Reconstruction of Anterior Skull Base Fracture Using Autologous Fractured Fragments: A Simple Stitching-Up Technique / 대한신경손상학회지

Objective@#A displaced fracture in the anterior cranial base may be complicated by cerebrospinal fluid (CSF) rhinorrhea and enophthalmos. This study introduces a reconstruction technique with direct dural repair and reduction and fixation of the autologous fractured fragments. @*Methods@#Displaced fractures in the anterior cranial base were reconstructed using a stitching-up technique: A bicoronal scalp incision and frontal craniotomy was performed and the displaced bone was withdrawn. The lacerated dura was repaired primarily using a graft.Small holes were created in the intact cranial bones and the displaced harvest bone. Black silk was passed through the holes and the displaced bone was repositioned on tying the silk.Lumbar drain was not placed in any of the cases. The feasibility and outcome were evaluated. @*Results@#Five patients with displaced skull fractures of the anterior cranial base were included. All cases were men who had a direct impact on the forehead and/or eye. All the displaced fractures occurred in the orbital roof, and ethmoid bone fractures were present in 4 cases. Dural laceration was involved in 4 cases and repaired by placing artificial dura in 3 cases and a pericranial graft in 1 case. Following surgery, all cases were uneventful, and the anterior cranial fossa was well reconstructed. CSF leakage or enophthalmos did not occur in any of the cases. @*Conclusion@#Direct dural repair and autologous stitching-up reconstruction using the fractured fragment could be an effective method to prevent CSF leakage and enophthalmos in displaced fractures of the anterior cranial base.

Analysis of hematologic parameters of donors, patients, and granulocyte concentrates to predict successful granulocyte transfusion

BACKGROUND: Granulocyte transfusion (GTx) is performed as a supportive therapy in severe neutropenic patients caused by various conditions. The study aimed to analyze the hematologic parameters of donors, patients, and granulocyte concentrates to predict successful GTx. METHODS: This study was performed in 281 donors, with their granulocyte concentrates being collected through apheresis, and in 54 severe neutropenic patients who had various hematologic diseases. Complete blood cell counts of donors pre- and post-apheresis, granulocyte concentrates, and patients pre- and post-GTx were analyzed. Patients were divided into two groups according to survival at discharge (Group S, survival; Group D, dead) to compare various factors including age, infection status, pre- and post-GTx total white blood cell counts (TWBCC) and absolute neutrophil counts (ANC), total number of GTx, infused TWBCC and ANC per weight, and use of G-CSF during therapy. RESULTS: Overall data of patients showed that both TWBCC and ANC were significantly increased after GTx (median values at pre-GTx, TWBCC=0.40×109/L, ANC=0.14×109/L; post-GTx, TWBCC=0.57×109/L, ANC=0.29×109/L, both P<0.0001). After GTx, Group S (N=25) showed significantly higher TWBCC and ANC than Group D (N=29) (P=0.01 and P=0.04, respectively). Using different cutoff levels, post-GTx TWBCC greater than 0.5×109/L showed statistically significant difference between the two groups (P<0.01). None of the other factors showed statistically significant differences. CONCLUSION: The TWBCC and ANC after GTx were significant factors to predict patients' outcome. Therefore, follow-up of those two parameters may be helpful to select or consider other therapeutic modalities including additional GTx.

EDTA Treatment for Overcoming the Prozone Effect and for Predicting C1q Binding in HLA Antibody Testing

The Luminex-based single antigen bead (SAB) assay is widely used to detect HLA antibody in transplant recipients. However, one limitation of the SAB assay is the prozone effect, which occurs mostly as a result of complement interference. We investigated the efficacy of EDTA treatment for overcoming the prozone effect and predicting C1q binding of HLA antibody. We subjected 27 non-treated (naïve) and EDTA-treated serum samples from highly sensitized patients to IgG-SAB assays, and we confirmed the prozone effect in 53% and 31% of class I and class II antibody tests, respectively, after EDTA treatment. When we conducted additional assays after dithiothreitol treatment and serum dilution, EDTA was the most efficacious in eliminating the prozone effect. Reducing the prozone effect by EDTA treatment strengthened the correlation between IgG mean fluorescence intensity (MFI) and C1q MFI values (ρ=0.825) as compared with the naïve sera (ρ=0.068). Although C1q positivity was dependent on the concentration of HLA antibody in EDTA-treated sera, the correlations varied individually. Overall, our results confirmed the efficacy of EDTA treatment for overcoming the prozone effect. EDTA treatment showed a positive effect on the correlation between IgG MFI and C1q MFI values.

Evaluation of Hemoglobin Trigger and Appropriateness of Perioperative Red Cell Transfusion in Surgical Departments / 대한수혈학회지

BACKGROUND: Red blood cell (RBC) transfusion is an essential practice during surgery to accommodate for bleeding. As such, there are efforts being made to allow for a safe and appropriate transfusion due to shortages of blood components and to minimize transfusion-related adverse reactions. However, a conventional transfusion decision with relatively high hemoglobin (Hb) threshold is still performed in clinical setting. In this study, we investigated the threshold of Hblevel and appropriateness of RBC transfusion in patients receiving perioperative RBC transfusion in surgical departments. METHODS: We investigated the pre-transfusion Hb level of 1,379 patients (2,170 episodes) receiving perioperative RBC transfusion in five surgical departments, including cardiothoracic surgery (CS), general surgery (GS), neurosurgery (NS), obstetrics and gynecology (OBGY), and orthopedics (OS), between June 2017 and March 2018. The appropriateness of transfusion was evaluated with two criteria: 1) pretransfusion Hb level ≤10 g/dL and 2) posttransfusion Hb level ≤10 g/dL. RESULTS: The median pretransfusion Hb level was 8.5 g/dL (interquartile range 7.7~9.4); that of each department was as follows: 8.6 g/dL (7.9~9.2) in CS, 7.9 g/dL (7.3~8.6) in GS, 9.1 g/dL (8.5~9.8) in NS, 8.5 g/dL (7.7~9.8) in OBGY, and 8.7 g/dL (7.9~9.7) in OS. With a criteria of pretransfusion of Hb level ≤10 g/dL, 85.4% of total episodes were appropriate. With criteria of post-transfusion of Hb level ≤10 g/dL, 44.7% were appropriate. CONCLUSION: This study presents a fundamental data observing the trend of RBC transfusion in a single institution. A significant proportion of inappropriate RBC transfusion are still being conducted in surgical setting. Continuous and effective education of clinicians and implementation of monitoring systems to assess the appropriateness of RBC transfusion may be necessary.

Diagnostic laparoscopy in a leopard cat (Prionailurus bengalensis) with intercostal abdominal hernia and hepatic lipidosis

Intercostal abdominal hernia in the 11th intercostal space was identified in a leopard cat. Although mild leukopenia was found in laboratory examinations, no remarkable abnormality was revealed in medical imaging. To investigate abdominal organs, diagnostic laparoscopy was performed after hernia repair. In laparoscopic view, closure of the herniation site and a lesion with whitish discoloration in the liver (left medial lobe) were observed. Subsequently, laparoscopic liver biopsy was performed against the affected hepatic tissue. Histologically, the sample was diagnosed as mild hepatic lipidosis. Laparoscopy is considered useful for abdominal visceral examination and liver biopsy in a leopard cat patient.

The Degree of Bacterial Contamination While Performing Spine Surgery

STUDY DESIGN: Prospective experimental study. PURPOSE: To evaluate bacterial contamination during surgery. OVERVIEW OF LITERATURE: The participants of surgery and ventilation system have been known as the most significant sources of contamination. METHODS: Two pairs of air culture blood agar plate for G(+) bacteria and MacConkey agar plate for G(-) bacteria were placed at 3 different locations in a conventional operation room: in the surgical field, under the airflow of local air conditioner, and pathway to door while performing spine surgeries. One pair of culture plates was retrieved after one hour and the other pair was retrieved after 3 hours. The cultured bacteria were identified and number of colonies was counted. RESULTS: There was no G(-) bacteria identified. G(+) bacteria grew on all 90 air culture blood agar plates. The colony count of one hour group was 14.5+/-5.4 in the surgical field, 11.3+/-6.6 under the local air conditioner, and 13.1+/-8.7 at the pathway to the door. There was no difference among the 3 locations. The colony count of 3 hours group was 46.4+/-19.5, 30.3+/-12.9, and 39.7+/-15.2, respectively. It was more at the surgical field than under the air conditioner (p=0.03). The number of colonies of one hour group was 13.0+/-7.0 and 3 hours group was 38.8+/-17.1. There was positive correlation between the time and the number of colonies (r=0.76, p=0.000). CONCLUSIONS: Conventional operation room was contaminated by G(+) bacteria. The degree of contamination was most high at the surgical field. The number of bacteria increased right proportionally to the time.

Pars Plana Ahmed Implantation Combined with 23-gauge Vitrectomy for Refractory Neovascular Glaucoma in Diabetic Retinopathy

PURPOSE: To evaluate the efficacy and safety of a pars plana Ahmed valve implantation combined with 23-gauge sutureless vitrectomy in the treatment of patients with medically uncontrolled neovascular glaucoma (NVG) in proliferative diabetic retinopathy (PDR). METHODS: The authors retrospectively reviewed the records of 11 consecutive patients with refractory NVG in PDR who underwent a 23-gauge sutureless vitrectomy combined with pars plana placement of an Ahmed valve implant. Control of intraocular pressure (IOP), pre- and postoperative best-corrected visual acuity and the development of intra- and postoperative complications were evaluated during the follow-up. RESULTS: The mean follow-up was 12.2 months (range, 8 to 25 months). Mean preoperative IOP was 35.9 +/- 6.3 mmHg and mean postoperative IOP at the last visit was 13.3 +/- 3.2 mmHg. Control of IOP (8 to 18 mmHg) was achieved in all patients, but 91% (10 of 11 patients) needed antiglaucoma medication (mean number of medications, 1.2 +/- 0.6). Postoperative visual acuity improved in 11 eyes, and the logarithmically to the minimum angle of resolution mean visual acuity in these eyes improved from 1.67 +/- 0.61 to 0.96 +/- 0.67. The complications that occurred were transient hypotony in one case, transitory hypertension in two cases, and postoperative vitreous hemorrhage which spontaneously cleared in two cases. CONCLUSIONS: We suggest the combination of 23-gauge pars plana vitrectomy and Ahmed valve implantation is safe and effective in PDR patients with refractory NVG.

Presumed Intraocular Natural Killer/T-cell Lymphoma Combined with Nasal Lymphoma

PURPOSE: To report a case of presumed intraocular natural killer/T-cell lymphoma (NKTL). CASE SUMMARY: A 61-year-old male presented with visual disturbance of the left eye for duration of 3 years. He had been treated with systemic chemotherapy and radiotherapy for nasal NKTL 1 year prior. Inflammatory reaction in the anterior chamber and vitreous opacity were observed in the left eye. The patient was diagnosed with uveitis in the left eye at a local clinic 3 years prior to visiting us. Because the patient did not respond to anti-inflammatory therapy, we performed diagnostic and therapeutic vitrectomy. Intraoperatively, vitreous opacity was thin sheet like in appearance. The vitreous specimen contained few lymphoid cells and was positive for Epstein Barr virus-encoded RNA (EBER). Systemic workups showed no metastasis to other organs. The patient was treated with systemic methotrexate chemotherapy and intravitreal methotrexate injected 3 times (once per week). During the 12-month follow-up period after the last intravitreal injection, the recurrence of lymphoma and related uveitis was not observed.

Prevalence and Risk Factors of Dry Eye Syndrome in the Incheon Area

PURPOSE: To investigate the prevalence, clinical manifestations, and risk factors of dry eye syndrome (DES) among people over 50 years old in the Incheon area. METHODS: A cross-sectional prevalence study was performed on 462 people over 50 years old in Dong-gu, Incheon. DES was defined as the constant or frequent presence of symptoms of both dryness and irritation. Symptoms and past medical history were assessed by a survey. Eye examination included slit lamp examination, Schirmer test, and tear break-up time (T-BUT). Age, sex, living habits, systemic and eye diseases were also analyzed to determine the risk factors of DES. RESULTS: The prevalence of DES was 26.2%. The major symptoms were as follows in descending order: dryness (77.9%), tearing (75.2%), and sandiness (72.7%). An average of 12.1 +/- 6.0 mm in the Schirmer test and 6.7 +/- 2.4 seconds in the T-BUT were significantly different in the DES group from the normal group (p < 0.001). Variables such as age, sex, living habits, and eye diseases were not related to the diagnosis of DES, whereas diabetes was the only risk factor of DES with statistical significance (p = 0.03). CONCLUSIONS: In the present study, the prevalence of DES among people over 50 years old in the Incheon area was 26.2%. Schirmer test and T-BUT were considered to be helpful tools for the diagnosis of DES, and diabetes was a significant risk factor of DES.

Survival and Prognostic Analysis of Adjacent Segments after Spinal Fusion

BACKGROUND: To examine the survival function and prognostic factors of the adjacent segments based on a second operation after thoracolumbar spinal fusion. METHODS: This retrospective study reviewed 3,188 patients (3,193 cases) who underwent a thoracolumbar spinal fusion at the author's hospital. Survival analysis was performed on the event of a second operation due to adjacent segment degeneration. The prognostic factors, such as the cause of the disease, surgical procedure, age, gender and number of fusion segments, were examined. Sagittal alignment and the location of the adjacent segment were measured in the second operation cases, and their association with the types of degeneration was investigated. RESULTS: One hundred seven patients, 112 cases (3.5%), underwent a second operation due to adjacent segment degeneration. The survival function was 97% and 94% at 5 and 10 years after surgery, respectively, showing a 0.6% linear reduction per year. The significant prognostic factors were old age, degenerative disease, multiple-level fusion and male. Among the second operation cases, the locations of the adjacent segments were the thoracolumbar junctional area and lumbosacral area in 11.6% and 88.4% of cases, respectively. Sagittal alignment was negative or neutral, positive and strongly positive in 47.3%, 38.9%, and 15.7%, respectively. Regarding the type of degeneration, spondylolisthesis or kyphosis, retrolisthesis, and neutral balance in the sagittal view was noted in 13.4%, 36.6%, and 50% of cases, respectively. There was a significant difference according to the location of the adjacent segment (p = 0.000) and sagittal alignment (p = 0.041). CONCLUSIONS: The survival function of the adjacent segments was 94% at 10 years, which had decreased linearly by 0.6% per a year. The likelihood of a second operation was high in those with old age, degenerative disease, multiple-level fusion and male. There was a tendency for the type of degeneration to be spondylolisthesis or kyphosis in cases of the thoracolumbar junctional area and strongly positive sagittal alignment, but retrolisthesis in cases of the lumbosacral area and neutral or positive sagittal alignment.

Tardy Spinal Cord Compression without Bone Cement Leakage after Kyphoplasty: A Report of 3 Cases

STUDY DESIGN: This is a case report. OBJECTIVE: We report here on three cases of late spinal cord compression without bone cement leakage after kyphoplasty from the view point of the common characteristics, the suspected etiologies and the performed treatments, and we propose a technique to prevent this kind of complication. SUMMARY OF THE LITERATURE REVIEW: Kyphoplasty is widely accepted as an effective and safe treatment for osteoporotic vertebral compression fracture (VCF). Complicated compression fractures and even bursting fractures with a compromised spinal canal are currently indicated for kyphoplasty. The wide spread application of kyphoplasty may be mainly due to reducing the complication rates associated with cement leakage and possible restoration, even though partially, of a vertebral kyphotic deformity. MATERIALS AND METHODS: we experienced three cases of newly emerged complications that caused delayed neurologic compromise after uneventful kyphoplasty without any immediate neurologic deficits. MR imaging was done to find the pathologic regions and surgical treatment was performed. RESULTS: Refracture of an augmented vertebra at the conus medullaris level can cause late occurring spinal cord compression without compromising the spinal canal. Posterior instrumentation and posterior fusion with posterior decompression were effective treatments. CONCLUSION: The anatomical peculiarity of the conus medullaris and the dynamic irritation of the spinal cord by a bone cement mass after refracture of an augmented vertebral body can be the causes of late spinal cord compression after kyphoplasty. The neurologic symptoms were treated by posterior decompression and fusion. This kind of complication can be prevented by injecting a sufficient amount of bone cement with a shape to support both endplates.

Lower-Pressure Percutaneous Vertebroplasty Using Larger-Diameter Bone-Cement Fillers

STUDY DESIGN: This is a retrospective, case-controlled study. OBJECTIVE: We wanted to evaluate the efficacy of lower-pressure percutaneous vertebroplasty (LP-PVP) using larger-diameter cement fillers for treating osteoporotic vertebral compression fracture (VCF). SUMMARY OF THE LITERATURE REVIEW: Despite the popularity of conventional PVP(C-PVP), critical complications associated with cement leakage have been widely reported due to the inadequate viscosity of flabby cement. MATERIALS AND METHODS: With excluding Kummell's disease, 23 VCF's were treated with LP-PVP using 2.8mm-diameter cement fillers, 51 VCF's were treated with kyphoplasty(KP) using the same size of cement fillers and 19 VCF's were treated with C-PVP using 1.4mm-diameter biopsy needles. The clinical and radiographic results along with the complications were investigated for more than one year. RESULTS: The visual analogue scale (VAS) was improved in all the groups. The infused cement volume was 5.9+/-1.6ml for the LP-PVP, 5.9+/-1.9ml for the KP and 3.5+/-1.0ml for the C-PVP (p=0.000). The collapsed vertebral height was restored by 10.8+/-10.3%, 13.0+/-12.7% and 4.7+/-7.6%, respectively, in each group (p=0.000) with a reduction loss of 2.1+/-1.8%, 1.1+/-1.4% and 5.9+/-4.2%. respectively, in each group (p=0.000) at follow-up. These was a reduction of the vertebral kyphotic angle by 3.0+/-4.0degrees, 3.7+/-4.4degrees and 4.2+/-4.4degrees, respectively, in each group (p=0.528) with reduction loss of 1.0+/-0.9degrees, 0.1+/-1.7degrees and 3.5+/-2.8degrees, respectively, in each group (p=0.000). There was a reduction of the regional Cobb's angle by 4.3+/-2.6degrees, 3.1+/-4.7degrees and 2.9+/-3.8degrees, respectively, in each group (p=0.184) with a reduction loss of 3.6+/-4.5degrees, 0.1+/-1.5degrees and 1.0+/-4.1degrees, respectively, in each group (p=0.000). Extravasation of cement was noticed in 6 cases (26.1%) of LP-PVP, in 14 cases (27.5%) of KP and 4 cases (26.1%) of C-PVP (p=0.689). No cases of additional VCF happened for the LP-PVP, eight cases of additional VCF happened (15.7%) for the KP and one case of additional VCF happened (5.3%) for the C-PVP (p=0.030). CONCLUSION: The LP-PVP showed clinically and radiologically results that were similar to those of KP with a higher amount of infused cement volume compared to that of C-PVP. LP-PVP is thought to be effective for the clinical and radiolographic aspects and to have fewer complications for the treatment of osteoporotic VCF.

The Surgical Treatment for Spinal Intradural Extramedullary Tumors

BACKGROUND: We wanted to investigate the results of surgical treatment and analyze the factors that have an influence on the neurologic symptoms and prognosis of spinal intradural extramedullary (IDEM) tumors. METHODS: The spinal IDEM tumor patients (11 cases) who had been treated by surgical excision and who were followed up more than 1 year were retrospectively analyzed. Pain was evaluated by the visual analogue scale (VAS) and the neurologic function was assessed by Nurick's grade. The pathological diagnosis, the preoperative symptom duration, the tumor location on the sagittal and axial planes and the percentage of tumor occupying the intradural space were investigated. In addition, all these factors were analyzed in relation to the degree of the preoperative symptoms and the prognosis. On the last follow-up, the MRI was checked to evaluate whether or not the tumor had recurred. RESULTS: The most common diagnosis was schwannomas (73%), followed by meningiomas (18%). The percentage of tumor occupying the intradural space was 82.9 +/- 9.4%. The VAS score was reduced in all cases from 8.0 +/- 1.2 to 1.2 +/- 0.8 (p = 0.003) and the Nurick's grade was improved in all cases from 3.0 +/- 1.3 to 1.0 +/- 0.0 (p = 0.005). The preoperative symptoms were correlated with only the percentage of tumor occupying the intradural space (VAS; r2 = 0.75, p = 0.010, Nurick's grade; r2 = 0.69, p = 0.019). One case of schwannoma recurred. CONCLUSIONS: The degree of neurologic symptoms was correlated with the percentage of tumor occupying the intradural space. All the tumors were able to be excised through the posterior approach. The postoperative neurologic recovery was excellent in all the cases regardless of any condition. Therefore, aggressive surgical excision is recommended even for cases with a long duration of symptoms or a severe neurologic deficit.

The Efficacy of Kyphoplasty on Osteoporotic Vertebral Compression Fracture : A 1-Year Follow-up Study / 대한척추외과학회지

STUDY DESIGN: This is a retrospective study. OBJECTIVE: We wanted to evaluate the efficacy of kyphoplasty for treating osteoporotic VCF and we wanted to determine the risk factors for additional VCF. SUMMARY OF THE LITERATURE REVIEW: Successful pain relief with performing kyphoplasty for VCF has been well documented. However, unsatisfactory reduction and additional VCF are remained problems for kyphoplasty. MATERIALS AND METHODS: Sixty-three patients who underwent kyphoplasty were followed up for more than 1 year. The degree of reduction of the collapsed vertebral height, the vertebral kyphotic angle, the regional Cobb's angle and the overall sagittal alignment, the visual analogue scale (VAS), the fracture configuration, the bone mineral density (BMD), the presence of intradiscal cement leakage and additional VCF were investigated. The risk factors for additional VCF were analyzed. RESULTS: In terms of deformity correction, the collapsed vertebral height were restored (67.3+/-15.6% to 82.5+/-11.8%), the vertebral kyphotic angle was improved (12.1+/-6.9degrees to 8.1+/-5.3degrees ), the degree of the regional Cobb's angle was reduced (3.1+/-4.5degrees ) and the overall sagittal balance was improved (1.7+/-5.3 cm to 0.5+/-3.9 cm) with clinical satisfaction (VAS: 6.9+/-1.3 points to 2.3+/-0.9 points). But less than 40% of the patients reached the expected reduction criteria (the vertebral height > 90%, the vertebral kyphotic angle and regional Cobb's angle reduction > 5degrees ). Additional VCF occurred in 10 patients (15.9%). The average BMD in the additional VCF group was T-score of -3.8 and that for the no-additional VCF group was T-score of -3.0 (p=0.025). The degree of reduction under general anesthesia was twice more than that under local anesthesia. Eleven cases (17.5%) of intradiscal cement leakages were noticed, but this showed no relevance to the fracture configurations and additional VCF. The overall sagittal alignment and cement volume showed no relevance to additional VCF. CONCLUSION: Kyphoplasty was excellent for pain reduction, but it was unsatisfactory for correcting deformity. Vertebral height correction was more effectively performed under general anesthesia. Additional VCF was caused by severe osteoporosis.

Precautions Against Infection Following Posterior Spinal Fusion Based on Types of Infection and Risk Factors / 대한척추외과학회지

STUDY DESIGN: This is a retrospective preparative study and prospective study OBJECTIVE: We instituted and verified the precautions against postoperative spinal infection. SUMMARY OF THE LITERATURE REVIEW: Postoperative infection comes from contamination during the operation and various strategies have been recommended to prevent it. MATERIALS AND METHODS: 583 cases that underwent instrumented posterior spinal fusion during two years (group I), were reviewed to discover the risk factors, and intraoperative cultures were done to detect the contamination routes and the causative microorganisms for the next 4 months. Six precautions, based on the results, were instituted. We analyzed 354 cases that underwent operation in the following year (group II) using the precautions. RESULTS: Twenty cases (3.4%) were infected in group I and the types of infection were superficial wound infection (4 cases), deep wound infection (4 cases), osteomyelitis around the interbody space (7 cases), osteomyelitis around the pedicle screws (4 cases) and a combination of wound infection and osteomyelitis around the pedicle screws (1 case). Infections happened more frequently in the cases of interbody fusion (p=0.034), revision (p=0.087) and those done in the summer season (p=0.025). S. epidermidis, as the causative bacteria, was cultured from both the operation environments and wounds. Six precautions based on the preliminary results were instituted as follows; irrigation method reformation, delayed opening of instruments, turning-off local air conditioners, changing of gowns before instrumentation, local bone irrigation and limited indications for interbody fusion. After implementation, two cases (0.6%) of infection developed in group II (p=0.002, odds ratio=0.160; 95% confidence interval = 0.037 to 0.688). CONCLUSION: Wounds, grafted bones or instruments can be contaminated under longer-time exposure to operating room air and so produce interbody or pedicle osteomyelitis without wound infection. The precautions were effective to decrease the postoperative infection rates following posterior spinal fusion.

Unicompartmental versus Total Knee Arthroplasty in the Same Patient / 대한정형외과학회잡지

PURPOSE: To compare the clinical and radiographic results of unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) in the same patient, and to investigate patient preference and satisfaction. MATERIALS AND METHODS: Among the 56 patients who underwent a UKA in one knee and a TKA in the opposite knee between January 2002 and December 2004, 51 patients were followed up. The average follow-up period was 4 years. RESULTS: The average Knee Society Score (KSS) improved from 53.5 preoperatively to 90.7 at last follow-up in the UKA knee, and from 50.4 to 89.8 in the TKA knee. The mean range of knee motion also improved from 124.7degrees to 133.2degrees in the UKA knee, and from 122.5degrees to 127.1degrees in the TKA knee. The tibiofemoral angle changed from 0.3degrees of varus to 5.6degrees of valgus in the UKA knee, and from 2.4degrees of varus to 5.8degrees of valgus in the TKA knee. For patient preference, 23 patients (45%) preferred the UKA knee and 19 patients (37%) preferred the TKA knee. Most patients (42 patients, 82%) reported being nvery satisfied' or nsatisfied' with both knees. CONCLUSION: The clinical and radiographic results of both the UKA and the TKA in the same patient were satisfactory at the 4-year follow-up. The UKA knee had a slightly better range of knee motion, but there was essentially no difference between the UKA knee and the TKA knee.

Oxford Phase 3 Unicompartmental Knee Arthroplasty: Minimum 5-year Follow-up Results

PURPOSE: We wanted to evaluate the postoperative clinical results, the complications and the survival rate of Oxford phase 3 unicompartmental knee arthroplasty (UKA), based on a prospective analysis and the follow-up study. MATERIALS AND METHODS: We operated on 142 patients, 180 cases of UKA using the Oxford phase 3 prosthesis from January 2002 to December 2002. Clinical assessments were made using the Knee Society score rating system. Among those, 152 cases (121 patients) were able to be followed up for at least 5 years after the operation. The mean patient age at the time of surgery was 61.1 years and the mean duration of follow-up was 5.5 years. RESULTS: For these 152 knees, the mean preoperative knee and function scores were 53.5 and 55.8, respectively, and they were improved to 88.7 and 83.1, respectively, at the last follow-up. The mean range of knee motion recovered to 133.1degrees and the mean tibiofemoral angle was changed to 4.9degrees of valgus. When we asked patients about their level of satisfaction, 88% of the patients said they were 'very satisfied' or 'satisfied'. There were 7 postoperative complications and the survival rate of the implant at 5 years was 96.8%. CONCLUSION: The Oxford phase 3 UKA was satisfactory for improving the clinical results, the subjective satisfaction of the patients and the survival rate of the implant.

The Effect of Demineralized Bone Matrix as a Graft Enhancer in Posterior Lumbar Interbody Fusion Using Cage and Local Bone Chips / 대한척추외과학회지

STUDY DESIGN: A randomized, controlled study OBJECTIVES: We wanted to investigate whether osteogenesis can be enhanced when a small amount of demineralized bone matrix (1 cc/segment) is mixed with local bone chips. SUMMARY OF LITERATURE REVIEW: Demineralized bone matrix (DBM) has been used for spinal arthrodesis. However, there are only a few reports about its use as a composite graft with local bone chips for posterior lumbar interbody fusion MATERIALS AND METHODS: Degenerative spine patients, who would normally be treated by decompression and posterior lumbar interbody fusion with using a pedicle screw system and one cage, were randomly, prospectively selected for whether they would be treated with using local bone chips mixed with 1cc of DBM (Group I: 15 patients and 19 segments) or local bone chips (Group II: 12 patients and 13 segments) for graft material. The sampling bias was investigated for gender, age, endocrine diseases, previous operation, habits (alcohol drinking, smoking), steroid medication, bone mineral density and the amount of local bone. The amount of bone formation was measured at 6 months after operation. On the sagittal and coronal reconstruction CT images, the bone formation outside of the cage was measured, and this was interpreted in a "blinded"fashion by 2 independent doctors who did not take part in the operations. RESULTS: There was no sampling bias between the 2 groups except for age (Group I= 65.3+/-7.1, Group II=58.9+/-6.0, p=0.010). The ratio of local bone chips and DBM was 5.98:1 in Group I. There was moderate concurrence between the 2 interpreters (kappa coefficiency= 0.494, p<0.001 for the sagittal plain images and kappa co-efficiency=0.467, p<0.001 for the coronal plain images) and Group I showed significantly more bone formation (p=0.003). CONCLUSION: DBM that is mixed with local bone chips, even with small amount, enhanced bone formation in the posterior lumbar interbody fusion. This is regarded to act as a graft enhancer to increase the fusion rate, even when using local bone chips for graft material, for the cases that show unfavorable conditions for fusion or for the cases that are prone to loosening of hardware.

Factors Affecting the Tibiofemoral Alignment in Minimally Invasive Unicompartmental Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: We analyzed affecting factors associated with the tibiofemoral alignment after minimally invasive unicompartmental knee arthroplasty (UKA) used to treat medial compartmental osteoarthritis of the knee. MATERIALS AND METHODS: From January 2003 to December 2003, 128 UKA were performed in 114 patients with minimally invasive surgery. The revealed tibiofemoral angle, tibial translation, posterior slope and the coronary orientation of the tibial and femoral component were measured using the preoperative and postoperative weight-bearing radiographs. The possible factors associated with the corrective tibiofemoral angle were analyzed statistically. RESULTS: The average corrective angle of the tibiofemoral axis was 5.8 degrees from varus 0.6 degrees preoperatively to valgus 5.2 degrees postoperatively. The average corrective angle of the tibiofemoral axis was 6.1 degrees in the mobile bearing group and 3.6 degrees in the fixed bearing group. There was significantly more corrective tibiofemoral angle postoperatively with a larger varus deformity of the knee preoperatively (p<0.0001). The corrective tibiofemoral angle had an increasing tendency with increasing bearing size but this was not statistically significant. Surgeons, the age of the patients, tibial translation, posterior slope of the tibial component, and coronary orientation of the tibial component and femoral component did not affect the degree of the corrective tibiofemoral angle. CONCLUSION: The average corrective angle of the tibiofemoral axis after minimally invasive UKA was 5.8 degrees. The preoperative tibiofemoral angle and the types of implants affected the postoperative tibiofemoral axis after minimally invasive UKA.

Revision of Total Hip Arthroplasty Using Extensively Porous-Coated Femoral Stem

Purpose: To report the outcomes of extensively porous-coated femoral stems based on diaphyseal fixation caused by extensive bone loss and osteoporosis of the proximal femur in revision total hip arthroplasty. Materials and Methods: 14 cementless femoral revision procedures performed between Aug, 2000 and Apr, 2003 were reviewed retrospectively. The follow up period ranged from 24 to 53 months, with an average of 33 months. The average age at surgery was 52.3 years, there were 10 males and 4 females. The reasons for the revision surgery were aseptic loosening in 11(78.7%) hips, progressive osteolysis in 1(7.1%), septic loosening in 1(7.1%) and periprosthetic fracture in 1(7.1%). Results: The Harris hip score improved from 50.4 points preoperatively to 88.5 points postoperatively. The complications encountered were a greater trochanteric fracture in 2 hips (14.3%), periprosthetic fracture in 1(7.1%), dislocation of the hip in 2(14.3%), and minimal thigh pain in 2(14.3%). Radiographic evidence of a bone ingrown stem was found in 11 hips (78.6%), and 3 hips (21.4%) showed stable fibrous fixation. Stem subsidence > 5mm was noticed in 1 hip (7.1%) and > 10mm in 2 (14.3%) but there was no further progression after 1 year. Moderate stress-shielding was noticed in 4 hips(28.6%). To date, no significant wear or osteolysis has been observed. Conclusion: An extensively porous-coated revision stem appears to be a reasonable choice in the presence of proximal femoral bone loss as a short term follow up. However, the concerns related to the postoperative complications will require a longer term follow up.