Cementless Total Hip Arthroplasty using Cone Prosthesis for Childhood Septic Hip Sequelae / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical and radiographic results of cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae. MATERIALS AND METHODS: Thirty-seven patients of childhood septic hip sequelae that were treated with total hip arthroplasty using cone prosthesis, were evaluated after at least 2 years of follow-up. The average age at the time of the operation was 44 years. The cause of hip infection was pyogenic in 34 cases and tuberculous in 3. The average duration of follow-up was 51 months. RESULTS: The average Harris hip score improved from 45 points preoperatively to 90 points postoperatively. The mean leg length discrepancy decreased from 3.1 cm preoperatively to 0.7cm postoperatively. There was one case of stem subsidence over 5 mm, which didn't progress further. One patient underwent revision for migration of acetabular cup at postoperative 53 months. Postoperative infection occurred in 2 patients at postoperative 6 and 9 months respectively, which were treated by prosthesis removal. Radiolucent line over 2 mm was observed between the bone and stem in 1 case, without any evidence of loosening. CONCLUSION: Cementless total hip arthroplasty using cone prosthesis for childhood septic hip sequelae resulted in excellent clinical and radiographic outcome.

The Clinical Results of Total Hip Replacement Arthroplasty for Infection Hip Sequelae with Dislocation and Severe Shortening / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to evaluate the results of total hip replacement arthroplasty (THRA) in sequelae of the infected hip with dislocation and severe shortening. MATERIALS AND METHODS: We reviewed 22 cases of THRA performed from January 1985 to March 1995, for painful, dislocated hips secondary to infection in childhood, with shortening of the limb more than 5 cm. Among 22 cases, seventeen were pyogenic infection sequelae, and five were tuberculous infection sequelae. RESULTS: Mean followup period was 44 months (range: 24-111 months) . The mean value of the Harris score was increased to 86.7, which had been 61. The mean postoperative limb-length discrepancy was 1.8 cm and amount of correction ranged from 2.5 cm to 6.1 cm (average : 4.2 cm) . There was remarkable difference between the Crowe Group I and combined Group II and III in correction of shortening. The incidence of radiological loosening was not related to preoperative morbid period or the age of patients. CONCLUSION: The main resistant factor in lengthening of the affected limb was soft tissue contracture related to old age or long term after infection, and complication rate (14%) was higher than that in the other kinds of disease on hip.

Total Knee Arthroplasty in Ankylosed Knee with Previous Infecton

Generally, exposure and the operative technique are common difficulty encountered in the total knee arthroplasty of ankylosed knee due to old infection sequelae. Also the postoperative range of motion and relief of pain is poor due to deformity and excessive soft tissue contracture around knee. There have heen few reports, however, that address the reconstructive challenge of total knee arthroplasty in a previously infected ankylosed knee. We perfoined TKA in thirty six patients who had ankylosed knee between July l986 and Dec. 199S. After follow up of average five years and one month, we analysed the results. The definition of ankylosis was a knee ROM less than 90 degree. Average age of patients were 36.7 years old. Twelve patients were meii and twenty four patients were women. Sixteen patients of partial ankylosis and twenty patients of complete ankylosis were performed operation. There were nineteen cases of healed tubercuiosis knees and seventeen cases of healed pyogenic knees. For the release of soft tissue contracture in 9 cases, we lengthened quadrceps tendon with the method of modified V-Y advancement technique. Patella tendon was proximally reattached with staples and suture in 6 cases and tibial tubercle was proximally transferred in 3 cases. As results, the postoperative average range of motion was 79.3 (30 - l21') in complete ankylosis, 107 (60 - 135 ) in partial ankylosis. The average Hospital for Speciai Surgery knee rating score improved from 56.3 points preoperatively to 84.8 points postoperatively. Radiolucent line was observed in two Knees with less than 2mm width in three years and four months, and four years postoperatively, hut the patient had no pain. In five patients who had poor gain of range of motion after operation, we perfonned arthroscopic adhesiolysis. In conclusion, regarding patient selection, reasonable hony development, relative]y healthy extensor mechanism and adequate soft tissue condition are important for success of TKA in old intection sequelae. TKA of ankylosed knee in old infection sequelae is a successful procedui which can ohtain the restoration of function of the ankylosed knee.