Morphologic Changes of Femoral Cam Lesion after Osteoplasty for Femoroacetabular Impingement / 대한정형외과학회잡지

PURPOSE: We evaluated the morphologic change of cam lesion of femoroacetabular impingement (FAI) using 3-dimensional computed tomography (3D-CT) at the minimum 2-year follow-up and estimated its relationship with clinical outcomes. MATERIALS AND METHODS: Between February 2007 and March 2014, all patients who underwent hip arthroscopic femoroplasty under the impression of FAI were retrospectively evaluated. We selected patients who received 3D-CT and were followed-up for more than 2 years. We estimated the quantitative volume of femoroplasty, alpha angle and femoral head-neck offset using 3D-CT. RESULTS: Thirty-two patients (37 cases) were selected in our study. The mean age was 31.2 years (16–69 years) and the mean follow-up duration was 47.3 months (26–119 months). The mean resection volume measured after femoroplasty using 3D-CT was 48.9 mm2 (13.2–106.4 mm2), and follow-up mean resection volume was 37.9 mm2 (7.83–90.37 mm2). A little bit of the mean volumatic overgrowth of the resection area between immediate postoperative and last follow-up was shown; however, there was no statistically significant difference in the mean values (p>0.05). The clinical outcomes showed a significant improvement during the perioperative and follow-up periods in all categories (p < 0.05). CONCLUSION: There was no significant regrowth of cam lesion after femoroplasty for FAI at maximum 9 years. Moreover, in most cases, clinical outcomes were improved. This suggests that we were able to achieve good clinical outcomes without harmful anatomical regrowth of cam deformity using arthroscopic femoroplasty.

Comprehensive Review of Advancements in Hip Arthroscopy / 대한고관절학회지

Hip arthroscopy is currently being leveraged in the diagnosis and treatment of a wide range of hip joint problems. In fact, great advancements in hip arthroscopy have resulted in an ever-expanding number of indications to which it is being applied. Minimally invasive hip arthroscopy allows for quicker initiation of rehabilitation and has attracted much attention as the field becomes increasingly focused on surgeries designed to preserve joints. This review aims to summarize the recent advances, applications, and impact of hip arthroscopy.

Descriptive Epidemiology of Patients Undergoing Total Hip Arthroplasty in Korea with Focus on Incidence of Femoroacetabular Impingement: Single Center Study

We analyzed the causes leading to total hip arthroplasty (THA), aimed to clarify the incidence of femoroacetabular impingement (FAI) among the causes, and compared the incidence in Korea with those in other countries. From January 2000 to December 2014, 1,206 hips of 818 patients who underwent primary THA at our institute were reviewed retrospectively in terms of radiographs and electronic charts. The radiographs and radiographic parameters were reviewed and measured by 2 of the authors, who are orthopedic surgeons. Patients were categorized in terms of the causes leading to THA as primary osteoarthritis (OA), rheumatoid arthritis (RA), posttraumatic arthritis, post infectious arthritis, avascular necrosis (AVN) of the femoral head, fracture of the femoral head or neck, ankylosing spondylitis (AS), developmental dysplasia of the hip (DDH), Legg-Calvé-Perthes disease (LCPD), FAI, and others. There were 32 patients (3.91%) in the primary OA group, 41 (5.01%) in the RA group, 84 (10.27%) in the posttraumatic arthritis group, 39 (4.77%) in the post infectious arthritis group, 365 (44.62%) in the AVN group, 39 (4.77%) in the fracture group, 21 (2.57%) in the AS group, 52 (6.36%) in the DDH group, 71 (8.68%) in the LCPD group, 52 (6.36%) in the FAI group, and 22 (2.69%) in the ‘other’ group. The causes leading to THA in Korea differ from those in Western countries. FAI could be causes of severe secondary OA that requires THA in Korea, therefore symptomatic FAI should not be neglected.

The Optimal Suture Site for the Repair of Posterior Horn Root Tears: Biomechanical Evaluation of Pullout Strength in Porcine Menisci

PURPOSE: There are few studies on biomechanical evaluation of suture points in repair of root tears. The purpose of this study was to determine the point of greatest pullout strength for root tear repair. MATERIALS AND METHODS: A total of 120 fresh porcine medial menisci were obtained. The red-red and red-white zones of the meniscus were divided by two lines designated as lines A and B (groups A and B). Groups A and B were further divided into three groups each by dividing lines A and B into three points: 3, 5, and 7 mm from the meniscal ligament root insertion. Vertical meniscal repair was performed on each point. The pullout failure strength was tested using a biaxial servohydraulic testing machine. RESULTS: The average maximal load at failure was significantly greater in group A than group B (87.65 vs. 62.93; p<0.001) The average length at maximal load failure was greater in group A than group B (4.35 vs. 3.2; p<0.001). Among the subgroups of 3, 5, and 7 mm in both groups A and B, 7 mm showed the greatest maximal load (p<0.001). CONCLUSIONS: The pullout strength was statistically significantly greater in group A than group B and in the 7 mm subgroup than the 3 and 5 mm subgroups. Thus, the 7 mm subgroup in group A showed the greatest pullout strength.

Efficiency and Safety of Demineralized Bone Matrix for Posterolateral Fusion / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to analyze the effects of demineralized bone matrix on posterolateral lumbar fusion. MATERIALS AND METHODS: From 2009 to 2012, 30 patients who had undergone posterolateral fusions using demineralized bone matrix (group I) and 30 who had received autogenous posterior iliac bone grafts (group II) were investigated. Bone union was determined by evaluating serial simple lumbar radiographs taken during the 24 months after surgery. Bone status was classified according to Lenke's scale and the bone fusion was finally determined by flexion/extension lateral radiographs. We also examined halo signs around the pedicular screws evident on the radiographs, scored back pain using a visual analogue scale (VAS), and Oswestry disability index (ODI) score 2 years after surgery to evaluate clinical status of patients. RESULTS: In group I, 19 patients showed union and 11 patients did not; the values for group II were 22 and 8. These proportions did not differ significantly (p=0.57). Time to union was somewhat shorter in group II (25.3±7.9 weeks), but did not differ significantly from that of group I (p=0.097). No statistical significance in the periscrew Halo count, VAS for back pain, and ODI score was observed between the two groups. CONCLUSION: The union rate after using demineralized bone matrix for lumbar posterolateral fusion is similar to that attained when autogenous bone grafts are employed, and lacks the morbidity associated with such grafts. Thus, demineralized bone matrix is an effective bone graft substitute when posterolateral fusion surgery of the lumbar spine is required.

Could Patient Undergwent Surgical Treatment for Periprosthetic Femoral Fracture after Hip Arthroplasty Return to Their Status before Trauma? / 대한고관절학회지

PURPOSE: The purpose of this study was to compare preoperative clinical outcomes before occurrence of periprosthetic femoral fracture (status before trauma) with postoperative clinical outcomes (status after operation) in patients with periprosthetic femoral fracture after hip arthroplasty. MATERIALS AND METHODS: A retrospective review was performed of all periprosthetic femoral fracture after hip arthroplasty treated surgically at our institution from January 2010 to January 2014. Among 29 patients who underwent surgical treatment for periprosthetic femoral fracture after hip arthroplasty, 3 patients excluded because of non-union of the fracture site. The clinical outcomes were determined by using visual analogue scale for pain (VAS), Harris hip score (HHS), and ambulatory ability using Koval classification. VAS, HHS and ambulatory ability was assessed for all the included patients at the last follow-up of status before trauma and after operation. RESULTS: The mean VAS, HHS and ambulatory ability at the last follow-up of status before trauma was 2.2 (range, 0-4), 78.9 (range, 48-92) and 1.9 (range, 1-5), respectively. The mean VAS, HHS and ambulatory ability at the last follow-up of status after operation was 3.1 (range, 1-5), 68.4 (range, 46-81) and 2.9 (range, 2-6), respectively. The clinical outcome of VAS, HHS and ambulatory ability were significantly worsened after surgical treatment for periprosthetic femoral fracture (P=0.010, P=0.001, and P=0.002, respectively). CONCLUSION: Patients with periprosthetic femoral fracture after hip arthroplasty could not return to their status before trauma, although patients underwent appropriate surgical treatment and the fracture union achieved.

Hip Arthroscopy for Incarcerated Acetabular Labrum following Reduction of Traumatic Hip Dislocation: Three Case Reports / 대한고관절학회지

Traumatic hip fracture-dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the hip joint. Incarceration, such as interposed labrum between acetabulum and femoral head that is not readily visualized preoperatively, is a rare but important cause of pain and can potentially be a source for early degeneration and progression to osteoarthritis. We present three cases, arthroscopic surgery of incarcerated acetabular osseo-labral fragment following reduction of traumatic hip fracture-dislocation.

Usefulness of Treatment with 6.5 mm Cancellous Screw and Steinmann Pin Fixation for Calcaneal Joint Depression Fracture / 대한족부족관절학회지

PURPOSE: To report the radiographic and clinical results of 6.5 mm cancellous full threaded buttress screw or Steinmann pin fixation to maintain a reduction of calcaneal posterior facet depression fracture. MATERIALS AND METHODS: From June 2009 to June 2012, 50 consecutive cases with calcaneal joint depression fracture that underwent open reduction and screw or pin fixation were enrolled in this study. A 6.5 mm cancellous full threaded screw was inserted from the posteroinferior aspect of the calcaneal tuberosity to the posterior facet (group A) or Steinman pin was inserted from the posterosuperior aspect of the calcaneal tuberosity to the calcaneocuboidal joint (group B). Both preoperative and postoperative Bohler and Gissane angles were measured radiographically, and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale on the final follow-up were assessed. RESULTS: The mean age of patients was 44.1 years, and the mean follow-up period was 27.2 months. According to the Sanders classification, 28 cases were type II and 22 cases were type III. In Sanders type II, Bohler and Gissane angles improved significantly from 10.1degrees and 126.2degrees preoperatively to 27.2degrees and 117.1degrees, respectively, in the immediate postoperative radiograph, and at the final follow-up, 26.6degrees and 118.6degrees, respectively. In Sanders type III, Bohler and Gissane angles improved significantly from 5.0degrees and 129.8degrees to 29.9degrees and 119.3degrees, respectively, in the immediate postoperative radiograph, and 26.9degrees and 120.2degrees at the final follow-up. All cases achieved bony union, and the average period until complete union was 13.3 weeks. AOFAS ankle-hindfoot scale was 82.6 in Sanders type II and 77.3 in Sanders type III at the final follow-up. CONCLUSION: A 6.5 mm cancellous full threaded buttress screw or Steinman pin fixation is a noninvasive treatment method with a merit of being able to maintain the bearing capacity of the posterior facet comparable to plate fixation.

Arthroscopic Treatment of Subchondral Bony Cyst in Early Osteoarthritis of the Hip Joint Using Allogeneic Bone Graft: A Report of Two Cases / 대한고관절학회지

Subchondral bony cyst, large solitary or multiple cysts in acetabular dome usually exacerbate progression to degenerative osteoarthritis in the hip joint. But it can be treated through arthroscopic intervention. We report two cases that treated by arthroscopic curettage and bone graft for subchondral bony cysts in early osteoarthritis of the hip joint, and it may delay progression to moderate osteoarthritis.