Acetabular Revision Using Uncemented Acetabular Cup

PURPOSE: The purpose of this study is to evaluate the clinical and radiological results of revision total hip arthroplasty with using impacted bone grafts and uncemented acetabular cups on the acetabulum with bone defects. MATERIALS AND METHODS: From June 1990 to March 2006, 131 revision total hip arthroplasties using an uncemented acetabular cup and impacted bone graft, were performed in 124 patients. The average follow-up period was 66 months. The clinical results were evaluated with the Harris hip score. The radiological results included the period of graft incorporation, the rate of resorption, the migration and the change of inclination of the cup. The failure rate and 13 year survival rate were analyzed. RESULTS: The Harris hip scores were 51.8 preoperatively and 82.5 postoperatively. The period of incorporation was a mean of 6.38 month. Most cases showed a resorption rate below 10%. The mean migrations of the acetabular cup were 1.37 mm superiorly and 1.20 mm medially. The mean change of inclination was 1.24 degrees. There were 5 re-revision surgeries. The failure rate was 3.8%. The survival rate of the revision that was done due to loosening was 94.9% at 13 years. CONCLUSION: Acetabular revision arthroplasty with bone grafts, and an uncemented cup is recommendable as it achieves favorable outcomes in terms of rapid incorporation of the grafted bone and stable fixation of the cup.

Surgical Treatment of the Myositis Ossificans in Supracondylar Fracture of the Humerus in Children: A Case Report

Supracondylar fracture of the humerus is a common injury in the pediatric patient. A less common complication is the development of myositis ossificans. Although frequently cited as a possible complication, there are few reported cases of this occurring in the pediatric patient. We present a case report of a 8 year old boy who developed myositis ossificans after a supracondylar fracture of the humerus. After one year of the injury, we could ascertained radiologically complete maturation of the mass which developed in front of the distal humerus and markedly made motion of the elbow joint limited. We could obtain further motion through the surgical resection and then physical therapy. Now, eleven months have lapsed since the mass was removed, the range of motion is almost normal, and the recurrence of myositis ossificans is not existed.

Comparison of Monoblock and Modular Femoral Stem on Isolated Acetabular Revision with Use of Uncemented Cup

Purpose: The purpose of our study was to assess the clinical and radiological results of isolated acetabular revision and the differences in the results between monoblock and modular femoral stems. Materials and Methods: Between October 1991 and June 2002, 39 patients (39 hips) underwent isolated acetabular revisions with use of uncemented cups and bone grafts. The mean period of follow-up was 5 years 3 months (range, 2 years 1 month to 9 years 8 months). The mean age of the patients at the time of the surgery was 51 years old (range, 26 to 75 years old). The monoblock femoral stems were used in 19 hips and the modular femoral stems were used in 20 hips. The monoblock stems were retained without exchange provided that there was no gross scratch on the femoral head and the femoral stem was confirmed to be stable and fixed intraoperatively. In the modular stems, the femoral heads were always exchanged with new ones. Results: The mean Harris hip score improved from 57 to 87 points. Radiologically, all the stems retained at surgery remained well osseointegrated without osteolysis. Re-revisions of the acetabular components were performed in 5 hips using monoblock stems due to periacetabular osteolysis caused by excessive wear of polyethylene and subsequent loosening of the cups in 3 hips and mechanically unstable acetabular cups without osteolysis in 2 hips. The mean wear rate of polyethylene coupled with the monoblock stem was 0.27 mm/year which was greater than the 0.11 mm/year in the cases with modular stems. Conclusion: To prevent failure of acetabular cups that may occur later by excessive wear of polyethylene, we recommend revision of the well-fixed monoblock femoral stems even though there is no gross scratch on the femoral heads of the monoblock stems.

Polyethylene Wear and Osteolysis in Uncemented Acetabular Component / 대한정형외과학회잡지

PURPOSE: To investigate the influence of the linear wear rate of polyethylene, the osteolysis threshold of the linear wear rate, and the related factors on polyethylene wear in an uncemented metal-backed-cup of a primary total hip arthroplasty. MATERIALS AND METHODS: This study examined 87 hips from 75 patients (57 men and 18 women) who had undergone a primary total hip arthroplasty with a minimum follow-up of five years. The mean age was 47.3 years (range, 25-68 years). The mean follow up period was 90 months (range, 60-148 months). The most frequent diagnosis was avascular necrosis of the femoral head. 18 Harris-Galante I and 69 Harris-Galante II cups, were used on the acetabular side, and 66 Anatomic and 21 Harris-Galantestems were used on the femoral side. Radiographic polyethylene wear was estimated using the method reported by Livermore, and the above mentioned factors that influence polyethylene wear were investigated and analyzed statistically. RESULTS: The overall mean linear wear rate of polyethylene was 0.21 mm/year. The linear wear rate of 22 hips with osteolysis and 65 hips without osteolysis was 0.29 mm/year and 0.12 mm/year respectively, showing a significant difference (p=0.001). The patients with high activity had a significantly higher mean linear wear rate (0.28 mm/year) than that those patients with low activity (0.16 mm/year) (p=0.048). Patients younger than 40 year-old had a significantly higher mean linear wear rate (0.23 mm/year) than the patients older than 40 year-old (0.19 mm/year) (p=0.049). However, there were no correlations between the mean linear wear rate and gender, weight, diagnosis, the type of cup and the thickness of the polyethylene. CONCLUSION: The polyethylene wear rate in an uncemented metal-backed-cup was significantly affected by age and the activity of the patients, which strongly influenced the development of osteolysis. Therefore, in order to reduce the incidence of aseptic loosening due to osteolysis in young patients with high activity, a bearing surface with mean linear wear rate of 0.12 mm/year or less is recommended.

Hydroxyapatite Coated CLS Femoral Stem in Patients with Rheumatoid Arthritis: Minimum 5 Year Results / 대한정형외과학회잡지

PURPOSE: The study was undertaken in order to characterize the clinical and radiological results of total hip arthroplasty using a fully rough blasted stem with proximal hydroxyapatite coating in rheumatoid arthritis patients. MATERIALS AND METHODS: Twenty three total hip arthroplasties were performed using CLS stems in rheumatoid arthritis patients. Mean patient age of the patients and follow-up period were 53 and 6.8 years, respectively. Both clinical and radiographical parameters were evaluated. RESULTS: Chronological change of Harris hip score showed good results after 1 year. Harris hip score and the incidence of thigh pain at the last follow-up were 94 and one case, respectively. The mean time weight bearing without support was 12.5 weeks. Most endosteal bone formations around the stem appeared in the first 3 to 6 months. This was present in more than 80% of cases in zones 1, 2, 6, 7 and from 50 to 70% of cases even in zones 3, 4, 5 at the final follow-up. Loosening or implant failure was not found. Incomplete calcar fracture occurred in three cases, liner fracture around the femoral stem in one, heterotrophic ossification in one and superficial infection in one. CONCLUSION: The total hip arthroplasty using a CLS stem with a proximal HA coating may be a good choice in rheumatoid arthritis patients requiring hip arthroplasty.

Meralgia Paresthetica by Iliopsoas Bursa associated with Osteonecrosis of the Femoral Head: A Case Report / 대한정형외과학회잡지

We present a patient with meralgia paresthetica by a distended iliopsoas bursa and associated with concurrent osteonecrosis of the femoral head. This manifestation is unusual and extremely rare because classically LFCN dose not pass near the iliopsoas bursa. We presume a mechanism of nerve injury by variation of the course of lateral femoral cutaneous nerve.

Results of Surgical Treatment of Spinal Tuberculosis: A Comparison between Anterior Fusion and Combined Fusion / 대한정형외과학회잡지

PURPOSE: This study was undertaken to compare anterior fusion surgery with combined fusion surgery and to evaluate the efficacy of a combined fusion procedure in the surgical treatment of spinal tuberculosis. MATERIALS AND METHODS: From March 1990 to March 1998 thirty-four patients who had with spinal tuberculosis were divided into two groups depending on the surgical treatment methods that were to be used; one group consisted of twenty-two patients who were treated by an anterior fusion surgery, and the other group consisted of twelve patients who were treated by an combined fusion surgery. There were twelve males and twenty-two females who had a mean age of 45.6 year old in the study. The mean follow-up period was four years and six months. The clinical and radiological results that were obtained were evaluated. RESULTS: In anterior fusion group, the mean loss of the corrected kyphotic angle was 6.9 degrees and an excellent or good result was shown in nineteen patients (86.4%). In the combined fusion group, the mean loss in the corrected kyphotic angle was 5.6 degrees and an excellent or good result was shown in ten patients (83.3%). There was no significant statistical difference between the two groups. CONCLUSION: We conclude that an anterior radical excision of the involved body and an anterior fusion was the appropriate method for surgical treatment of spinal tuberculosis, and combined fusion should be carefully considered.

Osteoid Osteoma of the patella: a case report / 대한정형외과학회잡지

Osteoid osteoma is a distinctive benign lesion characterized by a less then 2 cm, pea-like mass of abnormal bone (nidus). The common sites of osteoid osteoma are femur, tibia, humerus, spine and talus. Mastoid tip, clavicle, acetabulum, coccyx, rib, hamate, scapula and scaphoid are rare sites of osteoid osteoma. Osteoid osteoma of the patella is also very rare and on review of literatures we could find only one reported case which was treated by surgical excision. We also experienced one case of osteoid osteoma located at the patella, so we report this case with review of literatures.