More than 10 year Follow-up Study of Insall-Burstein Posterior Stabilized Knee / 대한정형외과학회잡지

Insall-Burstein Posterior stabilized knee prosthesis is a variant of total condylar prosthesis. It is designed to get more wide range of flexion and stability with the transverse cam. We analyze with modified HSS knee rating score clinically and scoring system of AKS(American Knee Society) radiologically. We report the operative results in 34 cases of 25 patients whom we operated with Insall-Burstein PSP from August, 1982 to May, 1985 and the long term follow-up result of 24 cases of 16 patients, excluding three death and 7 cases of 6 patients who were lost to follow up. Follow-up period is average 11 years and 5 months. The average preoperative flexion contracture improved markedly. The average preoperative flexion arc was 95° and preoperative flexion contracture was 14°. The postoperative ROM and flexion contracture improved markedly. The average preoperative modified HSS knee rating scoring was 52 points and improved to 91 points at last follow-up. Patients with rheumatoid arthritis had progression of other joints involvement which limited the activity of daily living. At the last follow up, loosening signs were not observed radiologically but three cases of radiolucent zone were observed in the zone I, II, III, IV, VII of tibial components and zone III, VI of femoral components. There were two deep infections.

Posterolateral Fusion in Spondylolisthesis / 대한정형외과학회잡지

After Kilian first described apondylolisthesis in 1854, there has been diverse opinions over the surgical treatment of the spondylolisthesis: in situ fusion vs. reduction and fusion, PLIF vs. PLF, and instrumentation vs. non-instrumentation. The advantages of the instrumentation are rigid fixation, better union rate of grafted bone and early rehabilitation after surgery. The disadvantages are long operation time and increased chance of the wound infection. The purpose of this retrospective study is to review the clinical results and fusion rate of 41 patients who were treated with decompression and posterolateral fusion in situ with autograft with or without instrumentation from January 1986 to June 1992. 1. Among 41 patients, 20 patients were degenerative type and 21 were isthmic type, and most commonly involved level was L4-5(46.4%). 2. Fusion was obtained in all patients. 3. Clinically 11 of 15 patients(73.4%) showed excellent or good results in instrumentation group, and 19 of 26 patients(73.0%) showed excellent or good results in non-instrumentation group. 4. Postoperative complications developed in two cases(13.3%) with instrumentation and five cases(19.2%) without instrumentation. Comparing with the non-instrumentation, we could not find great advantage of the instrumentation on the clinical results or union rate, although instrumentation showed a little better result.

Total Knee Arthroplasty using TC IV / 대한정형외과학회잡지

The proper distribution of stress & a low rate of wear has become major concern in recent design consideration of total knee prosthesis. The TC IV knee system has kept the original anatomical design of the total condylar knee and improved and refined it. And it has some characteristics: deep patellar groove of the femoral component, 5 degree posterior tilted tibial UHMWPE articulating surface with increased potential range of motion, and beaded porous coating applied to the bone-component interface. This study reports the consecutive 61 arthroplasties in 42 patients. Follow up period was average three years and six months. There were 29 osteoarthritis, 29 rheumatoid arthritis, and three infection sequelae. In all cases, we used TC IV prosthesis, bone-cement for prosthesis fixation and sacrificed PCL. All patients were assessed using HSS knee score and American knee society clinical rating system, and roentgenographic evaluation and scoring system. 1. The range of motion was significantly increased from average 87.8 degrees preoperatively to average 122.9 degrees postoperatively. 2. The HSS knee score increased from average 47.7 points preoperatively to average 90.9 points postoperatively, and the functional score of AKS was average 85.6 and knee score was 93.4 postoperatively. 3. The flexion contracture was decreased from average 29.3 degrees preoperatively to average 3.9 degrees postoperatively. 4. In radiological review, the tibiofemoral angle changed from average varus 1.5 degrees preoperatively to average valgus 6.3 degrees postoperatively, and the joint line changed average 9.3mm preoperatively to average 13.7mm postoperatively, and nine knees(14%) had a radiolucency with a width of 2mm or more beneath one or two tibial zone. 5. Complications included two superficial infections and each case of transient peroneal palsy and patellar component wear in the metal backing type. 6. In summary, although the follow-up period was short, functional score of TC IV is no less than that of the other prosthesis with PCL retention.

Ganglion in extensor tendon of the hand: case report / 대한정형외과학회잡지

Ganglion is a common clinical entity, usually superficial in location, therefore easily diagnosed and most common tumors of the hand which represent 50 to 70% of all soft tissue tumors of the hand. The soft mucin filled cyst is attached to the adjacent underlying joint capsule, tendon, or tendon sheath. The most common ganglion is the ganglion on the dorsal side of wrist, with its origin at the scapulolunate ligament and is usually located between the extensor digitorum communis of the index finger and the extensor pollicis longus tendons. Intratendinous ganglion is very rare lesion that originates within the tendon, which has been reported 10 cases in earliest articles and 1 case in Korean article. We report one case of ganglion that arose within the extensor digitorum communis of the middle finger.

Total Knee Replacement in Rheumatoid Arthritis / 대한정형외과학회잡지

The symptoms of the rheumatoid arthritis are variable enough to be ranged from mild to severe case. Synovectomy, fusion, and total knee replacement are to be applied according to the site and degree of involvement as surgical treatments. In the analysis, we compare the result of PCL retention TKR patients with those of PCL sacrificing TKR patients and of cemented TKR patients with those of cementless TKR patients. Function of the knee was evaluated using the knee score system of the Hospital for Special Surgery. From Nov, 1982 to Nov. 1990, total knee replacment was performed on 128 knees in 77 patients with rheumatoid arthritis at the Kyung Hee University Hospital and were followed for from two to ten years(average, four years eleven months). 1. The age at operation was ranged from 21 years to 72 years(average 53.2 years). There were seventy one female and six male patients. 2. The cruciate sacrificing prosthesis(group I ) were 42 cases and cruciate retention prosthesis(group II) were 86 cases. 3. The average preoperative range of motion was 85. 5 degree and the average post-operative range of motion was 107. 7 degree. Group I changed from 74. 7 degree to 105. 8 degree and Group II changed from 90. 5 degree to 108. 5 degree. 4. The average preoperative flexion contracture was 28. 7 degree and average post-operative flexion contracture was 7.8 degree. Group I changed from 37 degree to 8.4 degree and Group II changed from 24. 7 degree to 7. 5 degree. 5. The average preoperative tibiofemoral angle was varus 7. 4 degree in 69 cases and valgus 7. 6 degree in 59 cases. The average postoperative tibiofemoral angle was valgus 7. 2 degree. 6. The average preoperative knee Rating Score was 35. 2 point and the average postoperative score improved to 82. 7 point. Group I changed from 31. 3 point to 79. 4 point and Group II changed from 37 point to 84. 2 point. 7. 107 cases were cemented TKR and the 21 cases were cementless. There was no significant difference in those groups. 8. Additional operations were THR in eight cases, TER in five cases, TAR in four cases, TSR in one case, TWR in one case, Swanson prosthesis in one case, knee synovectomy in two cases, elbow synovectomy in three cases, and wrist synovectomy in two cases. 9. Complication included loosening in one case, partial ankylosis in three cases, and deep infection in one case.