The Analysis of Risk Factors in No Thumb Test in Total Knee Arthroplasty

BACKGROUND: We would like to analyze the risk factors of no thumb test among knee alignment tests during total knee arthroplasty surgery. METHODS: The 156 cases of total knee arthroplasty by an operator from October 2009 to April 2010 were analyzed according to preoperative indicators including body weight, height, degree of varus deformity, and patella subluxation and surgical indicators such as pre-osteotomy patella thickness, degree of patella degeneration, no thumb test which was evaluated after medial prepatella incision and before bone resection (1st test), no thumb test which was evaluated with corrective valgus stress (2nd test, J test), and the kind of prosthesis. We comparatively analyzed indicators affecting no thumb test (3rd test). RESULTS: There was no relation between age, sex, and body weight and no thumb test (3rd test). Patellar sulcus angle (p = 0.795), patellar congruence angle (p = 0.276) and preoperative mechanical axis showed no relationship. The 1st no thumb test (p = 0.007) and 2nd test (p = 0.002) showed significant relation with the 3rd no thumb test. Among surgical indicators, pre-osteotomy patella thickness (p = 0.275) and degeneration of patella (p = 0.320) were not relevant but post-osteotomy patellar thickness (p = 0.002) was relevant to no thumb test (3rd test). According to prosthesis, there was no significance with Nexgen (p = 0.575). However, there was significant correlation between Scorpio (p = 0.011), Vanguard (p = 0.049) and no thumb test (3rd test). Especially, Scorpio had a tendency to dislocate the patella, but Vanguard to stabilize the patella. CONCLUSIONS: No thumb test (3rd test) is correlated positively with 1st test, 2nd test, and post-osteotomy patella thickness. Therefore, the more patella osteotomy and the prosthesis with high affinity to patellofemoral alignment would be required for correct patella alignment.

Treatment for Periprosthetic Supracondylar Femur Fractures Following Total Knee Arthroplasty -Comparative Study of Retrograde Intramedullary Nailing and Locking Compression Plate Fixation-

PURPOSE: The purpose of this research is to compare the clinical and radiological results of retrograde intramedullary nailing and locking compression plate fixation. Both of these are surgical procedures for the treatment of periprosthetic supracondylar femur fractures that occur subsequent to total knee arthroplasty. MATERIALS AND METHODS: The subject population consisted of 23 cases: there were 10 cases that underwent retrograde intramedullary nailing fixation (group 1) and 13 cases that underwent use of a locking compression plate (group 2), and in both groups supracondylar femur fracture subsequent to total knee replacement occurred during the period between January 2004 and December 2008. The range of joint motion, the Hospital for Special Surgery (HSS) knee score, the tibio-femoral angle and the time to achieve bone union in each group were comparatively analyzed. RESULTS: The mean range of the knee joint motion decreased from 124.5degrees to 116.2degrees in group 1, and from 118.2degrees to 110.1degrees in group 2. The mean HSS knee score declined from 84.4 points to 75.8 points in group 1, and from 82.3 points to 79.0 points in group 2. The mean tibio-femoral angle changed from 6.3degrees eversion to 5.8degrees in group 1, and from 6.1degrees to 7.2degrees in group 2. The mean time to achieving bone union was 2.7 months in group 1 and 3 months in group 2. CONCLUSION: Both retrograde intramedullary nailing and locking compression plate fixation, as surgical procedures for the treatment of periprosthetic supracondylar femur fractures that occur subsequent to total knee replacement, allow solid fixation and early resumption of joint movement without any statistically significant differences between the two procedures. So, both procedures appear to be good methods of treatment.

The 'beta-wire Technique' for the Fixation of Ulnar Styloid Process Fracture: Surgical Technique

For the fixation of ulnar styloid process fracture, we want to introduce the 'beta-wire technique', which is easy to learn and practice and thought to give a compressive force to the fracture site.

Tardy Spinal Cord Compression without Bone Cement Leakage after Kyphoplasty: A Report of 3 Cases

STUDY DESIGN: This is a case report. OBJECTIVE: We report here on three cases of late spinal cord compression without bone cement leakage after kyphoplasty from the view point of the common characteristics, the suspected etiologies and the performed treatments, and we propose a technique to prevent this kind of complication. SUMMARY OF THE LITERATURE REVIEW: Kyphoplasty is widely accepted as an effective and safe treatment for osteoporotic vertebral compression fracture (VCF). Complicated compression fractures and even bursting fractures with a compromised spinal canal are currently indicated for kyphoplasty. The wide spread application of kyphoplasty may be mainly due to reducing the complication rates associated with cement leakage and possible restoration, even though partially, of a vertebral kyphotic deformity. MATERIALS AND METHODS: we experienced three cases of newly emerged complications that caused delayed neurologic compromise after uneventful kyphoplasty without any immediate neurologic deficits. MR imaging was done to find the pathologic regions and surgical treatment was performed. RESULTS: Refracture of an augmented vertebra at the conus medullaris level can cause late occurring spinal cord compression without compromising the spinal canal. Posterior instrumentation and posterior fusion with posterior decompression were effective treatments. CONCLUSION: The anatomical peculiarity of the conus medullaris and the dynamic irritation of the spinal cord by a bone cement mass after refracture of an augmented vertebral body can be the causes of late spinal cord compression after kyphoplasty. The neurologic symptoms were treated by posterior decompression and fusion. This kind of complication can be prevented by injecting a sufficient amount of bone cement with a shape to support both endplates.

Efficacy of High Intensity Laser Therapy in the Mild Osteoarthritis of the Knee: A Randomized Double-blind Controlled Trial / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to know the effect of high intensive laser therapy in patients with early stage of osteoarthritis of knee. MATERIALS AND METHODS: This study was a randomized, double blind controlled trial. 28 patients who had grade II osteoarthritis of Kellgren classification and knee pain were randomly divided into two groups. Patients underwent treatment 30 times, 5 times per week. the clinical evaluation was done by the pain, stiffness and functional score of the knee by the knee society clinical rating system, and the intensity of pain was measured also by a VAS (visual analogue scale), before and after the 1st sessions, Before and after the 2nd sessions and at 6 month after the 1st treatment. We checked hs-CRP and HA which was regarded as indexes of osteoarthritis activitiy. RESULTS: As a clinical result of high intensive laser therapy, VAS, pain and functional score were statistically more improved than those of before therapy, except stiffness (P<0.05). The results of the hs-CRP and HA which were not significantly different from those of before therapy. In the placebo group, all variables showed no difference. CONCLUSION: We concluded that Nd-YAG high intensive laser therapy in early stage of patient with osteoarthritis of knee would be helpful as noninvasive and conservative treatment for improvement clinical progress.