Comparison of Postoperative Infection-Related Complications between Cemented and Cementless Hemiarthroplasty in Elderly Patients: A Meta-Analysis

BACKGROUND: The purpose of this review was to assess the risk of infection-related complications following cemented and cementless hemiarthroplasty in elderly patients. METHODS: We searched PubMed, EMBASE, and Cochrane Library databases for published randomized clinical trials comparing cemented hemiarthroplasty with cementless hemiarthroplasty in patients with a femoral neck fracture and more than 65 years of age. Eight randomized controlled trials were available for analysis. A meta-analysis (with a fixed-effects model) and a meta-regression analysis (with continuous variables) were performed. RESULTS: The 8 trials included 1,204 hips (608 cemented and 596 cementless). There was no significant difference between the cemented and cementless groups regarding the incidence of deep infection, superficial infection, pneumonia, and urinary tract infection. The overall incidence of postoperative deep infection was 2.3% (14/608) in the cemented group and 1.2% (7/596) in the cementless group (relative risk, 1.74; 95% confidence interval, 0.74 to 4.14; I² = 0%; p = 0.206). No publication bias was found in the funnel plot. CONCLUSIONS: Results of our meta-analysis suggest that when selecting a fixation method for hemiarthroplasty, infection-related postoperative complications are not the determinant factor to consider.

Injury to the Anterior Tibial Artery during Bicortical Tibial Drilling in Anterior Cruciate Ligament Reconstruction

Many complications have been reported during or after anterior cruciate ligament (ACL) reconstruction, including infection, bleeding, tibial tunnel widening, arthrofibrosis, and graft failure. However, arterial injury has been rarely reported. This paper reports a case of an anterior tibial arterial injury during bicortical tibial drilling in arthroscopic ACL reconstruction, associated with an asymptomatic occlusion of the popliteal artery. The patient had a vague pain which led to delayed diagnosis of compartment syndrome and delayed treatment with fasciotomy. All surgeons should be aware of these rare but critical complications because the results may be disastrous like muscle necrosis as in this case.

The Effectiveness of Joint Position Sense Test in Evaluating the Proprioceptive Function after Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

We designed a study to evaluate the change of the proprioceptive function with joint position sense (JPS) during 1 year follow-up period after anterior cruciate ligament (ACL) reconstruction using hamstring autograft. Thirty-eight men who underwent ACL reconstruction were tested for International Knee Documentation Committee subjective knee score, Tegner activity score, Lysholm score, KT-2000 arthrometer, isokinetic strength test, functional performance test (carioca, co-contraction, shuttle run test, one-hop test) and JPS at preoperation, 6 months, and 12 months postoperation. The contralateral healthy knee was used as control. There were no significant differences of JPS between the involved knee and healthy knee at any time period. Repeated measures analysis of variance of the active JPS revealed that there was no significant difference during the follow up periods. The change patterns of passive JPS of extension and flexion were out of accordance with the improving clinical status following ACL reconstruction. Most of the clinical parameters did not show the significant correlation with active and passive JPS at any time period. In conclusion, JPS does not reflect the change of proprioceptive function following ACL reconstruction.

False Negative Bone Scan in 56-year Old Man with L2 Compression Fracture Performed 78 Hours after Trauma: A Case Report

It is very rare that the bone scan after 72 hours from the trauma doesn't exhibit the increased radio-nuclide uptake in the patient with fracture. The purpose of this study is to report the case that indicate the false negative finding in the bone scan performed after 78 hours from the trauma in the 56-year-old man with L2 compression fracture, including a review of the relevant literatures.

Change of Kyphotic Angle in Posterior Pedicle Screw Fixation for Thoracic and Lumbar Burst Fractures: Comparison Study by the Screw Fixation Level

PURPOSE: To evaluate the relationship between the level of screw fixation and the stability of the segment of endplate fracture after posterior pedicle screw instrumentation for thoracic and lumbar burst fractures. MATERIALS AND METHODS: The 41 patients of burst fractures who had been operated with pedicle screw instrumentation were retrospectively evaluated. The patients were divided into two groups by the levels of screw fixation. One group was treated with screws fixed by one-level to the direction of fractured endplate (One-level group, 16 cases). The other group was treated with screws fixed by two-level to the direction of endplate fracture (Two-level group, 25 cases). The two groups were compared by the radiographic changes of kyphotic angle between the day of surgery and 6 months after surgery. RESULTS: At the 6 months, one-level group showed the change of kyphotic angle of 17.5+/-2.4 degrees, which was different from two-level group of 5.2+/-0.8 degrees (p=0.000). CONCLUSION: In posterior pedicle screws fixation for thoracic and lumbar burst fractures, 2 vertebrae to the direction of the endplate fracture should be included to prevent the postoperative kyphotic change.

Short-term Results of Medial Displacement Calcaneal Osteotomy for Flexible Flatfoot / 대한족부족관절학회지

PURPOSE: To evaluate the short-term results of medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot deformity. MATERIALS AND METHODS: Twenty four patients (25 feet) who had undergone medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot between July 2004 and May 2007 were included. The mean age was 43.6 years (16~78 years). The mean follow-up was 26 months (14~50 months). Clinical outcomes were assessed using American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS). Six radiographic parameters were measured from weightbearing radiographs to assess the difference between preoperative and postoperative radiographs. RESULTS: The mean AOFAS score improved from 57.9 points preoperatively to 89.2 points at latest follow-up (p=0.000). The mean VAS improved from 62 points preoperatively to 23 points at latest follow-up (p=0.000). The mean talonavicular coverage angle on anteroposterior (AP) view changed from 20.2 degrees to 16.0 degrees (p=0.002). The mean calcaneal pitch angle on lateral view changed from 12.6 degrees preoperatively to 14.5 degrees at latest follow-up (p=0.001). Regarding these radiographic parameters, the difference between interobserver measurements was larger than that between pre- and post-operative measurements. The calcaneus was transferred medially by average 11.8 mm (p=0.003), which was 27.9% of the width of calcaneal tuberosity (p=0.000). The mean talo-first metatarsal angle on AP and lateral views, and navicular height on lateral view were not significantly changed. CONCLUSION: Medial displacement calcaneal osteotomy without flexor digitorum longus transfer for flexible flatfoot could lead to improve the clinical outcomes, although the restoration of medial longitudinal arch was not clinically significant.

Clinical Results of the Subtalar Arthroereisis for the Flat Foot / 대한족부족관절학회지

PURPOSE: To determine the clinical and radiographic results of arthroereisis using the Kalix(R) implant (Newdeal, Lyon, France) for the treatment of flexible flatfoot deformity. MATERIALS AND METHODS: From February 2005 to February 2007, we performed the subtalar arthroereisis on 8 patients (9 feet) of symptomatic flexible flat feet after more than 6 months of conservative treatment. Average age was 14.5 years (11~29 years) old. We checked the functional status with AOFAS functional score pre-operatively and at final follow-up. Radiologically, we took weight bearing anterior to posterior and lateral view of the feet, and measured the talo-first metatarsal angle, calcaneal pitch angle in pre-operatively and at final follow-up. RESULTS: Mean follow up period was 34.4 months. Average AOFAS score improved from preoperatively 65.6 to postoperatively 94.8. Average lateral talo-first metatarsal angle reduced from 12.8degrees preoperatively to 1.6degrees at final follow-up. Average anterior to posterior talo-first metatarsal angle was reduced from 15.1degrees preoperatively to 8.3degrees at final follow-up. Average calcaneal pitch angle was increased from 9.5degrees preoperatively to 12.0degrees at final follow-up. CONCLUSIONS: Subtalar arthroereisis with Kalix(R) implant can be considered to be one of treatment options symptomatic flatfoot deformity patients.

Acute Myelopathy due to Ruptured HNP in Cervical OPLL Patient: Case Report / 대한척추외과학회지

Ossification of the posterior longitudinal ligament (OPLL) is an uncommon disorder that may be associated with slowly progressing neurological symptoms. We encountered a case of acute cervical myelopathy due to a ruptured disc in an asymptomatic patient with OPLL, who was surgically managed by the anterior approach and fusion. We report the case with a review of the relevant literature.

Correlation between Progression of Compression and Bone Densiometry Index in Osteoporotic Compression Fracture of Thoracolumbar Spine

PURPOSE: To evaluate whether progression of compression correlates with bone densiometry index in patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine. MATERIALS AND METHODS: Using the results of bone densiometry, 30 patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine between March 2002 to March 2005 were categorized into 4 groups; above 80%, 70 to 80%, 60 to 70%, and below 60%. We compared the measurements of sagittal index and anterior vertebral height from the plain radiographs taken at the time of injury and following three consecutive months after the injury. RESULTS: Patients with lower bone densiometry index had greater amount of compression at the time of injury and more rapid progression of compression. We also found that progression of compression was lowest during the first month after injury in all groups. CONCLUSION: Patients with low bone densiometry index in osteoporotic thoracolumbar compression fracture are susceptible to more rapid progression of compression and should have early brace application and longer duration of treatment for osteoporosis.

MRI findings of Root Tear of Medial Meniscus

PURPOSE: This study was to elevate the accuracy of MRI diagnosis by means of inspection of the demonstrable findings of the root tear of medial meniscus. MATERIALS AND METHODS: From September 2003 to August 2004, MR images were obtained from 15 of 29 patients who had a root tear of medial meniscus on arthroscopic examination. Each sagittal, axial and coronal images was obtained. Of 15 patients, three were men and 12 were women. The mean age was 59.3 years. RESULTS: All of 15 patients were diagnosed as medial meniscus root tear. Sagittal images showed loss of shape and signal intensity. Axial images showed radial linear defect. And coronal images showed vertical linear defect. CONCLUSION: The characteristic findings from three planes of MRI were helpful for diagnosis of medial meniscus root tear.

Comparison of the Results of Percutaneous Vertebroplasty for Treating Osteoporotic Vertebral Compression Fracture and Posttraumatic Vertebral Collapse (Kummell's disease) / 대한척추외과학회지

STUDY DESIGN: The comparison was based on the radiographc and clinically differences of 96 vertebroplasty cases. PURPOSE: This study evaluated the clinical and radiological results of performing percutaneous vertebroplasty for acute or subacute osteoporotic vertebral compression fracture (group A) and for posttraumatic vertebral collapse (Kummell's disease) (group B). SUMMARY OF LITERATURE REVIEW: Percutaneous vertebroplasty is a minimal invasive procedure for the treatment of a painful collapsed vertebral body MATERIALS AND METHODS: We experienced 67 cases of group A and 29 cases of group B, and we followed these patients for 2 years or more. We evaluated the clinical results by using the serial visual analogue scale (VAS) and the radiological results were evaluated by measuring the restoration of the anterior vertebral height and the change of the kyphotic angle. We also compared both groups for their bone mineral density (BMD) and new fracture rate. RESULTS: Statistically significant pain relief was obtained by both groups in the perioperative period. The average VAS change was 6.5 (from 8.7 preoperatively to 2.2 postoperatively) in group A, and 7.1 (from 9.1 preoperatively to 2.0 postoperatively) in group B on a 10 point pain scale. The anterior vertebral height increased an average of 4.9mm (16.5%), (from 16.8mm preoperatively to 21.7 mm postoperatively) in group A, and 6.5 mm (21%) (from 12.8 mm preoperatively to 19.3 mm postoperatively) in group B on the perioperative period. But the height was minimally decreased more that it was measured at the immediate postoperative period: 18.7 mm in group A, and 16.2 mm in group B on the last follow up. The kyphotic angle was restored an average of 5.2 degrees (from 32.4 degrees preoperatively to 27.2 degrees postoperatively) in group A, and 4.9 degrees (from 39.5 degrees preoperatively to 34.6 degrees postoperatively) in group B on the perioperative period. But the angle was increased more than that measured preoperatively: about 1.7 degree in group A and group B on the last follow up. There's no significant difference in the BMD between the groups. New fracture developed in 17.9% (12) of group A, and 20.7% (6) of group B. We did this procedure for 15 cases of new fracture, and then the VAS change was an average 5.0 immediately after the operation. CONCLUSIONS: Percutaneous vertebroplasty was an effective treatment method for both groups and there were no statistically significant differences in the clinical and radiological results. Care must be taken due to the relatively high rate of new fracture and this can be resolved by repeat vertebroplasty

Degenerative Changes of Adjacent Segment Following Cervical Anterior fusion: Correlation with Preoperative MRI Findings of Adjacent Disc / 대한척추외과학회지

STUDY DESIGN: We retrospectively reviewed the preoperative and postoperative radiographs of patients who underwent anterior cervical discectomy and fusion. OBJECTIVES: We wanted to determine whether the preoperative Magnetic Resonance Imaging (MRI) findings of the levels adjacent to the level of fusion correlated with the postoperative degenerative changes seen on X-ray after anterior cervical discectomy and fusion. SUMMARY OF LITERATURE REVIEW: Anterior cervical fusion causes acceleration of the degenerative changes at the levels below or above the fused segment. These changes may be accelerated if preoperative MRI shows degenerative changes at the levels adjacent to the segment to be fused. MATERIALS AND METHODS: Twenty-two patients (forty-four adjacent levels) who underwent anterior cervical discectomy and fusion from January 1998 to August 2002 (average follow up: 2 years and 6 months, range: 2 to 4 years) were enrolled in this study. Preoperatively, all the patients had no degenerative changes at adjacent levels on the plain radiographs, but they had at least one adjacent level with degenerative findings on MRI. The patients were grouped according to the findings of the adjacent levels seen on MRI: low signal changes on the T2 weighted image (group A), disc bulging on the sagittal and axial images (group B), annular tear seen on the axial image (group C), osteophyte formation (group D), and no abnormalities (group E). RESULTS: Out of 44 cases of 22 patients, 14 cases (31.8%) showed degenerative changes. 2 out of 7 in group A, 6 out of 11 in group B, 3 out of 4 in group C, 2 out of 3 in group D and 1 out of 19 in group E showed degenerative changes on X-rays at the final follow up. CONCLUSION: Our findings suggest that abnormalities on the levels adjacent to the level to be fused, as seen on preoperative MRI, predispose these levels to degenerative changes postoperatively.

Surgical Treatment of Cervical Myelopathy Due to Soft Disc Herniation / 대한정형외과학회잡지

PURPOSE: To analyze the characteristics and surgical results in cervical myelopathy patients caused by soft disc herniation. MATERIALS AND METHODS: From June 1997 to August 1998. The authors treated cervical myelopathy patients who had a soft disc herniation. We evaluated the symptoms and signs, simple X-rays, the MRI, the JOA score and Hirabayashi's recovery rate. RESULTS: On simple X-ray, the narrowest A-P diameter was 13 mm, as the average was 14.9 mm, and no bony structural stenosis was found. On MRI, the average of the cord compression was 2.92 mm, and the average A-P compression ratio was 40.2%. An intermediate to high signal change in the cord was found in 8 cases. All patients improved after surgery and the average Hirabayashi's recovery rate was 61.1%. CONCLUSION: If, cord compression due to posterior soft disc herniation is severe, patients can have cervical myelopathy. Lateral disc herniation can also be a cause of cervical myelopathy. Cervical myelopathy due to soft disc herniation can be treated with a good results by using an anterior discectomy and interbody fusion method.

Analysis of Arthroscopic Management for Degenerative Knee / 대한정형외과학회잡지

PURPOSE: To correlate clinical results of arthroscopic debridement of degenerative knee with preoperative factors. MATERIALS AND METHODS: A retrospective survey of 61 patients (81 knees) with degenerative arthritis of knee treated with arthroscopic debridement from June 1995 to June 1997 was conducted. The average follow-up period was 22.7 months (12-35 months). There were 6 male and 55 female patients. The average age was 61.1 years. The arthroscopic procedure included excision of osteophytes, removal of loose body, meniscal trimming, synovectomy and irrigation of the knee joint. Statistical analysis was done for parameters such as knee alignment, joint space narrowing, flexion contracture, meniscal tear, articular cartilage degeneration, age, follow-up period and preoperative Insall knee score. RESULTS: A statistically significant difference in clinical results was noted in the separate subgroups for radiographic alignment (chi-square test, P=0.007) and degree of cartilage degeneration (P=0.006). Those patients with joint space narrowing, flexion contracture, meniscal tear or low Insall knee score had poor results after arthroscopic surgery. CONCLUSIONS: Though the result of arthroscopic debridement of degenerative knee is known to be unpredictable, some preoperative factors are correlated with poor outcomes, and arthroscopic treatment should be carefully selected.

Studies on Unreduced Fragments in Closed Interlocking Nailing of Comminuted Femoral Fracture / 대한정형외과학회잡지

PURPOSE: During interlocking nailing the displaced butterfly fragments can be left in situ or reduced by opening the fracture site. The purpose of this study is to investigate the fate of the displaced comminuted butterfly fragments when left unreduced and factors that influences fracture union in comminuted femoral fracture after closed interlocking nailing. MATERIALS AND METHODS: Out of 95 closed interlocking nailings done for fractured femur from July 1990 to July 1993, 43 femoral fractures that had comminuted fragments larger than 1 cm were followed for more than 18 months postoperatively, The correlations between the size of the comminuted fragments, its distance from the femoral shaft, the angulation of the fragment, the gap of the main fracture sites and bone union were analyzed. RESULTS: The distance between the fragment and the femoral shaft and angulation spontaneously decreased gradually, even the fractures having inverted fragments were united uneventfully, and the union rate of the fractures with gap less than 3 mm was higher than those with gap greater than 3 mm. CONCLUSIONS: The displaced fragment need not be reduced by open method and minimizing the fracture gap is recommended in increasing the union rate.

The Effects of Arthroscopic Lavage Combined with Percutaneous multiple Drilling in Patients with Degenerative arthritis of knee

42 knees with degenerative arthritis underwent arthroscopic lavage and 7 knees underwent arthroscopic lavage combined with multiple bone drilling in between 1994 and 1995 and followed average 12 months. Clinical evaluation using the hospita1 for specia] surgery knee scores (HSS scores) was done at last follow up and classified into 4 groups: excellent (90-99), good (80-89), fair (70-79) and poor (less than 70). The results were as follows: l. Of the 42 knees of the lavage group, 6 knees (16%) was excellent, 14 knees (33%) good, ]7 knees (40%) fair and 5 (11%) knees poor. Success group (Excellent & Good) were achived in 20 knees (49%). 2. Of 17 knees treated with arthroscopic lavage comhined with multiple bone drillig resulted in excellent in 9 knees (53%), good in 4 knees (23%), fair in 2 knees (12%) and poor in 2 knees (12%). Success group were achived in 13 knees (76%). 1n conclusion, we helieve that multiple bone drilling in conjunction with arthroscopic lavage has more favorable effect on the pain relief for degenerative osteoarthritis of the knee than arthroscopic lavage only.

Differential Diagnosis of Vertebral Lesion by Magnetic Resonance Imaging / 대한정형외과학회잡지

Differential diagnosis of vertebral lesion by simple radiography is not so easy whether the lesion is benign or malignant. The purpose of this study is to evaluate that the magnetic resonance imaging characteristics can differentiate benign or malignant vertebral lesions. In this study, thirty-nine cases of signal change within the vertebral body by MRI was reviewed retrospectively and the followings are the summary of the results. It is difficult to differenciate benign or malignant lesions, only based on MRI signal changes or vertebral lesion patterns. But those cases of pedicle involvement, complete replacement of bone marrow in T1image and associated soft tissue mass or cord compression are strongly suggest the possibility of malignancy and need further study.

Follow-up study of Surgical Treatment of Lumbar Spinal Stenosis Using Wiltse Instrumentation / 대한척추외과학회지

No abstract available.

Complication in Learning Process of Surgeon after Interlocking Intramedullary Nailing for Long Bone Fracture / 대한정형외과학회잡지

There are many advantages in treating long bone fractures with interlocking intramedullary nail and its advantages are well known. Although it is used widely, many major and minor complication can develop in spite of meticulous operation techniques. Frist fifty consecutive interlooking intramedullary nail of two different surgeon, total of 100 cases that were operated in Seoul Paik Hospital from January, 1991 to July, 1994, were reviewed and the complications were analyzed with various factors. 1. Among the 100 cases, a total of 30(30%) major and minor complications had developed. But only 4 major complications which needed reoperation or poor result occurred. 2. Among the complications that had developed, angulation and rotation deformity being 10 cases were the most common, other complications were delayed union in 5 cases, nonunion in 2 cases, problem of screw in 4 cases, metal failure in 2 cases, misentry point in 2 cases and others in 5 cases. 3. There were no remarkable difference between surgeon A and surgeon B. The complications decreased abruptly after 30th case for each surgeon and only a few complications, probably due to complex fracture pattern, occurred. In conclusion, complications after interlocking intramedullary nailing can be reduced by meticulous preoperative planning and learning process of surgeon.

Surgical Treatment of Cervical Disc Herniation / 대한정형외과학회잡지

To evaluate the results of anterior decompression and fusion with autogenous bone graft for cervical disc disease, the authors reviewed 18 cases of cervical disc herniation which were treated surgically at Inje Univ. Paik Hosp. from 1990 to 1994 with special interest in the thickness of the bone graft. All cases have been followed for more than 12 months. We try to know the clinical results of anterior decompression and fusion with autogenous bone graft. At this treatment, controversial point is a ideal thickness of graft and the width of distraction. Therefore, we follow up the correlation between thickness of graft on roentgenogram and clinical results. The clinical results were satisfactory as excellent in 11 cases, good in 5 cases according to criteria of Robinson et al. Successful fusion occured in 16 cases within 3 months after their initial procedure, and fusion failure resulted in 2 cases. 3mm distraction from baseline disc height was considered ideal thickness of graft after anterior decompression and all cases healed successfully. We concluded that 3mm distraction from baseline disc height is necessary for successful decompression & fusion.