Cervical Myelopathy with Retro-Odontoid Pseudotumor without Atlanto-Axial Instability / 대한정형외과학회잡지

An 82-year-old male patient was admitted for neck pain, motor weakness in both upper extremities, and gait disorder. The patient had no history of rheumatoid arthritis or other specific histories, and the findings of cervical myelopathy with retro-odontoid pseudotumor were confirmed by cervical magnetic resonance imaging. On cervical radiography, there was no evidence of atlantoaxial instability or subluxation. Therefore, posterior fusion was not performed; only a C1 laminectomy was performed. Immediately after surgery, the pain decreased, and neurological symptoms were also improved. In the case of a retro-odontoid pseudotumor without atlantoaxial instability, it is believed that the symptoms can be improved only with C1 laminectomy.

Schmorl’s Node Accompanying Multiple Osteonecroses / 대한정형외과학회잡지

A Schmorl’s node is defined as intervertebral disc herniation from the endplate to the adjacent vertebral body. This can cause pain and osteonecrosis in the vertebral body. The authors encountered a 59-year-old female patient with a Schmorl’s node accompanying multiple osteonecroses. To the best of the author’s knowledge, a Schmorl’s node accompanying multiple osteonecroses has not been reported in Korea. The authors report this case with a literature review.

Perioperative Medical Treatment to Improve Surgical Outcomes: Management of Osteoporosis / 대한정형외과학회잡지

As the population grows older and medical treatments are advancing, the number of spine surgeries in elderly patients has been increasing. To obtain a successful outcomes of spine surgery in elderly patients, surgeons should prepare meticulously because elderly patients can have osteoporosis and surgery can be more extensive than in younger patients. Therefore, this study reviewed the perioperative medical treatment, particularly for osteoporosis, to improve the surgical outcomes in elderly patients.

Overview of the Management of Chronic Non-Cancer Pain in Patients with Spinal Disease

STUDY DESIGN: Cross-sectional, multi-center survey study. OBJECTIVES: The objective of this study was to investigate the pain status, pain management methods, and pain experience after treatment among patients suffering from chronic non-cancer pain due to spinal disease. SUMMARY OF LITERATURE REVIEW: No thorough investigation of the current status of chronic non-cancer pain management in patients with spinal disease has recently been reported. MATERIALS AND METHODS: We surveyed 330 patients with chronic non-cancer pain who visited spine clinics in Korea. RESULTS: Prior to treatment, 86.7% of the patients had severe pain and 99.4% of the patients had taken oral analgesics for pain control. After treatment, the percent of patients with severe pain was reduced to 42.1%, and 52.4% of patients responded that they experienced intermittent pain. End of dose failure was experienced by 29.1% of patients, and 41.7% of patients experienced pain again 3–6 hours after taking analgesics. Furthermore, 8.2% of patients experienced breakthrough pain, and 29.1% of patients experienced pain that interfered with sleeping. CONCLUSIONS: Many patients with chronic pain reported experiencing pain due to end of dose failure after medication. As the causes of chronic pain are complex, appropriate analgesics should be considered and selected for effective pain management.

Risk Factors for Wound Infection in Spinal Surgery: A Focus on Diabetes Mellitus

STUDY DESIGN: Retrospective study. OBJECTIVES: To identify risk factors for infection after spinal surgery. SUMMARY OF LITERATURE REVIEW: Infection after spinal surgery is relatively uncommon. However, such infections cause serious consequences and increased costs and sequelae. Risk factors for infection after spinal surgery include a posterior approach, instrumentation, the use of an allogenic bone graft, transfusion, and a long operating time. Patient-related factors include diabetes and obesity. MATERIALS AND METHODS: From January 2009 to December 2013, 350 patients who underwent surgery at our hospital due to spinal disease, including 10 patients with a postoperative spinal infection, were evaluated. We investigated patients' age, gender, morbidity due to diabetes mellitus, body mass index, level of surgery, approach, location, instrumentation, and operation type. RESULTS: Ten of the 350 patients developed a spinal infection after surgery. The proportion of diabetic patients among the infected patients was higher than among the non-infected patients, although the difference was not statistically significant. Additionally, the proportion of diabetic patients with hemoglobin A1c levels greater than 7.0% was higher among the infected patients. Operating time, the surgical approach, drain tube insertion, transfusion, and the use of an allogenic bone graft were not significantly different between the infected and non-infected patient groups. CONCLUSIONS: Uncontrolled diabetes is the most important risk factor for the development of spinal infection after surgery. Therefore, in order to prevent infection after surgery, blood glucose should be controlled before surgery.

Overview of the Management of Chronic Non-Cancer Pain in Patients with Spinal Disease

OBJECTIVES@#The objective of this study was to investigate the pain status, pain management methods, and pain experience after treatment among patients suffering from chronic non-cancer pain due to spinal disease.SUMMARY OF LITERATURE REVIEW: No thorough investigation of the current status of chronic non-cancer pain management in patients with spinal disease has recently been reported.@*MATERIALS AND METHODS@#We surveyed 330 patients with chronic non-cancer pain who visited spine clinics in Korea.@*RESULTS@#Prior to treatment, 86.7% of the patients had severe pain and 99.4% of the patients had taken oral analgesics for pain control. After treatment, the percent of patients with severe pain was reduced to 42.1%, and 52.4% of patients responded that they experienced intermittent pain. End of dose failure was experienced by 29.1% of patients, and 41.7% of patients experienced pain again 3–6 hours after taking analgesics. Furthermore, 8.2% of patients experienced breakthrough pain, and 29.1% of patients experienced pain that interfered with sleeping.@*CONCLUSIONS@#Many patients with chronic pain reported experiencing pain due to end of dose failure after medication. As the causes of chronic pain are complex, appropriate analgesics should be considered and selected for effective pain management.

Risk Factors for Wound Infection in Spinal Surgery: A Focus on Diabetes Mellitus

OBJECTIVES@#To identify risk factors for infection after spinal surgery.SUMMARY OF LITERATURE REVIEW: Infection after spinal surgery is relatively uncommon. However, such infections cause serious consequences and increased costs and sequelae. Risk factors for infection after spinal surgery include a posterior approach, instrumentation, the use of an allogenic bone graft, transfusion, and a long operating time. Patient-related factors include diabetes and obesity.@*MATERIALS AND METHODS@#From January 2009 to December 2013, 350 patients who underwent surgery at our hospital due to spinal disease, including 10 patients with a postoperative spinal infection, were evaluated. We investigated patients' age, gender, morbidity due to diabetes mellitus, body mass index, level of surgery, approach, location, instrumentation, and operation type.@*RESULTS@#Ten of the 350 patients developed a spinal infection after surgery. The proportion of diabetic patients among the infected patients was higher than among the non-infected patients, although the difference was not statistically significant. Additionally, the proportion of diabetic patients with hemoglobin A1c levels greater than 7.0% was higher among the infected patients. Operating time, the surgical approach, drain tube insertion, transfusion, and the use of an allogenic bone graft were not significantly different between the infected and non-infected patient groups.@*CONCLUSIONS@#Uncontrolled diabetes is the most important risk factor for the development of spinal infection after surgery. Therefore, in order to prevent infection after surgery, blood glucose should be controlled before surgery.

Should We Check the Routine Postoperative MRI for Hematoma in Spinal Decompression Surgery?

BACKGROUND: A postoperative magnetic resonance imaging (MRI) is performed as a routine to assess decompression of the spinal cord as well as to evaluate postoperative complications. The purpose of this study is to analyze the efficacy of postoperative MRI for hematoma in spinal decompression surgery. METHODS: Between January 1, 2008 and January 31, 2015, 185 patients who underwent postoperative MRI after spinal decompression surgery were included in this study. We checked the history of the use of an anticoagulant or antiplatelet agent, withdrawal period, blood platelet count, and prothrombin time (international normalized ratio [INR]). We measured the total amount of suction drainage and duration until removal. We retrospectively reviewed the presence of hematoma and thecal sac compression. Postoperative prognosis was evaluated by a visual analog scale (VAS) and the Oswestry Disability Index (ODI). RESULTS: Hematomas were found on postoperative MRI scans in 97 out of 185 patients (52.4%). Thirty patients had a thecal sac compressing hematoma: 7 in the cervical spine, 1 in the thoracic spine, and 22 in the lumbar spine. The occurrence of hematoma did not show significant difference according to the use of an anticoagulant (p = 0.157). The blood platelet count, prothrombin time (INR), and suction drainage duration did not have a statistically significant correlation with the occurrence of hematoma (p = 0.562, p = 0.506, and p = 0.429, respectively). The total amount of suction drainage was significantly different according to the presence of hematoma (p = 0.022). The total 185 patients had a significant decrease in the postoperative VAS score (p < 0.001), and the diminution of VAS score was not significantly different according to the occurrence of hematoma (p = 0.243). Even in the cases of thecal sac compressing hematoma, the reduction of VAS score was not significantly different (p = 0.689). CONCLUSIONS: Postoperative MRI for hematoma in spinal decompression surgery has little effect on prognosis or management. Therefore, indiscriminate postoperative MRI should be avoided and MRI should be performed depending on the patient's status.

Perioperative Blood Loss in Intramedullary Hip Screw for Intertrochanteric Fracture: Analysis of Risk Factors

PURPOSE: We compared visible blood loss and calculated blood loss after intramedullary fixation in intertrochanteric fracture, and evaluated correlation between blood loss and its risk factors. MATERIALS AND METHODS: A total of 256 patients who underwent closed reduction and intramedullary fixation in femoral intertrochanteric fracture between 2004 and 2013 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including fracture pattern (according to Evans classification), gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score and use of antithrombotic agents. RESULTS: Total calculated blood loss (2,100+/-1,632 ml) differed significantly from visible blood loss (564+/-319 ml). In addition, the blood loss of unstable fracture patient was 2,496+/-1,395 ml and multivariate analysis showed a significant relationship between blood loss and fracture pattern (p<0.01). However, other factors showed no statistically significant difference. CONCLUSION: Total calculated blood loss was much greater than visible blood loss. Patients with unstable intertrochanteric fracture should be treated with care in order to reduce blood loss.

Simultaneous Bilateral Fracture of Femoral Neck in Korea: A Case Report / 대한고관절학회지

Unilateral femoral neck factures are common and their incidence is increasing. However, simultaneous bilateral femoral neck fractures are rare. Although cases of simultaneous bilateral femoral neck fractures have been reported, most were caused by strong muscle contractions during electroconvulsive therapy. Simultaneous bilateral femoral neck fractures caused by a simple fall are an extremely rare injury; therefore, limited literature is available, and no case has been reported in Korea. We report herein a case of simultaneous bilateral femoral neck fractures caused by a simple fall. An 83-year-old woman visited the emergency department with bilateral hip joint pain and gait disturbance, which developed 1 day after a fall. Tenderness and severe limitation in left hip joint range of motion and mild limitation in right hip joint range of motion were observed on a physical examination. A Garden type IV femoral neck fracture in the left hip joint and a Garden type I femoral neck fracture in the right hip joint were observed on plain radiography. She underwent right screw fixation and left bipolar hemiarthroplasty 2 days after admission. The patient could walk using a walker 4 weeks postoperatively. Bone union in the right femoral neck was observed at the 3 month follow-up. No specific findings were observed at the left hip hemiarthroplasty site.

The Epidemiology and Importance of Osteoporotic Spinal Compression Fracture in South Korea

STUDY DESIGN: Review of the literature on the epidemiology and importance of osteoporotic spinal fractures. OBJECTIVES: To determine the epidemiology and importance of osteoporotic spinal fractures. SUMMARY OF LITERATURE REVIEW: Osteoporotic spinal fractures have been increasing in recent years. MATERIALS AND METHODS: Review of the literature. RESULTS: Osteoporotic spinal fractures can lead to a reduced quality of life and reduced life expectancy with increasing morbidity. They can also be a major cause of additional spinal fractures or secondary fractures. CONCLUSIONS: In an aging society, osteoporotic spinal fractures are considered a social problem. Preventive care should be emphasized.

Usefulness of Minimally Invasive Posterior Foraminotomy using Tubular Retractor for Lumbar Spinal Stenosis with Foraminal Stenosis

STUDY DESIGN: Retrospective study. OBJECTIVES: The aim of this study was to report the usefulness of lumbar posterior foraminotomy and central decompression using tubular retractor with minimally invasive technique. SUMMARY OF LITERATURE REVIEW: Posterior decompression and arthrodesis for the treatment of lumbar spinal stenosis with foraminal stenosis is a classical surgical method. It is inappropriate for patients who have rejection to arthrodesis or medical problems, because it may have several complications. MATERIALS AND METHODS: Clinical results were obtained from 12 patients who underwent posterior foraminotomy and central decompression from January 2009 to April 2011 and were assessed using a Visual analogue scale, Oswestry disability index and the Prolo outcome scale. RESULTS: Six Of 12 patients showed immediate relief of radiculopathy. Postoperative posterior lumbar pain and spasm were negligible, and no surgically related complication was noted. During the follow-up period, the Oswestry disability index decreased from 24.25+/-2.89(pre-op) to 19.33+/-3.02(Last F/U)(p=0.28, paired t-test) in 8 of 12 patients. CONCLUSIONS: A minimally invasive posterior foraminotomy and central decompression could be an alternative surgical option for the treatment of lumbar spinal stenosis with foraminal stenosis, especially in subjects with old age, having medical problems and refusal of arthrodesis.

Regional Bone Loss as a Risk Factor for Distal Radius Fracture in Women under 60 Years Old / 대한골다공증학회지

OBJECTIVES: Some studies have suggested that lumbar spine and hip bone mineral density (BMD) are not associated with distal radius fractures (DRF), and a few studies have investigated regional BMDs at the fracture site, not just the lumbar or hip. We correlated distal radius BMD with DRF in postmenopausal women or =50 years old with DRF were enrolled in the fracture group, and 72 women without fractures were included as a control group. We measured distal radius BMD in the distal radius contralateral to the fractured bone in the fracture group and that of the lumbar body 5 days after the trauma. BMDs at the distal radius of each group were compared in three age groups (50~59, 60~69, and > or =70 years). Age- and site-specific BMDs were analyzed in each group. RESULTS: No significant differences in the rate of osteoporosis at the distal radius or lumbar spine were observed in patients > or =60 years old. However, BMD and T-score values of the distal radius in female patients were lower than those in controls <60 years old. BMD and T-score values of the distal radius were lower than those of the lumbar spine in the fracture group <60 years old. BMD of the distal radius also carried a higher relative risk. CONCLUSIONS: Low BMD of the distal radius was an indicator of regional BMD and could be a sensitive risk factor for DRF in women <60 years.

Association between BMI (Body Mass Index) and Proximal Femur Fractures Type in Korean People / 대한골다공증학회지

OBJECTIVES: The purpose of this analysis is to study whether the factors including bone mineral density (BMD) and age which influence fracture occurrence is involved in proximal femur fracture type. Any correlation of body mass index (BMI) and obesity to fractures of the proximal femur was investigated in particular. METHODS: Two hundred fifty two patients hospitalized for femur neck fracture and intertrochanteric fracture over 60 under 90 years old were examined. Only simple fall down trauma for excluding pathologic fractures was included. About 225 patients, past medical, drug and social history were investigated and BMD and BMI (body mass index) were measured. Patients were classified into two groups (femoral neck fracture and intertrochanteric fracture). Significant differences in BMD and BMI between these two groups were investigated. RESULTS: There was no statistically significant difference between two proximal femur fracture type with regard to age, sex and BMD. But two groups seem to have statistically significant different with BMI. Most patients had normal weight, thus no significant differences were found in degree of obesity between two groups. CONCLUSIONS: This study shows that the higher the patients have BMI, the more frequently intertrochanteric fracture is occurred. But, owing to normal obesity levels seen in most patients in this study, any definitive correlation between obesity and each type of proximal femur fracture could not be found.

Results of Syndesmotic Screw Fixation versus Posterior Malleolus Fixation in Syndesmotic Injury at Pronation External Rotation Stage IV Ankle Fracture with Posterior Malleolus Fracture: Postoperative One Year Follow-up / 대한족부족관절학회지

PURPOSE: The purpose of this study is to compare the radiologic and clinical results of syndesmotic screw fixation and posterior malleolar fixation for syndesmotic injury in Lauge-Hansen classification pronation-external rotation (PER) stage IV ankle fractures with posterior malleolus fracture. MATERIALS AND METHODS: We designed a retrospective study that included patients with Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture. Of 723 patients who underwent ankle fracture surgery from March 2005 to November 2012, 29 were included in this study. In this study, syndesmotic injury was treated with syndesmotic screw fixation or posterior malleolus fixation. There were 15 cases of syndesmotic screw fixation and 14 cases of posterior malleolar fixation. We compared the radiologic and clinical results at one year postoperatively. Posterior malleolus fragment size on a pre-operative computed tomographic image, and tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, and Takakura classification on a postoperative one year followup radiograph were used for comparison of the radiologic results. The clinical results were assessed using the American Orthopaedic Foot and Ankle Society score, visual analogue scale score, and patient subjective satisfaction score. RESULTS: Posterior malleolar fragment size was 12.62%+/-3.01% of the joint space in the syndesmotic screw fixation group and 27.04%+/-4.34% in the posterior malleolar fixation group. A statistical difference was observed between the two groups. However, other results, including tibiofibular overlap, medial clear space, articular step-off, Kellgren-Lawrence grade, Takakura classification, and clinical scores showed no statistical difference. CONCLUSION: In the Lauge-Hansen classification PER stage IV ankle fracture with posterior malleolus fracture, if the posterior malleolus fracture can be reduced anatomically and fixated rigidly, syndesmotic screw fixation, which can cause several complications, is usually not required for achievement of a satisfactory syndesmotic stability; this would be a recommendable option for treatment of syndesmotic injury.

Surgical Treatment of Ankle Fractures in the Elderly / 대한족부족관절학회지

PURPOSE: The optimal management for ankle fracture in elderly patients remains controversial. This study was undertaken to review the results of surgical treatment of ankle fracture in the elderly and to compare with other studies. MATERIALS AND METHODS: The participants in this study were 33 patients over the age of 65(average 71.5 years) who underwent surgical treatment of ankle fracture from January 2004 to December 2011. The study was a retrospective review of outcomes after open reduction and internal fixation (ORIF) of ankle fractures. To measure the clinical outcomes, we assessed postoperative complications, the pre- and post-operative mobility status, fracture union status, the time of fracture union and the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle-Hindfoot scale. The level of patient satisfaction was also identified. RESULTS: Delayed wound healing occurred in three patients(9.1%) but their wounds healed with repeated dressings without additional surgical treatment. Malunion occurred in one patient(3%). One patient(3%) had postoperative infection but healed with antibiotic treatment. 24 patients(96%) returned to preoperative mobility status. VAS score was lower than 2 in all patients. Bone union occurred with the 3.8 months (average months) after the surgery in all patients. Average AOFAS score was 87.4 and these were similar results as other studies of young patients. All patients were satisfied with surgical outcomes according to interviews. CONCLUSION: Surgical treatment of ankle fractures in the elderly can carry a significant risk of delayed wound healing and infection but incidence is relatively low. Internal fixation of ankle fractures in the elderly can be undertaken safely and the majority of patients can expect good outcome.

Clinical Analysis of Intractable Diabetic Foot Ulcers: Accessing Risk Factors / 대한족부족관절학회지

PURPOSE: Diabetic foot ulcer is one of the most important diabetic complications because it increases the risk of amputations. Moreover, it lowers the quality of patients' life and increases the social medical expenses. Authors analyzed risk factors of intractable diabetic foot ulcer using retrospective study. MATERIALS AND METHODS: From January 2007 to December 2010, 40 patients who could not achieve complete healing despite more than 12 weeks of proper management among who had been diagnosed and treated as diabetic foot ulcer at our hospital were included and evaluated retrospectively. We compared the risk factors between two groups who were finally treated by amputation and non-amputation. RESULTS: The sample was composed of 31 male patients (77.5%) and 9 female patients (22.5%). Comorbidity including hypertension and hyperlipidemia were 77.5% and 80% each. By Wagner classification, 30 patients (80%) had ulcerative lesion over the grade 3. From bacteriology results, 29 patients (72.5%) had polybacteria infection. 35 patients (87.5%) had neuropathy and 26 patients (65%) had vascular stenosis at least one level. The mean initial ankle-brachial index and toe-brachial index were 0.982 and 0.439. In comparison between amputation group and non-amputation group, ulcer severity, number of stenotic vessel and initial ankle-brachial index/toe-brachial index had statistical significance. CONCLUSION: The most commonly risk factor of intractable diabetic foot ulcer was peripheral neuropathy reaching 87.5% of cases. In comparison with non-amputation group, ulcer severity according to Wagner classification, number of stenotic vessel and initial ankle-brachial index/toe-brachial index were demonstrated as a risk factor of amputation in intractable diabetic foot ulcer.

Preserving Remnant Tissue in Arthroscopic ACL Reconstruction Using Achilles Tendon Allograft

PURPOSE: The purpose of this study was to determine the clinical usefulness of remnant preservation in anterior cruciate ligament (ACL) reconstruction using Achilles tendon graft. MATERIALS AND METHODS: Between April 2004 and June 2007, 26 patients who were followed up for at least 12 months after ACL reconstruction with Achilles tendon were included in this study. They were divided into two groups according to whether the remnant was preserved. The post-reconstruction state was evaluated using pivot-shift test, Telos anterior stress test, International Knee Documentation Committee (IKDC) scale, Lysolm score and single limb standing test. RESULTS: No statistically significant differences in mechanical stability and mean values of IKDC scale and Lysholm test between the two groups were present. In single limb standing test, the remnant-preserving group showed 1.1+/-0.8 cm and the remnant sacrificing group showed 1.8+/-1.2 cm (p=0.04). However, there were no significant differences between the injured knee and the intact knee in the group which the remnant was preserved. CONCLUSION: ACL reconstruction using allo Achilles graft showed satisfactory results in terms of stability and function. Preserving the tibial remnant seems to be helpful to restore knee joint proprioception.

Analysis of the Mechanical Axis of the Lower Limb in Patients with Isolated Meniscal Tear

PURPOSE: We wanted to evaluate the relationship between meniscal tear and the alignment of the lower limb. MATERIALS AND METHODS: Between Oct 2006 and Jun 2008, 125 patients aged 55 year or less with isolated meniscal tear and who were examined arthroscopically were included in this study. The patients had no severe lesion (ulceration or defect) of cartilage or ligamentous injuries. 21 individuals who had no abnormal findings on MRI were selected as the control group. The patients were divided into the complete discoid lateral meniscus, incomplete discoid lateral meniscus, lateral semilunar meniscus and medial semilunar meniscus groups and they were subdivided according to gender and whether there was an obvious history of trauma. The varus percentage was defined as a percentage of the width from where the mechanical axis passes the level of the tibial articular surface to the middle of the tibial articular surface on the orthoroentgenogram of the lower leg. Each individual's varus percentage was expressed as the mean of the measurements taken by three observers. The comparisons were done using the Wilcox Signed Ranks Test and the Mann-Whitney Test. RESULTS: There was no significant difference between the involved knee and the contralateral normal knee in terms of the varus percentage in all the groups (p>0.05). There were no significant differences in each group according to the history of trauma, a complete discoid lateral meniscus, an incomplete discoid lateral meniscus, a lateral semilunar meniscus and a medial semilunar meniscus. However, there was a significantly greater varus percentage for the medial semilunar meniscus group without a history of trauma. CONCLUSION: There was a statistical relationship between tears on the medial semilunar meniscus without a history of trauma and genu varum. Tears on a complete discoid lateral meniscus, incomplete discoid lateral meniscus and lateral semilunar meniscus had a little relationship with the mechanical axis of the lower leg.

The Clinical and Radiologic Results of Total Hip Arthroplasty with an AML Hip Prosthesis: Minimum 7 Years' Follow-up Study

PURPOSE: To evaluate the long-term results (minimum 7 Years'follow-up) of cementless total hip arthroplasty using an Anatomic Locking Medullary (AML) hip prosthesis. MATERIALS AND METHODS: Fifty-one patients (57 hips) underwent total hip arthroplasty between January 1995 and July 2002. They were followed up for a minimum of seven years (7.1 to 14.6) after the initial operation. The mean age of the patients was 56.8 years. The radiographs were reviewed and the clinical results were evaluated. RESULTS: The mean Harris hip score improved from 52.4 points preoperatively to 88.2 points postoperatively. Of the 40 hips showing a good press-fit, 29 hips (72.5%) exhibited bone ingrowth fixation. Of the remaining 17 hips with a poorer press-fit, 7 hips (35.3%) showed bone ingrowth fixation and 6 hips (35.3%) had unstable fixation. Of the 36 hips showing bone ingrowth fixation, 28 hips (77.8%) exhibited stress mediated bone resorption. On the last follow-up radiographic examination, osteolysis occurred around the femoral stem and acetabular cup in 21 (36.8%) and 6 (10.5%) hips, respectively. CONCLUSION: The results of cementless AML total hip arthroplasty were acceptable up to 7 years but polyethylene wear and osteolysis should be followed carefully over the long term.