Three Staged Revision Arthroplasty Using Structural Allograft in Chronic Periprosthetic Joint Infection Accompanied by Fracture: A Case Report

Revision arthroplasty for chronic periprosthetic joint infection is complex and determined by many variables. Generally, two-staged revision arthroplasty is the standard treatment for the management of chronic periprosthetic joint infection. However, it is difficult to resolve chronic infection accompanied by large bone deficiency due to pathologic fracture. I report a case of successful three-staged revision arthroplasty using frozen structural allograft in chronic periprosthetic knee joint infection accompanied by extensive bone defect due to fracture.

Outcome Differences of RemnantPreserving versus Non-Preserving Methods in Arthroscopic Anterior Cruciate Ligament Reconstruction: A Meta-analysis with Subgroup analysis

Purpose@#To analyze differences in clinical outcomes of arthroscopic anterior cruciate ligament reconstruction between remnant-preserving and non-preserving methods. @*Methods@#International electronical databases PubMed, Embase, and the Cochrane central database from January 1966 to December 2017 were searched for randomized controlled trials (RCTs) and observational studies that compared differences of clinical outcomes of ACL reconstruction with and without remnant preservation. A metaanalysis of these studies was performed to compare clinical outcomes. Subgroup analyses were conducted to evaluate the role of methodological quality in primary meta-analysis estimates. @*Results@#Five RCTsand six observational studies were included in this meta-analysis and subgroup analysis. The remnant-preserving method in arthroscopic ACL reconstruction showed a statistically significant difference compared to the non-preserving method regarding arthrometric evaluation (side-to-side difference). Lachman test, Lysholm scores, and IKDC subjective scores showed statistically minor difference in meta-analysis, but showed no significant difference in subgroup analysis. Remained parameters including pivot shift test, IKDC grades, incidence of cyclops lesion showed no statistically differences in meta-analysis or subgroup analysis. @*Conclusions@#This meta-analysis with subgroup analysis showed that arthroscopic remnant-preserving ACL reconstruction provided statistically significant but limited clinical relevance in terms of arthrometric evaluation. @*Results@#of Lachman test, Lysholm scores, and IKDC subjective scores demonstrated statistically minor differences.

Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Purpose@#Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. @*Materials and methods@#We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. @*Results@#The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSSknee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. @*Conclusions@#The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.

Comparison of functional outcomes between single-radius and multi-radius femoral components in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Purpose@#Our purpose in the current meta-analysis was to compare the functional outcomes in patients who have received single-radius (SR) or multi-radius (MR) femoral components in randomized controlled trials (RCTs) for primary total knee arthroplasty (TKA). The hypothesis was that there would be no statistically significant difference between two groups in terms of functional outcomes. @*Materials and methods@#We searched the international electronic databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to February 2020 for RCTs that compared functional outcomes of SR and MR femoral component designs after primary TKA. We performed a meta-analysis of nine RCTs using the Knee Society Score for the knee (KSS-knee), KSS-function, Knee Injury and Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), degree of knee flexion, extension, and complications, including postoperative infection and revision surgery. @*Results@#The meta-analysis revealed no statistically significant differences in all the analyzed variables, including KSSknee, KSS-function, KOOS, OKS, knee flexion, and knee extension. For postoperative complications, no statistically significant differences were detected for femoral component designs in postoperative infection or incidence of revision surgery between the two groups. @*Conclusions@#The current meta-analysis of RCTs did not show any statistically significant differences between SR and MR femoral component designs in terms of postoperative functional outcomes. Evaluated outcomes included functional outcome scores, degree of knee flexion, extension, and complications. However, because of the limited clinical evidence of this study owing to the heterogeneity between the included RCTs, a careful approach should be made in order not to arrive at definite conclusions.

Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur

Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Although the current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips.

Revision Arthroplasty Using a MUTARS® Prosthesis in Comminuted Periprosthetic Fracture of the Distal Femur

Periprosthetic fractures after total knee arthroplasty (TKA) are gradually increasing, reflecting extended lifespan, osteoporosis, and the increasing proportion of the elderly during the past decade. Supracondylar periprosthetic femoral fracture is a potential complication after TKA. Generally, open reduction and internal fixation are the conventional option for periprosthetic fracture after TKA. However, the presence of severe comminution with component loosening can cause failure of internal fixation. Although the current concept for periprosthetic fracture is open reduction and internal fixation, we introduce an unusual case of revision arthroplasty using a MUTARS® prosthesis for a comminuted periprosthetic fracture in the distal femur after TKA, with technical tips.

Comparison of Magnetic Resonance Imaging of Remnant Preserving versus Remnant Sacrificing Technique after Anterior Cruciate Ligament Reconstruction; Clinical Results and Second-Look Arthroscopic Findings: Pilot Study / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to clarify the difference between the remnant-preserving and remnant-sacrificing techniques in anterior cruciate ligament (ACL) reconstruction using stress test, functional score, 2nd look arthroscopy and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Among 66 patients having anatomical ACL reconstruction with the fourstrand hamstring autograft using outside-in technique (FlipCutter(R)) for the femoral tunnel from April 2012 to April 2014, 23 patients who underwent 2nd look arthroscopy and MRI were included. The remnant-preserving group included 12 patients and the remnant-sacrificing group included 11 patients. The two groups were compared and analyzed with regard to stability (Stress test using GNRB(R), pivot shift test), functional assessment (International Knee Documentation Committee [IKDC] scale, Lysholm score, one leg hoop test), and the result of second-look arthroscopy and signal to noise quotient (SNQ) ratio of the graft in MRI. RESULTS: The two groups did not differ significantly in the stability test, IKDC scale, and Lysholm test. The remnant-preserving group showed significant improvement in one leg hoop test compared with the remnant-sacrificing group (p0.05). CONCLUSION: More than 12 months after surgery, the graft of the remnant-preserving group showed lower signal intensity compared to that of the remnant-sacrificing group by MRI evaluation. The remnant preserving technique has biological difference compared with the remnant sacrificing technique in human study.

Rupture of the Pectoralis Major Muscle during Exercise / 대한스포츠의학회지

Rupture of the pectoralis major muscle may occur in youngers or athletes associated with extreme sports, especially during the weight training. It is uncommon, but the incidence is increased by the recent growth of athletic population. In young active individuals, ruptures of the pectoralis major muscle have the best results after surgical repair. However, if diagnosis of the pectoralis major muscle rupture is missed or delayed, the patient will be limited to return to sport activity. The object of this paper is to report our experience of pectoralis major muscle rupture in 3 cases.

Osteochondral Lesion of Humeral Head Associated with Shoulder Internal Impingement: Report of Three Cases / 대한스포츠의학회지

Internal impingement syndrome is characterized by the posterior shoulder pain when the arm is abducted and external rotated, and articular partial rotator cuff tear with posterosuperior labral fraying in throwing athletes. Osteochondral lesion of humeral head as an associated lesion is reported in some cases but, not considered to be a main origin of the symptoms. We found the similar features of osteochondral lesion on humeral head in three cases of internal impingement syndrome irrespective of conservative treatment for over three months and report good results obtained from arthroscopic debridement and microfracturing for these lesions with a review of the literatures.

Granular Cell Tumor in the Sartorius Muscle / 대한정형외과학회잡지

Granular cell tumor, a soft tissue neoplasm that originates in the nervous system, is a very unusual tumor. Granular cell tumor appears as a solitary painless lesion, which can arise at virtually any body site, but is mainly found on the skin, oral cavity, respiratory tract or digestive tract. However, an intramuscular granular cell tumor is very rare. We report on a case of a granular cell tumor in the sartorius muscle in a 71-year-old male patient along with a review of the literature.

Intradural Schwannoma Associated with Lumbar Spinal Stenosis: A Case Report / 대한골관절종양학회지

In the patient who has intradural mass associated with spinal stenosis, if the operation for spinal stenosis is performed alone, the symptom may remain. We report with literature review that we achieved the successful outcome after simultaneous decompression of spinal stenosis and space occupying mass removal in the case of intradural and extradural compression. A 71-year-old female patient suffering from low back pain and radiating pain of both lower extremities admitted. In magnetic resonance imaging, spinal stenosis on L4-5 and spondylolisthesis on L5-S1 compressed dural sac and intradural space occupying mass on L4 level compressed. By posterior approach, decompression and interbody fusion were carried out. Then mass was removed with median durotomy. Pathologic diagnosis was schwannoma and the symptom was improved remarkably.

Operative Treatment of the Bilateral Multiple Rays Brachymetatarsia using Callotasis (A Case Report) / 대한족부족관절학회지

Among congenital brachymetatarsias fourth metatarsal bone shortening is most common form and unusually involves multiple metatarsal bones. We report a case of the patient with bilateral 1st and 4th multiple rays brachymetatarsia treated with callostasis. Twenty eight months after procedure, right side showed 1st metatarsal lengthening about 11.5 mm (29.23%) and 4th metatarsal 17.86 mm (35.87%). Twenty one months later, left side showed 1st metatarsal lengthening about 14.58 mm (36.8%) and 4th metatarsal 20.52 mm (43.01%). In healing index right side showed 1st metatarsal 3.4 month/cm, 4th metatarsal 2.5 month/cm and left side showed 1st metatarsal 4.2 month/cm, 4th metatarsal 2.3 month/cm. Final follow-up results presented excellent outcome in cosmetic problem, easy wear of shoes, and measurement of patient's self satisfaction.

Delayed Diagnosis of Acute Hematogenous Osteomyelitis of the Acetabulum: Report of Two Cases / 대한정형외과학회잡지

Acute hematogenous osteomyelitis of the acetabulum is not a common disease with similar clinical symptoms and hematological findings to those of pyogenic arthritis of the hip joint. This symptom similarity might lead to a delayed diagnosis of the disease, and even to unnecessary surgery. We report two cases of acute hematogenous osteomyelitis of the acetabulum. One was a 13-year-old boy with non-specific radiological findings of the hip joint, who was initially diagnosed with fever of unknown origin. The other was an 11-year-old boy with hip joint pain and a recent history of minor trauma, which lead to a delayed diagnosis.

Comparison of Clinical Results in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft and Using Achilles Tendon Allograft / 대한정형외과학회잡지

PURPOSE: To compare clinical outcomes after arthroscopic ACL reconstruction using bone-patellar tendon- bone autograft and using fresh-frozen Achilles tendon allograft. MATERIALS AND METHODS: We enrolled 61 patients who underwent anterior cruciate ligament reconstruction by means of bone-patellar tendon-bone autograft or Achilles tendon allograft between March, 2002 and December, 2006. The bone-patellar tendon-bone group included 29 patients (mean age 30.4 years), and the Achilles tendon allograft group included 32 patients (mean age 32.5 years). The mean follow-up was 18.2 months and 25.7 months in each group, respectively. Preoperative and last follow-up clinical results were evaluated through physical examination, KT-2000 arthrometer, stress roentgenogram, IKDC knee rating system, and Lysholm knee score. RESULTS: The mean side-to-side difference in anterior translation, as measured by KT-2000 arthrometer, was significantly improved from 6.4 mm+/-3.0 to 3.2 mm+/-1.9 in the bone-patellar tendon-bone group, and from 7.6 mm+/-3.1 to 2.9 mm+/-2.0 in the Achilles tendon allograft group (p<0.001). The Achilles tendon allograft group improved more significantly than did the bone-patellar tendon-bone group (p=0.045). The mean side-to-side difference on stress roentgenogram was significantly improved from 5.3 mm+/-2.5 to 2.0 mm+/-2.1 in the bone-patellar tendon-bone group, and from 6.0 mm+/-3.4 to 2.2 mm+/-2.1 in the Achilles tendon allograft group (p<0.001). There was no significant difference between the two groups. According to the IKDC knee rating system at last follow-up, 26 (89.7%) patients in the bone-patellar tendon-bone group and 28 (87.5%) patients in the Achilles allograft group were normal or nearly normal. The mean Lysholm knee score significantly improved from 69.9 to 90.2 in the bone-patellar tendon-bone group, and from 64.4 to 91.4 in the Achilles tendon allograft group (p<0.001). CONCLUSION: Both bone-patellar tendon-bone and Achilles tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both bone-patellar tendon-bone autograft and Achilles tendon allograft be considered as graft substitutes for anterior cruciate ligament reconstruction.