An Overview of the Clinical Efficacy and Safety of Tissue Selective Estrogen Complex: From the Selective Estrogens, Menopause, and Response to Therapy (SMART) Trials / 고신대학교의과대학학술지

Hormone therapy (HT) is the most effective treatment for menopausal symptoms, and reduces both spinal and non-spinal postmenopausal osteoporotic fractures. However, a Women's Health Initiative (WHI) trial revealed that progestin-containing HT is associated with higher incidences of breast cancer and coronary heart disease than those associated with placebo. Tissue selective estrogen complex (TSEC) is a novel progestin-free HT option composed of conjugated estrogens (CE) and a selective estrogen receptor modulator. CE at a dose of 0.45 mg combined with 20 mg of bazedoxifene was the first TSEC medication approved in the United States and Korea for women with moderate to severe menopause-related vasomotor symptoms (VMS) and for preventing postmenopausal osteoporosis. This review summarizes the clinical efficacy, safety, and tolerability of TSEC as obtained from the five SMART clinical trials.

Spontaneous uterine rupture due to placenta percreta in the second trimester of pregnancy: a case report / 고신대학교의과대학학술지

A 32-year-old multiparous woman (gravida 2, para 2) with a history of previous cesarean section had acute abdominal pain and collapsed at 21 weeks of gestation. Exploratory laparotomy was performed because of the patient's worsening condition; ultrasound examination results were suggestive of massive hemoperitoneum, and fetus in vertex presentation with bradycardia. Uterine rupture between the left lower segment and borderline of the cervix in the anterior wall with active bleeding was confirmed. An uncomplicated classical cesarean section was performed, but the fetus was stillborn due to preterm birth. Hysterectomy was performed after the cesarean section. The patient was admitted to intensive care units for 3 days and was discharged in 12 days following delivery. Placenta percreta at the anterior lower segment of the uterus was confirmed in the pathology report.

Cementless Total Hip Arthroplasty with Medial Wall Osteotomy for the Sequelae of Septic Arthritis of the Hip

BACKGROUND: We performed a retrospective study to evaluate the results of acetabular circumferential medial wall osteotomy, a procedure designed to provide secure fixation of a cementless hemispherical acetabular cup for the sequelae of septic arthritis of the hip. METHODS: We assessed 38 total hip arthroplasties (THAs) with circumferential acetabular medial wall osteotomies performed on patients with sequelae of septic arthritis of the hip between 1993 and 2000, who were followed up for > or = 3 years. The average follow-up period was 8.3 years (range, 3 to 12 years). The indication for this technique was poor acetabular cup coverage of < or = 70% on preoperative templating. In all cases, cementless hemispherical acetabular cups were fixed to the true acetabulum. Additional procedures included soft tissue release in 16 hips and femoral derotational and shortening osteotomies in 12 hips. We evaluated both clinical and radiological results. RESULTS: The Harris hip scores improved from 57 points preoperatively to 91 points postoperatively. Radiological analysis revealed no aseptic loosening or radiolucent lines around the acetabular cup. Stable bony fixation of the acetabular cup in the true acetabulum was seen in all cases. Acetabular osteolysis was demonstrated in 12 hips. Revision surgery was performed in 6 hips, but there were no complications related to acetabular circumferential medial wall osteotomy. CONCLUSIONS: Circumferential acetabular medial wall osteotomy can provide appropriate positioning and sufficient coverage of the acetabular cup and thus preserve the medial wall thickness in cementless THA without the need for additional bone grafting for the sequelae of septic arthritis of the hip.

The Effect of Repeated Intraarticular Bleeding in the Synovium and Articular Cartilage: An Animal Model / 대한정형외과학회잡지

PURPOSE: We designed this study to demonstrate the pathophysiology of hemophilic arthropathy (HA) by creating an animal model for determining the effect of repeated intraarticular bleeding in the synovium and articular cartilage. MATERIALS AND METHODS: 20 normal male New Zealand white rabbits were used for this study. We injected 1 ml of autologous blood from the ear vein of the rabbits into the right knee joint three timeds a week for 18 weeks, and we injected 1 ml of normal saline into the left knee joint three times a week for 18 weeks as a control group. We examined the pathologic changes by microscopy and plain X-ray, and we determined the mRNA expression of proinflammatory cytokines in the synovium of the HA by performing real time RT-PCR at the 11th week and 18th week after starting blood-injection. We also examined the GAG and the PGE2 production in cultured chondrocytes that were extracted from the HA knees. RESULTS: At the 11th week, after blood injection there were no remarkable gross changes in the HA knees and the control knee joints. At the 18th weeks, the experimental knee joints (HA knees) showed grossly swelling and degenerative changes by X-ray. The infiltration of inflammatory cells and the synovial proliferation in the HA knee joints were compared with that in the control knee joints by microscopic examination. The expressions of the mRNA of TNF-alpha, IL-1, MMP-1 and MMP-3 in the HA synovium were increased, as determined by real time RT- PCR, as compared with that in the control knee. In the cultured chondrocytes, the GAG production was decreased and the PGE2 was increased, but the MMP-1 and MMP-3 were not changed, as determined by ELISA. CONCLUSION: Our results showed that the GAG production of chondrocytes of the HA knees was decreased and there was increased PGE2, so that the cartilage degeneration by intra-articular bleeding was caused by the decreased metabolism of chondrocytes rather than by increased catabolism of the chondrocytes. We suggest that HA was associated with synovitis and cartilage degeneration, but decreased cartilage metabolism was the major mechanism of HA.

Changes of the bone mineral density of proximal femur after hip resurfacing arthroplasty / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the changes of periprosthetic bone mineral density in femur after hip resurfacing arthroplasty.</p><p><b>METHODS</b>From July 2002 to June 2005, a comparative study was carried out on 52 hips in 52 patients. Twenty-six patients (26 hips) who underwent Birmingham hip resurfacing arthroplasty (group BHR), and 26 patients (26 hips) who performed cementless total hip arthroplasty with Versys System stem (group THA). The periprosthetic bone mineral density of the femur was measured through dual energy X-ray absorptiometry of the Gruen zones at pre-operation, post-operation 3, 6, 12 and 24 months in patients from both group BHR and group THA. The bone mineral density of femoral neck in group BHR was measured too. Changes of bone mineral density ratio in proximal femur between pre-operation and post-operation were compared and analyzed.</p><p><b>RESULTS</b>The mean ratio of bone mineral density of the proximal femur in group BHR reduced by 5.8%, 4.9%, 2.6% and 0.4%, in group THA reduced by 7.0%, 10.6%, 1.0% and 4.1% at 3, 6, 12 and 24 months respectively. In group BHR, the mean ratio of bone mineral density in range of interest 1 decreased to 89.7% at 6 months and increased to 103.8% at 24 months, in range of interest 7 decreased to 95.1% at 6 months and increased to 103.7% at 24 months. In group THA, the mean ratio of bone mineral density in range of interest 1 decreased to 90.8% at 6 months, 94.4% at 24 months and in range of interest 7 decreased to 94.2% at 3 months, 96.7% at 24 months. In group BHR, the bone mineral density of femoral neck was restored to the pre-operation level at 6 months. The bone mineral density in superior-lateral zone of femoral neck decreased to 97.1% at 3 months and increased to 107.4% at 24 months respectively. The bone mineral density in inferior-medial zone of femoral neck increased to 117.9% at 24 months.</p><p><b>CONCLUSION</b>The bone stock of proximal femur can be well preserved and recovered quickly after hip resurfacing arthroplasty.</p>

Acetabular Reconstruction with Impacted Morselized Allograft, Wire Mesh and Cemented Acetabular Cup in Severe Acetabular Bone Defect

PURPOSE: This study evaluated the clinical and radiographic results of an acetabular reconstruction with an impacted morselized allograft and wire mesh in revision total hip arthroplasty. MATERIALS AND METHODS: This study examined 21 cases of acetabular revisions involving 20 patients with a severe acetabular bone defect managed with an impacted morselized allograft, wire mesh and cemented acetabular cup between February 2000 and June 2003. The mean follow up period was 31.7 months. Clinically, the Harris hip score was evaluated. The radiographic parameters included bony incorporation between the host bone and allograft, the change in cup inclination, acetabular cup migration, radiolucency around the cup and loosening. RESULTS: The mean Harris hip score was improved from a preoperative 54.1 to 91.9 at the last follow up. Radiological incorporation between the host bone and allograft was achieved after an average 11.4 months after surgery. The mean change in cup inclination was 1.9 degrees, and the mean medial and superior migration was 3.93 mm and 4.41 mm respectively. The majority of these radiological changes occurred within 6 months after surgery. One case of Brooker grade I heterotopic ossification and one case of acetabular cup loosening was observed but there was no re-revision or complications, such as infection and dislocation. CONCLUSION: In a severe acetabular bone stock deficiency that cannot be reconstructed with a cementless acetabular cup, an acetabular reconstruction with an impacted morselized allograft, wire mesh and cemented acetabular cup showed good results in this short term follow up study.

Small bowel obstruction in midtrimester of pregnancy: A case report / 대한산부인과학회지

Small bowel obstruction in pregnancy is a rare critical condition with high morbidity and mortality. The diagnosis of small bowel obstruction in pregnancy is often delayed because the symptoms such as nausea, vomiting, and abdominal pain mimic typical pregnancy-associated complaints. So, a high level of suspicion especially in patients with a history of previous abdominal surgery is essential for early diagnosis. Once the diagnosis is made, surgery should be performed immediately. We present the first case of small bowel obstruction during pregnancy in Korea with a brief review of the literature.

Cementless Acetabular Component Fixation with Circumferential Medial Wall Osteotomy in Severely Hypoplastic Acetabulum / 대한정형외과학회잡지

PURPOSE: To evaluate the results of the acetabular circumferential medial wall osteotomy in obtaining secure fixation of cementless hemispherical acetabular cup to the hypoplastic acetabulum. MATERIALS AND METHODS: Seventy-nine THAs with a circumferential acetabular medial wall osteotomy in the dysplastic acetabulum performed between 1987 to 1997 and followed up for more than 6 years were assessed. The indication of this technique was acetabular coverage that could not achieve more than 70% after cup fixation. In all cases, a cementless hemispherical acetabular cup was fixed in the true acetabulum. Additional procedures included soft tissue releases in 23 hips, a derotational femoral osteotomy in 10 hips, a structural bone graft in 7 hips and femoral shortening in 8 hips. Both clinical and radiographic parameters were evaluated. RESULTS: The Harris hip scores were improved from 68.4 to 92.2 postoperatively. Radiographic analysis revealed no aseptic loosening or radioluacent line, and showed stable bony fixation at the true acetabulum in all cases. 7 hips showed acetabular osteolysis. Two acetabular components were revised due to dissociation of the polyethylene liner and 4 polyethylene liners were exchanged because of severe wear or osteolysis. CONCLUSION: The circumferential acetabular medial wall osteotomy can provide appropriate positioning, sufficient coverage of the acetabular cup with a preservation of the medial wall thickness in cementless THA without additional bone grafting in the dysplastic acetabulum.

Arthroscopic Findings of Dysplastic Hip & Usefulness of Preoperative Labral Test / 대한정형외과학회잡지

PURPOSE: To report the arthroscopic findings in symptomatic dysplastic hips and to clarify the efficacy of a labral test. MATERIALS AND METHODS: Between July 2001 and Nov 2004, arthroscopy was performed on 37 dysplastic hips. There were 7 males and 30 females and the average age was 38.8 years. The average center-edge angle was 6.54o. Radiographically, 28 hips were prearthritic and 9 hips showed arthritic changes. The arthroscopic findings of the labrum and cartilage and the efficacy of labral test were compared. RESULTS: Labral lesions were found in 25 cases, and cartilage lesions were found in 16 cases of 28 prearthritic hips. All patients with radiographic evidence of osteoarthritis had both labral and cartilage lesions. Labral lesions were found in 30 out of 33 cases with a positive labral test. CONCLUSION: This study identified the pathologic processes of acetabular labrum and cartilage in most cases, even though there was no radiographic evidence of osteoarthritis. Preoperative labral test is a useful physical examination in those suspected of having labral lesions.

Changes in BMD in the Proximal Femur after Cementless Total Hip Arthroplasty and Resurfacing Arthroplasty: Prospective, Longitudinal, ComparativeStudy / 대한정형외과학회잡지

PURPOSE: This study analyzed the differences in bone remodeling and stress shielding between cementless total hip arthroplasty and resurfacing arthroplasty by examining the serial bone mineral density around the prosthesis. MATERIALS AND METHODS: Fifty total hip arthroplasty procedures and 50 resurfacing arthroplasty procedures, which were performed between July 2002 and June 2003, were examined to this comparative study. The mean age at surgery was 44 years in the THA group and 36 years in the resurfacing arthroplasty group. The bone mineral density was measured by the DEXA at preoperation and 3 months, 6 months, 12 months after surgery in zone I-III of the acetabulum (classified by DeLee & Charnley) and zone I-VII of the femur (classified by Gruen), and the medial and lateral side of the femoral neck in the resurfacing arthroplasty group. RESULTS: In the acetabulum, zones I and II of both groups showed a significant decrease in the BMD 12 months after surgery but the level of bone loss in the resurfacing arthroplasty group was relatively small compared with those in the THA group. In the proximal femur, the overall amount of bone loss at 3, 6 and 12 months postoperatively were 0.7%, 5%, and 2.6% respectively, and those in zones I and VII at 12 months postoperatively in the THA group were 7.8% and 7.7%, respectively. In the BHR group, the overall bone loss in the proximal femur at 3, 6 and 12 months postoperatively were 5.8%, 4.4%, and 2.9%, respectively. However, those Gruen zones I and VII at 12 months postoperatively were 2.6% and 0.6%, respectively. CONCLUSION: The level of bone loss in Gruen zones I and VII of the resurfacing arthroplaty group was much lower, which suggests that resurfacing arthroplasty can prevent stress shielding and preserve the proximal bone stock around the femoral stem.

Antegrade Interlocking Intramedullary Nailing for Humeral Shaft Fractures / 대한정형외과학회잡지

PURPOSE: We report results of intramedullary nailing in humeral shaft fracture and upon the many factors which contributed to shoulder pain & motion limitations. MATERIALS AND METHOD: We reviewed the clinical results in twenty seven patients with a minimal 1 year follow up. There were 18 fresh fractures and 8 nonunions. We performed rotator cuff repair and acromioplasty in 6 patients with rotator cuff injuries at same time. RESULTS: The bone union was obtained in 26 patients, but not in one patient. Eighty nine% of patients were satisfied with the operative results. The average postoperative pain (VAS) was 0.1 at rest and 2.6 at maximal ROM. The limitations of motion compared with the unaffected side were; forward flexion 10 degrees , external rotation at the side 13 degrees , internal rotation 3 thoracic spine difference and abduction 14 degrees . The fracture type and the presence of nonunion did not affect shoulder pain or motion. The active patients had preferable results. Patients treated with rotator cuff repair and acromioplasty at same time had better results but there were not statistically significant. CONCLUSION: Antegrade interlocking intramedullary nailing for the treatment of humeral shaft fracture showed excellent results, especially in for long spiral, comminuted and segmental humeral shaft fractures. However, it should be noted that early rehabilitation after stable fixation and a delicate and accurate surgical technique are important to obtain good shoulder motion and bone healing.

Revision Total Elbow Arthroplasty Using Strut Allograft: Two Cases Report / 대한정형외과학회잡지

We describe the allograft technique and present its final results of revision total elbow arthroplasty (TEA) using a strut allograft in two cases that revealed prosthetic loosening and severe bone resorption after TEA. Two patients complained of pain and motion limitation, and had difficulty in hair combing and with hygiene. The preoperative Mayo elbow performance scores of both cases were 50 points and 45 points. They were followed up for 24 months and 18 months. There was no pain after surgery and the postoperative Mayo elbow performance scores were all 90 points. Radiographic bone unions were achieved 3 months after the operations and patients were satisfied with the results. The revision of TEA with a supporting allograft is a demanding procedure but can be tried when the elbow joint has badly destructed or has a large cavitary defect.