Apoptotic Cells and the Histopathologic Findings in Rotator Cuff Tears / 대한정형외과학회잡지

PURPOSE: We analyzed the relationship between the size of the torn rotator cuff and the frequency of finding apoptotic cells (apoptotic index) or pathological degeneration in the rotator cuff. MATERIALS AND METHODS: The edges of torn supraspinatus tendons were obtained from patients with rotator cuff tear (n=63). The study group consisted of 2 small, 22 medium, 22 large and 17 massive tears. For the histopathologic evaluation, the H&E stained sections of the torn supraspinatus tendons were examined. Apoptosis was detected with TUNEL assay. We analyzed the relationships between the tear size and the pathologic findings or the apoptotic index. RESULTS: Significant differences could not be found for the fibroblast cellularity, thickening of the synovial lining and proliferation of blood vessels according to the size of the rotator cuff tear. All the specimens had apoptotic cells that were concentrated around the margin of the tear site. The apoptotic indexes according to the tear size were 58.50 for the small tears, 27.25 for the medium tears, 33.29 for the large tears and 31.96 for the massive tears. No significant correlation was found between the tear size and the apoptotic index. CONCLUSION: There were no significant differences in the apoptotic indices, the fibroblast cellularity, the thickening of the synovial lining and the proliferation of blood vessels according to the size of the rotator cuff tear, and there were no correlations between the apoptotic index and the histopathologic findings.

Periacetabular Osteotomy in Hip Dysplasia with Deformed Femoral Head / 대한정형외과학회잡지

PURPOSE: To evaluate the results of a periacetabular osteotomy (PAO) combined with a femoral osteotomy (FO) for a dysplastic hip with a deformed femoral head. MATERIALS AND METHODS: Thirteen hips with dysplasia and a deformed femoral head were followed up for more than 12 months. Eight hips were in the PAO group and 5 hips were in the PAO and FO group. The two groups were compared clinically according to the HHS (Harris hip score), pain and limping VAS (visual analogue scale), and radiologically according to the CEA (central edge angle of Wiberg), Tonnis angle (acetabular index of weight bearing surface), FHC (femoral head coverage), AA (acetabular angle of Sharp), DBSPFH (distance between symphysis pubis and femoral head) and AI (acetabular index of depth to width). RESULTS: Regarding the clinical results, the PAO group showed improvement in the HHS from 66.5 preoperatively to 90.4 postoperatively (p=0.01) and the pain VAS from 6.7 to 1.9 (p=0.01). However, there was no significant improvement in limping (p=0.39). In the PAO with FO group, the HHS was improved from 78 to 91 (p=0.04). Radiologically, the CEA, Tonnis angle, FHC, AA and AI improved significantly but there were no significant improvement in the DBSPFH in the two groups. In addition, there was no significant clinical or radiological difference between the two groups. CONCLUSION: Periacetabular osteotomy is recommended for dysplastic hips with deformed femoral head. A concomitant femoral osteotomy should be considered in hips with a severely deformed femoral head.

The Methods and Results of Revision Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To suggest operative methods for revision total knee arthroplasty (TKA) according to the causes of revision surgery. MATERIALS AND METHODS: The operative methods of 70 revision total knee arthroplasties in 64 patients between December 1996 and December 2004 were analyzed according to the causes. The mean follow-up period was 65 months (25-120 months). The range of motion and Hospital for Special Surgery (HSS) score were used for the clinical evaluation and the scoring system of American Knee Society was used for the radiographic evaluation. RESULTS: The mean periods of revision surgery from the initial operation was 59 months (1 month-20 years). Posterior cruciate retaining prosthesis was used in 8 cases, posterior cruciate substituting prosthesis in 14 cases, and constrained type prosthesis in 48 cases. The extension stem was required in 51 cases, metal augmentation in 34 cases, and structural allograft in 15 cases for bone defect treatment and firm fixation. The average range of motion improved from 88.8o preoperatively to 105.8o at the final follow-up. HSS score also improved from 60.5 to 87.6 points. The complications after revision TKA were 3 infections (4.3%), 1 patellar dislocation (1.4%), and 1 polyethylene dislocation (1.4%). CONCLUSION: Constrained type prostheses were needed in many cases of revision TKA. Satisfactory results were obtained using an additional structural allograft, metal augmentation, and extension stem for bone defect treatment and firm fixation.