Reemplazo total de rodilla en pacientes menores de 55 años con gonartrosis. Seguimiento de 2 a 13 años / Total knee arthroplasty for gonarthrosis in patients <55 years old. A 2 to 13-year follow-up study

Introducción: Los reemplazos totales de rodilla en jóvenes siguen aumentando. Se publicaron resultados inconstantes sobre la función y las complicaciones, inclusive en pacientes con artritis reumatoide. El propósito de este estudio fue analizar un grupo de reemplazos totales de rodilla en pacientes <55 años para evaluar la sobrevida de la prótesis, las fallas radiológicas y los resultados funcionales. Materiales y Métodos: Se analizaron retrospectivamente 53 reemplazos totales de rodilla en 46 pacientes (promedio de edad: 49 años [rango 26-54]) y un seguimiento promedio de 6.5 años (rango 2-15). Los diagnósticos preoperatorios fueron: 46 gonartrosis idiopáticas, 5 postraumáticas y 2 osteonecrosis. Veintidós tenían cirugías previas. Se utilizaron 49 implantes importados y 4 nacionales. Los resultados clínico-funcionales se evaluaron mediante el Knee Society Score y el WOMAC, la evaluación radiológica se efectuó con el sistema de la Knee Society. Resultados: El puntaje KSS funcional mejoró de 49,3 a 92,6 en promedio y el puntaje propio de rodilla pasó de 46,8 a 91,4 en el posoperatorio. El puntaje WOMAC promedio fue de 2,3 para dolor, 2,6 para rigidez y 27,3 para capacidad funcional. El 16% presentó líneas de radiolúcidas <1 mm que no progresaron. Hubo tres infecciones que requirieron una revisión en dos tiempos, con evolución favorable, y cuatro casos de rigidez tratados mediante movilización artroscópica. La sobrevida de la prótesis fue del 94,34%. Conclusiones: El reemplazo total de rodilla en pacientes <55 años fue un procedimiento confiable en cuanto a la mejoría de la función, con una aceptable sobrevida de la prótesis considerando los antecedentes quirúrgicos. No se observaron fallas radiológicas al final del seguimiento. Nivel de Evidencia: IV

Introduction: Total knee arthroplasty is being performed with increasing frequency in young patients. Published data on the clinical scores and long-term durability for total knee arthroplasty in these patients are limited and most include patients with rheumatoid arthritis. The purpose of this study was to analyze a group of total knee arthroplasties in patients <55 years old, excluding those with rheumatoid arthritis, in order to assess prosthetic survival, radiographic failures and functional outcomes. Methods: A total of 53 total knee arthroplasties were retrospectively analyzed in 46 patients (average age: 49 years [range 26-54]) and a mean follow-up of 6.5 years (range 2-15). The preoperative diagnoses accounted for 46 idiopathic knee osteoathritis, 5 post-traumatic arthritis and 2 osteonecrosis. Twenty-two patients had previous surgeries. The clinical and functional outcomes were assessed using the Knee Society Score and the WOMAC, whereas radiological assessment system of the Knee Society was used. Results: Clinical and functional KSS improved from 49.3 to 92.6 and from 46.8 to 91.4 postoperatively on average, respectively. The average WOMAC score was 2.3 for pain, 2.6 for stiffness and 27.3 for functional capacity. Radiolucent lines <1 mm were observed in 16%, without progression over time. There were 3 infections requiring two-stage revision evolving favorably and 4 cases of stiffness that were manipulated under anesthesia or arthroscopy. The prosthetic survival rate was 94.34%. Conclusions: Total knee arthroplasty in patients <55 years provides functional improvements, with an acceptable prosthetic survival considering previous surgeries. At the end of the follow-up, no radiological failures were observed. Level of Evidence: IV

Revision of Total Hip Replacement / 대한정형외과학회잡지

The successful development of reliable total hip arthroplasties for the treatment of several diseased hips has led to it increasing application in this country. As with any mode of therapy, the more frequent its use, the greater chance of complication or failure. Infection and loosening of component which is mainly due to improper surgical and cementing technique are the most frequent of these complication and has been increased the incidence of revision, too. We have experienced 96 hips of total hip replacement in 90 patients from February 1980 to July 1986. Among them, 14 hips who had been undertaken revisional arthroplasty were followed-up for average 27 months, and the following results were obtained. 1. Average patients age was 50.5 years, and time from previous total hip replacement to revisional arthroplasty was 3 years in 11 cases of loosening but only 3 weeks in 3 cases of surgieal error, and the post-revision follow-up was average 27 months. The main cause of the revisional surgery in this study were aseptic loosening in 9 csses (64.3%), surgical error in 3 cases(21.4%) and septic loosening in 2 cases(14.3%). 2. Cementless total hip replacement seems to be more prefer in an attempt to in initial total and even in revisional hip replacement to prevent loosening. 3. There are three cases of surgical error with the fracture and penetrating the tip of femoral stem into the proximal femur. Their causes of initial hip arthroplasty wss dysplastic hip in one and two cases of secondary osteosrthritis due to late sequelae of Legg-Calve-Perthes disease with moderate degree of anteversion of femoral head. These patients were younger than most who require usually total hip replscement and therefore their bone was harder and the medullary canal was nsrrow. These surgical complications are initiated because any attempt to correct these anteversion of femoral head was not given preoperatively. These kinds of surgical error in total hip replacement can be prevented by careful anstomicsl and radiological analysis of proximsl femur preoperatively, and X-rays or viewing with the T-V image intensifier for the proximal femur during the operation.

Total Hip Replacement Arthroplasty in Tuberculous Arthritis of the Hip / 대한정형외과학회잡지

Although the incidence of tuberculous arthritis of the hip is being decreased with improvement of hygiene, preventive measures and chemotherapy, it remains as important disease in orthopedic surgery. In the tuberculous arthritis of the hip, eradication of the disease with improvement of joint function is ideal treatment. But classical treatment of anti-tuberculous chemotherapy, synovectomy, and especially hip fusion which was done in most cases in adults, have their own limitation in functional results. Recently the methods of total hip replacement arthroplasty done in tuberculous arthritis with treatment of infection by antituberculous chemotherapy reported good results. During the period from January 1970 to December 1984, total hip replacement arthroplasty were done in 55 patients of tuberculous arthritis of the hip in Seoul National University Hospital. The average follow-up period was 3 years and 1 months. And, the following results were obtained. l. of the 55 cases, 50 cases(90.9%) were resulted in success without reactivation of tuberculosis, and 5 cases(9.1%) were resulted in failure. In those cases, the follow-up period were more than 1 year. 2 . The average period of immediate preoperative anti-tuberculous chemotherapy was higher in the success cases with 10.0 weeks than in the failure cases with 4.5 weeks. 3 . The average preoperative ESR was lower in the success case with 12.4mm/ hr than in the failure cases with 28mm/hr. 4 . Failure cases were restricted to active cold abscess in operative finding. 5. The positive bacteriology was fewer in the success cases with 4% than in the failure cases with 60%. 6. Follow-up functional results of the success cases were superior to any other methods of treatment. It is our conclusion that preoperative anti-tuberculous chemotherapy is important to reduce inflammatous reaction, and although granulation or caseation necrosis is found in operation field, total hip replacement can be successful if there is no active cold abscess.

Total Knee Replacement in Gonarthrosis / 대한정형외과학회잡지

We studied the results in forty-three knees in thirty patients-three male and twenty seven femalewho had rheumatoid arthritis, osteoarthritis, traumatic arthritis and osteonecrosis in the knee and were treated by total knee joint replacement. The average age of the patients was 56.7 years. The results were anaysed after follow-ups ranging from one year to three years and seven months, average being 23.6 months. The assessment was made upon the knee rating system of the Hospital for Special Surgery; the results were excellent in 29 knees, good in 12, fair in one and poor in one. The improvement of the flexion contractures was significant (postoperative average 1.7 degrees compared with preoperative average 20.1 degrees). The postoperative active flexion ranged from 70 degrees to 140 degrees (mean 110.2 degrees). One knee had a deep wound infection. The radiological loosening demonstrated in three cases, two of them had incomplete, nonprogressive radiolucent line, being less than one millimeter in width in the tibial component, one who had a deep infection showed three millimeters radiolucent line.

Acetabular Bone Graft in Total Hip Arthroplasty / 대한정형외과학회잡지

The effect of acetabular augmentation with bone graft was reviewed in 12 patients with acetabular deficiency in total hip arthroplasty, performed between 1981 and 1984 at Hanyang University Hospital. Follow-up ranged from 12 to 18 months and averaged 23.3 months. Follow-up radiographs were analyzed. Based on radiography, all grafts were regarded as incorporated and equally successful with autogenous and allograft bone. Long-term follow-up evaluation revealed no evidence of progressive radiolucency or graft resorption. There was one sciatic nerve palsy after operation but recovered at 11 months later.