Surgical Treatment of Gouty Tophi in Bilateral Popliteal Cysts / 대한정형외과학회잡지

Gout often occurs in the first metatarsophalyngeal joint, and also in the ankle joint and posterior foot. Knee joint gouty arthritis is commonly reported, but gouty tophi in bilateral popliteal cysts, such as this case, are rare. We report on a case treated by cystectomy of gouty tophi in bilateral popliteal cysts and review.

Arthroscopic Decompression of an Inferior Paralabral Cyst of the Shoulder in an Elderly Patient: A Case Report

The widespread use of diagnostic radiography, especially using magnetic resonance imaging, has helped to increase the diagnosis of paralabral cysts in patients with chronic shoulder pain. These paralabral cysts are frequent in the anterior, the superior, and the posterior compartment of the shoulder joint but are rare in the inferior compartment. Paralabral cysts in the shoulder appear particularly in men in their third and fourth decades but rarely in elderly patients. We report a case of an inferior paralabral cyst in an elderly patient whom we treated through arthroscopic decompression.

Arthroscopic Decompression of an Inferior Paralabral Cyst of the Shoulder in an Elderly Patient: A Case Report

The widespread use of diagnostic radiography, especially using magnetic resonance imaging, has helped to increase the diagnosis of paralabral cysts in patients with chronic shoulder pain. These paralabral cysts are frequent in the anterior, the superior, and the posterior compartment of the shoulder joint but are rare in the inferior compartment. Paralabral cysts in the shoulder appear particularly in men in their third and fourth decades but rarely in elderly patients. We report a case of an inferior paralabral cyst in an elderly patient whom we treated through arthroscopic decompression.

Synchronous Development of Schwannoma in the Rectus Abdominis and Lipoma in the Chest: A Case Report / 대한골관절종양학회지

We experienced a case of 63 years old male patient who had synchronous rectus abdominis intramuscular schwannoma and chest wall lipoma. Schwannoma is rare benign tumor which derived from nerve sheath and mainly peripheral nerve of flexor part. The authors report rare synchronous schwannoma and lipoma development.

Rapid Destruction of the Hip Joint Accompanied by an Enlarged Iliopsoas Bursa in a Healthy Man / 대한고관절학회지

Association between enlarged iliopsoas bursa and hip lesions such as osteoarthritis of the hip or femoral head necrosis is infrequently seen. Enlarged iliopsoas bursa with a rapidly destructive arthropathy is claimed to be seen only in patients with rheumatoid arthritis. In this paper, we report a patient with a rapidly destructive arthropathy accompanied by an enlarged iliopsoas bursa that has been misdiagnosed as an infection.

Necrotising Fascitis of the Thigh through Short External Rotator Muscles Due to an Unrecognized Perforated Rectal Cancer / 대한고관절학회지

Necrotizing fasciitis is one of the few true emergencies in orthopedic surgery that has a very high mortality rate unless recognized promptly and treated aggressively. The authors report a case of a patient with necrotizing fasciitis on the thigh that developed secondary to an unrecognized rectal cancer perforation through the short external rotator muscles. Clinicians should always be alert to the potential that rectal cancer perforations can cause necrotizing fasciitis in rare cases.

Hip Arthroplasty for Failed Internal Fixation of Intertrochanteric Fractures / 대한고관절학회지

PURPOSE: To analyze the clinical and radiological results of hip arthroplasty following the failed internal fixation of intertrochanteric fractures of the femur. MATERIALS AND METHODS: We analyzed the reasons for failure in 29 cases of hip arthroplasty from January 1997 through December 2008 in which the hip arthroplasty was necessary due to failed internal fixation of an intertrochanteric fracture of the femur. Furthermore, we tried to find pitfalls encountered when performing the operations. We assessed those patients and drew both clinical (Harris hip score, HHS) and radiological results. The follow-up period was 34.2 months(12-96 months), on average. RESULTS: The average operating time was 174 min.(115-205 min.) and the mean amount of perioperative bleeding was 1,335 ml(759-2,450 ml). The amount of packed RBC transfusion was 2.8 units(0-10 units) on average. We could see prolonged operation time and a large amount of blood loss as we performed both the removal of the previously fixed implant and reduction of the displaced bone fragment simultaneously. The mean Harris hip score of the patients was improved from the preoperative score of 43 to the postoperative score of 85.7. No cases showed any radiological signs of loosening of acetabular cups or femoral stems, although an articular dislocation and a postoperative joint infection occurred. CONCLUSION: Although hip arthroplasties performed because of a failure in internal fixation could provide relatively satisfactory outcomes, as they result in extended surgery time and greater blood loss, a requirement for higher-level surgical skills, and greater consideration required for the systemic conditions of patients before performing surgery.

Traumatic Disassembly of a Bipolar Hip Prosthesis: A Case Report

We report a rare case of a complete disassembly of the inner head from the bipolar cup without polyethylene wear and locking system failure. An 84-year-old man who had a femur neck fracture of the right hip underwent a replacement of the bipolar prosthesis 4 months ago. He fell down from a height of a chair and felt a sudden sharp pain in the right hip. Roentgenograms revealed that the inner head was dislocated from the outer cup; subsequently, a revision surgery was carried out. When the outer head was removed from the acetabulum, the bearing insert and locking ring were not deformed. Because there was no evidence of loosening of the femoral stem, identicallysized bipolar cup and metal head replacement was performed. At a 6 months follow-up, he had mild hip pain but had returned fully to daily living.

The Results of Cementless Total Hip Arthroplasty for Primary Osteoarthritis Compared with Avascular Necrosis of the Femoral Head

PURPOSE: Cementless total hip arthroplasty was performed to treat primary osteoarthritis of the hip and avascular necrosis of the femoral head. The clinical and radiological results of the acetabular cups and femoral stems were compared. MATERIALS AND METHODS: The subjects were 84 cases who underwent primary cementless total hip arthroplasty from March 1992 to May 2001. The 84 cases were followed up for at least eight years. The patients were divided into the following two groups: group (A), 38 cases of degenerative osteoarthritis of the hip; and group (B), 46 cases of avascular necrosis of the hip. The clinical evaluation was conducted based on the Harris Hip Score (HHS). A radiological assessment was performed to determine if osteolysis or acetabular loosening had occurred. The results were analyzed statistically. RESULTS: The postoperative HHS of groups A and B at the final follow-up were 92.1 and 91.2, respectively (p=0.483). The radiological results revealed 9 and 15 cases of acetabular osteolysis (p=0.671) and 1 and 3 cases of vertical migration of the acetabular cups in the group A and B, respectively. Eight and 7 complications (p=0.572) were encountered in group A and B, respectively. Among these, 4 and 5 cases of revisional total hip arthroplasty were performed in group A and B, respectively. The results of survival analysis were similar in the two groups (p=0.969). CONCLUSION: The clinical and radiological features of the acetabular cups and stems were similar in the two groups. Nevertheless, further studies will be needed due to the high rate of polyethylene liner wear and osteolysis around the acetabular cups or femoral stems.

Validity of Repeated MRI in Degenerative Lumbar Disease with Conservative Management / 대한정형외과학회잡지

PURPOSE: This study examined the value and indications of repeated MRI in degenerative lumbar diseases under conservative management by comparing the primary MR and repeated MR images with respect to the symptomatic and radiological changes. MATERIALS AND METHODS: Seventy patients with degenerative lumbar disease under conservative management underwent repeat MRI. Five MRI findings, including disc, foramen, facet joint, nerve root, and ligamentum flavum, were used to examine the difference between the initial and repeat MRI. The severity was graded using a four-point scale for each item. The patients were divided into 3 groups in order to compare the radiological changes and symptomatic changes, as follows; Group I no change from the initial symptoms (38 cases), Group II aggravation of the initial pain (18 cases), and Group III aggravation of the initial neurology or the development of a new neurology (14 cases). RESULTS: The mean scores of each item the disc, foramen, facet joint, nerve root and ligamentum flavum increased from 1.76, 1.31-1.79, 1.71, and 1.47, respectively, to 1.90, 1.47, 1.80, 1.79, and 1.53, respectively. Group III showed the greatest proportion of cases with an increasing grading score (78%, 11 cases) only the disc was significant. CONCLUSION: Repeat MRI in degenerative lumbar disease under conservative management was found to be valuable only in cases with aggravated neurological symptoms, and was not relevant in cases with persistent symptoms or aggravated pain alone.