Relationship Between ground Surface and Tibial Posterior Slope at Erect Posture in Total Knee Arthroplasty

PURPOSE: To evaluate the perioperative changes of the relationship between tibial posterior slope and ground surface and the factors which influence the perioperative changes of the relationship between tibial posterior slope and ground surface following total knee arthroplasty. MATERIALS AND METHODS: Between Sept. 2005 and Feb. 2006, 94 consecutive primary total knee arthroplasty with posterior cruciate ligament-retaining type performed in 50 patients by one surgeon. Posterior slope of the proximal tibia resection in extramedullary guide was fixed at 5degrees. All the retrieved patients wore a 90degrees ankle brace and stood on the ground during radiographic examination. We prospectively analyzed the measurement of tibial posterior slope angle, the angle between tibial posterior slope and ground surface and the angle between a midline from 1st metatarsal shaft to talus and ground surface on preoperative and postoperative 2-weeks radiographs. RESULTS: On preoperative radiograph, average of tibial posterior slope angle is 11.3degrees and 11.5degrees in right and left knee, respectively. Angle between tibial posterior slope and ground surface is an average of 8.8degrees and 9.5degrees in right and left knee, respectively. On postoperative 2-weeks radiograph, tibial posterior slope angle is an average of 9.3degrees and 9.1degrees in right and left knee, respectively. Angle between tibial posterior slope and ground surface is an average of 6.2degrees and 6.4degrees in right and left knee. There are significant differences between tibial posterior slope angle and the angle between tibial posterior slope and ground surface on preoperative and postoperative 2-weeks radiograph (p<0.05). CONCLUSION: According to ankle lateral angle, it is possible that tibial posterior slope associated with the ground surface may decrease at erect posture in total knee arthroplasty. This may lead to overly decrease tibial posterior slope associated with the ground surface at comfortable erect posture in total knee arthroplasty.

The Efficacy of Suction Drains arter Total Hip Arthroplasty

Purpose: The goal of this study was to evaluate the efficacy of suction drains following total hip arthroplasties, by comparing the post-operative results between the group with suction drains and the group without suction drains. Materials and Methods: Eighty-six patients, who underwent primary total hip arthroplasties from June 2001 to June 2004, were divided into two groups: group 1 (48 patients), with suction drains; and group 2 (38 patients), without suction drains. We assessed the perioperative hemoglobin and platelet levels, the amount of total blood loss, the amount of post-operative blood transfusions, post-operative ranges of motion (ROMs, at 6 weeks), wound problems, and general conditions. Results: Although the postoperative hemoglobin level was greater in group 2 than in group 1, there was no statistically significant difference. The amount of total blood loss and blood transfusions in group 1 were statistically greater than in group 2 (p<0.05). There were no statistically significant differences in the post-operative ROMs and wound complications between groups 1 and 2. Conclusion: There were no limitations of hip motion and no wound complications in the patients without suction drains after total hip arthroplasties. However, they required fewer post-operative blood transfusions than did the patients with suction drains, due to less post-operative blood loss; and the absence of a suction drain might prevent retrograde tube infections. In addition, patients without suction drains after total hip arthroplasties seemed to recover better did than those with suction drains. Therefore, suction drains might provide no benefit in total hip arthroplasties.

Posterior Lumbar Interbody Fusion Using Titanium Cages and Morselized Local Bone Autograft / 대한척추외과학회지

STUDY DESIGN: A retrospective study to evaluate the results of posterior lumbar interbody fusion (PLIF) using titanium cages filled with morselized local bone. OBJECTIVE: To verify the clinical and radiological results of the PLIF procedure using rectangular titanium cages filled with morselized local bone. SUMMARY AND LITERATURE REVIEW: Stabilization of the spine can be achieved by interbody arthrodesis through the posterior approach. However many significant problems including bone graft collapse, resorption, nonunion, and iliac donor site morbidity caused by the classic PLIF procedure need to be solved. The use of local bone and a titanium cage might be a solution. MATERIALS AND METHOD: Fifty-nine patients(average age at surgery, 51.3 years), who underwent surgery for degenerated low back disease, were enrolled in this study. The average follow-up duration was 19.9 months. The radiological fusion status, intervertebral disc heights, visual analogue scales, clinical outcomes were evaluated. RESULTS: Forty-three (73%) patients were classified as complete-union, 16 (27%) patients as probable-union, and no patients were classified as non-union. The average intervertebral disc height increased by 3.7 mm at immediate postoperatively, and the average subsidence was 1.1 mm at the final follow-up. The average visual analogue scale decreased from 5.5 to 1.4 for back pain and from 6.6 to 0.8 for radicular pain. Nineteen (32%) and 28 (48%) patients were classified as excellent and good, respectively, according to clinical outcome assessment by Kim and Kim criteria. The complications encountered were a dural tear in 8 patients, partial root injury in 1, and upper adjacent segment instability during follow-up in 2. CONCLUSION: PLIF using titanium cages filled with morselized local bone has the advantages of maintaining an intervertebral disc height, immediate stability, and the avoidance of donor site morbidity. However, longer-term results are needed, because the follow-up period of this study was relatively short