Angiographic and Clinical Factors Related with Good Functional Outcome after Mechanical Thrombectomy in Acute Cerebral Artery Occlusion

OBJECTIVE: The aim of this study is to investigate good prognostic factors for an acute occlusion of a major cerebral artery using mechanical thrombectomy. METHODS: Between January 2013 to December 2014, 37 consecutive patients with acute occlusion of a major cerebral artery treated by mechanical thrombectomy with stent retrievers were conducted. We analyzed clinical and angiographic factors retrospectively. The collateral flow and the result of recanalization were sorted by grading systems. Outcome was assessed by National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at 90 days. We compared the various parameters between good and poor angiographic and clinical results. RESULTS: Twenty seven patients demonstrated good recanalization [Thrombolysis in Cerebral Infarction (TICI) 2b or 3] after thrombectomy. At the 90-day follow up, 19 patients had good (mRS, 0-2), 14 had moderate (3-4) and four had poor outcomes (5-6). The mRS of older patients (> or =75 years) were poor than younger patients. Early recanalization, high Thrombolysis in Myocardial Infarction risk score, and low baseline NIHSS were closely related to 90-day mRS, whereas high TICI was related to both mRS and the decrease in the NIHSS. CONCLUSION: NIHSS decreased markedly only when recanalization was successful. A good mRS was related to low initial NIHSS, good collateral, and early successful recanalization.

Anti-diabetic effect of purple corn extract on C57BL/KsJ db/db mice

BACKGROUND/OBJECTIVES: Recently, anthocyanins have been reported to have various biological activities. Furthermore, anthocyanin-rich purple corn extract (PCE) ameliorated insulin resistance and reduced diabetes-associated mesanginal fibrosis and inflammation, suggesting that it may have benefits for the prevention of diabetes and diabetes complications. In this study, we determined the anthocyanins and non-anthocyanin component of PCE by HPLC-ESI-MS and investigated its anti-diabetic activity and mechanisms using C57BL/KsJ db/db mice. MATERIALS/METHODS: The db/db mice were divided into four groups: diabetic control group (DC), 10 or 50 mg/kg PCE (PCE 10 or PCE 50), or 10 mg/kg pinitol (pinitol 10) and treated with drugs once per day for 8 weeks. During the experiment, body weight and blood glucose levels were measured every week. At the end of treatment, we measured several diabetic parameters. RESULTS: Compared to the DC group, Fasting blood glucose levels were 68% lower in PCE 50 group and 51% lower in the pinitol 10 group. Furthermore, the PCE 50 group showed 2- fold increased C-peptide and adiponectin levels and 20% decreased HbA1c levels, than in the DC group. In pancreatic islets morphology, the PCE- or pinitol-treated mice showed significant prevention of pancreatic beta-cell damage and higher insulin content. Microarray analyses results indicating that gene and protein expressions associated with glycolysis and fatty acid metabolism in liver and fat tissues. In addition, purple corn extract increased the phosphorylation of AMP-activated protein kinase (AMPK) and decreased phosphoenolpyruvate carboxykinase (PEPCK), glucose 6-phosphatase (G6pase) genes in liver, and also increased glucose transporter 4 (GLUT4) expressions in skeletal muscle. CONCLUSIONS: Our results suggested that PCE exerted anti-diabetic effects through protection of pancreatic beta-cells, increase of insulin secretion and AMPK activation in the liver of C57BL/KsJ db/db mice.

Short-term of Reverse Total Shoulder Arthroplasty for the Treatment of Irreparable Massive Rotator Cuff Tear

BACKGROUND: To investigate the effectiveness of reverse total shoulder arthroplasty (RTSA) in treating irreparable massive rotator cuff tears (RCTs). METHODS: Twenty-nine patients who underwent RTSA for the treatment of irreparable massive RCTs and completed follow-up for at least 1 year were selected. Their mean age was 69.7 years (range, 59-80 years). The mean follow-up was 17.7 months (range, 12-42 months). The shoulder range of motion was measured preoperatively and at final follow-up. The functional result was evaluated using visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon (ASES) score, and Korean Shoulder Society (KSS) score. Additionally, the shoulders were categorized into two groups depending on prior history of surgery and the clinical outcomes were analyzed between two groups. RESULTS: Mean pain VAS improved, from 6.6+/-1.2 to 2.7+/-0.9 (p=0.001), and the mean functional VAS from 35.7+/-4.2 to 73.3+/-5.4 (p=0.006). The mean ASES score improved from 37.2+/-2.8 to 75.0+/-3.8 (p=0.012). The mean KSS improved from 36.5+/-7.2 to 75.6+/-5.4 (p=0.009), the mean forward elevation from 66.3+/-4.7 to 135.6+/-8.4 (p=0.0001), and the mean abduction from 45.2+/-4.2 to 119.0+/-6.5o (p=0.0001). Internal rotation differed significantly from the first sacral to the third lumbar vertebrae (p=0.036). External rotation did not change significantly (p=0.076). There was also no statistically significant difference between groups (no previous operation versus none). Four complications occurred: one superficial infection, one with anterior dislocation, one acromial fracture, and one clavicle fracture. CONCLUSIONS: RTSA provides reliable pain relief and recovery of shoulder function in patients with massive irreparable RCTs in short-term follow-up.

A Case of an Isolated Abscess in an Extraocular Muscle

PURPOSE: To report the case of an isolated abscess in an extraocular muscle. CASE SUMMARY: We report a case of an isolated abscess in an extraocular muscle in a patient who was treated with systemic chemotherapy for precursor B lymphoblastic leukemia. A 54-year-old female who had undergone systemic chemotherapy for precursor B lymphoblastic leukemia presented with right ocular pain and limited eye movements. On ophthalmic examination, she had elevated intraocular pressure (IOP) and limited upward and downward gaze. MRI (magnetic resonance imaging) examination revealed an isolated abscess in right inferior rectus muscle. Although the patient was treated with empirical intravenous antibiotics and IOP-lowering agents, the size of the abscess increased, as confirmed by MRI findings. Therefore, we performed a pus drainage procedure by the transconjunctival approach. We were not able to find any residual abscess lesions on CT scans 3 months postoperatively. The patient's ocular pain disappeared and the limited eye movements improved significantly 6 months postoperatively. CONCLUSIONS: There have been no case reports of an isolated abscess in an extraocular muscle in Korea. For immunocompromised patients unresponsive to systemic empirical antibiotic treatment, an early pus drainage procedure by the transconjunctival approach may be a useful and effective therapeutic method in the management of an idiopathic isolated abscess in an extraocular muscle.

Short-term of Reverse Total Shoulder Arthroplasty for the Treatment of Irreparable Massive Rotator Cuff Tear

BACKGROUND: To investigate the effectiveness of reverse total shoulder arthroplasty (RTSA) in treating irreparable massive rotator cuff tears (RCTs). METHODS: Twenty-nine patients who underwent RTSA for the treatment of irreparable massive RCTs and completed follow-up for at least 1 year were selected. Their mean age was 69.7 years (range, 59-80 years). The mean follow-up was 17.7 months (range, 12-42 months). The shoulder range of motion was measured preoperatively and at final follow-up. The functional result was evaluated using visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeon (ASES) score, and Korean Shoulder Society (KSS) score. Additionally, the shoulders were categorized into two groups depending on prior history of surgery and the clinical outcomes were analyzed between two groups. RESULTS: Mean pain VAS improved, from 6.6+/-1.2 to 2.7+/-0.9 (p=0.001), and the mean functional VAS from 35.7+/-4.2 to 73.3+/-5.4 (p=0.006). The mean ASES score improved from 37.2+/-2.8 to 75.0+/-3.8 (p=0.012). The mean KSS improved from 36.5+/-7.2 to 75.6+/-5.4 (p=0.009), the mean forward elevation from 66.3+/-4.7 to 135.6+/-8.4 (p=0.0001), and the mean abduction from 45.2+/-4.2 to 119.0+/-6.5o (p=0.0001). Internal rotation differed significantly from the first sacral to the third lumbar vertebrae (p=0.036). External rotation did not change significantly (p=0.076). There was also no statistically significant difference between groups (no previous operation versus none). Four complications occurred: one superficial infection, one with anterior dislocation, one acromial fracture, and one clavicle fracture. CONCLUSIONS: RTSA provides reliable pain relief and recovery of shoulder function in patients with massive irreparable RCTs in short-term follow-up.

Ureteral Penetration Caused by Drilling During Internal Pelvic Bone Fixation: Delayed Recognition / 대한배뇨장애요실금학회지

A 49-year-old man was referred to our department with profuse serous fluid discharge from a Penrose drain after undergoing internal fixation with metal screws for multiple pelvic bone fractures. A definite ureteral penetration was identified that was orientated from the lateral to the medial aspect of the right distal ureter. The patient was surgically treated with excision of the 2-cm injured ureteral segment, end-to-end ureteroureterostomy, and double J ureteral stent placement. To our knowledge, a penetrating ureteral injury caused by bone drilling has not been reported previously in the published literature. This case shows that surgeons who do pelvic surgery, including orthopedic surgeons, should be familiar with the anatomical relationship of the ureter and its potential injuries.

The Association Between Corneal Biomechanical Properties and Progression of Visual Field Loss in Normal Tension Glaucoma

PURPOSE: To evaluate the association between corneal biomechanical properties and progression of visual field loss in normal tension glaucoma. METHODS: This study enrolled 73 eyes of 73 patients with normal tension glaucoma who were undergoing medical treatment, and classified them into progressing and nonprogressing groups by visual field trend analysis. The corneal biomechanical properties measured by the Ocular Response Analyzer (ORA; Reichert Instruments, Depew, NY, USA), central corneal thickness, and Goldmann applanation tonometry were comparatively analyzed between the 2 groups. RESULTS: Twenty-six eyes reached a progression endpoint. The prevalence of hypertension was higher in the progressing group (42.3%, progressing, 17.0%, nonprogressing; p = 0.03). Progressing eyes had lower corneal hysteresis (9.1 +/- 1.3 vs. 9.8 +/- 1.5 mm Hg, p = 0.03) and lower corneal resistance factor (9.5 +/- 1.5 vs. 10.4 +/- 1.4 mm Hg, p = 0.01) compared with nonprogressing eyes. Upon multivariate analysis, the presence of hypertension (odds ratio [OR] = 3.46, p = 0.03) and corneal hysteresis (CH) (OR = 0.66 per mm Hg lower, p = 0.02) remained statistically significant. CONCLUSIONS: The CH measurement with ORA was significantly associated with risk of visual field progression in normal tension glaucoma. Eyes with lower CH had a greater risk of progression of visual field loss than those with higher CH.

Risk Factors Related to Modular Femoral Stem Failures in Revision Hip Arthroplasty / 대한고관절학회지

PURPOSE: The purpose of this study was to analyze failure rates and causes of hip arthroplasty revisions associated with the use of cementless modular femoral stems. MATERIALS AND METHODS: This study comprised 93 patients(100 hips) that were followed up for more than two years after revision involving modular femoral stem arthroplasty. The clinical results were evaluated using the Harris Hip Score and the radiologic results were evaluated using leg length discrepancy, subsidence and bone formation assessments. We analyzed the relationship between the number of hip surgeries performed and the bone deficiencies and failures observed. Preoperative femoral bone deficiencies were described by Paprosky Grade; Grade I or II were identified in 24 hips, IIIa in 4 hips, IIIb in 28 hips and IV in 3 hips. RESULTS: We observed 80 hips with aseptic loosening, 10 hips with infection after previous revision, 8 hips with periprosthetic fractures and 2 hips with dislocations. Clinical results improved from a preoperative score of 42 (HHS) to a postoperative mean score of 81.5. The cause of early failure in 4 hips was identified as femoral stem subsidence, and the cause of late failure in 3 hips was due to infection. According to the comparison analysis, there was no statistical significance between femoral bone deficiency (P=0.727) and application of cement (P=0.087), but hips with previous revision surgery showed a higher rate of failure (P=0.024). CONCLUSION: Cementless modular stems produced satisfactory results. The main cause of failure was subsidence. A significant risk factor for failure was hips which had undergone previous revision surgery.

Is CT Angiography a Reliable Tool for Diagnosis of Traumatic Vessel Injury in the Lower Extremities?

PURPOSE: Computed tomographic (CT) angiography is the first choice of diagnosis in traumatic vessel injury in the lower extremities, replacing angiography. The purpose of this study was to investigate the clinical reliability of CT angiography through a retrospective study. MATERIALS AND METHODS: Seventeen patients underwent CT angiography before surgery for traumatic vessel injury in the lower extremities from 2009 to 2010, and a comparative analysis of operative findings in all patients with a positive predictive value and sensitivity were measured. RESULTS: In all patients, 16 artery ruptures and 1 compartment syndrome occurred. In 15 artery ruptures, preoperative findings of CT angiography and surgical findings were consistent, and the positive predictive value was 93.8%. One patient with posterior tibial artery rupture was revealed as normal in CT angiography; thus, sensitivity was 93.8% (15/16 patients), and the accuracy rate was 88.2% (15/17 patients). CONCLUSION: Though CT angiography is a reliable tool for diagnosis in traumatic vessel injury in the lower extremities, a more invasive test will be needed, especially peripheral angiography or diagnostic exploration, in cases of relatively small vessel injuries around the ankle or compartment syndrome because of low accuracy.

Comparison of Floating Knee according to Presence of Knee Joint Injury

PURPOSE: To compare the clinical outcomes of floating knee according to the presence of knee joint injury. MATERIALS AND METHODS: Between March 2004 and March 2009, we investigated 36 patients, who underwent surgical treatment for floating knee injuries. We classified the floating knee into two groups as type I (12 cases) has no knee joint injury and type II (24 cases) has knee joint injury. We compared two groups about combined injury (orthopedics or other part), open fracture or not, neurovascular injury,union time, range of motion, and complication rate. RESULTS: There is statistically no significant difference between two groups as type I (6 cases, 50%) and type II (13 cases, 54.2%) in orthopedic combined injury (p=0.813), and also same as type I (3 cases, 25%) and type II (12 cases, 50%) in combined injury on the other department (p=0.151), and in floating knee with open fracture as 4 type I (33%) and 12 type II (50%) of 16 cases (44%), and Gustilo-Anderson 3 type I, 4 type II, 1 IIIA, 4 IIIB, and 4 IIIC (p=0.423). There is statistically no significant difference between two groups in neurovascular injury as 1 type I (8.3%), and 3 type II (12.5%) (p=0.708). There is a statistically significant difference between two groups in the mean bone union time as 18.2+/-5.37 weeks (12~24 weeks) for type I and 24.95+/-9.85 weeks (16~33 weeks) for type II (p=0.045), and in the mean range of knee joint motion as 133+/-12.74 degree (120~150 degree) for type I and 105+/-19.00 degree (80~135 degree) for type II (p=0.012). CONCLUSION: Floating knee with knee joint injury is severe itself and related with severe combined injuries, subsequent range of knee joint motion limitation, the delay of union time, and high complication rate. Therefore, we should take care in surgical treatment for this trauma entity.

Acute Compartment Syndrome in Association with Spontaneous Muscle Infarction / 대한정형외과학회잡지

Diabetic muscle infarction is a rare complication of diabetes mellitus that is not clearly defined in the orthopedic literature. In addition, acute compartment syndrome in association with diabetic muscle infarction is a rarer disease, which has had only a few cases have been reported up to date. A large and painful swelling was noticed in the thigh of a 55-year-old female, who had not experienced trauma. The patient was diagnosed as having compartment syndrome with diabetic muscle infarction by magnetic resonance imaging. The patient underwent immediate fasciotomy, and recovered without any complications.

A Case of Asymmetric Bilateral Discoid Medial Menisci

Discoid medial meniscus is a very rare condition of the knee. Even less frequent is the presence of bilateral medial discoid menisci and in fact only 18 cases have been described in the medical literature. We present here one case of asymmetric bilateral discoid medial meniscus. One knee had an incomplete type of discoid medial meniscus with a horizontal cleavage tear confirmed by both magnetic resonance imaging (MRI) and arthroscopy. The other knee showed a complete type of discoid medial meniscus with posterior cyst formation on MRI.

Comparison of Tunnel Enlargement between Single and Double Bundle Anterior Cruciate Ligament Reconstruction / 대한정형외과학회잡지

PURPOSE: The aim of this study was to compare the tunnel enlargement in patients who had undergone a double-bundle (DB) or single-bundle (SB) anterior cruciate ligament (ACL) reconstruction, and to determine the correlation between the extent of bone tunnel enlargement and the clinical results. MATERIALS AND METHODS: Among 224 primary ACL reconstructions performed from January 2004 to May 2008 we examined in this study 38 patients who underwent a SB-ACL reconstruction and 30 patients underwent a DB-ACL reconstruction. They were followed up over 1 year. The evaluation methods were the Lachman test, pivot-shift test and KT-1000 measurement for knee stability and the Lysholm score and International Knee Documentation Committee (IKDC) ratings for the functional results. Tunnel enlargement was measured at the sclerotic ridge of the most widest area on the anteroposterior and lateral radiographs in longitudinal and vertical axis of the tunnel. RESULTS: The tunnel enlargement on the femoral side was similar in the DB-ACL group and the SB-ACL group. On the other hand, on the tibial side, the tunnel enlargement was less in the DB-ACL group than in the SB-ACL group (p=0.001, ICC: 0.94). The two groups showed different functional results and extent of stability recovery. The KT-1000 arthrometer revealed 1.1 mm and 93% of negative in the pivot-shift test for the DB-ACL group, which induced an improved tendency compared to the SB-ACL group. No correlation was found between the tunnel enlargement and clinical results. CONCLUSION: A DB-ACL reconstruction results in less tunnel enlargement on the tibial side than a SB-ACL reconstruction. There was no correlation between the tunnel enlargement and clinical results.

Open Repair of Acute Tibial Avulsion Injury of Posterior Cruciate Ligament: Clinical Outcomes and Usefulness of Preoperative 3-D CT / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcome of open repair of acute tibial posterior cruciate ligament (PCL) tibial avulsion injury using the posteromedial approach, and to examine the usefulness of pre-operative 3D-computed tomography (CT) imaging. MATERIALS AND METHODS: From July 2004 onwards, among the 33 patients with acute tibial avulsion injury of the PCL, 22 patients were available for a 1-year follow-up. Patients underwent internal fixation using screws, pullout sutures or staples through the posteromedial approach. Clinical evaluations were performed using the posterior drawer test, posterior drawer stress x-ray, range of motion and Tegner score. In addition, size of the fragment, visibility, comminution, displacement and presence of extension were studied and were compared to the pre-operative X-ray and 3D-CT imaging. RESULTS: Four cases demonstrated 10-degree restriction in flexion and 1 case demonstrated 10-degree restriction in extension compared to the unaffected side. Except for the 2 cases which had Grade I posterior instability on the posterior drawer test, the results of the post-operative joint stability were negative and the posterior drawer stress X-ray using the Telos device showed an average of 0.57+/-0.4 mm. Like the average pre-operative Tegner score of 6.7+/-0.9, the Tegner score was restored to 6.2+/-0.7 (p>0.05) at the last follow-up. 3D-CT showed an improved accuracy in visibility (55.6%), comminution (50%) and displacement (44.4%) compared to the simple X-ray. CONCLUSION: The acute tibial avulsion injury treated with the appropriate internal fixation through the posteromedial approach based on the fracture size demonstrated exellent outcomes. The pre-operative 3D-CT was useful for identifying the fracture pattern and choosing the appropriate internal fixation.

Spinal Epidural Cavernous Hemangioma Resembling a Metastatic Tumor in an 89-year-old Man: A Case Report

Cavernous hemangioma is a vascular malformation that can be encountered in any organ of the body; however, purely epidural cavernous hemangioma is a rare entity with a benign nature. The authors report a case of thoracic epidural cavernous hemangioma in an 89-year-old man with radiologic findings resembling those of a metastatic spinal tumor. Initially, the patient refused surgery because of his age and presumed malignancy. However, due to the progression of bilateral leg weakness, he later underwent total mass removal and decompression without neurological deficit. Intraoperative findings and a postoperative biopsy revealed cavernous hemangioma. Because initial radiological findings may suggest a malignant nature for several benign pathologies, the authors recommend that, unless malignancy is proven, aggressive tissue biopsy and treatment should be considered, even in elderly patients.

Comparison of Clinical Results for Repairing Lateral Discoid Meniscus Tear between the Contouring Surgery Group and the Additional Repair Group

PURPOSE: We aimed to compare the clinical results of treating lateral discoid meniscus tear between the contouring surgery group and the additional repair group. MATERIALS AND METHODS: We evaluated 60 cases (58 patients) with lateral discoid meniscus tear and who were arthroscopically treated between September 2003 and February 2007 and we followed them for at least two years. The sixty cases were divided into two groups: thirty-two cases underwent contouring surgery (Group A) and twenty-eight cases underwent contouring surgery and repair (Group B). The duration of symptoms, the tear patterns and clinical results between the two groups were investigated. RESULTS: The most frequent types of tear pattern were longitudinal and central hole tears in group A, while complex tear was most common in group B. The mean duration of the symptoms was 5.6 months (range: 1~24) in group A and 16.6 months (range: 1~84) in group B, which was statistically significant (p=0.025). Based on Ikeuchi's grading, the proportions with good or excellent outcomes were not different between the two groups (p=0.12). However, group A had a larger proportion of excellent outcomes (p=0.031) than group B. CONCLUSION: The contouring surgery and additional repair group had a significant longer duration of symptoms, a more complex tear pattern and less excellent results than did the contouring group.

Treatment of Traumatic Posterior Dislocation of the Hip Joint Associated with Femoral Head Fracture

PURPOSE: This study examined the treatment of patients with posterior hip dislocation and femoral head fracture, according to the Pipkin classification, and we analyzed their clinical and radiological results. MATERIALS AND METHODS: The subjects consisted of 45 patients who were treated for posterior hip dislocation and femoral head fracture. The subjects had an average age of 39, and 38 were men and 7 were women. The average follow-up period was 33 months. The cause of injury was traffic accident in 41 cases and falling for the other four cases. According to the classification, there were 26 Type I cases, 5 Type II cases, 1 Type III case and 13 Type IV cases. The treatment methods were selected according to the patients' condition and the form of fracture. The Ebstein criteria and the Merle d'Aubigne and Postel score were used to determine whether there was a combined injury and to examine the clinical and radiological results. RESULTS: All the cases classified as Type I, II and III showed good or excellent clinical results. A primary osteosynthesis was performed on the Type III cases according to the patient's age and condition, with particularly good results. An anatomical reduction in the early stages affected the clinical results of the Type IV cases. The observed complications were posttraumatic osteoarthritis (38.4%) and avascular necrosis (15.3%). CONCLUSION: The prognosis was determined by the injury's initial severity, the time for reduction and the anatomical reduction and firm fixation of the femur and the fracture fragment of the acetabulum.

Analysis of Treatment Outcomes for Open Fractures of the Tibia in Children / 대한정형외과학회잡지

PURPOSE: Our objective was to analyze outcomes of treatment for open fractures of the tibia in children according to the classification of Gustilo-Anderson type. MATERIALS AND METHODS: We reviewed thirty five pediatric patients who underwent surgery for open fractures of the tibia between June 1998 and June 2007. We followed up over more than 1 year. Fractures were grouped into three types according to Gustilo-Anderson classification (Types I, II, and III). External fixation or flexible intramedullary nailing was used as the surgical method. We analyzed the period required to achieve radiologic bony union, tibial alignment, leg length discrepancy and complications. Clinical outcomes were assessed using the Karlstrom-Olerud method. RESULTS: Radiologically, bony union was achieved in 11.35+/-3.08 weeks, 10.50+/-2.20 weeks, and 21.62+/-7.19 weeks for types I, II, and III, respectively. Delayed union occurred in one case of type II and 3 cases of type III fractures. Complications such as nonunion, malunion and osteomyelitis were seen only in type III. Clinical outcomes showed excellent or good results in all cases except one (type III). CONCLUSION: Excellent outcomes for open fractures of the tibia in children can be obtained regardless of Gustilo-Anderson type when adequate procedures are performed.

Muscle Free Flap Transplantation in Chronic Osteomyelitis of the Lower Extremities

PURPOSE: To evaluate the result of muscle free flap transplantation in chronic osteomyelitis of the tibia and calcaneus occurred from open fractures and exposed bones and internal fixatives. MATERIALS AND METHODS: The free muscle flap were transferred in the tibia and calcaneus and followed up average 7.3 years at the department of orthopedic surgery from March 1997 to September 2009. Six patients were male and 1 case female averaged 50.3 years of age. Two latissimus dorsi myocutaneous free flaps were transplanted to the exposed 2/3 of the tibia with soft tissue defect, one rectus abdominis muscle free flap to the mid 1/3 of the tibia and four gracilis muscle free flaps to the distal 1/3 of the tibia and calcaneus. RESULTS: At average 7.2 years follow-up, all of the 7 cases obtained solid bone union in the X-ray and kept sound soft tissues without pus discharges. The overall result of bone union, healed soft tissues defect and normal knee and ankle joint range of motion were excellent. CONCLUSION: The free muscle flap transferred to the chronic osteomyelitis of the tibia and calcaneus showed excellent results in bone union and eradication of the pus forming bacteria by its abundant blood flow.

The Retrieval Study of the Rough Blasted Surface Finish Cement Stem in Metal on Metal Total Hip Arthroplasty

PURPOSE: This study investigated the possible etiologic role of stem loosening and osteolysis by examining the surface of a rough blast retrieval cement stem and physical activity in second generation metal-on-metal (MOM) total hip arthroplasty (THA) MATERIALS AND METHODS: Forty one patients (43 hips) were analyzed retrospectively from Jan. 1996 to Dec.1998. Of the femoral stem, a rough blasted (Ra=1.6 um) cement stem and a cementless Ti-alloy stem was used in 18 and 25 hips, respectively. The mean follow-up duration was 10.15 years. Each patient was evaluated clinically by the HSS and radiographically by Engh's method. Scanning electron microscopy was used to observe the retrieved femoral stem and histology studies were performed. RESULTS: The mean Harris hip score improved from 56.2 points before surgery to 92.6 points after surgery. All the cementless stems and cups showed excellent results at the last follow-up. Eight of the rough blast cement stems were revised. Seven showed loosening and one was a recurrent dislocation. Cross-validation evaluation revealed osteolysis to be associated with a rough surface cement stem of metal on metal THAs (p=0.001). In addition, patients who underwent strenuous activity had a higher incidence of osteolysis (p=0.031). CONCLUSION: These findings suggest that a rough blast surface cement stem is associated with early osteolysis and loosening in patients with a metal-on-metal hip replacement. A prospective study with a large group of patients and multiple diagnostic methods will be needed to determine if there is a causal relationship between metal hypersensitivity and osteolysis. These results suggest that a cement stem with a rough blasted surface should be considered in metal-on-metal total hip arthroplasty.