The Effect of Electrocautery around the Patellar Rim in Patellar Non-Resurfacing Total Knee Arthroplasty

PURPOSE: The purpose of this study was to evaluate the clinical effect of electrocautery on the reduction of pain in patellar non-resurfacing bilateral total knee arthroplasty. MATERIALS AND METHODS: A total of 50 patients were enrolled into this study; all patients had undergone bilateral patellar non-resurfacing total knee arthoplasty at our hospital, between January 2007 to December 2008. The minimum follow-up period was 1 year. The electrocautery of the patellar rim was performed randomly on one side only. The clinical results were evaluated between the electrocautery group and the non-electrocautery group based on measures of anterior knee pain, range of motion, American Knee Society clinical rating score, Feller knee score, Western Ontario and McMaster Universities score, and radiographic analysis. RESULTS: There were statistically significant differences between preoperative and postoperative status for all parameters. There were no statistically significant differences noted between the electrocautery group and the non electrocautery group for all parameters. CONCLUSIONS: Electrocautery of patellar rim is thought to be less effective in reducing anterior knee pain.

An Autotransfusion Device Reduces the Amount of Allogenic Transfusion in Bilateral Sequential Total Knee Arthroplasty

PURPOSE: This study examined the difference in the reduction of the amount of required allogenic transfusion after bilateral total knee arthroplasty when an autotransfusion device was used. MATERIALS AND METHODS: The subjects were ninety five patients who underwent sequential bilateral total knee arthroplasty from January 2006 to May 2010 by one surgeon. The first group was 50 patients who did not have an autotransfusion device used and second group of 45 patients were those who had an autotransfusion device used during the postoperative period. Group 1 received allogenic blood transfusion with a standard level of postoperative hemoglobin. The group 2 patients were reinfused with as much blood as was collected by an autotransfusion suction bag and then they received allogenic blood transfusion with a standard level of postoperative hemoglobin. RESULTS: The total blood loss and amount of blood transfusion were almost the same in the two groups. The mean amount of allotransfusion was 1,270.0 mL in group 1 and 564.4 mL in group 2 and the reduced amount of allotransfusion in group 2 was statistically significant (p<0.05). CONCLUSION: Using an autotransfusion device is a good method to reduce the mean amount of allotransfusion after bilateral sequential total knee arthroplasty.

Ceramic-on-Ceramic Bearing Total Hip Arthroplasty: Five-Year Midterm Follow-up Results

PURPOSE: We believe that cemented femoral stems will relieve the stiffness of ceramic-based bearings, resulting in reduced complication of ceramic-on-ceramic bearing total hip arthroplasty (THA). The purpose of this study was to evaluate the midterm effect of ceramic-on-ceramic bearing THA using cemented femoral stems. MATERIALS AND METHODS: We studied 32cases (30 patients) of THA using ceramic-on-ceramic bearing cemented femoral stems and 33 cases (31 patients) of THA using ceramic-on-ceramic bearing cementless femoral stems. All total hip arthroplasties were performed between January 2004 and December 2005 and were followed up for more than 5 years. The clinical results and radiographic results were evaluated. RESULTS: The mean HHS improved from points pre-operatively to points at the last follow-up in both the cemented and cementless stem groups (P<0.05). The mean WOMAC score also improved from points pre-operatively to points at the last follow-up in both the cemented and cementless stem groups (P<0.05). But no statistically significant difference was noted between the cemented and cementless stem groups in HHS and WOMAC scores (P=0.304, P=0.769). There were 3 patients with a sense of discomfort on ambulation and 5 patients with thigh pain in the cementless stem group and no cases in the cemented stem group. There was no instance of acetabular loosening in either group. Subsidenc of the cemented femoral stem was less than 1mm in 30 cases and less than 2 mm in 2 cases. All cementless femoral stems acquired firm bony union. CONCLUSION: Midterm results showed no statistical links between ceramicon-ceramic-bearing THA using cemented femoral stems or cementless femoral stems.

Patellar Clunk Syndrome with Polyethylene Wear and Medial Synovial Hypertrophy after Mobile Bearing Total Knee Arthroplasty: A Case Report

Patellar clunk syndrome after total knee arthroplasty is a complication that causes pain and poping or catching of patella. We experienced a case after mobile bearing total knee arthroplasty that medial synovial tissue was impinged between patella and femoral component and intra-articular fibrotic nodule of superior pole of patella was observed. Also, wear of Polyethylene were observed at anterio side. We resolved the patient symptom after excision of fibrotic nodule, synovectomy of medial synovial hypertrophy, and change of polyethylene. We report this case with literature review.

The Effect of Conservative Treatment for the Calcific Tendinitis on Gluteus Medius Tendon / 대한스포츠의학회지

Calcific tendinitis on gluteus medius tendon of the amateur athletes were reviewed, and a study on the therapeutic effect of conservative treatment methods. From January 2003 to December 2010, among the patients who had been treated with calcific tendinitis on gluteus medius tendon, there were nine patients available to monitor more than a year as outpatients. ten cases were observed from them and were retrospectively analyzed and magnetic resonance examinations were performed in every case. All of the ten cases were initially treated with non-steroid anti-inflammatory oral doses. If a non-steroid anti-inflammatory treatment could not relieve pain or caused an aggravation of a condition, a local steroid injection was enforced. There were responses to non-steroid antiinflammatory oral doses of therapeutic methods in four cases and the time required for the symptoms to be improved was approximately 3 weeks (range: 1-3 weeks). In the remainder of six cases, conditions got worsened or did not improve even after 3 weeks. In these cases, the condition was altered for better in 3 days (range: 1-3 days) by using local steroid injections. There was no recurrence in all cases. The amateur athlete with a severe pain around his or her hip joint should be questioned with calcific tendinitis on gluteus medius tendon and differential diagnosis of hip around diseases. After calcific tendinitis was diagnosed, initial treatment was considered conserevative treatment. Although it is invasive, the initial treatment with a local steroid injection is considered to be helpful in treating amateur athletes with calcific tendinitis.

The Talus-1st Metatarsal Angle, the Talo-Horizontal Angle and Calcaneal Pitch Angle of Young Men in Korea / 대한족부족관절학회지

PURPOSE: The purpose of this study is to find out the normal angles of the talus-1st metatarsal angle, the talo-horizontal angle and calcaneal pitch angle for diagnosis of foot deformity in Korea. This would be helpful as it would provide a basic angular measurement of flat and cavus foot that indicates the need for operation. MATERIALS AND METHODS: Within a period of four months from January 2007 to April 2007, We have established 600 feet of 300 males without trauma history of foot. The source to image distance is 40 inches and erect weight bearing radiographs are obtained in anteroposterior and lateral projections. The significant angular measurements that define flat or cavus foot are the talus-1st metatarsal angle, the talo-horizontal angle and calcaneal pitch angle. RESULTS: The mean age was 21 years (19-22 years) old. The mean talus-1st metatarsal angle was 0+/-6.9degrees, the mean talo-horizontal angle was 25.8+/-4.5degrees and the mean calcaneal pitch angle was 23.9+/-5.1degrees. CONCLUSION: We can consider that mean talus-1st metatarsal angle, talo-horizontal angle and calcaneal pitch angle are 0+/-6.9degrees, 25.8+/-4.5degrees and 23.9+/-5.1degrees as an normal angle limit of young age in Korea.

A Clinical Analysis of Choledochal Cyst: Review of twenty three cases / 대한소화기내시경학회지

BACKGROUND/AIMS: Choledochal cyst is an unusual but serious condition which most commonly affects Oriental people. And it is an unusual entity that has increasingly been encountered by ultrasonography and computed tomography scan, even if the symptoms are variable. METHODS: We reviewed 23 patients with choledochal cyst who were treated at the Department of Internal Medicine, Pusan Paik Hospital from April, 1986 to April 1995. RESULTS: 1) Age ranged from 14 years to 73 years, and sex ratio was 1:1.4 in male vs female. 2) The durations of symptoms varied from 4 days to several years. 3) The major clinical symptoms were right upper quardrant pain in 19 cases, jaundice in 4 cases, abdominal mass in 2 cases. One case had all of above three symptoms. 4) The diagnostic tools were ultrasonography(USG) in l7 cases, ERCP in 11 cases, abdominal CT in 11 cases, PTC in 6 cases and oral GB in 1 case. The eight cases(61.5%) were confirmed as anomalous junction of the pancreaticobiliary ductal system(AJPBS) among the 13 cases who had performed ERCP. 5) The choledochal cysts were classified into type I to V according to the classification of Todani; Fifteen cases were type I, six cases type IVa, one case was type II and one case was type V, respectively. 6) Excision of choledochal cyst and Roux-en-Y hepaticojejunostomy was performed in 10 cases, and choledocho-jejunostomy in 4 cases, and Whipple's operation in 2 cases. 7) The associated diseases were CBD stone in 8 cases, cholecystitis in 6 cases, intrahepatic stone in 2 cases, GB cancer in 1 case, and colon cancer in 1 case. CONCLUSIONS: ERCP should be used when choledochal cyst is suspected by USG, aiming at demonstrating both AJPBS and enabling the morphologic classification. In addition, Surgical procedures including the excision of choledochal cyst and Roux-en-Y hepaticojejunostomy may be effective to reduce mortality and morbidity related to complication of choleclochal cyst.