Relationship between Tibial Bone Defect and Extent of Medial Release in Total Knee Arthroplasty

PURPOSE: To understand the relationship between tibial bone defect and extent of medial release in total knee arthroplasty. MATERIALS AND METHODS: We evaluated 32 knees in 22 patients with variable degrees of tibial bone defect on medial plateau has undergone total knee arthroplasty. In this study, 31 cases had been diagnosed as degenerative osteoarthritis and 1 case was osteonecrosis. We excluded cases with infection, traumatic arthritis, or neuropathic joints. With regard to gender, 29 cases were female and 3 cases were male. The following relationships were analyzed: preoperative degrees of tibial bone defect and varus deformity; the femorotibial angle of both weight-bearing whole extremity radiogram, distractive stress radiogram, and the extent of medial release. RESULTS: Average tibial bone defect was 9.8+/-4.1 mm. Average femorotibial angle on weight-bearing whole extremity radiograph was varus 10.0degrees+/-6.2degrees. Average femorotibial angle on distractive stress radiograph was varus 0.7degrees+/-4.6degrees. Statistically the extent of medial release showed no significant relationship with the degree of tibial bone defect and femoro-tibial angle of whole extremity radiogram. However, it revealed a statistically significant relationship with the femorotibial angle on distractive radiogram (r=0.465, p=0.007). CONCLUSIONS: Preoperative distractive stress radiograph might be a useful method to predict the extent of intraoperative medial release during total knee arthroplasty.

A Comparison of the Clinical and Radiographic Results of Press Fit Condylar Rotating-Platform High-Flexion and Low Contact Stress Mobile Bearing Prosthesis in Total Knee Arthroplasty: Short term Results

PURPOSE: This study compared the results of rotating-platform high-flexion (RP-F) total knee arthroplasty with low contact stress (LCS) for clinical and radiographical assessment after a short-term period. MATERIALS AND METHODS: 68 total knee arthroplasties using a RP-F and LCS system were analyzed retrospectively. Thirty-five of the 68 were osteoarthritic knees and were followed-up for more than 2 years. The clinical evaluation included range of motion (ROM), Knee Society Knee Score and Function Score (KSKS and KSFS), tailor position and kneeling. The radiographic evaluation included femorotibial angle, position of implants, radiolucent line and position of patella. RESULTS: The postoperative ROM, KSKS, and KSFS improved statistically in both implants. Comparing RP-F with LCS there were statistically no differences in ROM (p=0.863), KSKS (p=0.835), KSFS (p=0.535) and tailor position (p=0.489). There were no significant radiographic differences. CONCLUSIONS: Total knee arthroplasty with RP-F and LCS showed similar clinical and radiographic results; it also showed excellent and predictable results at the short-term follow up. However, in RP-F there was 1 case of early osteolysis, 1 case of patella clunk syndrome and 1 case of painful patella crepitus; therefore, further case studies and follow-up are needed.

Delayed Knee Locking after Complicated Anterior Cruciate Ligament Reconstruction Despite Good Stability Using A Bio-Transfix

We describe a case of delayed cyst formation that presented as intermittent knee locking after complicated anterior cruciate ligament (ACL) reconstruction using a Bio-TransFix implant in a 21-year-old male patient. During femoral fixation, we could not pull out the guide wire that was temporarily used for the femoral fixation. However, stability was good, and the guide wire was not removed. This was shown to be a wrong type of fixation in a later study. During follow-up, the patient was satisfied and stability was relatively good until 18 months post-operatively. From the 2nd post-operative year, he experienced intermittent knee swelling and locking and pain around the lateral femoral condyle. Follow-up magnetic resonance imaging showed a large cyst around the broken wire tip, but the reconstructed ACL was fine.

Rupture of Posterior Cruciate Ligament: Diagnosis and Treatment Principles

Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90degrees of flexion. Vascular assessment and treatment should be done to avoid critical complications. An individualized treatment plan should be established after consideration of the type of tear, time after injury, associated collateral ligament injuries, bony alignment, and status of remnant. The rehabilitation should be carried out slower than that after anterior cruciate ligament reconstruction.

Short Term Results of Oxford Unicompartmental Knee Arthroplasty

PURPOSE: To report the results of Oxford unicompartmental knee arthroplasty after short term follow up. MATERIALS AND METHODS: Twenty nine knees from 26 patients who had undergone Oxford unicompartmental knee arthroplasty from March 2002 to February 2006 were reviewed. There were 25 females (28 knees) and 1 male (1 knee) and the average age was 65.9 years. The preoperative diagnosis was 22 cases of medial osteoarthritis and 7 cases of osteonecrosis of the medial femoral condyle. We evaluated the intraoperative complications. The clinical evaluation was accomplished by assessing the pre-and postoperative knee society pain and function scores, Lysholm score and HSS score. The radiologic evaluation was accomplished using the weight bearing AP view and lateral films. RESULTS: The postoperative knee society pain and function score, Lysholm score and HSS score were improved compared with the preoperative scores. The tibiofemoral angle was improved from varus 2.8degrees preoperatively to valgus 6.6degrees. Three cases of medial tibial condyle fracture occurred and 1 case of overhang of the tibial component were observed. Three cases were revised due to component loosening. CONCLUSION: Even though a high incidence of complications and loosening were observed, the clinical results of Oxford unicompartmental knee arthroplasty were improved during the short term follow up. We thought that thorough preparations should be done prior to surgery and there is room to improve femoral component design for the stability against rotational torque such as two pegs on the femoral component.

Bronchospasm during the Maintenance of General Anesthesia: A case report / 대한마취과학회지

Although a bronchospastic attack is common during the induction and emergence of general anesthesia, it is quite rare during maintenance of it. We experienced a severe case of a bronchospasm in a male patient during the maintenance of general anesthesia. His past medical history indicated no risk factors for the bronchospasm except for heavy smoking. He suffered from poor ventilation, hypercarbia and a pneumothorax that occurred abruptly, 2 hours after inducing general anesthesia. Ten hours later, he recovered his normal respiratory function without any respiratory complication. This case highlights the possibility of a bronchospasm during the maintenance of general anesthesia.

Effects of Low Dose Propofol on Core and Peripheral Temperatures during Spinal Anesthesia / 대한마취과학회지

BACKGROUND: Core hypothermia during the first hour after induction of anesthesia results primarily from a redistribution of body heat. Propofol in low doses provides reliable sedation and is associated with fast recovery. However, propofol-induced peripheral vasodilation is likely to facilitate core-to-peripheral heat redistribution. This study was designed to evaluate the effects of low dose propofol on core and peripheral temperatures during spinal anesthesia. METHODS: Fifty patients of ASA status I or II, aged 20 to 60, undergoing lower extremity surgery under spinal anesthesia were studied. Spinal anesthesia was administered to all patients, who were assigned sedation as follows: 1) control (n = 25), 2) propofol (n = 25); propofol infusion rates were, 8 mg/kg/h for the first 3 min, 4 mg/kg/h for the next 10 min, and 2 mg/kg/h for the next 15 min. Temperatures were recorded after beginning surgery at 5-min intervals for 30 min. RESULTS: Core temperature was significantly decreased after 15, 20, 30 min of surgery in the propofol group, and this result was statistically different between the two groups. Forearm skin temperature decreased in the control group and increased in the propofol group, without significance. Fingertip skin temperature did not changed significantly in the control group, but increased significantly after 15 min in the propofol group and continued to increasing to 30 min. Forearm minus finger skin temperature gradients were not changed significantly in control group, but decreased between 5 and 30 min in the propofol group, which was statistically significant. CONCLUSIONS: Low dose propofol may induce a degree of hypothermia during spinal anesthesia. Close monitoring is needed to prevent core hypothermia, if sedation is induced using propofol during spinal anesthesia.

Anesthetic Experience of Appendectomy of a Patient with Implantable Cardioverter Defibrillator: A case report / 대한마취과학회지

Implantable Cardioverter Defibrillator (ICD) devices have been developed for prompt recognization and termination of life-threatening ventricular arrhythmias. We experienced a case of 34-years old male patient with ICD diagnosed as Brugada Syndrome and undergone appendectomy under general anesthesia. Before anesthetic induction, the device was turned off to avoid electromagnetic interference (EMI) from electrocautery during operation and turned on again after surgery. There was no significant cardiac events during perioperative period and postoperative care for 7 days of admission.

Intracerebral Hemorrhage and HELLP Syndrome in Eclampsia: A Case Report / 대한산부인과학회잡지

Eclampsia is defined as the occurrence of convulsions, not caused by any coincidental neurologic disease such as epilepsy, in a woman whose condition also meets the criteria for preeclampsia. Intracerebral hemorrhage with eclampsia is rare but maternal mortality is 30-40%. Fetal outcome parallels that of the mother and reflects the maternal condition as well as gestational age at delivery. With noninvasive imaging technique of CT, the early diagnosis and proper management of intracerebral hemorrhage in a patient can be achieved. The syndrome of Hemolysis, Elevated Liver enzyme, Low Platelets (HELLP) is considered to be complication of severe preeclampsia-eclampsia. We report a case of intracerebral hemorrhage and HELLP syndrome in a patient with eclampsia.