Total Knee Arthroplasty Using Computer-Assisted Navigation in Patient with Ipsilateral Hemiarthroplasty and Angle Blade Plate Fixation: A Case Report

A 79-year-old female patient had bipolar hemiarthroplasty because of a nonunion of the intertrochanteric fracture of the right femur seven months ago. As she got hurt from slip down during rehabilitation and supracondylar fracture of the ipsilateral femur occurred, she underwent open reduction and internal fixation with angle blade plate. Her walking and daily living were seriously limited because of degenerative arthritis of the right knee joint. She underwent the total knee arthroplasty using computer-assisted navigation without removal of the hard wares inserted in the femur.

Patient Perspectives on Currently Controversial Issues in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To examined the level of patient knowledge and their perspectives about the controversial issues in total knee arthroplasty (TKA), and to evaluate the effect of a relevant explanation about the issues on the patient preferences for their particular option. MATERIALS AND METHODS: One hundred patients who visited our clinic and decided to undergo TKA were asked to complete a questionnaire asking about their knowledge and preference for 4 controversial issues: 1) surgical timing of the bilateral TKAs, 2) use of computer assisted surgery, 3) use of minimal invasive surgery, and 4) use of ceramic femoral component. The patients completed the same questionnaire after the advantages and disadvantages of each option had been explained using an explanatory document designed based upon what was documented in the literature. RESULTS: The patients were not well-informed about the issues and received their information through a non-professional source. The patients tended to prefer new options with claimed promises before an explanation. The patients preferred the options with safety, accuracy, and proven evidence after an explanation. Male patients tended to prefer simultaneous TKAs more than female patients. Younger patients preferred ceramic femoral component claimed to have better longevity more than older patients did. CONCLUSION: This study demonstrates that patients' knowledge of the current controversial issues is very limited, and that patient preferences would be significantly changed if they were given an explanation from a physician. Balanced information should be given to patients in order for them to reach a fair decision.

Vibrio vulnificus Infection Presenting as Septic Arthritis of the Knee: A Case Report / 대한정형외과학회잡지

Vibrio vulnificus is a fatal marine Gram-negative bacillus that might cause septicemia, necrotizing cellulites in patients with underlying liver disease or an immunocompromised health status, and is associated with high mortality. It is usually attributed to the ingestion of raw shellfish or traumatic exposure to the marine environment. The clinical manifestation includes fever, chill, hypotension, and skin lesions such as erythematous patch, vesicle, bullae that develop into necrosis and wound infections. We report a case of Vibrio vulnificus septicemia and necrotizing fascitis in a patient who presented with septic arthritis of the knee as the first clinical manifestation.

Radiologic Reduction Loss after Surgical Treatment of Distal Radius Fracture

PURPOSE: To compare and analyse radiologic reduction loss between fixation with K-wire only group and fixation with K-wire and external fixator group for surgical treatment of distal radial fracture. MATERIALS AND METHOD: We analysed 60 patients who received the operative treatment with K-wire fixation only or K-wire and external fixator and also were in regular follow up at least one year. We compared radiologic reduction loss of radial length, radial inclination and volar tilt between immediate post-operative radiograph and latest follow up radiograph according to operative methods, fracture patterns and age groups. RESULTS: Reduction loss of volar tilt was greater in fixation with K-wire only group than fixation with K-wire and external fixator group (p<0.05). Reduction losses of radial length and radial inclination were more in intra-articular subgroup than extra-articular subgroup in fixation with K-wire only group (p<0.05). No significant difference of reduction loss was noted between intra-articular and extra-articular subgroups in fixation with K-wire and external fixator group. CONCLUSION: More radiologic reduction loss can be expected in fixation with K-wire only group for intra-articular distal radius fracture compared with extra-articular distal radius fracture. Additional external fixation should be added in intra-articular distal radius fracture to reduce radiologic reduction loss.

Total Hip Arthroplasty with Hydroxyapatite-coated ABG(R) Hip Prosthesis: Minimum 5 Year Follow-up / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiological results of total hip arthroplasty (THA) with a hydroxyapatite (HA)-coated ABG(R) (AnatomicalBenoist Giraud, Howmedica, Europe) hip prosthesis. MATERIALS AND METHODS: From March 1992 to December 1996, we performed 204 total hip arthroplasty with HA-coated hip prosthesis. This study included 142 hips. The causes of THA were osteonecrosis of the femoral head (122 hips), osteoarthritis (16 hips) and infectionsequalae (4 hips). Clinical results were evaluated using Harris hip score. We observed osteointegration, cortical hypertrophy, reactiveline around femoral stem, subsidence, polyethylene wear, osteolysis and radiolucent line around acetabular cup on the follow-up radiographs. RESULTS: Harris hip score was an average of 84.5 points at last follow-up. Only one femoral stem was revised for loosening. Reactive lines around uncoated portion of femoral stem was observed in 70 hips. The cortical hypertrophy was observed at zone 2, 3, 5 and 6 in 46hips. Forty-five acetabular cups (31.7%) were revised. The causes of cup revision were polyethylene liner wear and osteolysis (24 hips), loosening (19 hips) and recurrent dislocation (2 hips). CONCLUSION: We found that the HA-coated ABG(R) femoral stem had high survival rate at minimum 5 years follow-up after THA, but acetabularcup had high revision rate for loosening and osteolysis.

The Effects of Radiofrequency Energy on Human Articular Cartilage: The Effect of Power Setting and Mode of Treatment on Chondrocyte Viability / 대한정형외과학회잡지

PURPOSE: The objective of this study was to investigate the effects of radiofrequency energy on human chondrocyte viability, and to correlate confocal laser microscopy fluorescence to sulfate uptake and to the histological integrity of articular cartilage. MATERIALS AND METHODS: The chondroplasty procedure for chondromalacic articular cartilage was performed using a 3.0-mm ArthroWand (Arthroscopic Electrosurgery System, ArthroCare Corporation) on fresh human articular cartilage. Radiofrequency energy was applied to the cartilage surface through the probe at a velocity of 10-mm per second in contact and non-contact mode. Three power settings were used. The treated cartilage was analyzed for chondrocyte viability by confocal laser microscopy and (35)S uptake. RESULTS: Confocal laser microscopy demonstrated partial-thickness chondrocyte death irrespective of treatment method. No mode of treatment or radiofrequency energy power setting resulted in full-thickness chondrocyte death. The depth of cartilage ablation was increased in the treated areas in contact mode in proportion to the power level and the time of treatment. No statistically significant difference in radiolabeled sulfate uptake of the specimens was observed with respect to the treatment modes and power settings. CONCLUSION: The extent of chondrocyte death by radiofrequency energy was not as significant as reported previously when the probe was moved at the speed of 10 mm/sec. Radiofrequency energy may be useful to treat chondromalacic cartilage in a contact mode using a proper energy level and delivery time.