Hydrothorax due to extravasation of intravenous contrast through left subclavian catheter -A case report- / 대한마취과학회지

Central venous catheterization is associated with a large number of complications, such as pneumothorax, hydrothorax, hemothorax, phlebothrombosis, pericardial tamponade, air embolism, aberrant placement and line sepsis. There are many case reports of the extravasation of various central venous catheter fluids, including the intravenous fluids, total parenteral nutrition and chemotherapeutic agents into the pleural cavity and mediastinum. These have led to hydrothorax, hydromediastinum and pericardial effusions. We report a case of the extravasation of intravenous contrast into the pleural cavity after dynamic CT through a left subclavian catheter.

Five Year Results of Hydroxyapatite Coated Hip System: Early Severe Wear and Acetabular Osteolysis / 대한정형외과학회잡지

PURPOSE: To assess the midterm results of the hydroxyapatite hip system with acetabular cups, with particular emphasis upon cup wear and loosening, using a computer assisted-3 dimensional technique. MATERIALS AND METHODS: From March 1992 to December 1996, 52 patients (61 hips) were available for inclusion in this study after an average duration of follow up of 6 years and 4 months. Clinical evaluation was performed using the Harris hip scoring system. Initial postoperative and long term follow up films were digitized, and 2 dimensional linear and 3 dimensional wear was measured by using a computer assisted-3 dimensional technique. Acetabular bone changes are described using previous published methods. RESULTS: An analysis of the clinical results showed a mean Harris hip score of 47.2 points preoperatively and 89.8 points at the final visit. The mean polyethylene 3D-linear wear rate was 0.26 mm/year and mean volumetric wear rate was 105.9 mm3/year. In 16 hips (26.2%) the linear wear rate was more than 0.3 mm/year (0.30-0.74 mm/year). Osteolytic changes of the acetabulum were recorded in 51% around acetabular cups, in which considerable wear of the acetabular polyethylene was evident by the five-year radiographic findings. CONCLUSION: Midterm results of hydroxyapatite coated acetabular cups were disappointing in terms of acetabular cup and liner wear, despite early accelerated bone remodeling by hydroxyapatite and excellent early clinical results.

Reconstruction of Diabetic Foot Ulcers by Regional Flap Surgery / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the value of regional flap surgery for diabetic foot ulcers combined with infection or bone and tendon exposure. MATERIALS AND METHODS: We reviewed eight patients, nine cases of diabetic foot ulcers, which were treated by regional flap surgery. There were two Wagner's grade 2 ulcers and six Wagner's grade 3 ulcers. We performed four reversed sural artery neurocutaneous flaps, two lateral supramalleolar flaps, two medial plantar artery flaps and one first dorsal metatarsal artery flap. RESULTS: Seven of nine flaps completely survived after regional flap surgery. One partial and one complete flap necrosis occurred. One partially necrotized flap needed an additional skin graft. One completely necrotized flap needed free rectus abdominis myocutaneous flap surgery. There were two new ulcers, which were treated by free flap surgery. No patient needed amputation above the ankle joint. CONCLUSION: Satisfactory results were obtained by regional flap surgery for diabetic foot ulcers. Regional flap surgery is regarded as an effective treatment modality for diabetic foot ulcer combined with bone and tendon exposure with infection.

Bone Ongrowth of Hydroxyapatite-Coated ABG Acetabular Cups / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of the smooth surface hydroxyapatite (HA)-coated acetabular cup in total hip arthroplasty. MATERIALS AND METHODS: From March 1992 to June 1998, 289 smooth surface HA coated acetabular cups were implanted. This study included 29 retrieved cups that had been in situ for an average of 54.9 months. The three dimensional acetabular cups were converted into two dimensional figures using a digital camera, and the ratio of bone ongrowth and HA absorption were calculated using a computer imaging analysis system (analySIS-pro 3.0, Soft Imaging System GmbH, Germany). The central hole and the peripheral 12 holes were excluded from total surface area of the cup, which was divided into 3 surfaces by 2 circular grooves. RESULTS: Bone ingrowth was noted in 26 of the 29 cases; in 11 cases (37.9%) on the central surface, 12 cases (41.3%) on the middle surface and 8 cases (27.5%) on the peripheral surface. Bone ongrowth was noted in 22 cases (75.8%) on the medial groove and in 21 cases (72.4%) on the lateral groove. The average rate of bone ongrowth was 13.8 percent. HA absorption was noted in all cases and averaged 60.5 percent. CONCLUSION: Bone ongrowth on the smooth surface HA-coated acetabular cup was very scant. Bone ongrowth was seen more on the grooves than on the surfaces. We believe that a rough surface would enhance bone growth on HA-coated acetabular cup.

Total Hip replacement with AML Prosthesis for Avascular Necrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic results of the primary total hip arthroplasty with uncemented AML (anatomic medullary locking) hip prosthesis for avascular necrosis of the femoral head. MATERIALS AND METHODS: Forty-nine patients (65 hips) had a primary total hip arthroplasty between May 1987 and March 1992. Average follow-up was 9.6 years. The mean age of the patients was 46.9 years. The canal fit of the stem at the proximal canal and isthmus level was obtained from postoperative radiograph. Components stability, stress shielding, polyethylene wear and periprosthetic osteolysis were evaluated from serial follow up radiographs. RESULTS: The average Harris Hip Score was to 92.1 points at the last follow-up. Twelve hips (18.5%) had a good fit at both the proximal canal and isthmus level and 15 hips (23.1%) had a poor fit at both levels. All twelve hips that had a good fit at both the proximal canal and isthmus level had bone ingrowth. Thirty-three hips (56.3%) had femoral osteolysis. Twenty-one hips (32.3%) had acetabular osteolysis. Fourteen hips had acetabular and femoral osteolysis. The overall rate of revision was 16.7% (11 hips). Ten cases were revised because of excessive polyethylene wear and osteolysis. Revision of the femoral component for aseptic loosening was only one case. CONCLUSION: The result of our study suggests that total hip arthroplasty using the AML hip prosthesis with an ACS (acetabular cup system) polyethylene liner should be monitored closely for catastrophic wear of the polyethylene liner. We recommend early revision arthroplasty in case of excessive wear of the ACS polyethylene liner.

Comparison Between Standard and elevated-rim Acetabular Liner in Total Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: Elevated-rim acetabular liner enhances stability in total hip arthroplasty and has been widely accepted. But it has potential adverse effects. So, we assessed the effects of the elevated-rim acetabular liner clinically and radiologically. MATERIALS AND METHODS: We reviewed the results of 74 total hip arthroplasties of 64 patients that had been performed from January 1993 to March 1995. Thirty-six cases of the 74 cases used elevated rim acetabular liner and 38 cases did standard liner. Dislocation rate, Harris hips score, osteolysis and revision rate were compared between two groups. RESULTS: There were no significant differences in mean anteversion, abduction angles of the cup and femoral offsets between two groups. Four of the 38 cases with the standard liner had a dislocation, compared with one of 36 cases with the elevated-rim liner (P=0.358) . Femoral osteolysis was observed 7 cases (18.4%) in the standard liner group and 14 cases (38.8%) in the elevated-rim liner group. Acetabular osteolysis was observed 17 cases (44.7%) in the standard group and 21 cases (58.3%) in the elevated-rim group. Nine cases (23.6%) had been revised in the standard group and 6 cases (16.6%) in the elevated group. CONCLUSION: Excessive wear and breakage of the polyethylene by impingement was developed in the elevated-rim polyethylene liner.