Total Knee Arthroplasty: Is It Safe? A Single-Center Study of 4,124 Patients in South Korea

Background@#Although total knee arthroplasty (TKA) is considered an effective treatment for knee osteoarthritis, it carries risks of complications. With a growing number of TKAs performed on older patients, understanding the cause of mortality is crucial to enhance the safety of TKA. This study aimed to identify the major causes of short- and long-term mortality after TKA and report mortality trends for major causes of death. @*Methods@#A total of 4,124 patients who underwent TKA were analyzed. The average age at surgery was 70.7 years. The average follow-up time was 73.5 months. The causes of death were retrospectively collected through Korean Statistical Information Service and classified into 13 subgroups based on the International Classification of Diseases-10 code. The short- and long-term causes of death were identified within the time-to-death intervals of 30, 60, 90, 180, 180 days, and > 180 days. Standard mortality ratios (SMRs) and cumulative incidence of deaths were computed to examine mortality trends after TKA. @*Results@#The short-term mortality rate was 0.07% for 30 days, 0.1% for 60 days, 0.2% for 90 days, and 0.2% for 180 days. Malignant neoplasm and cardiovascular disease were the main short-term causes of death. The long-term (> 180 days) mortality rate was 6.2%. Malignant neoplasm (35%), others (11.7%), and respiratory disease (10.1%) were the major long-term causes of death.Men had a higher cumulative risk of death for respiratory, metabolic, and cardiovascular diseases. Age-adjusted mortality was significantly higher in TKA patients aged 70 years (SMR, 4.3; 95% confidence interval [CI], 3.3–5.4) and between 70 and 79 years (SMR 2.9; 95% CI, 2.5–3.5) than that in the general population. @*Conclusions@#The short-term mortality rate after TKA was low, and most of the causes were unrelated to TKA. The major causes of long-term death were consistent with previous findings. Our findings can be used as counseling data to understand the survival and mortality of TKA patients.

Efficacy of the Harmonic Scalpel in Parotidectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The use of the harmonic scalpel recently has been described in various surgery, such as thyroidectomy, tonsillectomy and submandibular gland resection. It appears that the use of harmonic scalpel results in decreased operative time and blood loss compared to conventional techniques of vessel ligation and tissue division without increasing the incidence of nerve injury. The aim of this study was to determine whether the application of harmonic scalpel in parotidectomy was effective and safe compared to conventional parotidectomy techniques. SUBJECTS AND METHOD: From March 2001 through Jun 2005, 21 patients who underwent parotidectomy under aid of Harmonicscalpel were compared with 38 patients of conventional parotidectomy techniques. Intraoperative blood loss, operation time, facial nerve injury, wound complication, postoperative drainage and hospital stay were compared between two groups. RESULTS: There were no significant differences between two groups with postoperative wound complication, facial nerve function and hospital stay. But the use of harmonic scalpel was associated with a significant reduction in operation time and intraoperative blood loss. CONCLUSION: The application of harmonic scalpel was very useful and relatively safe in parotidectomy. However, further research involving a randomized study is needed.

Motor Paresis Caused by Herpes Zoster in Patients with Rotator Cuff Tear: A report cases / 대한통증학회지

Segmental zoster paresis is characterized by focal, asymmetric motor weakness in the myotome corresponding to the dermatome of the rash. A 73-year-old man, who presented with severe right shoulder pain and shoulder girdle muscle weakness, was diagnosed with segmental zoster paresis involvement of the C5 C6 motor roots as a complication of herpes zoster. Girdle muscles (supraspinatus, deltoid and infraspinatus) atrophy had developed in his right shoulder. An MRI showed rotator cuff tearing in his right shoulder; therefore, an arthroscopic rotator cuff repair was performed. Herein, this case is presented to emphasize the importance of considering post-herpetic segmental motor paresis in the differential diagnosis of acute painful motor weakness of the upper extremities.