Long-Term Follow-Up Results of a Second-Generation Cementless Femoral Prosthesis with a Collar and Straight Distal Fixation Channels

PURPOSE: We evaluated the results of more than 10 years of follow-up of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels. MATERIALS AND METHODS: One hundred five patients (129 hips) who underwent surgery between 1991 and 1996 for primary total hip arthroplasty using cementless straight distal fluted femoral stems were followed for more than 10 years. Ninety-four hips in 80 patients were available for clinical and radiologic analysis. The mean age at the time of surgery was 47 years, and the mean duration of follow-up was 14.3 years. RESULTS: The mean Harris hip scores had improved from 58 points to 88 points at the time of the 10-year follow-up. Activity-related thigh pain was reported in nine hips (10%). At the last follow-up, 93 stems (99%) were biologically stable and one stem (1%) was revised because of loosening. No hip had distal diaphyseal osteolysis. Proximal femoral stress-shielding was reported in 86 hips (91%). We found no significant relationship between collar-calcar contact and thigh pain, stem fixation status, or stress-shielding. The cumulative survival of the femoral stem was 99% (95% confidence interval, 98-100%) after 10 years. CONCLUSION: The long-term results of total hip arthroplasty using a second-generation cementless femoral prosthesis with a collar and straight distal fixation channels were satisfactory; however, the high rate of proximal stress-shielding and the minimal effect of the collar indicate the need for some changes in the stem design.

Evaluation of Postoperative Range of Motion and Functional Outcomes after Cruciate-Retaining and Posterior-Stabilized High-Flexion Total Knee Arthroplasty

PURPOSE: The purpose of this study was to compare postoperative range of motion and functional outcomes among patients who received high-flexion total knee arthroplasty using cruciate-retaining (CR-Flex) and posterior-stabilized (PS-Flex) type prostheses. MATERIALS AND METHODS: Among 127 patients (186 knees) who underwent high-flexion total knee arthroplasty between 2005 and 2007, 92 knees were placed in the CR-Flex group, and 94 knees were placed in the PS-Flex group. After two years of postoperative follow-up, clinical and radiographic data were reviewed. Postoperative non-weight-bearing range of knee motion, angle of flexion contracture and functional outcomes based on the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) functional sub-scale were assessed and compared between the two groups. RESULTS: After the 2-year postoperative period, the mean range of motion was 131degrees in the CR-Flex group and 133degrees in the PS-Flex group. There were no significant differences in postoperative range of motion between the two groups. Only age at operation and preoperative range of motion were significantly associated with postoperative range of motion after high-flexion total knee arthroplasty. Postoperative functional outcomes based on the WOMAC functional sub-scale were slightly better in the CR-Flex group (9.2+/-9.1 points) than in the PS-Flex group (11.9+/-9.6 points); however, this difference was not statistically significant (p=non-significant). CONCLUSION: The retention or substitution of the posterior cruciate ligament does not affect postoperative range of motion (ROM) or functional outcomes, according to 2 years of postoperative follow-up of high-flexion total knee arthroplasty.

The Influence of Obesity on Clinical Outcomes after Total Knee Arthroplasty: A Five-year Minimum Follow-up

PURPOSE: To evaluate the effects of obesity on clinical outcomes following total knee arthroplasty in osteoarthritis patients. MATERIALS AND METHODS: Between June 1999 and February 2002, 239 osteoarthritis patients underwent total knee arthroplasty, and 118 knees of 94 patients treated during this period were followed for a minimum of 5 years. Seventy knees belonged to 56 obese patients (body mass index, BMI>25 kg/m2), while 48 knees belonged to 38 non-obese patients (BMI80 points at final follow-up) (p>0.05). With regard to revision, 4 liner exchanges took place in the obese group due to liner dislodgement, and no liner exchanges took place in the non-obese group. However, there was no significant difference in the incidence of liner exchange between the two groups (p>0.05). CONCLUSION: Obesity (BMI>25 kg/m2) has no effect on total knee arthroplasty outcomes in osteoarthritis patients at 5 years follow-up.

Obesity and Perioperative Morbidity after Total Hip Arthroplasty in Osteoarthritis Patients

PURPOSE: To evaluate the effect of obesity on perioperative morbidity following total hip arthroplasty in patients with severe osteoarthritis. MATERIALS AND METHODS: Between April 1987 and April 2007, 272 patients with severe osteoarthritis underwent total hip arthroplasty. One hundred seventeen patients were obese (body mass index, BMI> or =25 kg/m2), and 155 were not obese (BMI0.05). However, the medical complication rate was significantly higher in the obese group compared to the non-obese group (4.3% vs. 0.6%, p or =25 kg/m2) has no observable effect on perioperative morbidity in terms of length of hospital stay, operation time, total blood loss and replacement, or surgical complication rate, but is associated with a higher medical complication rate.

Operative Treatment for Nonunions of Distal Radial Fracture: A Report of 7 Cases / 대한정형외과학회잡지

PURPOSE: To report the treatment results of 7 cases of distal radius nonunion with a review of the relevant literature. MATERIALS AND METHODS: Seven patients treated with an autoiliac bone graft and rigid internal fixation for nonunion of the distal radius were analyzed retrospectively for the cause of injury, the factors affecting nonunion, radiological findings, treatment method and complications. The results were analyzed radiologically using Kreder's method and functionally using the Anderson' protocols. RESULTS: Union was achieved in all cases after a mean period of 19 weeks. The functional result of treatment at the last follow-up was excellent in 4 cases and satisfactory in 3 cases. The probable factors of nonunion were instability of the fracture site in three cases, type II or III open fracture in 2 cases, postoperative infection in one case and idiopathic in one case. CONCLUSION: Infection control using a stepwise operation, rigid internal fixation and autogenous iliac bone graft showed satisfactory results in distal radius nonunion, which had developed in those with severe open fractures, postoperative infection, instability on the fracture site and associated distal ulnar fracture.

Comparison between the Results of Minimally Invasive Total Knee Arthroplasty Performed with Mini-Midvastus Technique and Quadriceps-Sparing Technique

PURPOSE: To compare the short-term clinical results of mini-midvatus minimally invasive total knee arthroplasty(TKA) with quadriceps-sparing minimally invasive TKA. MATERIALS AND METHODS: Between August 2005 and February 2006, 23 bilateral (46 knees) minimally invasive total knee arthroplasties were performed simultaneously using quadriceps-sparing surgical technique at one side and mini- midvastus minimally invasive technique at the contralateral side. The same surgeon performed all the operations with the same type of prosthesis(Nexgen LPS-flex Total Knee System) using MIS quadriceps-sparing instrument. The pos- toperative clinical and radiological results were analyzed in each group. RESULTS: There were no significant differences between the two groups in the operating time, total blood loss, length of skin incision, radiological results and postoperative HSS scores at 8 weeks and 1 year follow-up(p>0.05). Also, there were no differences in the postoperative range of motion and pain score assessed by visual analog scale at 1 day, 3 days, 7 days, 14 days, 8 weeks and 1 year follow-up(p>0.05). Conclusions: Compared to quadriceps-sparing TKA, mini-midvastus minimally invasive TKA revealed no significant differences in the short-term clinical and radiological results. Therefore, it can be considered as an effective, alternative minimally invasive technique.

Tumors in the Foot and Ankle (185 Cases) / 대한족부족관절학회지

PURPOSE: Tumors arising in the foot and ankle are uncommon and the malignant tumors are known to be rare compared with those of the other sites. We analyzed the clinical data of patients who have been diagnosed as having a tumor of the foot and ankle. MATERIALS AND METHODS: From 1989 to 2006, we analyzed 185 patients who have been treated surgically and were pathologically confirmed of having tumors of the foot and ankle. Their clinical characteristics were reviewed retrospectively. RESULTS: One hundred and fifty-seven cases were benign (84.9%) and 28 cases (15.1%) were malignant. 108 cases (58.4%) were benign soft tissue tumors and 49 cases (26.5%) were benign bone tumors. Malignant tumors included 17 cases (9.2%) of soft tissue tumors, 8 cases (4.3%) of primary bone tumors and 3 cases (1.6%) of metastatic bone tumors. The most common benign soft tissue tumor was ganglion (23 cases). Enchondroma (9 cases) was the most common among the benign bone tumors. Malignant peripheral nerve sheath tumor was the most common malignant tumor (4 cases). The predilection site for benign tumors was at the forefoot around toes while for the malignant tumor was around the ankle. 4.6% of benign soft tissue tumors and 8.2% of benign bone tumors had locally recurred and 14 cases (50%) of malignant tumor were confirmed as having distant metastasis. CONCLUSION: The ratio of malignant tumor and its metastasis rate was high. Therefore, the histopathologic confirmation is essential when treating tumors of the foot and ankle.

Radiographic Morphometry of Lumbar Intervertebral Disc Space in Normal Korean / 대한척추외과학회지

STUDY DESIGN: Radiographic measurement of the lumbar disc height OBJECTIVES: To measure the lumbar disc height on the radiographs in normal Koreans. SUMMARY OF LITERATURE REVIEW: Many reports show good results after many procedures, such as inter-vertebral body fusion using a cage or total disc replacement, which restores the adequate disc height. However, there are no references regarding the range of normal lumbar disc heights in Korean adults, which can be used as a standard for the implant size. MATERIALS AND METHODS: One hundred and thirty two subjects (age range 20 to 40 years), who had no previous history of low back pain and no significant findings on the physical examination, were enrolled in this study. The plain lateral lumbar spine radiograph was taken in the supine position. The intervertebral disc heights were measured at the anterior, middle and posterior portion of each lumbar disc. The average magnification rate was 115%, and the disc heights were corrected by the magnification rate in each segment. RESULTS: The lumbar disc height showed a cranio-caudal pattern in both the male and female groups. The L4-5 disc heights were highest at the anterior, middle and posterior portion in males. The L4-5 disc heights were highest at the middle and posterior portion in females. The L5-S1 disc height was highest at the anterior portion in females, but there was no significant difference between the L4-5 and L5-S1 disc height at the anterior portion. There was no significant difference in disc height between males and females except at the anterior portion of the L1-2 and L2-3 disc. There was no significant decrease in disc height in overweight people at all measured site in males and females except at the posterior portion of the L1-2 disc in males. CONCLUSION: This study is meaningful in that it provides a reference value for the lumbar disc height in Korean adults. The measured values might also be useful for manufacturing a Korean model of an artificial lumbar disc prosthesis or surgical instruments for lumbar interbody fusion.

Clinical Results of Sutureless Phacotrabeculectomy

We performed the prospective study on the clinical result of sutureless phacotrabeculectomy using 3.0mm ~ 6.5mm self-sealing scleral tunnel incision. This study included 9 eyes of 8 patients who have been suffering from chronic angle-closure glaucoma or chronic open-angle glaucoma with coexisting cataract. The mean preoperative intraocular pressure(IOP) was 28.55mmHg and mean postoperative IOP was 15.55mmHg. The IOP maintained below 19mmHg in all cases after 6 months. The number of medications decreased from 1.77 preoperatively to 0.33 postoperatively. No medication needed in 7 eyes postoperatively. The mean preoperative cup-disc ratio was 0.64. Visual acuity improved in 8 eyes and 5 eyes recovered to 20/40 or better. The blebs were visible in 8 cases which shows low diffuse in character in most cases. Postoperative complications were hypotony in 5 cases, hyphema in 1 case, partial posterior capsular rupture in 1 case and posterior capsular opacification in 1 case respectively. This result suggests that sutureless phacotrabeculectomy may be performed as safe and effective combined procedure in the management of coexisting cataract and glaucoma.

Spontaneous Separation of Epiretinal Membrane in Young Adult

In children and young adults, secondary epiretinal membranes after ocular trauma, pars planitis, ocular toxocariasis, and Coat's disease are common and spontaneous separation occurs in a relatively higher rate with improvement in visual acuity than elderly patients. In a 31-year-old man with pars planitis, diffuse epiretinal membrane in the macula became thinner during systemic and topical steroid therapy. Two years after treatment, the preretinal membrane spontaneously separated from the macula to the inferior temporal arcade, and visual acuity improved from 0.15 to 1.0. The authors reviewed the available literatures regarding the possible mechanisms for the spontaneous separation ofepiretinal membrane.

Effect of YAG Laser Iridotomy on IOP in Chronic Angle-closure Glaucoma

The effect of YAG laser iridotomy on intraocular pressure was investigated in 24 eyes of 19 patients with chronic angle-closure glaucoma prospectively for 3 months. In most cases(75%) the intraocular presure was reduced and the mean amount of reduction was 4.33mmHg. The amount of pressure reduction has no significant correlation with the extent of peripheral anterior synechiae and visual field loss. This result shows that laser iridotomy should be considered in the management of chronic angle-closure glaucoma irrespective of the extent of peripheral anterior synechiae and visual field loss and some amount of intraocular pressure reduction may be expected after laser iridotomy.