Complication Rate and Clinical Result of One-Week Interval Staged Bilateral Total Knee Arthroplasty: Compared to Simultaneous and Several-Months Interval Staged Bilateral Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to compare the clinical results and the rates of complication among three groups that received the simultaneous total knee replacement (TKR), one-week interval staged bilateral TKR, or several-months interval staged TKR. MATERIALS AND METHODS: We conducted a retrospective study of patients who had been diagnosed with bilateral degenerative osteoarthritis undergoing bilateral TKR from 2004 May to 2012 March. We divided patients into three groups which received simultaneous TKR (Group A, n=84), one-week interval staged bilateral TKR (Group B, n=124), or several-months interval staged TKR (Group C, n=65). Hospital for special surgery (HSS) score and the rate of complication were evaluated and compared. RESULTS: Mean postoperative HSS score showed significant improvement in the three groups. No difference in postoperative HSS was observed among the three groups (p=0.325). The complication rate in Group A was lower than that in Group B (p=0.049) and that in Group A was similar to that in Group C (p=0.786). CONCLUSION: Group A had a better result than Group B and was similar to Group C in complication rate. One-week interval staged TKR can be good choice in patients with bilateral degenerative osteoarthritis.

Recovery of Limitation of Motion in Secondary Osteoarthritis of the Hip Using Arthroscopy / 대한고관절학회지

PURPOSE: To analyze the arthroscopic findings and treatment results of patients with a limitation of hip motion caused by early degenerative osteoarthritis. MATERIALS AND METHODS: Retrospective analysis was performed on 13 patients who underwent arthroscopic treatment from May 2009 to March 2010, among patients with a limitation of hip motion and femoroacetabular impingement symptoms by early degenerative osteoarthritis. Head-neck offset, anteversion, and a change in the alpha angle was compared. At the final follow up, the VAS (Visual analogue scale), modified Harris hip score, and range of motion were compared. RESULTS: The arthroscopic findings showed diffused synovitis in all 13 cases. Among them, 9 cases were accompanied with a labral tear, and 2 cases showed a labral deformity. The VAS decreased from 7.5 preoperatively to 1.8 postoperatively and the modified Harris hip score improved from 49.3(35-60) before surgery to 90.1(85-95) after surgery. Each flexion and internal rotation improved significantly (P<0.05) from 95.2degrees (60-120degrees) to 127.7degrees (110-140degrees) and 4.6degrees (-5-25degrees) to 25.4degrees (15-30degrees), respectively. CONCLUSION: This study shows that the arthroscopic treatment of femoroacetabular impingement with a limitation of the range of motion by early degenerative arthritis can be expected with an improvement in flexion and internal rotation of the hip.

PS-TKA with more than 10degrees of Preoperative Posterior Tibial Slope

PURPOSE: We wanted to evaluate the effects of a preoperative posterior tibial slope of more than 10degrees on the extension gap and patellar height during posterior substituted total knee arthroplasty. MATERIALS AND METHODS: One hundred ten posterior substituted total knee arthroplasties were divided into group I (more than 10degrees of preoperative posterior tibial slope, n=56) and group II (less than 10degrees of slope, n=54). Each group was evaluated to compare the frequency of additional distal femoral resections due to an insufficient extension gap and the correlation with the decrease of the patellar bone height. RESULTS: In each group, the preoperative tibial slope was 12.77degrees (+/-3.22degrees) vs. 6.72degrees (+/-2.58degrees), respectively (p=0.000) and the decrease of the posterior slope was 10.74degrees (+/-3.54degrees) vs. 4.78degrees (+/-2.66degrees), respectively, (p=0.000). The frequencies of additional distal femoral resection were 54.5% vs. 46.1%, respectively, (p=0.448) with flexion contracture and 11.8% vs. 34.1%, respectively, (p=0.022) without flexion contracture. The decrease of the patellar bone height was 0.35 (+/-4.79) mm vs. 1.99 (+/-4.78) mm, respectively, (p=0.075). There was weak correlation between the decrease of the patellar bone height and the decrease of the posterior tibial slope (r=-0.253, p=0.016). CONCLUSION: In the group having more than 10degrees of preoperative posterior tibial slope without flexion contracture, the decrease of the posterior tibial slope had to be considered as one of the factors that affected making the extension gap significantly greater during the gap technique and to preserve the patellar bone height.

Short-Term Outcomes of Miller Galante(R) Fixed-Bearing Unicondylar Knee Arthroplasty: A Comparative Study in Outcomes according to Postoperative Correction Angle / 대한정형외과학회잡지

PURPOSE: To evaluate short-term clinical and radiographical results of fixed bearing unicondylar knee arthroplasty (UKA) comparing results between over-corrected group and under-corrected group. MATERIALS AND METHODS: Clinical and radiographical outcomes of 47 Miller-Galante(R) UKAs with a minimum of 4-year follow-up were evaluated. We also compared both clinical and radiographical results between over and under corrected groups, which were divided by 2degrees varus of mechanical axis postoperatively. RESULTS: HSS and WOMAC scores improved from 75.4 and 57.7 preoperatively to respectively, 95.2 and 12.1 at the last follow up. Radiographically, the mechanical axis changed from 7.2degrees varus preoperatively to 2.8degrees varus at the last follow-up. A partial radiolucent line on the medial side of the tibia was observed in 23% of the 47 cases. Degenerative changes in the lateral compartment and the patellofemoral joint were observed, respectively, in 23% and 26%. There were no significant differences between the two groups in clinical and radiographical results (p>0.05). In the undercorrected group, three cases converted to total knee arthroplasty because of medial tibial collapse. CONCLUSION: Miller-Galante(R) UKA showed good outcomes in short-term follow-up with the exception of three failures. There were no significant differences between more than 2degrees varus corrected and under 2degrees varus corrected groups in clinical and radiographical results. However, all 3 conversions to total knee arthroplasties occurred in the undercorrected group.

Influence of health education on clinical effect and treatment compliance in middle aged and aged patients with degenerative osteoarthritis / 中国实用护理杂志

Objective To evaluate the effect of health education on clinical effect and treatment compliance in middle aged and aged patients with knee degenerative osteoarthritis (KOA or KDOA). Methods 60 cases of patients with KOA were randomly divided into the intervention group and the control group with 30 patients in each group. The control group was given the conventional clinical care intervention; on the basis of the control group, the intervention group was given health education nursing intervention. After intervention the clinical effect and treatment compliance of the two groups were observed and evaluated. Results After intervention, the total clinical effective rate of the intervention group was 93.3%, the control group was 73.3%, the difference was significant between the two groups; the excellent and good rate of treatment compliance of the intervention group was 100.0%, the control group was 76.7%, the difference was significant between the two groups. Conclusions Health education can improve the clinical effect and treatment compliance of middle aged and aged patients with KOA, and it is worthy of being popularized.

A Study on the Development of Degenerative Osteoarthritis after Arthroscopic Total Menisectomy / 대한정형외과학회잡지

PURPOSE: This study compared the clinical and radiological incidence of osteoarthritis after a total meniscectomy. MATERIALS AND METHODS: Seventy eight patients, who underwent a total meniscectomy, were evaluated after a minimum follow up of five years. The operations were a medial meniscectomy (group I) in 16 cases, a lateral meniscectomy (group II) in 17 cases, a discoid meniscus (group III) in 29 cases and medial meniscectomy with an anterior cruciate ligament reconstruction (group IV) in 16 cases. The development of degenerative osteoarthritis was analyzed using the Kaplan-Meyer survivorship. RESULTS: At postoperative 5 years and 7 years, degenerative osteoarthritis developed in 17% and 36% of patients, respectively. The incidence ofdegenerative osteoarthritis at postoperative 5 years and 7 years in groups I, II, III and IV was 9% and 18%, 14% and 29%, 25% and 46%, and 28% and 55%, respectively. The difference was statistically significant. CONCLUSION: The meniscus deficient knee joint which varies according to the patterns of a meniscal injury, had a higher incidence of degenerative osteoarthritis. Careful attention should be paid to the treatment of meniscal tears.

The Wear Pattern of Articular Cartilage of Medial Tibial Plateau with or without Functional ACL in Patients with Degenerative Osteoarthritis of the Knee / 대한정형외과학회잡지

PURPOSE: This study examined the wear pattern of the articular cartilage of the medial tibial plateau with or without a functional ACL in patients with degenerative osteoarthritis of the knee. MATERIALS AND METHODS: Between July 2003 and May 2004, 71 cases (52 patients) of total knee arthroplasty due to degenerative osteoarthritis of the knee were enrolled in this study. The intraoperative evaluations such as a test for the functional status of the ACL and the wear pattern of medial tibial plateau were performed, and the associations with the physical examinations such as, range of motion (ROM), Lachman test and pivot shift test, and tibio-femoral angle (TFA), were analyzed. RESULTS: There were 43 cases with a functional ACL, and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 8 cases (18.6%), central in 30 cases (69.8%), and central and posteromedial in 5 cases (11.6%). There were 28 cases with a non- functional ACL and the wear pattern of the medial tibial plateau was differentiated as anteromedial and central in 1 case (3.6%), central in 2 cases (7.2%), and central and posteromedial in 25 cases (89.2%). In the group with the non-functional ACL, the most prevalent wear pattern was central and posteromedial (p<0.001). CONCLUSION: In patients with degenerative osteoarthritis of the knee without a functional ACL, the wear pattern of the articular cartilage of the medial tibial plateau was more posteromedially than patients with a functional ACL.

The Effect of Human Joint Fluid in the Surviviorship and Proliferation of Bone-Marrow Derived Progenitor Cell / 대한정형외과연구학회지

PURPOSE: To investigate the effect of human joint fluid media on the survival and proliferation of bone marrow derived precusor cell, and to provide the basic data of the intraarticular injection with scaffold-free progenitor cell in advanced degenerative osteoarthritis (OA). MATERIALS AND METHODS: We obtained the joint fluid and bone marrow from 15 patients who had total knee arthroplasty due to degenerative OA, and isolated the mesenchymal progenitor cells (MPCs) from bone marrow by washing and ten times subculture. We devided the control and experiment groups according to the addition of joint fluid at various ratios (1/100, 1/10, 1, 10, 100, 1000 microliter), and statistically analyzed the numbers of mesenchymal progenitor cell proliferated according to the culture period. RESULTS: The experiments using joint fluid without centrifuge showed the increase of MPCs as the culture poriod was extended and was independent to the existence of fetal bovine serum, the dose dependent pattern in the increase of MPCs in proportion to the dose of joint fluid, and statistically significant increase MPCs in 10, 100, 1000 microliter of serum contained groups, 1000 microliter of serum-free groups (p=0.039, p=0.017, p=0.077, p=0.004). The experiments using joint fluid with centrifuge showed the increase of MPCs as the culture period was extended and was independent of fetal bovine serum, and the dose dependent pattern in the increase of MPCs in proportion to the dose of joint fluid, and statistically significant increase MPCs in 1000 microliter of both serum contained and serum-free groups (p=0.006, p=0.024). CONCLUSION: MSCs not only can survive, but also proliferate in human joint fluid. The rate of proliferaton is increased faster by the adding of joint fluid than only using common media in cell culture. And the experiment shows the dose dependent pattern in the increase of MPCs in proportion to the dose of joint fluid.

Total Knee Arthroplasty for Posttraumatic Arthritis : Comparison of the Results with Primary Degenerative Osteoarthritic Patients

PURPOSE: To compare the results of a total knee arthroplasty (TKA) between the degenerative osteoarthritic patients and the posttraumatic arthritic patients. MATERIALS AND METHODS: 38 cases with posttraumatic arthritis (group A) and 40 cases with degnerative osteoarthritis (group B) had a total knee arthroplasty between April 1995 and May 2002. The knee score, functional score, activity level and radiologic analyses were performed. RESULTS: There were no significant difference in the knee score, functional score, activity level and radiological findings between the two groups. The range of motion arcs were reduced in the posttraumatic arthritic patients. There is a higher complication rate in the post-traumatic arthritic patients (36%) when compared with the degenerative osteoarthritic patients (15%) after TKA . CONCLUSION: In group A showed a higher complication rate and reduced range of motion arcs. However, in terms of our results, we considered that a total knee arthroplasty is an useful treatment for the posttraumatic arthritis in spite of the technical difficulties.

Evaluation of the Efficacy of Sodium Hyaluronate to Degerative Osteoarthritis of the Knee

OBJECTIVE: To obtain a effect of intraarticular injection of Sodium Hyaluronate in the patient with degenerative osteoarthritis without restriction of activities of daily living. METHOD: Twenty-five patients were participated in this study. These patients are diagnosed as degenerative osteoarthritis by clinical symtoms and radiographic findings. Sodium hyaluronate, 2.5 ml, 3 mg/ampule, were injected intraarticulary without local anesthesia once a week for 5 times consecutively. For evaluation of the effectiveness of sodium hyaluronate, we assess the parameters for subjective and objective symtoms scored from 0 to 3 on 3 items, and for activities of daily living scored from 0 to 4 on 4 items. And then, we compared these data between pre-injection and at post-injection 2, 4, and 5 weeks. Changes of subjective and objective symtoms, and activities of daily living are assessed using Kellgren's X-ray grading of degenerative osteoarthritis. Improvement of the subjective pain is recorded by visual analogue scale. RESULTS: 1. Subjective and objective symtoms, and activities of daily living with time progression were significantly increased at post-injection 4, 5 weeks compared with pre-injection status (P<0.05). 2. Subjective and objective symtoms, and activities of daily living according to Kellgren's X-ray classification were significantly increased at stage II and III (P<0.05). 3. Visual analogue scale is significantly decreased after injection (P<0.05). CONCLUSION: Intraarticular injection of sodium hyaluronate showed improvement of patient's subjective and objective symtoms, and activities of daily living. The improvement was pronounced in the cases of high grade of degenerative osteoarthritis (stage II, III) according to Kellgren's X-ray classification as well as low grade (Stage I).

Arthroscopic Abrasion Arthroplasty in Degenerative Osteoarthritis & Posttraumatic Osteoarthritis of the Knee

Between Feb. 1992 and Apr, 1995, the authors have performed arthroscopic abrasion arthroplasty in 78 knees of 76 patients with degenerative osteoarthritis. The followup period was between 24 and 58 months, with on an average of 41 months. All patients had Zarins grade IV articular cartilage change. The results were as follows. 1. Of the total 78 knees, results were excellent in 25(32%), good in 33(42A), fair in 12(17%), poor in 8(10%) knees respectively. 2, The best results were obtained patellofemoral abrasion arthroplasty. 3. The poor results were obtained in patients with the both femoral condyle, lesion. 4. The results were much better in young age group (below 40 years). Aroscopic abrasion arthroplasty is not a curative but palliative method. But it could be an appealing altemative to total knee arthroplasty or high tibial osteotomy or can be performed postoperated after these reconstructive proeedures.

Spontaneous Hemarthrosis of the Knee in the Elderly

The etiology of spontaneous hemarthrosis of the knee joint in elderly pattents is still unknown. This report discusses seven spontaneous hernarthroses, three that were managed witla conservative measures such as aspiration, rest and knee immobilization because of poor general condition and four in which arthroscopic evaluation and treatment were performed. These patients were elderly indi.viduals without an obvious history of trauma. The roentgenograms of each involved knee demonstrated degenerative osteoarthritic changes of knee joint. Arthroscopic examination revealed denuded articular cartilage and subchondral bone exposure in four operative cases and degenerative meniscal tear in one case of four. These patients underwent mthroscopic debridement and did not experience recurrenees of the hemarthrosis. We think that the origin of the bleeding was most likely from the subchondral cancellous bone which was exposed due to degenerative change of the knee joint and the senile changes of the vessels around the knee joint with aging process may contribute the spontaneous bleeding into the knee joints.