Effect of Regional Nerve Block in Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: The goal of this study is to evaluate the efficacy of femoral, obturator, and sciatic nerve regional blocks with using ropivacaine during total knee arthroplasty. MATERIALS AND METHODS: As a prospective study, we performed total knee arthroplasty for 383 patients from Oct. 2004 to Feb. 2009. There was 139 cases of femoral and obturator nerve regional block, 123 cases of femoral, obturator, and sciatic nerve regional block, and 121 cases of lidocaine local anesthesia at the synovium and subcutaneous tissue during wound closure. All the femoral nerve block cases used a femoral catheter for an additional ropivacaine injection at 10 hours after surgery. The pain was examined using a visual analogue scale (VAS). The VAS scores were checked on the day of surgery and at post operative 24 hours, 48 hours and 6 days. The pain control effects among the 3 groups were compared with one-way ANOVA test and Scheffe`s multiple comparison test. RESULTS: The mean postoperative VAS score on the day of surgery and at post operative 24 hours, 48 hours and 6 days in the femoral and obturator nerve block group, were 6.3, 5.6, 5.3, and 4.7, respectively. For the cases of femoral, obturator and sciatic nerve block, the VAS scores were 3.9, 4.3, 3.5 and 1.9, respectively, and the VAS scores in the lidocaine local anesthetic group were 7.1, 6.1, 5.8 and 5.2, respectively. There was a statistical significance in all three groups (p<.0001), and the additional sciatic nerve block groups had significant effectiveness. CONCLUSION: Pain control with the ropivacaine regional nerve block is more effective than the lidocaine local anesthesia, and additional sciatic nerve block is a important factor for decreasing the postoperative pain after total knee arthroplasty.

Autologous Chondrocyte Implantation for Articular Cartilage Defect of Femoral Condyle / 대한정형외과학회잡지

PURPOSE: To evaluate the midterm clinical and histological results after autologous chondrocyte implantation (ACI) for an articular cartilage defect of the distal femoral condyle. MATERIALS AND METHODS: Twenty four cases with an articular cartilage defect (Outerbridge grade IV) of the femoral condyle that was confirmed by MRI and the arthroscopic findings underwent ACI. Their mean age at the time of surgery was 42.8 years and the mean follow-up period was 53.2 months (range, 20-82 months). At the last follow up, the articular cartilage view (SPGR) of MRI was examined and the clinical results were evaluated using the HSS and Lysholm scores. In 8 cases, second-look arthroscopy and biopsy were performed and evaluated using histological and histochemical methods. RESULTS: All cases except for one showed well-regenerated articular cartilage on MRI. All cases showed significant clinical improvement in the HSS and Lysholm scores (p<0.0001), with the exception of the Lysholm score of an articular cartilage fracture. Histologically, the regenerated tissue appeared to be a hyaline-like cartilage in all specimens. CONCLUSION: ACI for the treatment of articular cartilage defects of the distal femoral condyle showed a good clinical and MRI results. In OA, the clinical results were relatively acceptable after an associated high tibial valgus osteotomy. However, a longer term follow-up study will be needed to reach a final conclusion.

Secondary Septic Arthritis Due to Lateral Malleolar Bursitis: A Case Report / 대한족부족관절학회지

Lateral malleolar bursitis rarely progresses to septic arthritis. In our case, the 27 year old man visited due to progressive left ankle pain, despite the antibiotics treatment of lateral malleolar bursitis. 8 years ago, modified Brostrom procedure was performed owing to chronic ankle instability. Previous surgery altered anatomical structure of lateral ankle bursa, so it may cause the infection to spread to the ankle joint. We reported rare case of secondary septic arthritis caused by lateral malleolar bursitis.

Fat-suppressed 3D SPGR MR Imaging of Articular Cartilage Lesion of Medial Femoral Condyle in Osteoarthritic Knee / 대한정형외과학회잡지

PURPOSE: To evaluate the efficacy of sagittal fat-suppressed 3D SPGR MR imaging of the osteoarthritic medial femoral condyle in terms of extent and degree of a focal articular cartilage defect of the knee. MATERIALS AND METHODS: The MRI findings (Disler scale) of normal and osteoarthritic medial femoral condyles from 112 knees were prospectively compared with the arthroscopic findings (Jackson staging). The arthroscopic findings were normal in 10 cases, stage I in 26 cases, stage II in 36 cases, stage III in 21 cases and stage IV in 19 cases on arthroscopy. RESULTS: All 10 cases arthroscopy findings were grade 0 in MRI. Among the 26 knees in arthroscopic stage I, only 11 knees (42.3%) showed surface irregularities on MRI that were consistent with grade 1, otherwise grade 2. All cases of arthroscopic stage II showed grade 2 or grade 3. Stage III was grade 3 in all cases on MRI. Among the 19 knees in arthroscopic stage IV, 16 knees (84.2%) with a large defect showed grade 4 on MRI. The sensitivity, specificity and accuracy of the MRI compared with the arthroscopic findings was 97%, 100% and 97.3%, respectively. The weighted kappa index was 0.7194 and the SE (standard error) was 0.053, suggesting significant consistency. CONCLUSION: The sagittal fat-suppressed 3D SPGR MR imaging is valuable for determining the extent and degree of the articular cartilage lesion of the medial femoral condyle in an osteoarthritic knee.