Long-term Results of Hybrid Total Knee Arthroplasty: Minimum 10-years Follow-up

PURPOSE: To evaluate the survival rate and long term clinical outcomes of hybrid total knee arthroplasty (TKA). MATERIALS AND METHODS: We retrospectively analyzed 113 hybrid TKAs (NexGen) in 86 patients that were followed for more than 10 years. Kaplan-Meier survival curves were generated using revision as an end point. Knee Society Score (KSS) and range of motion were evaluated for clinical assessment and plane radiographs were used to evaluate implant problems. RESULTS: At 11.2 years (range, 10 to 12.2 years) of follow-up on average, 7 knees required revision. The reason for revision was aseptic loosening in 4 knees (1 in femoral and tibial component and 3 in tibial component only) and infection in 3 knees. The survival rate was 93.8% at 12 years for all knees, and 96.5% when septic loosening was excluded. The KSS improved from 29.3 to 91.5 in the Cruciate-Retaining type (CR) and from 21.5 to 90.3 in the posterior stabilizing type (PS) at latest follow-up. The average range of motion was improved from 120.6degrees to 133.8degrees in the CR type and 119.5degrees to 135.5degrees in the PS type. CONCLUSIONS: Hybrid TKA provides good survival rates and clinical results comparable to cemented TKA.

The Length of the Patellar Tendon in Normal Adults

PURPOSE: This study was conducted to measure the length of the patellar tendon in normal adults and to analyze the effect of several anthropological variables on the patellar tendon length. MATERIALS AND METHODS: The study included 316 knees (278 males, 38 females) that were undergoing anterior cruciate ligament reconstruction with a bone-patellar-bone autograft. The patellar tendon length was measured on the middle 1/3 of the ipsilateral patellar tendon taken during the operation and we analyzed the relationships between the tendon length and age, weight, height and gender using simple correlation tests and linear regression analysis. RESULTS: The mean tendon length was 42.6 mm (range: 30~60 mm) and the mean age, mean weight and mean height was 32.7 years, 72.8 kg and 170.2 cm, respectively. There was weak negative correlation between the tendon length and age (Pearson correlation r=-0.187) and weak positive correlation between the tendon length and weight (r=0.288) but there was no significant correlation between tendon length and the body mass index (p=0.282) There was a positive correlation between tendon length and height (r=0.434). There was a significant difference between the males and females for the length of tendon (p<0.001), yet after removing the variance of height, the difference was statistically insignificant (beta=-0.041, p=0.491). The linear regression equation for the patellar tendon length (y, in centimeters) as a function of height (x, in centimeter) can be expressed as y=0.032x1.183. CONCLUSION: The length of the patellar tendon is correlated with height, and a patient's height can predict the length of the patellar tendon.

Factors Affecting the Range of Motion after Revision Total Knee Arthroplasty

PURPOSE: We aimed to analyze the clinical results and investigate the factors that affect the range of motion (ROM) after revision total knee arthroplasty. MATERIALS AND METHODS: We measured the range of motion from 61 knees of 55 patients who underwent revision total knee arthroplasty using the Nexgen(R) LCCK and we investigated the factors affecting the postoperative ROM, including age, the body mass index (BMI), the preoperative ROM, deformity, causes of revision (septic vs. aseptic) and the type of polyethylene inserts (constrained vs. posterior-stabilized). The clinical results and radiographic findings were assessed using the American Knee Society Score and the roentgenographic method of the American Knee Society. RESULTS: The mean range of motion was improved from 113.7degrees to 127.2degrees. The preoperative ROM (p=0.000) and diagnosis (p=0.006) significantly influenced the postoperative ROM, yet age (p=0.386), BMI (p=0.054), deformity (p=0.218) and the type of polyethylene insert (p=0.195) were not related to the postoperative knee ROM. The American Knee Society Knee Score and Function Score on average was improved from 31.7 and 27.9 points to 86.7 and 64.7 points, respectively. CONCLUSION: The range of motion and clinical results were satisfactory after revision total knee arthroplasty using the Nexgen(R) LCCK, and the important factors affecting the range of motion after operation were the preoperative ROM and the causes of revision. The range of motion after arthroplasty using the constrained type polyethylene insert was not inferior to that using the posterior-stabilized insert.

Recent Trend and Transition of Last 10 Years of Ski and Snowboard Injuries / 대한스포츠의학회지

To analysis the trend of ski and snow board injury, and use this study result in designing injuries prevention strategy. We studied 25,292 patients who had the ski and snow board injuries in a ski resort in Pyeongchang Gun, Gangwon Do, Korea during 1999-2001 season, 2005-2007 season, and 2008-2010 season. They were studied with a questionnaires, physical examination and radiograph. And the analysis was based on age, sex, injury type and site and slope level of difficulty. Snow board related injury have increased, injury to teens and thirties increased, injury to female snowboarder increased (p<0.001), contusion type of ski and snow board injury increased (p<0.001) and upper extremity injury increased but beginner grade slope injury (p<0.001) decreased since last 10 years. The overall type and site of ski and snowboard injuries have changed due to increased snowboard injury, gender and age of them have shown the diversity since last 10 years.

Bony Ankylosis Secondary to Heterotopic Ossification Following Total Knee Arthroplasty: A Case Report

Bony ankylosis secondary to heterotopic ossification following total knee arthroplasty is extremely rare, and to the best of our knowledge, there has been no reported case of this in Korea. We present such a case in a 48 year-old female who underwent primary total knee replacement due to traumatic osteoarthritis.

Treatment of the Acromioclavicular Joint Dislocation Using a AO Hook Plate

PURPOSE: We wanted to evaluate the results of treating acromioclavicular joint dislocation using an AO hook plate. MATERIALS AND METHODS: Between February 2008 and September 2009, 10 patients underwent implant removal after surgical treatment of acromioclavicular joint dislocation using a AO hook plate. The Constant-Murley scoring system was administered postoperatively for evaluating the clinical results, and simple X-ray was taken for evaluating the state of reduction. RESULTS: All cases showed satisfactory results on the clinical and radiological study. The mean Constant-Murley score at follow-up was 90.5 (range: 84~95). Three patients had some degree of discomfort with the hook plate, but these symptoms were relieved on removal of the plate. The radiological evaluation showed restoration of the vertical displacement of the clavicle in all the patients. No complications occurred such as infection, plate failure or redislocation after removal of the plate. CONCLUSION: The short term follow-up results of treating acromioclvicular joint dislocation using an AO hook plate were satisfactory both clinically and radiologically.

Patellofemoral Evaluation in Korean Patients using Three-dimensional Computed Tomography

PURPOSE: The purpose of this study was to analyze sex- and laterality-specific patellofemoral alignment using three-dimensional computed tomography (3D-CT) in normal Korean patients. MATERIALS AND METHODS: The study included 90 patients (45 men, 45 women; 180 knees) with no history of anterior knee pain or malalignment by physical examination. The mean patient age was 42.2 years (Range: 24~66 years). 3D-CT scanning was performed with each patient in the supine position with 15degrees of knee flexion. Patellofemoral joint alignment was evaluated by measuring the sulcus angle, congruence angle, lateral patellofemoral angle, condyle-patellar angle, and condyle-lateral angle. RESULTS: Comparing men and women, respectively, the sulcus angles were 145.9degrees+/-8.9 and 149.4degrees+/-9.7, the congruence angles were 12.6degrees+/-22.7 and 12.0degrees+/-19.6, the lateral patellofemoral angles were 9.9degrees+/-6.0 and 8.5degrees+/-4.3, the condyle-patellar angles (lateral facets) were 14.2degrees+/-7.1 and 11.8degrees+/-4.8, the condyle-patellar angles (patellar axes) were -8.5degrees+/-7.7 and -10.6degrees+/-6.1, and the condyle-lateral angles were 15.5degrees+/-7.6 and 16.4degrees+/-4.0. There was no significant difference in these measurements between left and right knees, but there was a significant difference in the sulcus angle and condyle-patellar angle between men and women (p<0.05). CONCLUSION: These data will hopefully serve as a basis for evaluating normal patellofemoral alignment and for diagnosing patellofemoral malalignment in Korean patients.

Relationship between the Arthritic Changes and a Deficiency of the Anterior Cruciate Ligament in Osteoarthritic Knees

PURPOSE: The aim of this study is to determine the relationship between the arthritic changes and a deficiency of the anterior cruciate ligament (ACL) in osteoarthritic knees. MATERIALS AND METHODS: Between May 2003 and January 2008, 815 cases of total knee arthroplasty that were due to degenerative osteoarthritis of the knee were enrolled in this study. Flexion contracture, the tibia-femoral angle, translocation of the tibial spine and erosion on the posteromedial tibial plateau were assessed and we tried to determine the relationship between these findings and an ACL-deficiency. RESULTS: The mean flexion contracture in the knees with a deficient ACL was 10.7degrees and this was 8.8degrees in the knees with an intact ACL, and this difference was statistically significant (p=0.001). The tibia-femoral angle of the patients with an ACL-deficiency was 7.97degrees varus on average, and that for patients with an intact ACL was 4.38degrees varus, and the difference was found to be highly dependent upon the ACL's integrity (p=0.000). 77.6% of the knees with varus deformity exceeding 15degrees showed an abnormal ACL. Translocation of the tibial spine doesn't predict ACL integrity. Bone erosion on the posteromedial tibial plateau was significantly frequent in patients with ACL-deficient knees (p=0.000). For the knees with erosion on the posteromedial tibial plateau, 85% of these knees showed an ACL deficiency. CONCLUSION: Varus deformity exceeding 15degrees and erosion on the posteromedial tibial plateau can reflect ACL deficiency.

Early Results of MIS-QS Total Knee Arthroplasty: A Comparison with Conventional Procedure for the Same Patient / 대한정형외과학회잡지

PURPOSE: This study assessed the early clinical and radiological results of Minimally Invasive Surgery- Quadriceps sparing total knee arthroplasty (MIS-QS TKA), and compared these results with those of conventional TKA. MATERIALS AND METHODS: Between August 2004 and March 2005, 17 patients with bilateral TKA on their one side using a regular procedure and the other using the MIS-QS technique were evaluated and compared. The clinical assessment was performed by measuring the range of motion, Knee Society Score, and a radiological evaluation by standing anteroposterior, supine lateral, and Merchant view preoperatively, 2 weeks, 6 weeks, 3 months and 1 year after surgery. Statistical analysis was performed using a paired t-test. RESULTS: The average range of knee motion was slightly larger in the MIS-QS group at all periodsbut there was no statistical difference between the two groups. The Knee Society Score was similar at the 3 month and 1 year periods. The alignment of the implants was satisfactory in both groups and postoperative patellar alignment checked in the Merchant view was better in the MIS-QS group at all periods. CONCLUSION: There were no differences in the clinical aspects at 1 year period between the two groups. However, the MIS-QS group showed better patellar alignment than the conventional group for up to 1 year.

Pain after Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study examined the factors affecting pain, the pattern of pain, as well as the intensity and duration after a total knee arthroplasty. MATERIALS AND METHODS: As a prospective study, 69 osteoarthritic knee patients who underwent total knee arthroplasty from Jan. 2004 to Nov. 2004, were examined using a visual analogue scale (VAS) in order to determine the pain intensity, duration, pain character and pattern at 6 weeks, 3 months, 6 months and 1 year after surgery. We checked for possible factors such as height, body weight, body mass index (BMI), HSS score, deformity, range of motion preoperatively, prosthesis type and operation procedure intraoperatively, the HSS score and range of motion at postoperative one year. The Pearson correlation test and Kruskal-Wallis test were used for statistical analysis. RESULTS: The mean preoperative and 1-year postoperative HSS score was 61.4 and 94.6, respectively. The height, body weight, body mass index (BMI), HSS score, deformity, range of motion, prosthesis type and surgical procedure were not related to the intensity and duration of the pain. The mean postoperative VAS score at 6 weeks and 3, 6 and 12 months was 4.3+/-1.0, 2.7+/-0.9, 1.6+/-0.4, 1.3+/-0.4, respectively. Five patients had mild pain until postoperative one year. CONCLUSION: The pain after total knee arthroplasty disappeared with time. However, mild knee pain sometimes remained even 1 year after surgery.

Treatment of Periprosthetic Femoral Fractures with Cable Plate

PURPOSE: To evaluate the results of Cable plate fixation for the treatment of periprosthetic femoral fracture after hip arthroplasty. MATERIALS AND METHODS: We reviewed 10 cases of periprosthetic femoral fractures after hip arthroplasty between Nov. 2002 and May 2004. The mean follow up periods were 20 months. The fractures were classified according to Vancouver classification. Seven cases of type B1, one case of type B3 and two cases of type C were treated with open reduction and internal fixation with Cable plate. Evaluation of results was based on mean union time, postoperative complications and Harris hip score. RESULTS: The mean time for bony union was 4.8 months in type B1, 6 months in type B3 and 8 months in type C fracture. As for complications, there were refracture, metal breakage and nonunion. The postoperative mean Harris hip score was 91.5 points for type B1, 85 points for type B3 and 72.5 points for type C fracure. CONCLUSION: Cable plate can be useful for treatment of periprosthetic femoral fractures after hip arthroplasty, but the selection of treatment methods should be cautiously made according to the type of fracture and status of patients.

Percutaneous Vertebroplasty in the Treatment of Osteoporotic Compression Fracture (99 Patients, 171 Vertebral Bodies)

PURPOSE: This study was designed to compare the clinical and radiologic outcome of the patients who underwent percutaneous vertebroplasty among the groups based on follow-up period and BMD. MATERIALS AND METHODS: A total of 99 patients (171 vertebral bodies) underwent percutaneous vertebroplasty from January 2001 to September 2003. The patients were divided into 3 groups by follow-up periods, and also divided into 2 groups by BMD. We investigated the difference of radiologic and clinical effects among the groups. Radiologic findings was assessed as vertebral height restoration rate and rate of reduction loss by measurement of the height of vertebral body. The clinical outcomes were graded into 5. The statistical analysis was done using Chi-squire test and Independent-samples T test. RESULTS: Among the groups divided by follow-up period, there was no statistically significant difference of clinical and radiologic results except the rate of reduction loss between group I and group III (p>0.05). Between the groups divided by BMD, there was no statistically significant difference of clinical and radiologic results. CONCLUSION: Percutaneous vertebroplasty with bone cement for the osteoporotic compression fracture is an efficient procedure and considered as technique producing pleasurable clinical and radiologic results regardless of follow up-period and BMD.

The Effect of Aprotinin for Reducing Blood Loss and Amount of Transfusion in Total Knee Arthroplasty

PURPOSE: To evaluate the effect of Aprotinin in reducing postoperative blood loss and amount of transfusion in total knee arthroplasty. MATERIALS AND METHODS: In a prospective study, 100 patients undergoing bilateral total knee arthroplasty were investigated. A low dose Aprotinin was administred in randomly selected fifty patients and the other fifty patients were selected as control group. Postoperative blood loss, the amount of intraoperative and postoperative transfusion, preoperative and postoperative value of hemoglobin and hematocrit were evaluated and statiscally compared. Postoperative complications were assessed. RESULTS: Significant reduction in postoperative total blood loss was observed (Aprotinin group:1195 ml, control group:2216 ml). The amount of packed red blood cells transfusion was also reduced in Aprotinin group (Aprotinin group: 2.0 units, control group: 4.0 units), and fresh frozen plasma (Aprotinin group: 0.1units, control group: 1.2 units) as well. Aprotinin also reduced the decline in hemoglobin and hematocrit levels at the first, second and fourth postoperative days. There were no clinical evidence of complications such as anaphylactic shock, deep vein thrombosis, thromboembolism, myocardiac infarction and acute renal failure. CONCLUSION: Aprotinin is safe and effective in reducing postoperative blood loss and amount of blood transfusion in total knee arthroplasty.

Two Stage Surgical Treatment of Acute Traumatic Knee Dislocation / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to determine the effectiveness of a new two stage surgical treatment for acute traumatic knee dislocation. MATERIALS AND METHODS: The study involved 15 knees in 14 patients treated between October 1997 and November 2001. The mean follow-up period was 24 months. In the first surgical stage, medial and/or lateral ligament complexes were repaired or reconstructed within two weeks of the injury. In the second surgical stage, once full range of motion was obtained 3-6 months later, anterior or posterior cruciate ligaments (ACL or PCL) were reconstructed if significant laxity was present. The final outcomes were assessed using stress X-rays, range of motion and Lysholm score. RESULTS: There were ten cases of MCL tear and eight cases of LCL tear. All MCL and LCL injuries were either repaired or reconstructed. All cases had both ACL and PCL tears. Following the first stage of MCL/LCL surgery, the second stage surgery of ACL or PCL reconstructions was deemed to be necessary in three and seven cases, respectively. Five cases did not require ACL or PCL reconstruction. In stress X-rays at the last follow up examination, MCL, LCL, ACL and PCL instability was graded as 0 or 1 in 15, 14, 15 and 11 cases, respectively. PCL instability was graded as 2 in four cases. The mean postoperative Lysholm score was 87.6 points. CONCLUSION: The two stage surgical approach described here resulted in good outcomes for patients suffering from acute knee dislocation patients in terms of range of motion and stability.

Incidence of Acetabular Retroversion in Dysplastic Hip / 대한정형외과학회잡지

PURPOSE: This study analysed the incidence and the degree of an acetabular retroversion in a dysplastic hip. MATERIALS AND METHODS: 28 cases of dysplastic hips, in whom the CE angle was <20 degrees, and 20 cases of control group with a normal CE angle were enrolled in this study. Four cuts among the CT images (most superior cut of the femoral head, middle cut of the proximal half, middle portion, and middle cut of the distal half of the femoral head) were used to measure the acetabular anteversion. RESULTS: In the control group, anteversion of four cuts (form the cranial to caudal) were observed with an average of 4.1, 10.3, 16.5, 19.7degrees, and there was one case with a retroversion. In the dysplastic hips, the average anteversion angles were 4.4, 11.0, 17.9, 20.8degrees, and 9 cases with retroversion were discovered. In all cases showing retroversion, an overlapping of the acetabular anterior and posterior wall (cross-over sign) was observed on the simple pelvis AP radiography. CONCLUSION: There was a 32% incidence of acetabular retroversion, which was much higher than the control group (p<0.05). Therefore, in order to prevent an over-correction of the retroversion, which may cause impingement, the presence and the amount of retroversion must be recognized using CT before performing a periacetabular osteotomy.

Acetabular Degeneration in Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: To determine the degree of acetabular cartilage degeneration and factors that influence acetabular cartilage degeneration in osteonecrosis of the femoral head (ONFH). MATERIALS AND METHODS: We obtained acetabular cartilage from weight bearing and non-weight bearing portions, including subchondral bone, from 34 hips in 32 patients with ONFH who underwent total hip arthroplasty. Histologic grading by Hematoxylin & Eosin staining and Safranin O staining, and immunohistochemical staining with chondroitin sulfate antibody and type II collagen antibody were performed. RESULTS: Histological grade had no significant correlation with stage, age, weight, or duration or degree of head depression, by the Wilcoxon rank sum test. The weight bearing and the non-weight bearing portions of acetabular cartilage were divided into two groups according to the existence and non-existence of femoral head depression. A significant difference (p=0.01), by Fisher's exact test, was found between the two weight bearing groups in terms of histologic grade. However no significance (p=0.45) was found between the two non-weight bearing groups. The distribution of type II collagen antibody's stainability score show most values in the normal range, while that of chondroitin sulfate antibody's was mainly in the upper. CONCLUSION: The degeneration of the weight bearing portion of acetabular cartilage in ONFH is considered to be due to local rather than general changes. When head depression in absent, acetabular cartilage degeneration is less severe than previously reported.

Effect of Norepinephrine Irrigation in Primary Total Knee Replacement Arthroplasty / 대한정형외과학회잡지

PURPOSE: We studied the effect of norepinephrine irrigation during total knee replacement arthroplasty (TKRA) on blood loss reduction. MATERIALS AND METHODS: A prospective study of 30 patients who received TKRA from the same surgeon between March 2003 and November 2003, was done. Patients were alternately allocated into two groups. The study group included 15 cases in which 1: 200, 000 diluted norepinephrine was used for irrigation intra-operatively, whereas the control group included 15 cases received normal saline irrigation. Postoperative drain and transfusion amounts were compared between the two groups using the independent t-test. RESULTS: Early bleeding amounts for 6 hours after surgery were a significant difference between the two groups (study group 410.3 cc, control group 517.3 cc, p-value=0.03). However, delayed bleeding amounts during postoperative 6-48 hours (study group 163.8 cc, control group 244.7 cc, p-value=0.05) and transfusion amounts (study group 0.80 unit, control group 1.47 unit, p-value=0.07) were smaller in the study group, but showed no significant differences. CONCLUSION: Using norepinephrine diluted in normal saline as an irrigation solution during TKRA can be considered for reducing early post operative bleeding.

Treatment of Distal Tibial Metaphyseal Fracture Using MIPPO Technique / 대한족부족관절학회지

PURPOSE: To evaluate the results of MIPPO (minimal invasive percutaneous plate osteosynthesis) technique for distal tibial metaphyseal fractures. MATERIALS AND METHODS: It is a retrospective study of 13 patients who were treated by MIPPO technique for distal tibial metaphyseal fractures from Jan. 2001 to Jan. 2003. The average age was 46.7 years and mean follow-up period was 13.3 months. According to AO classification, there were 8 cases of A1, 3 cases of A2, 1 case of B1 and 1 case of C2. One case of A1 was a Gustilo-Anderson type I open fracture and fibular fractures were combined in 12 cases. We applied anatomical reduction and internal fixation for the fibular fractures and internal fixation on the medial side of the tibia by MIPPO technique for distal tibial metaphyseal fractures. Clinical results were evaluated using radiographic results, Neer score, the starting time of postoperative exercise and clinical complications. RESULTS: According to the Neer score, all cases showed satisfactory results. Active ankle ROM was started at average 2.4 weeks (2~4 weeks) and full weight bearing ambulation at average 5.2 weeks (4~8 weeks) postoperatively. Union of fractures was obtained by average 14.4 weeks (8~18 weeks) postoperatively. Two cases showed 5 degrees limitation of motion without functional deficits and other cases showed satisfactory ROM results. One case had 6 degrees valgus deformity without functional deficits. There were not any other complications like soft tissue problems and delayed-or non-union. CONCLUSION: MIPPO technique for the treatment of distal tibial metaphyseal fractures is a feasible technique with a good clinical outcomes.

Comparative study on postoperativeevaluation methods of knee ligament injuries / 대한정형외과학회잡지

No abstract available.