ABSTRACT
PURPOSE: To analyze the clinical results of debridement arthroplasty through a medial approach for primary osteoarthritis of the elbow. MATERIALS AND METHODS: Ten patients with primary osteoarthritis treated with debridement arthroplasty trough a medial approach were investigated. The ulnar nerve was transposed anteriorly in all patients. The mean duration of follow-up was 20.8 months. The clinical results were evaluated by measuring the preoperative and postoperative range of motion (ROM) of the elbow and using Mayo Elbow Performance Score (MEPS). RESULTS: The mean flexion contracture of the elbow joint was reduced from 23 degrees preoperatively to 10 degrees, postoperatively and the mean further flexion was improved from 93 degrees preoperatively to 131 degrees postoperatively. The mean MEPS improved from 55.3 points preoperatively to 86.9 points postoperatively. CONCLUSION: Debridement arthroplasty through a medial approach is considered as an useful method for primary osteoarthritis of the elbow.
Subject(s)
Humans , Arthroplasty , Contracture , Debridement , Elbow , Elbow Joint , Follow-Up Studies , Osteoarthritis , Range of Motion, Articular , Ulnar NerveABSTRACT
The conversion of the fused hip to THA may be used for patients with painful pseudoarthrosis, and malposition of the arthrodesed hip. It may also be used for patients with disabling pain in the ipsilateral knee, contralateral hip or lower back. Nineteen fused hips have been converted to total hip arthroplasty from January 1985 to December 1993. They were followed up for an average of 6 years. The causes of the fused hip were post-traumatic osteoarthritis (8 cases), tuberculous arthritis (6 cases), ankylosing spondylitis (3 cases) and rheumatoid arthritis (2 cases). The results of THA were satisfactory in all cases. The average Harris hip score after THA was improved from 56 to 84.1. The results of THA were best in patients with tuberculous arthritis and poorest in patients with ankylosing spondylitis. The average range of motion after THA is as follows: flexion 82 degree, abduction 28 degree, adduction 16 degree, external rotation 27 degree and internal rotation 13 degree. The average leg length discrepancy improved from 3 cm to 1.5 cm. The conversion of the fused hip to THA improves the patient s quality of life, so it is a useful treatment for the fused hip.
Subject(s)
Humans , Arthritis , Arthritis, Rheumatoid , Arthroplasty, Replacement, Hip , Hip , Knee , Leg , Osteoarthritis , Pseudarthrosis , Quality of Life , Range of Motion, Articular , Spondylitis, AnkylosingABSTRACT
We report a case of acute septic arthritis of the hip in a child due to H. influenzae with review of the problems encountered. A one year and 9 months-old male child was admitted because of fever, limping and restlessness of 48-hour duration. Under the impression of septic arthritis of the right hip, blind broad-spectrum antibiotic regimen was initially instituted. Fever subsided immediately and two blood cultures yielded no growth, as did joint tapping. But fever recurred on the 8th day of admission. MRI demonstrated fluid collection in the right hip. Arthrotomy yielded thin pus. The antibiotic regimen was shifted to vancomycin, according to the culture report of S. aureus. However, spiking fever continued. On the 4th week of admission, recheck MRI demonstrated fluid collection in and out of the hip joint. A second arthrotomy yielded frank pus. H. influenzae was reported in pus culture for the first time, being susceptive only to chloramphenicol. Fever was down to normal temperature after injection of urfamycin. Radiograph on the 17th day after the 2nd arthrotomy revealed posterior dislocation of the right hip. MRI demonstrated granulation tissue within the acetabulum. Open reduction confirmed granulation tissue without pus. This case suggests: 1. Routine blind antibiotic regimen for gram-positive and negative organisms in the initial phase of treatment may fail in the rare case of H. influenzae. This may lead the surgeon to miss the optimum time of surgical intervention despite early diagnosis, 2. Arthrotomy may fail if not followed by antibiotics sensitive to the pathogen. 3. Delayed pathologic dislocation may ensue due to invasion of granulation tissue.
Subject(s)
Child , Humans , Infant , Male , Acetabulum , Anti-Bacterial Agents , Arthritis, Infectious , Chloramphenicol , Joint Dislocations , Early Diagnosis , Fever , Granulation Tissue , Hip Joint , Hip , Influenza, Human , Joints , Magnetic Resonance Imaging , Psychomotor Agitation , Suppuration , Thiamphenicol , VancomycinABSTRACT
Deep infection following arthroplasty of the knee is a serious complication resulting in pain, discharge and loss of function. The incidence of deep infection ranges from 1% to 2% in a majority of reported series. There are several options for treatment of infected total knee arthroplasty: (1) antibiotic suppression, (2) debridement, (3) resection arthroplasty, (4) reimplantation, (5) arthrodesis, (6) amputation. Among them, recent reports have favored a two-staged regimen exchanging the prosthesis in an infected knee by using an antibiotic impregnated cement spacer. The result of our study support this option for treatment. We have experienced 14 cases of two-staged reimplantation in infected total knee arthroplasty, diagnosed according to the criteria described by Bengstons and followed up for more than two years. The average interval from prosthesis removal to revision was 6.85 weeks. Prior to revision, the average knee score was 50 points, and the average range of motion was 74 degree. After revision, the average knee score was 81 points. The average range of motion was 95 degree. Our protocol for the treatment successfully eradicated the deep infection in 13 patients, only a patients who had severe rheumatoid arthritis was the sole documented case of reinfection.
Subject(s)
Humans , Amputation, Surgical , Arthritis, Rheumatoid , Arthrodesis , Arthroplasty , Debridement , Incidence , Knee , Prostheses and Implants , Range of Motion, Articular , ReplantationABSTRACT
Among the 85 cases of prosthetic replacement of femoral neck fracture which had been operated at Department of Orthopaedic Surgery, Korea Veterans Hospital from January, 1982 to May, 1990, 32 cases (15 unipolar hemiarthroplasty and 17 bipolar hemiarthroplasty) were examined clinically and radiologically at an average 7.7 years postoperatively. And the results were as follows; 1. The group I (Unipolar hip hemiarthroplasty without cement) had Harris hip score - average 79.4. The group II (Unipolar hip hemiarthroplasty with cement) had Harris hip score average 87.3. The group III (Bipolar hip hemiarthroplasty without cement) had Harris hip score average 80.5. The group IV (Bipolar hip hemiarthroplasty with cement) had Harris hip score average 86. 2. There were 2 cases of stem loosening (13%) among 15 cases in unipolar hip hemiarthroplasty and 1 case (6%) among 17 cases in bipolar hip hemiarthroplasty. 3. The movement of two components in bipolar hip hemiarthroplasty was noted in all cases and the movement of the outer bearing joint was more active than that of the inner. And the movement of the two components was not correlated with the use of cement. But Harris hip score was superior cement stem group to noncement stem group. 4. Unipolar hip hemiarthroplasty showed the similar clinical and radiological results with bipolar hip hemiarthroplasty of femoral neck fracture in the elderly. As a result, unipolar and bipolar hip hemiarthroplasty were considered the proper treatment method of the femoral neck fracture in the elderly.
Subject(s)
Aged , Humans , Femoral Neck Fractures , Femur Neck , Hemiarthroplasty , Hip , Hospitals, Veterans , Joints , KoreaABSTRACT
The Marcus ankle arthrodesis was carried out in 16 patients at department of orthopaedic surgery of Korea Veterans Hospital from January 1989 to December 1993. All of patients were reviewed and evaluated with subjective and functional rating scales according to the Mazur scoring system. The average follow up was 23 months, ranging from 12 months to 60 months. The Marcus ankle arthrodesis involves a chevron osteotomy, tibial onlay graft medially, internal fixation with staples and screws. According to the Mazur score, the results were 6 cases of Excellent, 7 cases of Good. The average Mazur score was 75.1. There were 4 cases of complication, a non-union, a superficial wound infection, a bursitis, and a tendon injury. In summary the Marcus ankle arthrodesis by chevron osteotomy seems to be a good procedure, which gives solid bony union with short duration, relief of pain, normal looking ankle configuration without leg length discrepancy and good function with few complications.
Subject(s)
Humans , Ankle , Arthrodesis , Bursitis , Follow-Up Studies , Hospitals, Veterans , Inlays , Korea , Leg , Osteotomy , Tendon Injuries , Transplants , Weights and Measures , Wound InfectionABSTRACT
Deep infection is the most serious complication of total hip arthroplasty with difficulty to treat and occasionally results into catastrophic consequences. The treatment methods are antibiotics, incision & drainage of the hip, debridement & modified Girdlestone resection arthroplasty, one stage revision to total hip arthroplasty, two stage revision and hip disarticulation. The purpose of this report is to consider the treatment of the infected total hip arthroplasty. Since 1979, we have treated 12 cases of infected arthroplasty including 6 cases from other hopital. Duration of interval between primary hip arthroplasty and diagnosis of infection were average 42,4 months(minimum 2 months to maximum 16 years). The results were as follows; 1. The incidence rate of the infected total hip arthroplasty was 1.3%. 2. By Fitzgerald classification, 2 cases were in acute stage, 6 cases in delayed stage and 4 cases in late stage. 3. The causative organisms were coagulase negative Staphylococcus aureus in 6 cases, Staphylococcus hemolyticus in 2 cases, Pseudomonas in 1 case and negative culture in 3 cases. 4. Increased uptake on Bone Scan in all 12 cases and increased ESR ranged from 28mm/hr to 82mm/hr. 5. Our treatment methods were secondary revision to total hip arthroplasty with cement bead insertion in 4 cases, primary revision in 1 case, incision & drainage of hip in 1 case, debridement & modified Girdlestone resection arthroplasty in 2 cases and hip disarticulation in 2 cases. And the rest 2 cases have been followed up after modified Girdlestone resection arthroplasty because of the remained infection. In our experience, two stage revision to total hip arthroplasty with antibiotics mixed cement bead was more useful in the treatment of the infected total hip arthroplasty.
Subject(s)
Anti-Bacterial Agents , Arthroplasty , Arthroplasty, Replacement, Hip , Classification , Coagulase , Debridement , Diagnosis , Disarticulation , Drainage , Hip , Incidence , Pseudomonas , Staphylococcus , Staphylococcus aureusABSTRACT
In the paget's disease involving the vertebra, the symptom and sign of compression come from encroachment on the spinal cord due to the enlarging vertebral bodies, pedicles and laminae. The cord compression appears to be preceded by a long insidious period of noncharacteristic clinical symptoms with minor neurologic dysfunction. The lumbar syndrome of Paget's disease is classified according to its severity, clinical findings, biochemical factors and radiologic patterns. The severity of neurologic complication in Paget's disease involving the vertebra varies according to the level involved. The outcome depends on the suddeness of symptom onset and the effectiveness of decompression. We have experienced a case of Paget's disease involving long bones and lumbar spine in 56 year old male patient, in which surgical decompression produced improvement. We report a case of spinal stenosis in paget's disease with brief review of literature.
Subject(s)
Humans , Male , Decompression , Decompression, Surgical , Neurologic Manifestations , Spinal Cord , Spinal Stenosis , SpineABSTRACT
The impingement syndrome has an anatomical character that occur against the anterior edge and the undersurface of anterior third of the acromion, coracoacromial ligament and acromioclavicular joint. The treatment consists of conservative and surgical things. We consider the surgical intervention only in cases fail to control pain by conservative treatment over 3 months(from Feb. 1990 to Jan. 1994). The author experienced 15 cases (14 pts) in positive impingement sign & test and evaluated by shoulder arthrography in all cases. 1. The mean age was 60 years ranged from 48 to 68 years and the average symptom duration was 23 months. 2. There were all positive impingement sign & test clinically. 3. There were partial tear of rotator cuff in 3 cases and complete tear in 12 cases radiologically. 4. The anterior acromioplasty with division of coracoacromial ligament was performed in all cases, additional rotator cuff repair in 3 cases and bicipital tenodesis in 2 cases. 5. At the follow up based on UCLA shoulder rating scale, results were excellent & good in 13(86%) and unsatisfactory in 2(14%) cases.