Comparative Study for the Results of Unicompartmental Knee Arthroplasty in Patients Younger and Older than 60 Years of Age / 대한정형외과학회잡지

PURPOSE: We wanted to assess the relations between age and the outcome of unicompartmental knee arthroplasty (UKA) based on a comparative study of UKA patients younger than 60 years and UKA patients older than 60 years of age. MATERIALS AND METHODS: Among the patients who underwent a UKA between January 2002 and June 2003, 230 cases (the group of patients with ages under sixty consisted of 89 knees - group I, and the group of patients with ages over sixty consisted of 141 knees - group II) were followed up for at least 5 years after the operation. Clinical assessments were made using the Knee Society Score (KSS) rating system. RESULTS: The average KSS knee and function scores improved from 54.2 and 57.1 preoperatively to 87.3 and 85.2 at the last follow-up in group I, and from 54.7 and 54.3 to 89.5 and 81.7 in group II, respectively. The mean range of knee motion also improved from 129.4degrees to 132.9degrees in group I and from 126.8degrees to 133.2degrees in group II, respectively. There were 5 cases of failed UKAs in each group, and the survival rate of the implant at 5 years was 94.7% in group I and 96.6% in group II. CONCLUSION: The clinical results of UKA were satisfactory in both age groups. Group I had better results on the knee function score at the last follow-up, but there was no significant difference between both age groups. UKA can be a one of the reliable methods for the treatment of osteoarthritis in patients younger than 60 years of age.

Oxford Phase 3 Unicompartmental Knee Arthroplasty: Minimum 5-year Follow-up Results

PURPOSE: We wanted to evaluate the postoperative clinical results, the complications and the survival rate of Oxford phase 3 unicompartmental knee arthroplasty (UKA), based on a prospective analysis and the follow-up study. MATERIALS AND METHODS: We operated on 142 patients, 180 cases of UKA using the Oxford phase 3 prosthesis from January 2002 to December 2002. Clinical assessments were made using the Knee Society score rating system. Among those, 152 cases (121 patients) were able to be followed up for at least 5 years after the operation. The mean patient age at the time of surgery was 61.1 years and the mean duration of follow-up was 5.5 years. RESULTS: For these 152 knees, the mean preoperative knee and function scores were 53.5 and 55.8, respectively, and they were improved to 88.7 and 83.1, respectively, at the last follow-up. The mean range of knee motion recovered to 133.1degrees and the mean tibiofemoral angle was changed to 4.9degrees of valgus. When we asked patients about their level of satisfaction, 88% of the patients said they were 'very satisfied' or 'satisfied'. There were 7 postoperative complications and the survival rate of the implant at 5 years was 96.8%. CONCLUSION: The Oxford phase 3 UKA was satisfactory for improving the clinical results, the subjective satisfaction of the patients and the survival rate of the implant.

Unicompartmental versus Total Knee Arthroplasty in the Same Patient / 대한정형외과학회잡지

PURPOSE: To compare the clinical and radiographic results of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in the same patient, and to investigate patient preference and satisfaction. MATERIALS AND METHODS: Among the 56 patients who underwent a UKA in one knee and a TKA in the opposite knee between January 2002 and December 2004, 51 patients were followed up. The average follow-up period was 4 years. RESULTS: The average Knee Society Score (KSS) improved from 53.5 preoperatively to 90.7 at last follow-up in the UKA knee, and from 50.4 to 89.8 in the TKA knee. The mean range of knee motion also improved from 124.7degrees to 133.2degrees in the UKA knee, and from 122.5degrees to 127.1degrees in the TKA knee. The tibiofemoral angle changed from 0.3degrees of varus to 5.6degrees of valgus in the UKA knee, and from 2.4degrees of varus to 5.8degrees of valgus in the TKA knee. For patient preference, 23 patients (45%) preferred the UKA knee and 19 patients (37%) preferred the TKA knee. Most patients (42 patients, 82%) reported being nvery satisfied' or nsatisfied' with both knees. CONCLUSION: The clinical and radiographic results of both the UKA and the TKA in the same patient were satisfactory at the 4-year follow-up. The UKA knee had a slightly better range of knee motion, but there was essentially no difference between the UKA knee and the TKA knee.

Mobile Bearing Subluxation after Unicompartmental Knee Arthroplasty Treated by Arthroscopy : A Case Report

A polyethylene mobile bearing subluxation is a very rare complication after mobile type unicompartmental knee arthroplasty (UKA). Of 436 cases which had been followed up for 1 year after UKA, we experienced 9 cases of bearing dislocation and a case of bearing subluxation. We treated a case of mobile bearing subluxation by arthroscopy. We achived stable reduction of the bearing using arthroscopic surgery and the patient was satisfied with the outcome. So we report a case of mobile bearing subluxation after UKA treated by arthroscopy.

Factors Affecting the Tibiofemoral Alignment in Minimally Invasive Unicompartmental Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: We analyzed affecting factors associated with the tibiofemoral alignment after minimally invasive unicompartmental knee arthroplasty (UKA) used to treat medial compartmental osteoarthritis of the knee. MATERIALS AND METHODS: From January 2003 to December 2003, 128 UKA were performed in 114 patients with minimally invasive surgery. The revealed tibiofemoral angle, tibial translation, posterior slope and the coronary orientation of the tibial and femoral component were measured using the preoperative and postoperative weight-bearing radiographs. The possible factors associated with the corrective tibiofemoral angle were analyzed statistically. RESULTS: The average corrective angle of the tibiofemoral axis was 5.8 degrees from varus 0.6 degrees preoperatively to valgus 5.2 degrees postoperatively. The average corrective angle of the tibiofemoral axis was 6.1 degrees in the mobile bearing group and 3.6 degrees in the fixed bearing group. There was significantly more corrective tibiofemoral angle postoperatively with a larger varus deformity of the knee preoperatively (p<0.0001). The corrective tibiofemoral angle had an increasing tendency with increasing bearing size but this was not statistically significant. Surgeons, the age of the patients, tibial translation, posterior slope of the tibial component, and coronary orientation of the tibial component and femoral component did not affect the degree of the corrective tibiofemoral angle. CONCLUSION: The average corrective angle of the tibiofemoral axis after minimally invasive UKA was 5.8 degrees. The preoperative tibiofemoral angle and the types of implants affected the postoperative tibiofemoral axis after minimally invasive UKA.

Degenerative Change of Adjacent Segments according to the Fusion Method after L4-5 Segmental Fusion: Comparative Study of Posterolateral Fusion and Posterior Lumbar Interbody Fusion / 대한정형외과학회잡지

PURPOSE: We wanted to investigate the difference in the incidence of post-fusion adjacent segment degeneration between performing posterolateral fusion and posterior lumbar interbody fusion. MATERIALS AND METHODS: One hundred fifty seven patients who underwent L4-5 fusion using pedicle screws for degenerative lumbar disease and followed up more than three years were analyzed retrospectively. Eighty-six cases of posterolateral fusion (group I) and 71 cases of posterior lumbar interbody fusion (group II) were compared. Sampling bias was evaluated by comparing gender, age, the preoperative degeneration of adjacent segments, the sagittal angle of fusion segments on the last follow up and the follow-up period. The differences of adjacent segments degeneration and the revision rate between the two groups were investigated multilaterally. The actual risk factors for such degeneration were investigated by performing multiple logistic regression test, which contrasted the degeneration group with the non-degeneration group for all the above factors, including whether interbody fusion was done or not. RESULTS: Sampling bias was excluded except for the preoperative proximal adjacent segments degeneration (p=0.036). There was no statistical difference in the final proximal degeneration (31/86, 36% in group I, 26/71, 37% in group II, p=0.536) and revision (8/86, 9% in group I, 6/71, 8% in group II, p=0.536). There was no statistical difference in the final distal degeneration (9/86, 10% in group I, 8/71, 11% in group II, p=0.536) and revision (4/86, 5% in group I, 2/71, 3% in group II, p=0.435). When comparing those cases who developed degeneration on either side with the non-degeneration cases, the odds ratio of old age and an insufficient sagittal angle of the fusion segments reached statistical significance (p=0.024, 0.001). CONCLUSION: There were no differences in adjacent segments degeneration between the posterolateral fusion group and the posterior lumbar interbody fusion group. Rather than the operation methods, old age and insufficient sagittal angle of the fusion segments were the actual risk factors of such degeneration.

Acute Compartment Syndrome of the Thigh Caused by the Pseudoaneurysm of the Femoral Artery: A Case Report / 대한정형외과학회잡지

A pseudoaneurysm occurs as a late complication of an arterial wall injury after a surgical procedure or injuries such as a fracture, stab injury and penetrating trauma. Acute compartment syndrome as an elevation of the pressure in a closed compartment results in vascular compromise and a dysfunction. However, its occurrence in the thigh is quite rare. We report a case of a patient treated with an excision of a pseusoaneurysm and an artificial vessel graft who had compartment syndrome of the thigh caused by a pseudoaneurysm of the femoral artery that had developed after a blunt injury.

Operative Treatment of Lumbosacral Spondylitis Through a Posterior-only Approach / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of this operative method, which includes removal of infected materials, insertion of a bone graft and fixation with pedicle screws through a posterior-only approach in spondylitis with advanced bone destruction and radicular pain. MATERIALS AND METHODS: Ten patients with refractory single level spondylitis of the lumbosacral spine, who underwent the above operation and were followed-up for more than 2 years, were analyzed retrospectively. Six cases were tuberculous and 4 cases were pyogenic in etiology. Radiologically, bone union and restoration of sagittal alignment were assessed. Clinically, Visual Analog Scales (VAS) for back pain, leg pain and resolution of neurologic symptom were analyzed. RESULTS: Bone union was achieved in all cases. Sagittal angle was corrected significantly from -3.6+/-12.5 degrees to -11.4+/-9.3 degrees (p=0.007). However, loss of correction was noted from -16.2+/-10.2 degrees at immediate after surgery to -11.4+/-9.3 degrees at last follow-up (p=0.005). Back pain VAS was improved from 8.3+/-0.7 to 2.6+/-1.6 (p=0.005) and leg pain VAS was improved from 6.8+/-2.1 to 0.5+/-0.9 (p=0.005). There was strong positive correlation between age and final back pain (r=0.79, p=0.011) and leg pain VAS (r=0.75, p=0.020). There was no meaningful correlation between the sagittal angle and back pain (r=0.30, p=0.430) and leg pain VAS (r=0.41, p= 0.274). Implant related complications and deep wound infections did not occur. CONCLUSION: In single level spondylitis of the lumbosacral spine, a posterior-only surgical approach is a useful method in which debridement, bone graft placement and pedicle screw fixation can be performed. This procedure did not provide increased risk with respect to infection control, and it allowed correction of the sagittal angle. The younger the age of the patients, the better the back pain and leg pain VAS results.