The Usefulness of Three-dimensional Computed Tomography as an Assessment of Periacetabular Osteolysis in Revision Total Hip Arthroplasty / 대한고관절학회지

PURPOSE: This study was performed to determine the usefulness of three-dimensional computed tomography (3D-CT) in measuring periacetabular osteolysis by comparing the real volume of osteolysis in revision surgery. MATERIALS AND METHODS: Twnety-three patients who had undergone revision surgery due to periacetabular osteolysis but not included septic osteolysis and implant loosening. The mean age of patients at the time of surgery was 55.2 years. And the mean time interval between the primary total hip arthroplasty and revision surgery was 13.3 years. We measured the polyethylene wear in plain radiographs using computer assisted vector wear analysis program, the volume of acetabular osteolytic lesions in high-resolution spiral CT scans using Rapidia 3D software version 2.8 algorithms before the revision surgery were performed. Intraoperative real osteolytic volume was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume. RESULTS: Strong correlation was found between the volume of acetabular osteolytic lesions measured on 3D-CT and intraoperative real osteolytic volume which was calculated as the sum of the volumetric increments of the acetabular cup and impacted allo-cancellous bone volume. CONCLUSION: 3D-CT is considered a useful method for assessing and measuring the volume of periacetabular osteolysis before revision surgery.

Clinical Results of Lumbar Spinal Fusion in Degenerative Spine Disease in Patients over 75 Years Old: Comparative Study of Patients over 65 Years Old and Patients less than 75 Years Old / 대한정형외과학회잡지

PURPOSE: The elderly patients have been known for high incidence of postoperative complications following a lumbar fusion surgery. This study was conducted to determine the results of clinical outcomes after a lumbar fusion surgery in patients older than 75 years and to compare with those in patients between 65 and 74 years old. MATERIALS AND METHODS: One hundred twenty-five patients who underwent lumbar fusion were enrolled. The mean follow-up was 22.5+/-15.7 months. Preoperative diagnosis was spinal stenosis in 113 patients and degenerative spondylolisthesis in 12 patients. Revision surgery or multi-level spinal fusion (>4 segments) was excluded. There were 27 patients in group A (>75 years) and 98 patients in group B (65-74 years). Preoperative American Society of Anesthesiologists (ASA) scores, visual analog scale (VAS), Oswestry disability index (ODI), postoperative complications, and bone union rate were compared. RESULTS: The mean age was 78.6 years and 68.8 years in Group A and Group B, respectively. The mean preoperative ASA score was statistically different between group A and group B (p=0.025). The mean bone mineral density T score in group A was higher than that in group B (p=0.002). The mean VAS did not show a difference between the groups (p=0.171). There was no difference in the mean ODI between the groups in the improvement of VAS and ODI. The major and minor complications of early complications and late complications were observed without any statistical difference. CONCLUSION: Although preoperative ASA score was higher and osteoporosis was severe in the elderly patients (>75 years old), the improvement of clinical outcome was satisfactory as much as younger patients (65-74 years old) following a lumbar fusion surgery for degenerative spinal disease.