Short-term Follow-up of Posterior Cruciate Ligament-sacrificed Total Knee Arthroplasty Using a Mobile Polyethylene Insert: Navigation-aided Technique

PURPOSE: Recently, a mobile ultracongruent polyethylene insert was used to increase joint stability in the posterior cruciate ligament sacrificed total knee arthroplasty with non-posted mobile bearing. However, as yet there have been no reports about this implant. In this study, the clinical and radiological results of surgery using the implant were analyzed through a navigation system. MATERIALS AND METHODS: The subjects included 95 cases of 70 patients to whom the rotating tibial implant was applied after posterior cruciate ligament resection among the patients who underwent total knee arthroplasty from September 2006 to December 2008. The follow-up duration was at least 24 months, and 40 months on average. For clinical evaluation, the knee score and functional scores were measured preoperatively and at the time of final follow-up. With reference to a 5 mm joint line change measurement recorded by the navigation system, which can affect the clinical result, the comparison and evaluation were performed by dividing the subjects into group I (5 mm). Radiological evaluation was performed by measuring the angle of the mechanical axis of the lower extremities and the patella tilting angle preoperatively and at the time of final follow-up using plain radiographs. RESULTS: Seventy subjects (95 cases) were followed up for at least 24 months. According to the clinical results, the mean KSS knee score improved from a preoperative score of 43.4 to a final follow-up score of 90.6 (p<0.0001). In addition, the mean functional score improved from a preoperative score of 51 to a final follow-up score of 88.4 (p<0.0001). Finally, the mean joint line change, which can affect the clinical result, was 5.82 mm, ranging from -1 to 12 mm. The clinical and radiological evaluations were performed by dividing the subjects into two groups in relation to the reference value of 5 mm, but no significant difference was found. The mechanical axis angles of the lower extremities improved from the preoperative value of varus 10.01degrees to the final follow-up value of varus 1.89degrees, and the difference was significant (p<0.0001). The mean patella tilting angles were 8.8degrees and 9.3degrees, respectively, at the time before the operation and after the final follow-up; this difference was not significant (p=0.89). CONCLUSION: Good clinical and radiological results were observed after at least two years of follow-up subsequent to total knee arthroplasty, in which a rotating ultracongruent polyethylene insert was applied after posterior cruciate ligament resection using a navigation system.

Short-term results of ABO-incompatible living donor kidney transplantation: comparison with ABO-compatible grafts / 대한외과학회지

PURPOSE: ABO incompatible (ABOi) kidney transplantation (KT) has been increasing to compensate for the shortage of organ donors. However, detailed comparative analyses of ABOi KT with ABO compatible (ABOc) KT are still rare. METHODS: This retrospective study compared 12 consecutive ABOi KTs to 50 ABOc KTs that employed the same maintenance immunosuppressive agents during the same period. Comparisons of patient survival, graft survival, graft function, and complications were made until post-transplant day 90. RESULTS: Baseline characteristics of the two groups were similar except for the positivity of panel reactive antibody (12% in the ABOc group vs. 42% in the ABOi group; P = 0.029). There were no significant differences in patient survival, graft survival, post-operative renal function, incidence of acute rejection, infections, or medical and surgical complications. However, bleeding complications were more common in the ABOi group (25%) than versus the ABOc group (6%) (P = 0.08). The preoperative and total hospital stay of the ABOi patients was significantly longer than the ABOc patients (P = 0.001). CONCLUSION: ABOi KT is a viable and safe option for patients whose only donor is blood incompatible, despite the longer preoperative hospital stay for preparation.

Short Term Results of Cruciate Retaining TypeMobile Bearing Total Knee Arthroplasty: Using a Navigation System

PURPOSE: We wanted to report the minimum 3 year follow-up clinical results of the patients who underwent navigation guided cruciate retaining mobile bearing total knee arthroplasty and to evaluate the radiological results for a consecutive series of patients. MATERIALS AND METHODS: Cruciate retaining mobile bearing total knee arthroplasties with using a navigation system were performed for 54 knees. The mean patient age was 65 years old (range: 51~76 years). The mean follow up period was 44 months (range: 36~61 months). The Knee Society Score (KSS) and range of motion (ROM) were evaluated for the preoperative and postoperative clinical assessments. We evaluated the alignment and the position of the implants by using plane radiographs for the radiological assessment, and we investigated the wear and loosening of implants in the same manner at the last follow-up exam. RESULTS: The knee score improved from 38 to 91 (p=0.001) and the functional score improved from 46 to 92 (p=0.001). The mean range of motion was also improved postoperatively. The radiological results of the coronal axis alignment of the lower extremity and the implant position were satisfactory in 98% of the cases. Periprostheic osteolysis occurred in 4 cases, but there were no clinically significant osteolysis seen on the follow-up radiographs. CONCLUSION: Soft tissue balancing and the accuracy of implantation are necessary when performing cruciate retaining mobile bearing total knee arthroplasty. For this type of implant, navigation is useful tool to perform total knee arthorplasty for insuring the accuracy of the surgical procedure.