ABSTRACT
The main aims of surgery for severe cord compression and myelopathy caused by atlantoaxial subluxation are decompression of the spinal cord and achievement of rigid fixation and fusion. Direct decompression by resecting the bony structures that compress the spinal cord includes transoral decompression and resection of the posterior arch of the atlas. The shortcomings of these procedures are a high complication rate and a relatively low rate of union. Indirect decompression can be performed by a reduction of the subluxation and fixation without bone resection. To the best of our knowledge, there are no domestic reports on the use of indirect decompression for severe cord compression and myelopathy for atlantoaxial subluxation. We report a case of a patient that had atlantoaxial subluxation and severe myelopathy; satisfactory reduction of the subluxation and decompression with an improvement in the myelopathy symptoms was achieved by indirect decompression using segmental screw fixation.
Subject(s)
Humans , Decompression , Spinal Cord , Spinal Cord DiseasesABSTRACT
Purpose: To evaluate the efficacy of the preventive abduction brace in dementia patients after bipolar hemiarthroplasty of the hip. Materials and Method: A review of 30 patients who had dementia prior to bipolar hemiarthroplasty of the hip. 20 females and 10 males were evaluated and their mean age was 80.4 years old (range, 68 to -92 years old). The average MMSE-K in dementia patients was 14.2 (range, 8 to 20). The reasons for the bipolar hemiarthroplasties were femoral neck fractures in all the cases. We analyzed the dislocation rates of those who had preventive abduction braces applied prospectively. Results: The average follow-up period after hemiarthroplasty was 2.2 years. All 30 patients had preventive abduction braces and no dislocations occurred after the bipolar hemiarthroplasties. Conclusion: Hip dislocations were not detected in those patients who preventive abduction braces applied. The present findings suggest that having a preventive abduction brace will definitely reduce the dislocation rate in dementia patients who have difficulties with rehabilitation after their operations.
Subject(s)
Female , Humans , Male , Braces , Dementia , Joint Dislocations , Femoral Neck Fractures , Follow-Up Studies , Hemiarthroplasty , Hip Dislocation , Hip , Prospective Studies , RehabilitationABSTRACT
PURPOSE: To analyze the clinical results of treatment for infected total knee arthroplasty(TKA). MATERIALS AND METHODS: Between October 1993 and March 2003, 20 patients with infection after TKA were treated at our department. The average follow-up period was 3 years 8 months and the average age was 65.5 years(range, 50-79); there were 18 females and two men. Infected TKAs were managed with several methods ; 16 patients were treated two-stage reimplantation, 2 arthrodesis, and 2 debridement and polyethylene insert change. We assessed knee function before and after revision, according to the knee rating system of the Hospital for Special Surgery. RESULTS: Prior to revision operation, the average knee score in 16 reimplantation cases was 49.3 points and the average range of motion was 64.9 degrees. After revision, the average knee score was 80.5 points and the average range of motion was 90.3 degrees. Two of them relapsed within postoperative two weeks, and then we performed debridement. There was one recurrence of infection after debridement and polyethylene insert change and then we performed two stage reimplantation. Two patients had complete union at each 4, 5 months after arhtrodesis. CONCLUSION: Thoughtful method of treatment should be decided and precise operative technique should be performed in managing infected TKA.
Subject(s)
Female , Humans , Male , Arthrodesis , Arthroplasty , Debridement , Follow-Up Studies , Knee , Polyethylene , Range of Motion, Articular , Recurrence , ReplantationABSTRACT
PURPOSE: To evaluate the mid-term (over 5 years) clinical and radiologic results of AGC(R)(Anatomical Graduated Components, Biomet, USA) total knee arthroplasty(TKA) retrospectively. MATERIALS AND METHODS: Out of 121 cases who underwent TKA with AGC(R) knee system, 90 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 survial rate were evaluated. RESULTS: Average flexion contracure was improved from 10.4degrees preoperatively to 0.6degrees at final follow-up and average ROM was improved from 107.5 degrees preoperatively to 120.9 degrees at final follow-up (p<0.05). Average HSS score was improved from 52.2 preoperatively to 81.5 at final follow-up and average KSCRS score was also improved from 77.2 to 152.5. Average tibio-femoral angle was changed from 6.3 degrees varus preoperatively to 4.3 degrees valgus at final follow-up. There were 6 complications, including infection in three cases, patellar dislocation, supracondylar fracture and aseptic loosening in one case respectively. Survival rate was 96.7 percent. CONCLUSION: AGC(R) TKA showed excellent results and good survival rate at more than five years follow-up. However, more long-term follow-up should be necessary.
Subject(s)
Arthroplasty , Cimetidine , Contracture , Follow-Up Studies , Knee , Patellar Dislocation , Retrospective Studies , Survival RateABSTRACT
STUDY DESIGN: This is a retrospective study. OBJECTIVE: We wanted to evaluate the efficacy of epidural steroid injection (ESI) for treating lumbar spinal stenosis (LSS) SUMMARY OF LITERATURE REVIEW: Treatment for lumbar spinal stenosis has generally consisted of some form of conservative treatment or surgery. Surgery may be contraindicated in many stenotic patients because of their significant comorbidities. Therefore, conservative management is necessary for those who cannot or do not want to undergo surgery. MATERIALS AND METHODS: From January 2002 to June 2003, we retrospectively analyzed 128 patients, 55 years or older, who received ESI (s). The average age of the men and women was 47 and 81, respectively. Their mean age was 76 (age range: 55~84). The injection materials were 2 ml methylprodnisolone acetate (40 mg/cc) in combination with 3 cc normal saline and 3 cc lidocaine. The follow up period was 12 months to 30 months. We measured the outcomes by the duration and amount of pain relief, the change in functional status and the rate of performing surgery; patient satisfaction was assessed by a 5-item questionnaire. RESULT: Of the 128 participants, 31% reported more than 2 months of pain relief, 41% reported less than 2 months of pain relief and 27% reported no relief from the injection (s). Sixteen percent subsequently had surgery. Sixty-nine percent reported improvement in their functional abilities. Seventy-two percent were at least somewhat satisfied with ESI as a form of treatment. CONCLUSION: ESI is a reasonable treatment for LSS as it provided one third of our patient population with sustained relief and more than half with sustained improvement in function.
Subject(s)
Female , Humans , Male , Comorbidity , Follow-Up Studies , Lidocaine , Patient Satisfaction , Surveys and Questionnaires , Retrospective Studies , Spinal Stenosis , SpineABSTRACT
PURPOSE: To compare the clinical, radiologic results and complications between the patellar non-resur-faced and resurfaced cases in total knee arthroplasty. MATERIALS AND METHODS: From March 1998 to May 2003, the subjects were 37 patellar non-resurfaced and 45 patellar resurfaced cases followed up more than a year among the patients who had total knee arthroplasty in degenerative arthritis. The results were evaluated by the range of motion, Hospital for Spe-cial Surgery (HSS) knee rating score, and Laurin's and Merchant's congruence angle. Student t-test was used in statistical analysis in comparison of both groups. RESULTS: In non-resurfaced group, the range of motion was incrased from 90.6 degree preoperatively to 108.6 degree postoperatively and HSS score from 62.6 to 84.1 respectively, while in resurfaced group, range of motion was increased from 88.2 degree preoperatively to 110.4 degree postoperatively and HSS score from 59.3 to 85.3. There were no significant differences between two groups (p>0.05). There were some patella-asso-ciated complications in each group, and revision due to patella-associated complications were 1 case (3%) and 2 cases (4%) each. So, patella-associated complications and revision rates revealed no significant dif-ferences (p>0.05). CONCLUSION: There is no difference in the clinical results and complications between patella resurfacing and selective non-resurfacing with relatively good cartilage, More follow up is needed for the necessity of revision due to patella-associated complications.
Subject(s)
Humans , Arthroplasty , Cartilage , Follow-Up Studies , Knee , Osteoarthritis , Patella , Range of Motion, ArticularABSTRACT
PURPOSE: We compared the results of total knee arthroplasties combined with lateral retinacular release with those without lateral retinacular release. MATERIALS AND METHODS: Results of 277 total knee arthroplasties from 1996 to 2002, follow up for at least one year ( average follow-up periods : 32 months). Lateral retinacular release was performed in 190 knees (70.1%) and not performed in 87 knees (29.9%). The clinical results of total knee arthroplasties were evaluated by the Knee Scoring System of hospital for Special Surgery (HSS) and range of motion. The patello-femoral complications were evaluated by tilt and displacement of patella at the last follow-up Hughston 's view. Osteonecrosis and fracture of patella were evaluated by simple x-ray. RESULTS: HSS score and range of motion improved postoperatively in both groups, but there was no sig-nificant difference between the two groups. There were 3 cases (3.4%) with patellar subluxations and 1 case (1.1%) with patellar dislocation in the group without lateral retinacular release. There was no avascu-lar necrosis or fracture of patella in either group. CONCLUSION: We suggest that lateral retinacular release can be performed without great risk of potential patellar complications in total knee arthroplasties requiring lateral retinacular release for proper patellar tracking.
Subject(s)
Arthroplasty , Follow-Up Studies , Knee , Necrosis , Osteonecrosis , Patella , Patellar Dislocation , Range of Motion, ArticularABSTRACT
PURPOSE: To analyze the cause of failure and average period in patients who had revision surgery within 5 years of their primary total knee arthroplasty (TKA). MATERIALS AND METHODS: 786 total knee arthroplasties were performed between August 1994 and May 2003. During the period, there were 38 cases, 36 females and 2 males, of revision surgery within 5 years. The mean age was 66 years. The most common causes of disease in revision were degenerative arthritis. We analyzed the reasons for early failure retrospectively. RESULTS: Revision TKA were performed at average 2 years after primary TKA. The causes of revision were polyethylene wear in 18 cases (47.4%), deep infection in 16 (42.1%), instability in 2, and aseptic loosening in 1, dissociation of patella component in 1. The degree of varus in tibial cutting was 5.1degrees in average in polyethylene wear group. The obliquity of the tibial joint line was more than 3degreesvarus in 14 cases (82.4%). Most patients had their knee in hyperflexion and squatting position during activities of daily living. CONCLUSION: Thirty eight cases (4.8%) were performed revision surgery within 5 years of primary TKA. Polyethylene wear and deep infection were the common causes of early failure of primary TKA. The component malalignment, hyperflexion and squatting position during activities of daily living may be related to polyethylene wear. Diabetes mellitus and long term steroid application, may be related to infection.
Subject(s)
Female , Humans , Male , Activities of Daily Living , Arthroplasty , Diabetes Mellitus , Joints , Knee , Osteoarthritis , Patella , Polyethylene , Retrospective StudiesABSTRACT
Spontaneous hemarthrosis of the knee after a total knee arthroplasty is a rare complication, and thereis no report is available in Korea. We report a case that was cured with an open synovectomy in the spontaneous hemarthrosis, which developed 10 months after the total knee arthroplasty for degenerative osteoarthritis in a 60-year-old woman.
Subject(s)
Female , Humans , Middle Aged , Arthroplasty , Hemarthrosis , Knee , Korea , OsteoarthritisABSTRACT
PURPOSE: To investigate postoperative incidence of complications and functional results between two groups, primary bipolar hemiarthroplasty and internal fixation with compression hip screw on unstable intertrochanteric fractures of the femur with severe osteoporosis in elderly patients. MATERIALS AND METHODS: 78 cases treated under unstable intertrochanteric fractures of the femur with severe osteoporotic elderly patients from March 1997 to August 2001 who have been followed up for more than a year were evaluated retrospectively between the group of bipolar hemiarthroplasty, 38 cases out of 60 cases and group of compression hip screw, 40 cases out of 59 cases. The incidence of complications and functional ability according to Merle d'Aubigne scale and the mortality rate were compared using student t-test. RESULTS: The means of Merle d'Aubigne scale for the hemiarthroplasty group and the compression hip screw group were at the last follow up, 15.0 and 13.6 respectively. The differences were statistically significant (p=0.04). Bipolar group revealed significant differences in general (18%) and mechanical complications (5%) between two groups (p0.05). CONCLUSION: We consider that primary bipolar hemiarthroplasty would be better method in the treatment of the unstable femoral intertrochanteric fracture with severe osteoporosis but we need much longer follow up.
Subject(s)
Aged , Humans , Femur , Follow-Up Studies , Hemiarthroplasty , Hip Fractures , Hip , Incidence , Mortality , Osteoporosis , Retrospective StudiesABSTRACT
PURPOSE: By developing on-line statistics program to record the information of radiation oncology to share the information with internet. It is possible to supply basic reference data for administrative plans to improve radiation oncology. MATERIALS AND METHODS: The information of radiation oncology statistics had been collected by paper forms about 52 hospitals in the past. Now, we can input the data by internet web browsers. The statistics program used windows NT 4.0 operation system, Internet Information Server 4.0 (IIS4.0) as a web server and the Microsoft Access MDB. We used Structured Query Language (SQL), Visual Basic, VBScript and JAVAScript to display the statistics according to years and hospitals. RESULTS: This program shows present conditions about man power, research, therapy machines, technics, brachytherapy, clinic statistics, radiation safety management, institution, quality assurance and radioisotopes in radiation oncology department. The database consists of 38 inputs and 6 outputs windows. Statistical output windows can be increased continuously according to user's need. CONCLUSION: We have developed statistics program to process all of the data in department of radiation oncology for reference information. Users easily could input the data by internet web browsers and share the information.
Subject(s)
Brachytherapy , Internet , Radiation Oncology , Radioisotopes , Safety Management , Web BrowserABSTRACT
PURPOSE: To evaluate subjective satisfaction of patients and clinical results after arthroscopic ACL reconstruction using freeze-dried allograft. Materials & Methods : From May 1994 to January 1997, arthroscopic ACL reconstruction with freeze-dried allograft were performed in 33 patients in ACL deficient knee. Minimum follow-up period is 3 years, and average follow-up is 4.6 years. We analyzed clinical results according to the Lysholm scores, physical examination and KT-2000 knee ligament arthrometer. RESULTS: The average preoperative Lysholm score was 60 11, and the average postoperative score was 89 6. Anterior drawer tests and Lachmann tests were positive in 24 cases preoperatively and in 11 cases postoperatively. Postoperative instrumented laxity tests with KT-2000 knee ligament arthrometer (MEDMetric, San Diego, CA) were also performed postoperatively, and its average results was 3.7mm 1.3mm on 30lbs. There was no restriction or complaint in regular daily activities. But the postoperative ligament laxity was more prominent than that of using fresh-frozen allograft or autograft CONCLUSION: Despite the relatively good outcome of the patient's satisfaction, the use of freeze-dried allograft using the standard technique in arthroscopic ACL reconstruction can cause more laxity than that of fresh-frozen allograft.
Subject(s)
Humans , Allografts , Anterior Cruciate Ligament , Autografts , Follow-Up Studies , Knee , Ligaments , Physical ExaminationABSTRACT
Since penile prosthesis were introduced clinically, higf operation success rates and good patient satisfaction ratings have been reported. Nevertheless, the complication rates have been reported to range from 4% to 7% penile prosthesis (AMS-CXM) and widespread condylomata on the genitaile. Physical examination revealed that the right prosthesis cylinder had perforated the distal medial side of the corpus cavernosum and almost perforated the distal urethra, and the left cylinder had perforated the distal midline septum and was overhanging the right cylinder. Additionally, condylomata acuminata infected the whole penile skin and lower pubic area. The patient underwent multiple treatments for condyloma, including podophyllin, electrocoagulation, and coagulation using a laser, for 6 months and a "windsock" operation using Gore-Tex in both corpora cavernosa with a penoscrotal skin incision for his prosthetic probiem. There have been no complications at 9 months'follow-up.