Are Western Knee Designs Dimensionally Correct for Korean Women? A Morphometric Study of Resected Femoral Surfaces during Primary Total Knee Arthroplasty

BACKGROUND: The purpose of this study was to determine the shape of the distal femur of Korean women compared with the prostheses currently available in Korea. METHODS: Morphometric data (5 parameters) were measured in 356 resected femurs of Korean women undergoing primary total knee arthroplasty (TKA) utilizing the LCS knee implant (DePuy). The data were then compared with 5 additional contemporary TKA implant systems. RESULTS: Implant designs based on Caucasian population data do not ideally match the distal femoral morphology of Korean women. Overhang at the anterior mediolateral width was observed in 84.8% for the LCS while a gender-specific implant resulted in undercoverage of the bone in 86%. Posterior overhang was observed in up to 51.2%. Most implant designs have a narrower intercondylar notch than the morphologic data of Korean women. CONCLUSIONS: Since there is some difference between the shape of distal femur of Korean women and that of the implants, surgeons should have this in mind when selecting an implant for a patient. These data may also be used as a guideline for future prosthetic design options for Korean women population.

Long Term Results of LCS Mobile Bearing Knee System in Total Knee Arthroplasty

PURPOSE: To evaluate the long-term (over 10 years) clinical and radiologic results of LCS (low contact stress, Depuy, USA) total knee arthroplasty (TKA) retrospectively. MATERIALS AND METHODS: Out of 57 cases who underwent TKA with LCS knee system between June 1994 and August 1995, 33 cases could be analysed clinically and radiographically. Clinical analysis was performed according to flexion contracture, ROM, Knee Society Clinical Rating System (KSCRS) and Hospital for Special Surgery (HSS) score system. Radiographic analysis was performed according to the roentgenographic evaluation criteria of American Knee Society. Complications and survival rate were evaluated. RESULTS: Average flexion contracture was improved from 10.0degrees preoperatively to 3.7degrees at final followup and average ROM was improved from 104.0degrees preoperatively to 115.3degrees at final follow-up (p<0.05). Average HSS score was improved from 49.5 preoperatively to 80.1 at final follow-up and average KSCRS score was also improved from 77.2 to 152.5. Average tibio-femoral angle was changed from 3.3degrees varus preoperatively to 3.5degrees valgus at final follow-up. There were 4 complications, including infection in two cases and fracture dislocation of polyethylene implant in two cases respectively. Ten year survival rate was 94.1 percent. CONCLUSION: LCS TKA showed excellent results and good survival rate at more than ten years followup. However, more cases should be necessary for statistic significance.

Patellar Tendon Length Change after Donor Tendon Repair in ACL Reconstruction

PURPOSE: Shortening of the patellar tendon after ACL reconstruction has been one of the causes of postoperative complieations such as anterior knee pain, patellar baja syndrome because of that reason, donor tendon defect was not closed generally. It took at least two years far the tendon to fill the gap by regenerated tendon tissue. But, sometimes protrusion of infra-patellar fat pad may prohibit the regenera-tion of patellar tendon, This study was designed to assess the amount of actual tendon shortening after tendon closure and complications because of it. MATERIALS AND METHODS: Thirty-two cases of arthroscopically assisted midthird patella tendon autograft ACL reconstruction were studied. Patella tendon defect was closed in all cases and the follow-up duration was more than 12 months. The patellar tendon length was measured before and after the defect site closure in operating room, Also, radiolagic tendon length changes were assessed using Insall-Salvati technique. RESULT: The mean patellar tendon length that had been measured in operating room was 51.5mm, 49.8mm (before and after the tendon defect closure). So, the mean shortening was 1.71mm(3.3%). The mean LT/LP ratio was 0.922, 0.894, 0.898(pre-operative and post-operative 6months, 12months). so, the radiologic mean shortening was 3.0%(6months), 2.6%(12months). There were only 4 cases of anterior knee pain and other complications were not found. CONCLUSION: Patellar tendon length change after donor tendon defect closure was about 3% and there were no complications associated with it.

Serial one-year follow-up of shoulder impingement syndrome after arthroscopic subacromial decompression / 대한정형외과학회잡지

PURPOSE: To analyze the improvement in the patient self-evaluation for shoulder function and range of motion after arthroscopic subacromial decompression for shoulder impingement syndrome. Materials and Method: We performed a study of 21 patients out of 45 patients who could be assessed preoperatively and at 6 weeks and 3, 6, 9 and 12 months, using the standardized method of Research Committee of American Shoulder & Elbow Surgeons. We used two-sample unequal variance student t-test and Mann-Whitney U test to compare the initial findings. RESULTS: Nineteen patients were satisfied subjectively at 12 months after operation. Pain improvement was significant at 6 weeks. The total score of patient self-evaluation, put on a coat and manage using the toilet improved at 3 months, while sleep on painful side, wash back, comb hair, reach a high shelf and lift 5 kg above the shoulder improved at 6 months. Throwing a ball overhead improved at 9 months. The gain in range of motion was not noticeable except for internal rotation, which improved from T11 to T8. CONCLUSION: We found an arthroscopic subacromial decompression to be an effective method for treating impingement syndrome of the shoulder. Functional recovery could improve during a prolonged period despite of early relief of pain.

The Measurement of Strain of the Anterior Cruciate Ligament in vivo / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to measure the strains of normal and lax anterior cruciate ligament (ACL) under serial loading using specially designed ACL strain analyzer (ASA) during arthroscopic examination. MATERIALS AND METHODS: The study is based on sixty-eight patients. Before the arthroscopic examination, all cases were divided into three groups according to their laxity based on Lachman test, KT2000 arthrometer, and magnetic resonance imaging. During arthroscopic examination, the ASA was connected with ACL using anteromedial portal with the knee flexed in 90. Under serial loading to ACL, the strains were illustrated and calculated. RESULTS: A statistically significant differences had been shown in strains between normal and lax ACL. Using ANOVA test, the ASA results according to preoperatively divided groups showed no significant differences between all groups and each loads. CONCLUSION: We had designed newly diagnostic method for estimate of ACL laxity, and measured the strains of lax ACL compared with normal ACL. This diagnostic method will be helpful to establish treatment plan for injuried ACL during arthroscopic examination.

Early Failure of Mobile Meniscal in LCS Total Knee Replacement Arthroplasty: A Case Assessment / 대한정형외과학회잡지

PURPOSE: The mobile bearing, low contact stress, total knee replacement arthroplasty has proven successful with a high long-term survival rate and a low complication rate. Over 1,200 LCS knee has been successful with 97% survival. MATERIALS AND METHODS: However, we found fifteen knees showing early failure of mobile meniscal bearings with fracture, dislocation, and early wear, in some cases within three years. This caused the knee to subluxate and the bearings to dislocate. All fifteen knees had good surgical results with high HSS scores, normal valgus alignment, adequate sizing of the implants, lack of changes in the prosthese/bone interface as evidenced by the x-rays, and good ligament balancing. RESULTS: The reasons of the failure were: 1. Proportionately overweight patients. 2. Probable poor polyethylene quality due to air gamma radiation sterilization of the implant. 3. Overuse by the patients, causing undue load on the polyethylene. All patients with meniscal bearing failure had undergone revision surgery with good surgical results. CONCLUSIONS: We feel this merits further study to determine the relationship between the load and size of polyethylene mass in the rate of wear. While there are studies in the importance of thickness in relation to wear, we found no study on the effect that load has on the mass of polyethylene. We recommend a larger polyethylene tibial implant and rotating platform prostheses be used for an overweight patient and/or patient with high level of activity, both of which forecast a high load on the implant.

Mutilating Psoriatic Arthritis: A case report / 대한정형외과학회잡지

Psoriatic arthritis is an uncommon disease in the community and probably occurs in no more than 5 percent of the general psoriatic population. The authors experienced a patient who had the findings of mutilating type of psoriatic arthritis with severe joint deformities. A 30 year-old man was admitted to our hospital due to multiple joint pain and deformities with wheel chair bound state. We report a case of mutilating type in the psoriatic arthritis with brief review of literatures.

Acromial Downslping and Subacromial Interval in Shoulder Impingement Syndrome / 대한정형외과학회잡지

INTRODUCTION: There are three anatomic findings that correlate with a patient risk for developing anterior acromial impingement : acromial shape, anterior downsloping of the acromion. To analyze the effect of anterior and lateral downslopings and subacromial interval to the impingement syndrome retrospectively, the authors reviewed 32 patients who performed MRI of the shoulder joint in the Dankook university hoipital. MATERIALS AND METHODS: Eighteen males & fourteen females were reviewed and the average age was 46.6 years old. There were 23 cases of impingement syndrome and 9 cases of control group. The authors analyzed oblique coronal images and oblique sagittal images in shoulder MRI.

Developmental Coxa Vara / 대한정형외과학회잡지

Deveolopmental coax vara represents coax vara not present at birth but rather developing in early childhood, showing a progressive deterioration in the proximal femoral neck-shaft angle during growth. In order to determine the factors that could affect the results of corrective osteotomy, we evaluated the results of 15 developmental coax vara in 12 patients who had been treated with the femoral osteotomy at the Department of Pediatric Orthopedic Surgery, Seoul National University Children's Hospital, from February 1983 to March 1993. Of the 12 patients, there were 6 boys and 6 girls. Three patients had bilateral operations, 5 patients on the right, and the remaining 4 patients on the left. Average at the onset of symptoms was 4 years plus 5 months(range; from 1 year to 7 years plus 2 months), and average age at the tome of operation was 6 years plus 3 months(range; from 2 years plus 4 months to 10 years). We could obtain the following results: 1. Average post-operative loss of neck-shaft angle was 5% in the cases in which post-operative neck-shaft angle was converted more than 130 degrees, and was 8% in the cases in which post-operative neck-shaft angle was converted less than 130 degrees. 2. Loss of neck-shaft angle was higher during the first post-operative period, and was higher in cases in which the triangular osseous defect was persistent post-operatively. There was no correlation between the post-operative neck-shaft angle and disappearance of triangular osseous defect. 3. The femoral anteversion was converted 8.7 degrees to 27.2 postoperatively. 4. The premature arrest of the capital femoral physis was higher in cases in which the neck-shaft angle was less than 130 degrees postoperatively. 5. Leg length discrepancy, which was 2.1 cm preoperatively, did not change in cases in which the neck-shaft angle was more than 130 degrees postoperatively. However, it was converted to 3.3 cm in cases in which the neck-shaft angle was less than 130 postoperatively. 6. we could observe the femoral head deformity in 6 out of 7 cases in which the operation was performed after 7 years of age. We could draw the following conclusion based on our results: 1. We must correct the neck-shaft angle more than 130 degrees. 2. We could not equalize the leg length discrepancy by corrective osteotomy alone. 3. It may be reasonable to perform the corrective osteotomy before 7 years of age.

A study on the serial changes of the bone mineral density around the femoral stem after cementless hip replacement arthroplasty: Changes during the first 6 months after operation / 대한정형외과학회잡지

No abstract available.

Distal femoral osteotomy for knee flexion contracture in residual poliomyelitis / 대한정형외과학회잡지

No abstract available.

An Analysis of the Admitted Geriatric Orthopedic Patients Over the Age of 70 / 대한정형외과학회잡지

The geriatric population tends to increase, worldwidely, and the same in orthopedic fields. In this age group, senile changes, both physical and mental, appear. In addition, psychiatric problems due to retirement from the job and changes of the role in his society and in the family, are included. The geriatric orthopedics is peculiar and its importance is increasing, which makes great demands on both medical and surgical skills as well as an enthusiastic teamwork. Fifty six patients over the age of 70, who were admitted and treated at the Department of Orthopedic Surgery, Seoul National University Hospital, between 1986 to 1987, were analysed. The results were as follows. 1. Thirth four patiens were female and twenty two were male. 2. The fracture was the most common cause, and degenerative arthritis, tumor are the next causes. 3. Operation was performed in 38 cases. 4. The associated diseases were hypertension, diabetes, U.T.I., renal failure, poor sight, pulmonary and cardiovascular diseases, which were more common than other age group. 5. Intra or postoperative complications were hypertension, liver function abnormalities, renal and respiratory failures and et al., which were also more common. 6. Old age is a major risk factor for surgery, but is not a contraindication, so careful evaluation and managements are needed, which can be done by specialized geriatric orthopedic team.

A New Method for Measurement of Femoral Anteversion: A Comparative Study with Other Roentgenographic Methods / 대한정형외과학회잡지

The authors designed a new biplanar method of measuring femoral anteversion, which may be considered a modified Magilligan's method. In addition to true A-P view, a true lateral view is taken, instead of trans-cervical lateral view in the Magilligan's technique. Acute angles(α and r) between the long axis of the femoral shaft and the femoral neck on both the A-P and lateral films are measured. The true angle (r1) of anteversion is calculated by substituting the values of tan(90-α) and tan (90-r) for the trigonometric formula tan r1 = tan(90-α)/tan(90-r). The measurement by the Magilligan's and the author's methods and the conventional CT method were compared with direct measurement for their accuracy in 20 sdult dried femora. Also correlativity among these three methods were analyzed clinically in 40 femora of 20 children. Following results were obtained, 1. Compared with the direct measurement, the Magilligan's, suthor's methods and CT method deviated an average of + 6.050 degrees, + 3.600 degrees and −1.150 degrees, respectively, all three being statistically accurate(p>0.05). The values for the latter two were closer to that of direct measurement. However, there was no statistical difference between the two. 2. The Magilligan's method overestimated in 95% and underestimated in 5% of the cases, and there was over-or under- estimation of less than 5 degrees in 20% and less than 10 degrees in 95%. The author's method overestimated in 70% and underestimated in 0% of the cases, and there was over-or under-estimation of less than 5 degrees in 55% and less than 10 degrees in 100%. The CT method overestimsted in 30% and underestimated in 60% of the cases, and there was over-or under-estimation of less than 5 degrees in 95 and less than 10 degrees in 100%. Both Magilligan's and autor's methods tended to overestimate and the CT method tended to underestimate(p<0.05). 3. The correlation coefficients among the Magilligan's and author's methods, the Magilligan's and CT methods, and author's and CT methods were 0.830, 0.592, 0.478 respectively, in clinical aspects. It is concluded that author's new method of biplanar measurement of femoral anteversion is more accurate than the Magilligan's method, while it is not less accurate than the conventional CT method.

Tuberculous Lesion after Local Steroid Injections / 대한정형외과학회잡지

Local steroid injection is applied for the various problems in orthopaedic fields. Its not well known whether local steroid injection can induce or aggrevate the tuberculous lesion of the injection site. Tuberculous lesion of the shoulder and posterior compartment of the lumbar spine is rare, but rather commonly noted in the steroid injection group. Fifteen patients of tuberculous lesion(8 in shoulder and 7 in posterior compartment of the lumbar spine) after local steroid injection were treated surgically at the Department of the Orthopaedic Surgery, College of Medicine, Seoul National University, from Jan. 1980 to Agu. 1986, and following results were obtained; 1. The highest incidence was in the 6th decade and male to female ratio was 2: 13. 2. The average number of the injection was 16 times and the average duration was 6 months. 3. The duration from the last steroid injection to the first sign of the tuberculous lesion was from 2 weeks to 3 months and average 2.4 months. 4. Of the 15 cases, active tuberculous lesion at other sites were associated in 6 patients. 5. All cases were treated by complete curettage. It took 5.2 months for the primary wound healing. 6. Local steroid injection could induce or aggrevate the local tuberculous lesion. Radical extirpation of the lesion is the treatment of choice, but with high recurrence rate.