Conversion Total Hip Arthroplasty for Ankylosed Hip / 대한정형외과학회잡지

Total hip arthroplasty for ankylosed hip has a higher risk of failure due to the poor condition of the hip abductors and the altered configuration of the bone, which lead to poor positioning or fixation of the prosthesis. Fifty-one hips (42 patients) converted to total hip arthroplasty between March 1983 and March 1994 have been reviewed three to thirteen years six months after operation. The average period of follow-up was four years nine months. Twenty six of the patients were men and sixteen were women. The average age at the time of operation was 40 years old (range,19 to 70 years). Among the 51 hips, bony ankylosis were 27 hips and fibrous ankylosis were 24 hips, spontaneous ankylosis were 40 hips and surgical ankylosis were 11 hips. The duration of hip fusion was 13 years six months in the bony ankylosis and 16 years one month in the fibrous ankylosis. Preoperatively 33 cases had low back pain, ipsilateral or contralateral knee or hip pain. In asymptomatic 18 cases, conversion total hip arthroplasty was also performed for the management of functional disabilities due to severe malpositioned ankylosis. At the time of the last follow-up, 25 cases were free from pain and six patients had a mild degree pain on the hip, knee or thigh. In bony ankylosis, the postoperative average hip motion ranged from 1.1 degrees to 93.2 degrees (average arc of motion of 92.1 degrees). In fibrous ankylosis, the postoperative average hip motion ranged from 1.7 degrees to 96.6 degrees (average arc of motion of 94.9 degrees). The average Harris hip score was improved from 66 to 86.9 in bony ankylosis and from 49 to 89.5 in fibrous anklyosis. The postoperative leg length discrepancy was 1.1 cm in average. The postoperative complications included heterotropic ossification in 25 cases (49%), cup loosening in two cases (3.9%) and stem loosening in three cases (5.6%). As for the clinical results, 24 cases (89%) of bony ankylosis and 23 cases (96%) of fibrous ankylosis had satisfactory functional results at the last follow-up. In conclusion, the conversion total hip arthroplasty could provide functional improvement, pain relief and especially correction of leg length discrepancy in most cases of ankylosed hip.

Rapidly Destructive Coxarthrosis / 대한정형외과학회잡지

From August 1976 to February 1997, we have experienced 29 cases of rapidly destructive coxarthrosis in 23 patients who represented severe hip pain and destruction of the femoral head more than 50% within one year. The retrospective analyses of clinical, radiographic and operative findings of 2090 hips in 1534 patients, who have been diagnosed as ischemic necrosis of femoral head were performed to investigate the correlation between ischemic necrosis of the femoral head and rapidly destructive coxarthrosis. The incidence of rapidly destructive coxarthrosis was 1 % of the overall ischemic necrosis of the femoral head. The average duration of hip pain was 9 months. The average age of the patients was 56 years old and most of them were male. The cultures of synovial fluid for bacteria were negative in all cases except one case of non-pathogenic organism. But, the erythrocyte sedimentation rate and C-reactive protein were elevated. The pathologic findings were not different from the ischemic necrosis except the destruction of articular cartilage. Therefore, we concluded that rapidly destructive coxarthrosis is a subtype of ischemic necrosis of the femoral head.

A Biomechanical Study of Graft Fixation in Posterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

Injuries of the posterior cruciate ligament have almost universally been treated nonoperatively in the past due to indignity of this complex structure. Recent studies have shown new informations on the anantomical, histological, biomechanical characteristics of the Posterior cruciate ligament PCL), and thereby interest of reconstruction surgery is increasing. But intraarticular PCL reconstruction still remains one of the most challenging problems in knee surgery. Although, various types of graft and surgical techniques have been used for reconstruction, results of surgery has been variable. In this study, three different methods of graft fixation for PCL reconstruction are evaluated biomechanically to determine the effect on mechanical property of reconstructed PCL using 30 porcine knees. Grafts used in this study were bone-patellar tendon-bone fixed with interference screw and Achilles tendon tied with suture. Additionally, five original PCLs were also tested by Instron universal testing instrument to determine its mechanical proprety. Tensile test was performed at extended knee position. It was demonstrated that mechanical strength of bone-patellar tendon-bone graft is superior to that of Achilles tendon graft. All of the failures of bone-patellar tendon-bone graft and Achilles tendon graft occurred at tibial fixation site whereas original PCLs which failed at proximal midsubstance of ligament. In conclusion, tensile strength of Bone-patellar tendon-bone graft used for PCL reconstruction is higher than that of Achilles tendon but latter can be used in terms of as clinical meanings.

Magnetic Resonance Imaging of Radiographically Negative Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

Magnetic resonance imaging has been recognized as more suitable method than radiography and bone scan for the early detection of avascular necrosis of the femoral head. Segmental collapse is the most important factor in the prognosis of patient with avascular necrosis. The authors studied the appearance of avascular necrosis with both radiography and magnetic resonance imaging and then determined which lesions remained unchanged, progressed or led to collapse, as determined wih follow-up radiography in the 61 radiographically negative avascular necrosis of the femoral heads. 1. The necrosis-progression rates according to the extent were 36% in Extent A, 83% in Extent B, and 93% in Extent C. The necrosis-progression rate was significantly correlated with the extent of necrosis initially involved. 2. The necrosis-progression rates according to the location were 37% in Type I, 70% in Type II, and 95% in Type III. The necrosis-progression rate was significantly correlated with the weight bearing area of necrosis initially involved. 3. There was no correlation between necrosis-progression rate and signal intensity. 4.All of the cases which had combinations of the Extent C, and Type III location showed progression. 5. None of the femoral heads that had been treated at the radiographically negative stage was collapsed, but 35% of the femoral heads those had been treated at the radiographically positive stage were collapsed. 6. In the cases which were treated early, all of the Extent C, Type III were collapsed, but none of the Extent A, Type I were collapsed. In conclusion, magnetic resonance imaging is useful for evaluation of the risk of collapse or for anticipation of the prognosis of the affected hip joint as well as for the early diagnosis of radiographically negative avasular necrosis of the femoral head.

Autografted and Allogrfted Meniscal Transplantation in the Knee Joint / 대한정형외과학회잡지

The degenerative arthritis following total menisectomy has led to consideration of the need for meniscal transplantation, this study evaluates the morphologic and histologic changes fol lowing fresh meniscal autograft and allograft in therabbits. Transplantation of the medial meniscus was carried out in two groups of 32 rabbits(autograft group=16 rabbits, allograft group=16 rabbits). The morphological and histological changes of the transplanted auto-and allografted menisci and the articular cartilage of the medial femoral and tibial condyle were observed at 2,4,6,8,10,12,22,28 weeks postoperatively. There were no significant differences between auto and allograft groups in gross appearance. Histologically, the fibrous adhesion was noted between grafted meniscus and joint capsule 2 weeks after operation, but complete healing was seen at the suture sites without rejection phenomenon at 6 weeks in both groups. There were prominent inflammatory reactions such as lymphocytes and inflammatory cells infiltration during early postoperative stages(2,4 weeks) only in the allograft group, and more prominent fibrotic reactions in the allograft group than auto-graft group. The results of this study suggest that meniscal allografts are able to adapt to the host tissues, survive within the joint environment, and provide a functional replacement for the removed meniscus, but further studies for graft-host immune response and a method to take the maintenance and deposits of graft must be needed to perform the meniscal allograft in human.

Total Knee Arthroplasty in Charcot's Joints / 대한정형외과학회잡지

Four total knee arthroplasties were performed in 3 patients with the diagnosis of classical Charcot's joints associated with syphilis during past 4 years from 1985 to 1988. All patients had positive reaction in serology test(VDRL, TPHA). We corrected the bone loss and severe joint instability with allograft or autogenous bone grafting and ligament balancing. The knee score was increased from preoperative 37 points to postoperative 87.3 points. We expect that total knee arthroplasty may be the alternative treatment to the conservative treatment or knee arthrodesis in Charcots joints.

Comparative Analysis of TKR in Preoperative Ambulatory and Non / 대한정형외과학회잡지

At Orthopaedic Department of Kyung Hee University Hospital, we performed 50 total knee replacement in 32 patients who had suffered from rheumatoid arthritis during the period from Aug. 1982 to Dec. 1987. We studied these cases and compared the results of total knee replacement surgery in preoperative ambulatory patients(group I ) with those in preoperative non-ambulatory patients(group II ). 1. Preoperatively, 19 patients were able to walk, and 13 patients were unable to walk. 2. 7 patients of bilateral TKR(36.8%) were included in group I, and 11 patients (86.9%) in group II. 3. The improvement of range of motion after TKR was greater in group II (34 degrees) and in group I, average postoperative range of motion was similar to the average preoperative ROM. 4. Flexion contracture was more markedly improved in group II. 5. In group I, the average preoperative knee rating score by Hospital for Special Surgery rating system was 38.8 and improved to 93.4 postoperatively. In group II, the average preoperative knee rating score was 27.4 and improved to 85.7 postoperatively. 6. Postoperatively most of the patients were able to walk without support except one cases of infection(group I ) and the other who had severe rheumatoid involvements in other joints (group II ). 7. Preoperative evaluation for involvements of cervical spine and surrounding soft tissue structure was necessary endotracheal anesthesia. 8. There was 2 cases of complications in group I, and 4 cases in group II.

Anatomy of Peroneal Buoy Flap / 대한정형외과학회잡지

Authors analysed 36 cases(33 patients) of Peroneal Buoy Flap to investigate branching pattern, course, length of vascular pedicle, and perforating level of the perforating cutaneous branches from Oct. 1985 to July 1988. The results were as follows. 1. The perforating cutaneous branchea were classified into four types, the Straight Branch (18 cases), the Proximal Oblique Branch (8 cases), the Branch from Muscular Artery (8 cases), the Distal Oblique Branch(2 cases) respectively. The most common patten was Straight Branch. 2. There were 3 pathways of these branches, the most common one passed between the Soleus and Peroneus muscles(23 cases, 64%), and second one passed through the snterior part of Soleus muscle(8 cases, 22%), the third one passed through the posterior part of Peroneus muscle(5 cases, 14%). 3. The length of vascular pedicle in Buoy Flap was variable from 3cm to 15cm, but 27 cases(75%) were distributed between 4cm and 6cm. 4. The perforating level of branches were 6.3cm in average from Fibular Neck, 88% of them were distributed within 10cm. 5. Peroneal Buoy Flap in possible to reconstruct both seperated bone and skin defect in some distance by One-Stage Operation.