive Total Knee Arthroplasty

PURPOSE: To evaluate the effect of autotransfusion system in minimally invasive total knee arthroplasty (TKA). MATERIALS AND METHODS: Seventy-one patients who underwent unilateral minimally invasive TKA between October 2009 and June 2010 were selected. The first group included 36 patients who received standard vacuum drainage and the second group, 35 patients who underwent autologous retransfusion drainage. In the first group, allogeneic blood transfusion was performed if the postoperative hemoglobin level was <7.0 g/dL or 7.0-8.0 g/dL with the presence of a medical complication and an anemic symptom. The second group received autotransfusion and allogeneic transfusion additionally according to the same criteria. Changes in the pre- and postoperative hemoglobin level, amount of auto- or allotransfusion, and frequency of allogeneic transfusion were assessed. RESULTS: Allogeneic transfusion was required in 13 patients (36.1%) in the first group and four patients (11.4%) in the second group. The mean allogeneic transfusion volume was significantly low in the second group compared to the first group (64.4 mL vs. 278.9 mL; p<0.05). The hemoglobin level on the 1st postoperative day compared to the preoperative level decreased by 22.6% in the first group and 11.7% in the second group. The postoperative hemoglobin level was higher in the second group (p<0.05). CONCLUSIONS: Minimally invasive unilateral TKA with an autotransfusion system can be beneficial in patients with no medical complications because of the decreased allogeneic transfusion.

Incidence and Risk Factors of Ipsilateral Foot and Lower Limb Reamputation in Diabetic Foot Patients / 대한족부족관절학회지

PURPOSE: To evaluate the incidence and risk factors of ipsilateral reamputation after lower limb amputation in the patient with diabetic foot lesions. MATERIALS AND METHODS: Between May 2005 and June 2009, 88 patients who underwent lower limb amputation were analyzed. Group 1 consisted of 73 patients who didn't have a ipsilateral reamputation after lower limb amputation and group 2 consisted of 15 patients who underwent reamputation. We compared several factors between two groups, such as age, gender, BMI, ABI, Wagner classification, wound culture, site of amputation, vascular surgery, the period of diabetes mellitus, chronic renal failure. RESULTS: Fifteen (17%) of 88 patients had a ipsilateral limb reamputation and 13 patients (87%) of them underwent reamputation within 6 months. When we compared the two groups, average age was 59.3 (range, 48-74 years); 62.9 (range, 44-78 years). Age was significantly associated with reamputation rate (p=0.02) and no reamputation after initial amputation above ankle joint was found. Other factors did not show statistically difference between both groups. CONCLUSION: There were no significant difference between diabetic limb amputation and reamputation group in our concerned risk factors except age and amputation level. There should be careful consideration when determine level of amputation in diabetic foot lesions especially in elder patients.

Total Ankle Replacement in Pigmented Villonodular Synovitis of Ankle Joint (A Case Report) / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) is a rare proliferative disease affecting joint synovium, tendon sheaths, bursae. The usual treatment for PVNS is a surgical excision. If destructive joint lesions have occurred, complete resections must be performed followed by arthrodesis or arthroplasty. We report a case of a pigmented villonodular synovitis involving an ankle joint which was treated by total ankle replacement for recurrence after simple synovectomy.

Multiple Noncontiguous Fractures in Cervical Spine: Cases Report

STUDY DESIGN: Cases report OBJECTIVES: We report 2 cases of relatively rare cervical fracture. SUMMARY OF LITERATURE REVIEW: Although numerous studies in the literature have investigated cervical spine injuries, patients with multiple-level cervical fractures have not been commonly described. Multiple non-contiguous cervical fractures are distinctively unusual. MATERIALS AND METHODS: First case was a girl aged 8 years and 4 months who had multifocal compression fracture of C3, 5, 6 & T7, 8 without spinal cord injury. Second case was a thirty nine-year-old female who had Type I Hangman's fracture and compression fractures of C3, 7. RESULTS: We had satisfactory results of them treated nonsurgically. CONCLUSIONS: We should remind that cervical spinal column can incur multiple injuries in variant patterns.

Patient-Controlled Analgesia Using Accufuser-plus kit(R) after Arthroscopic Rotator CuffRepair: Subacromial Catheter vs Intravenous Injection / 대한정형외과학회잡지

PURPOSE: To compare the efficacy of a patient-controlled subacromial with intravenous analgesia following arthroscopic rotator cuff repair. MATERIALS AND METHODS: In this prospective study, 40 cases of arthroscopic rotator cuff repair who received patient-controlled analgesia by Accufuser-plus kit(R) were analyzed. There were 21 men and 19 women with a mean age of 54 years (range, 33 to 73). The patients were divided into two groups, one (20 cases in each) receiving subacromial infusion with 0.5% bupivacaine and the other receiving an intravenous infusion with fentanyl and ketorolac tromethamine. A visual analog scale (VAS) was used to record the patient's level of pain every 12 hours until the first 72 hours after surgery, and for 48 hours after the patient-controlled analgesia was stopped. RESULTS: The mean preoperative VAS during motion was 6.8 in the subacromial infusion group and 5.8 in the intravenous infusion group. The immediate postoperative VAS was 7.6 and 7.4. The subacromial infusion showed significantly better results than the intravenous infusion in 24 hours, 48 hours at rest and 48 hours during motion. After the patient-controlled analgesia was stopped, the VAS increased for the first 12 hours but decreased thereafter. Acromioplasty did not affect the results and the number of supplemental analgesic injections during patient-controlled analgesia was similar in the two groups. Three cases in the intravenous infusion group gave up the patient-controlled analgesia due to transient hypotension, nausea and vomiting. CONCLUSION: Patient-controlled analgesia using Accufuser-plus kit(R) after an arthroscopic rotator cuff repair showed that a subacromial infusion is a faster and more effective method of decreasing the level of postoperative pain than an intravenous infusion with less complications.

Anatomic Reconstructive Surgery of the Posterolateral Instability of the Knee Using Split Acilles Allograft / 대한정형외과학회잡지

PURPOSE: This paper describes a new anatomic reconstructive surgical procedure that simultaneously reconstructs the fibular collateral ligament, popliteal tendon and popliteofibular ligament using a split Achilles allograft and compares the clinical results of this new technique with the posterolateral corner sling procedure used for posterolateral instability of the knee. MATERIALS AND METHODS: Forty-six patients were treated for a posterolateral instability of the knee between 1998 and 2003. The posterolateral corner sling procedure (Group A) was performed in 25 patients and anatomic reconstructive surgery (Group B) in 21 patients. The minimum follow-up was 12 months. An arthroscopic evaluation was performed in all cases. The clinical review included the Lysholm knee scores as well as a lateral instability and tibial external rotation assessment. RESULTS: The mean Lysholm knee scores in groups A and B were 54.8 points and 54.4 points prior to surgery, and 86.9 and 93.6 points at the time of the latest follow-up, respectively (p<0.05). Tibial external rotation of 5 degrees more than the contralateral uninjured knee was noted in 12% of group A and in 5% of group B (p<0.05). Lateral instability of 5 mm greater than the contralateral knee was observed in 28% of group A and in 14% of group B (p<0.05). CONCLUSION: Anatomic reconstruction of the posterolateral corner resulted in less lateral instability and tibial external rotation than did the posterolateral corner sling procedure.

Clinical Outcome of Shoulder Replacement in Non-Traumatic Arthritis: A Comparison of Hemiarthroplasty and Total Shoulder Arthroplasty / 대한정형외과학회잡지

PURPOSE: To compare the clinical outcomes and complications of hemiarthroplasty (HHR) and total shoulder arthroplasty (TSR) in non-traumatic arthritis patients. MATERIALS AND METHODS: Thirty-two patients (34 shoulders) underwent shoulder arthroplasty for nontraumatic shoulder arthropathy. There were sixteen patients with rheumatoid arthritis, nine with osteoarthritis, four with avascular necrosis and etc. HHR was performed in eleven shoulders and TSR in twentythree shoulders. RESULTS: In HHR, the pain score decreased from preoperatively 7.09 to 0.91 postoperatively. The mean forward elevation was 137degrees and the mean external rotation at the side and abduction were 55degrees and 131degrees, respectively. The mean ASES score was 82.4. In TSR, the pain score decreased from 7.04 preoperatively to 1.17 postoperatively. The mean forward elevation, external rotation at the side and abduction were 132degrees, 44degrees, and 132degrees, respectively. The mean ASES score was 81.2. In rheumatoid arthritis, the mean ASES score of the HHR and TSR were 77.8 and 78.1, respectively. In osteoarthritis, the mean ASES score was 84.7 and 90.8, respectively. During the follow up, glenoid erosion was observed in three HHR cases, and glenoid loosening in two TSR case. CONCLUSION: HHR and TSR produced similar results in terms of the functional improvement. The clinical results were much better in patients with osteoarthritis than in those with rheumatoid arthritis, and TSR was performed on most cases of rheumatoid arthritis.

Arthroscopic Versus Mini-Open Rotator Cuff Repair: Comparison of Clinical Results / 대한정형외과학회잡지

PURPOSE: To compare the clinical results of an arthroscopic rotator cuff repair with those of a mini-open repair. MATERIALS AND METHODS: Sixty-three patients with a rotator cuff tear were enrolled in this study. Thirty patients had an arthroscopic repair and 33 patients underwent a mini-open repair. The average age was 50 years (range, 23-74) in the arthroscopic group and 50 years (range, 38-69) in the mini-open group. In the arthroscopic group, 8 patients had small-sized tears (0.05], the range of motion, muscle strength, patient's satisfaction, the ASES score [91.7 vs. 88.6, p>0.05] and the UCLA score [32.4 vs. 31.2, p>0.05] were compared. The size of the tear did not produce different results. In the arthroscopic group, the tendon tore again in one patient, and one anchor-related complication was noted. In the mini-open group, one patient developed a stiff shoulder. CONCLUSION: An arthroscopic and a mini-open repair of rotator cuff tears produced similar clinical results and the size of the tear had little effect. The clinical results depend on the surgical technique and the patient's condition, rather than the method of repair.

Range of Motion after Fixed Bearing Total Knee Arthroplasty

PURPOSE: The purpose of this study is to to analyze the range of flexion after total knee arthroplasty(TKA). MATERIALS AND METHODS: From January 1997 to June 2002, conventional fixed bearing TKA was car-ried out on 952 knees of 628 patients. The preoperative diagnosis was degenerative osteoarthritis in 816 knees and rheumatoid arthritis in 136 knees. The cruciate retaining(CR) prosthesis was used in 592 knees and the PCL substituting(PS) prosthesis in 360 knees. The range of flexion was measured using goniome-ter. In 40 knees, the lateral radiograph at full flexion position was obtained and the criterion validity(r) between the goniometric and radiographic measurement was analyzed. We measured and compared the range of flexion according to the preoperative diagnosis and type of prosthesis. RESULTS: Criterion validity(r) between goniometer and radiographic measurement was 0.92. At mini-mum one year follow-up after TKA, the average flexion was 127.8 +/-15.0 degree. There was no statistical sig-nificance in range of flexion between rheumatoid arthritis and osteoarthritis and between cruciate retain-ing and posterior stabilized prosthesis. CONCLUSION: The average flexion was 127.8 degree after TKA. 248 knees(26.1%) had ROM between 130 degree and 140 degree and 100 knees(10.5%) had 140 degree or more.

Reconstruction for Medial Instability of the Elbow Joint using Palmaris Longus Tendon: 4 Case Reports / 대한정형외과학회잡지

We report upon our experiences of 4 cases of reconstruction using the palmaris longus tendon for medial instability of the elbow joint. All patients were male and preoperatively the average age was 22 (19-25) years old; the average follow up period was 21 (17-28) months. Three patients were pitchers who had pain and instability during the late cocking and acceleration phase. One patient had been hit directly on the medial side of the elbow and experienced instability during normal activities. The provocation test for medial instability of the elbow was positive in all patients, and magnetic resonance imaging showed complete disruption of the ulnar collateral ligament. The three baseball pitchers could throw well without symptoms at the last follow up. One patient was comfortable during the normal and sports-related activities. No ulnar nerve symptom was evident in any patient postoperatively. The results of reconstructive surgery for medial instability of the elbow were excellent or good. The surgical approach between the palmaris longus and the flexor carpi ulnaris muscles provided a good operative field without damage of the common flexor group. In the absence of a history of ulnar neuropathy preoperatively, it was found not to be necessary to transport the ulnar nerve anteriorly.