Comparison of Clinical and Radiological Results according to Glenosphere Position in Reverse Total Shoulder Arthroplasty: A Short-term Follow-up Study

BACKGROUND: In a previous biomechanical study, eccentric glenospheres with more inferior position of the center of rotation were shown to improve range of motion and reduce the incidence of scapular notching after reverse total shoulder arthroplasty (RSA). The purpose of this study was to compare the clinical and radiological results of RSA using an eccentric glenosphere to those using a concentric glenosphere and to determine the usefulness of the eccentric glenosphere. METHODS: From 2009 to 2015, we performed a retrospective review of 20 consecutive patients who underwent RSA using a deltopectoral approach. Nine patients underwent RSA using a concentric glenosphere (group A) while 11 had an eccentric glenosphere (group B). The average follow-up period was 13.9 months (range, 12 to 18 months). All glenoid components were placed with 15° of inferior tilt. Clinical results were assessed using the visual analog pain scale score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, the Korean shoulder scoring system (KSS), and the Constant score. On radiological evaluation, prosthesisscapular neck angle (PSNA), peg-glenoid rim distance (PGRD), scapular neck-inferior glenoshere rim distance (inferior glenoshpere overhang), acromion-greater tuberosity (AT) distance, glenoid-greater tuberosity (GT) distance, and severity of notching according to the Nerot-Sirveaux classification were assessed. RESULTS: The clinical results improved significantly in both groups, but there was no statistically significant difference between the two groups. A significant intergroup difference was observed with regard to PGRD (24.8 ± 1.6 mm for group A vs. 22.2 ± 1.9 mm for group B; p = 0.002) and inferior glenosphere overhang (2.0 ± 1.7 mm for group A vs. 5.8 ± 1.6 mm for group B; p = 0.000). Seven of 9 patients in group A developed notching compared with 2 of 11 patients in group B (p = 0.022). The other radiological parameters such as inferior tilt and AT and GT distances were not significantly different between two groups. Complications such as loosening and scapular fractures did not occur. CONCLUSIONS: The eccentric glenosphere in RSA was more effective in reducing the rate of notching than the concentric glenosphere although clinical outcomes were not significantly different in the short-term follow-up.

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope.

Isolated Musculocutaneous Nerve Palsy after the Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty has been performed with promising results in rotator cuff tear arthropathy. However, the global complication of the reverse total shoulder arthroplasty is relatively higher than that of the conventional total shoulder arthroplasty. Neurologic complications after reverse total shoulder arthroplasty are rare but there are sometimes remaining sequelae. The cause of the neurologic complication is multifactorial, including arm traction, position and the design of the implant. Most cases of neurologic palsy following reverse total shoulder arthroplasty occur in the axillary nerve and the radial nerve. The authors report on a case of a 71-year-old man with isolated musculocutaneous nerve palsy after reveres total shoulder arthroplasty with related literature.

The Short-term Clinical Outcome of Total Hip Arthroplasty Using Short Metaphyseal Loading Femoral Stem / 대한고관절학회지

PURPOSE: The purpose of this study was to retrospectively evaluate the short-term clinical and radiological outcomes of total hip arthroplasty (THA) with short metaphyseal loading femoral stem. MATERIALS AND METHODS: We retrospectively reviewed the records of 56 cases in 47 patients who had undergone THA with short metaphyseal loading femoral stem from April 2010 to December 2011. There were 20 males and 27 females. The mean age was 54 years (range, 26-77 years). The average follow up period was 4.6 years. Clinical results were evaluated by Harris hip scores (HHS) before the operation and at the last follow-up. Radiographic analysis was done by evaluating osteolysis, loosening, stress shielding, and alignement. RESULTS: The mean HHS significantly improved from 45 (range, 15-58) preoperatively to 98 (range, 85-100) at the last follow-up. In radiographic analyses, there was no evidence of osteolysis or loosening around the stems and the acetabuluar components. All cases showed rounding off of the calcar, grade 1 bone resorption of the proximal femur. With regard to implant alignment, 51 femoral component (91.1%) were in neutral position, and 5 (8.9%) were in varus position. There was 1 intraoperative fracture treated by cerclage wiring and no case was revised during follow-up period. CONCLUSION: Although longer follow-up is needed to confirm the durability of the short metaphyseal loading femoral stem, this short stem might provide stable fixation without diaphyseal fixation and demonstrated good clinical result at mean 4.6 year short term follow-up.

New Retear Pattern after Rotator Cuff Repair at Previous Intact Portion of Rotator Cuff

Retear patterns after arthroscopic rotator cuff repair are classified into two patterns according to retear location. Type 1 is when the retear pattern occurs directly on the tendon at the bone repair site using the suture anchor repair method. Type 2 is when the retear pattern occurs at the musculocutaneous junction with a healed footprint in patients who undergo the suture bridge method. Here, the authors report another retear pattern, which was identified as a type 2 retear on magnetic resonance imaging in patients who had undergone arthroscopic rotator cuff repair by the suture-bridge technique. This pattern was different from the type 2 retear and occurred at the portion of the cuff away from the healed rotator cuff under the view of the arthroscope.

Isolated Musculocutaneous Nerve Palsy after the Reverse Total Shoulder Arthroplasty

Reverse total shoulder arthroplasty has been performed with promising results in rotator cuff tear arthropathy. However, the global complication of the reverse total shoulder arthroplasty is relatively higher than that of the conventional total shoulder arthroplasty. Neurologic complications after reverse total shoulder arthroplasty are rare but there are sometimes remaining sequelae. The cause of the neurologic complication is multifactorial, including arm traction, position and the design of the implant. Most cases of neurologic palsy following reverse total shoulder arthroplasty occur in the axillary nerve and the radial nerve. The authors report on a case of a 71-year-old man with isolated musculocutaneous nerve palsy after reveres total shoulder arthroplasty with related literature.

Synovial Chondromatosis of the Ulnocarpal Joint

Synovial chondromatosis is a rare, benign and progressive metaplasia of the synovial membranes associated with the formation of cartilage in joints, tendon sheaths, or bursae. There are a few reports of synovial chondromatosis with wrist involvement. Here, we report a case of a 59-year-old woman with synovial chondromatosis of the ulnocarpal joint of the right wrist, with an 18-month follow-up and review of the literature.

Intraarticular Fibroma of the Tendon Sheath arising from the Infrapatellar Plica in the Knee / 대한정형외과연구학회지

A fibroma of the tendon sheath (FTS) is a rare and less well-known benign soft-tissue tumor. FTS infrequently develop in the knee region. Especially intraarticular FTS of the knee was found in a few case reports. We present a rare case of FTS arising from the infrapatellar plica of the knee in 12-year-old man without a history of specific trauma. Magnetic Resonance Imaging (MRI) and an arthroscopic examination revealed an encapsulated soft tissue mass arising from the infrapatellar plica anterior to the anterior cruciate ligament. The histological diagnosis is FTS in the intraarticular of the knee. To the best of our knowledge, this report is the first reported case of FTS involving the infrapatellar plica of the knee.

Neurological Complication Following Total Knee Arthroplasty

PURPOSE: This study retrospectively evaluated the nerve injuries that occurred after total knee arthroplasty. MATERIALS AND METHODS: Among 1,582 cases of total knee arthroplasty in 1,362 patients who underwent total knee arthroplasty from 1982 to 2002, 162 cases of neurologic complications in 148 patients who were followed up for over five years, and these case were examined in this study. RESULTS: Among the 9 cases of peroneal nerve palsy in 8 patients, 6 cases of 5 patients were caused by compression of the peroneal nerve after applying a cylinder splint. One case was caused by damage of the peroneal nerve and soft tissue contracture due to peroneal compartment syndrome and two cases failed to reveal the cause of the peroneal nerve palsy. Seven cases recovered within 2 years. Among the 153 cases with sensory change that was caused by injury of the infrapatellar branch of the saphenous nerve, 76 cases recovered to 50% or more within three years postoperatively, and 105 cases recovered to 70% or more within 5 years postoperatively. Eight cases fully recovered. CONCLUSION: The causes of peroneal nerve palsy were considered to be multifactorial and almost all the cases recovered within 2 years. The injury of the infrapatellar branch of the saphenous nerve does not affect the results and the patients' satisfaction.

Cementless Total Hip Arthroplasty Using VerSys Fiber Metal Midcoat Stem: a Minimum 3-Years Follow-up

PURPOSE: The purpose of this study was to retrospectively evaluate the results of cementless total hip arthroplasties that used a Versys fiber metal midcoat femoral stem. MATERIALS AND METHODS: From March 2000 to June 2005, 28 cases in 23 patients were followed up for a minimum of three years. The average follow up period was 5.1 years. Clinical results were evaluated by Harris hip scores. Radiographic analysis was done by evaluating fixation stability, osteolysis, stress shielding, and cortical hypertrophy. RESULTS: The mean Harris hip score improved from 43.1 to 93.8 at the last follow up. In radiographic analyses of the stem, there was no evidence of positional changes or vertical subsidence. There was heterotopic ossification in four, distal cortical hypertrophy in two, proximal stress shielding in twenty, and femoral osteolysis in five cases. The femoral stem revealed a stable bony ingrowth in all. The acetabular cup revealed a stable bony ingrowth in all. There was no evidence of horizontal or vertical migration or of a change of inclination angle of the acetabular cup. CONCLUSION: Cementless total hip arthroplasty using a Versys fiber metal midcoat femoral stem showed good clinical and radiologic results, but long term follow up is needed.

Intradural Extramedullary Metastasis to Lumbar Spinal Nerve of Cholangiocarcinoma : A Case Report / 대한척추외과학회지

An intradural extramedullary metastasis to the spinal nerve root across dura mater is extremely rare. The authors encountered a case 39-year-old man who suffered radiculopathy arising from a soft mass around nerve root mimicking a nerve sheath tumor compressing the 4th lumbar nerve root in the right intervertebral foramen between the 4th and 5th lumbar spine. After an excisional biopsy, the metastatic infiltration of adenocarcinoma was confirmed pathologically. The primary lesion was found to be an intrahepatic cholangiocarcinoma with multiple metastases. This report suggests that an intradural metastatic tumor can show similar clinical and radiographic findings to other disease,s such as a nerve sheath tumor. The results also suggest that proper diagnosis and further treatment are possible only by pathological confirmation after and excisional biopsy.

Two Cases of Primary Biliary Cirrhosis / 대한내과학회지

Primary biliary cirrhosis(PBC) is a chronic cholestatic liver disease of unknown origin. The small and medium sized intrahepatic bile ducts are destroyed by an inflammatory process, which, it has been suggested, is of the autoimmune type. It is strongly associated with the presence of antimitochondrial antibodies, predominantly IgM and IgG. The liver changes are classified into four stages, of which stage IV represents the development of cirrhosis, which required orthotropic liver transplantation in the longrun. The prevalence rates was reported 128 per millon in Sweden , but the disease is relatively rare in Oriental area. In medical treatment, long-term administration of ursodeoxycholic acid improves both clinical and biochemical signs, slows the progression of the disease and reduces the complication requiring liver transplantation. We report two cases of PBC, one with histologically proven cirrhosis, and the other with bile duct destruction consistent with stage III and hypothyroidism.