Functional Results of the TKA with Non-resurfaced Patella according to Articular Degeneration of the Patella / 대한정형외과학회잡지

PURPOSE: We evaluated the functional outcome as degeneration of articular surface of the patella after total knee arthroplasty without resurfacing the patella. MATERIALS AND METHODS: From 2002 to 2003, 63 cases of 52 osteoarthritis patients who underwent total knee arthroplasty without resurfacing the patella as randomized selection were evaluated. Average age was 67.2 years old. Female were 49 patients, and male 3 patients Average follow-up periods were 32 months. Used implant were all PFC-sigma. Clinical outcomes was analyzed as Feller's patella score (perfect score; 30 points), anterior knee pain, crepitation according to the extent of involvement of articular surface of the patella and patello-femoral tracking. RESULTS: The Feller's patella score increased from mean 20.1 to 26.9 (p0.05). The patella score was low with patellar malalignment. Anterior knee pain after operation increased during postoperative 6 months according to the extent of degeneration of patellofemoral joint, but after 6 months there is no statistically significant differences except group 4 and all groups gradually decreased. Crepitation was increased during postoperative 1 year according to the extent of cartilage degeneration and after that its incidence decreased with time. CONCLUSION: The clinical results of total knee arthroplasty without resurfacing the patella was not influenced by the extent of degeneration of patello-femoral joint, but by alignment of patellofemoral joint. Anterior knee pain and crepitation increased in proportion to the extent of degeneration of patello-femoral joint in early period, but it fade out with time.

Retrograde Intramedullary Nailing for the Treatment of Ipsilateral Femoral Shaft and Neck Fracture / 대한정형외과학회잡지

PURPOSE: To evaluate the results of the operative method for ipsilateral femoral shaft and neck fractures using retrograde nailing technique. MATERIALS AND METHODS: Seventeen fractures (sixteen patients), followed-up more than 1 year, were included in this study. There were 14 men and 2 women, and the mean age was 44 years-old. According to the Winquist-Hansen classification, type II was most common with 11 cases. In femoral neck fractures, type B was most common with 13 cases according to AO-OTA classification and 6 of them were type II in Garden stage. After retrograde nailing of femoral shaft fractures, neck fractures were fixed by cannulated screw or dynamic hip screw. RESULTS: The average time for union of shaft fractures was 27.3 (14-60) weeks. Nonunion occurred in five patients, who required bone grafts or changes of fixation. The average time for union of neck fractures was 11 (8-12) weeks. All united, except for one case of nonunion with avascuar necrosis, which was a Garden stage IV fracture. Functional results using Friedman-Wyman criteria were good in 16 cases, and fair in one. The only fair result was nonunion of the femoral neck, which had the joint arthroplasty. CONCLUSION: Although the union rate of femoral shaft must be improved, retrograde nailing can provide an easy fixation and a favorable result for ipsilateral femoral neck fractures.

Results of Recurrent Patellar Instability after Trauma According to Anatomical Predisposing Factors

PURPOSE: We analyzed the results of lateral retinacular release(LRR) and proximal realignment for recurrent patellar instability after trauma according to the anatomical predisposing factors. MATERIALS AND METHODS: Twelve patients of fifteen cases of recurrent patellar instability had been evaluated. Clinical assessment were performed by Q-angle, apprehension test, passive patellar tilt test and general joint laxity. The anatomical predisposing factors assessed by plain radiographs included patella alta, sulcus angle, femoral trochlear dysplasia, genu valgum and patellar dysplasia. Clinical results were assessed by Kujala scoring system. Radiographic results were assessed by congruence angle. The results were analyzed according to the predisposing factors. RESULTS: Patella alta was observed in eight, increased sulcus angle in six, trochlear dysplasia in twelve, genu valgum in five and patella dysplasia in four cases. The result of treatment (Kujala score / congruence angle) was 85.8 / 9.7degrees in group A(predisposing factors > or = 3) and 91.4 / -5.3degrees in group B (predisposing factors<3)(p=0.036). We had 4 cases of recurrence after operation and genu valgum was related with recurrence rate. CONCLUSION: The clinical results of LRR and proximal realignment for recurrent patellar instability developed after trauma were worse in cases with more anatomical predisposing factors.

Combined Reconstruction of Posterior Cruciate Ligament and Posterolateral Rotatory Instability with Fresh-frozen Achilles Tendon Allograft

PURPOSE: We analyzed the clinical and radiologic results after arthroscopic reconstruction of the posterior cruciate ligament and posterolateral rotatory instability using fresh frozen Achilles tendon allograft. MATERIALS AND METHODS: Nine patients (10 cases) were evaluated. Male was 8 and female 1. Mean age was 38.4 years (23~59) and interval after trauma was 12.4 months (3~25 mo). Mean follow-up period was 14 months (12~21 mo). Posterior cruciate ligament was reconstructed with arthroscopic transtibial, single bundle technique and posterolateral rotatory instability with figure of "8" method using fibular tunnel. Clinical evaluation was done using posterior drawer test, posterolateral drawer test, varus stress test, prone external rotation (dial) test and range of motion. Functional evaluation was done by Lysholm knee score and Tegner activity scale. RESULTS: 90% of cases showed improvement to grade I by posterior drawer and to normal by posterolateral drawer, varus stress and dial test. One case showed flexion limitation more than 10degrees compared to opposite knee. Lysholm knee score and Tegner activity scale have been improved from mean 48.5 and 2.1 preoperatively to mean 80.2 and 4.5 postoperatively (p<0.05). Posterior drawer stress radiographs showed the improvement from mean 17 mm to 4.2 mm(p<0.05). CONCLUSION: Successful results were obtained by combined reconstruction of the posterior cruciate ligament and posterolateral rotatory instability with fresh frozen Achilles allograft.

Fixation Failure of LCP during the Treatment of Proximal Humerus Fractures

PURPOSE: To evaluate the causative factors in the catastrophic failure of LCP in the proximal humerus fracture. MATERIALS AND METHODS: Six patients (6 cases) were collected between October 2003 and July 2005. The mean age was 55.6 years (range: 38~70). The cause of injury was road traffic accident in four, fall down in one and slip down in one. According to the Neer classification, four were 2 part fractures, each one in 3 part fracture and 4 part fracture. RESULTS: Fixation failure occurred due to back-out of the plate and screw in five and plate breakage in one. Analysis of the preoperative radiographs revealed medial cortical defect in all and no bone graft and tension band wiring in the greater tuberosity fragment were carried out. Postoperative radiographs showed the anatomical reduction in three and non-anatomical in three. CONCLUSION: Non-anatomical reduction, insufficient medial bony buttress, inadequate screw length to the head and the neglect for the greater tuberosity fragment were the contributing factors to the failure of LCP. Knowledge of these factors will enable the surgeon to avoid failure of the LCP. Augmentation fixation and bone graft procedures with careful preoperative planning are necessary for successful fixation of LCP.

Accuracy of Limb Alignment in Total Knee Arthroplasty using Image-Free Navigation System: Comparison with Conventional Total Knee Arthroplasty

PURPOSE: We analyzed the comparative results of limb alignment after total knee arthroplasty using conventional method and image-free navigation system. MATERIALS AND METHODS: Total knee arthroplasties were performed in sixty-four patients(74 knees) with conventional method(37 cases)(Group A) and Orthopilot 4.0 image-free navigation system(37 cases)(Group B). We measured the femoro-tibial angle, femoral and tibial component angle in coronal and sagittal plane using the weight bearing whole leg radiograph taken 1-month postoperatively. RESULTS: Mechanical femoro-tibial angle was 1.4 degrees of varus in conventional group (Group A) and 0.8 degrees of varus in the navigation group (Group B) on average. Femoral and tibial component angle in the coronal plane was mean 1.8 degrees of varus and 0.7 degrees of varus in group A, 0.3 degrees of valgus and 0.5 degrees of varus in group B on average. Average femoral and tibial component angle in sagittal plane was 0.3 degrees of flexion and 0.8 degrees of anterior tilt in group A, 0.7 degrees of flexion and 1.7 degrees of anterior tilt in group B. There were no statistically significant differences between two groups in the femoro-tibial angle, femoral and tibial component angle in coronal and sagittal plane. But the ranges of deviation from desired angle were smaller in Group B than Group A. Statistically significant different results of the limb alignment (femoro-tibial angle and femoral component angle in coronal plane) were observed in 5 cases with severely bowed femoral shaft in group B (average femoro-tibial angle 0.9 degrees and femoral component angle in coronal plane 0.9 degrees varus) than group A (average femoro-tibial angle 3.5 degrees and femoral component angle in coronal plane 3.9 degrees varus). CONCLUSION: Accuracy of limb alignment in total knee arthroplasty using navigation system was not statistically significant difference than using the conventional method, but had better results in the deviation of mechanical femoro-tibial angle and femoral component angle in coronal plane than the conventional method, especially in severely bowed femoral shaft.