Clinical Results after Design Modification of Lospa Total Knee Arthroplasty System:Comparison between Posterior-Stabilized (PS) and PS Plus Types

Background@#Lospa posterior-stabilized (PS) Plus type is a modified version of Lospa PS, in which the polyethylene insert shape is modified to reinforce stability and prevent patella-post impingement compared to Lospa PS. However, studies comparing the clinical and radiographic results of the two designs have not been reported yet. This study aimed to compare the clinical results of total knee arthroplasty (TKA) using the existing PS type and the modified Lospa PS Plus type. @*Methods@#A retrospective study was performed on 558 knees of 342 patients who underwent TKA using the Lospa PS or PS Plus types and were followed up for at least 2 years. Cases were divided into two groups according to the implant used: 212 cases in the PS group and 346 cases in the PS Plus group. For clinical outcome assessment, knee range of motion (ROM), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and Knee Society Score (KSS) were recorded before surgery and at the 2-year follow-up. Radiographic outcomes were evaluated according to the American Knee Society method. The incidence of postoperative complications and survival rates were compared between the two groups. @*Results@#Both groups showed significant clinical improvement after surgery. The average KSS significantly improved from 53.4 points in the PS group and 52.3 points in the PS Plus group preoperatively to 91.3 points and 93.2 points after surgery, respectively (p < 0.001). The average WOMAC score improved from 50.4 points in the PS group and 52.3 points in the PS Plus group before surgery to 15.6 points and 14.8 points after surgery, respectively (p < 0.001). There was no significant difference between the two groups in ROM, the alignment of the lower limbs, and the implant position after surgery. The complication rates were also similar between the groups (p = 0.167). @*Conclusions@#The Lospa PS Plus model is a modified design that improves the post structure from the previous PS type. Compared to the PS type, the PS Plus type showed similar statistical results at 2-year follow-up and good clinical results. The short-term average survival rate was over 98%, showing promising results.

Hip Arthroplasty Using the Bencox® Hip System: An Evaluation of a Consecutive Series of One Thousand Cases / 대한고관절학회지

PURPOSE: This is a report on the outcomes associated with a consecutive series of 1,000 cementless hip arthroplasties utilizing the Bencox® hip stem–the first Korean-developed hip prosthesis. MATERIALS AND METHODS: A consecutive series of 1,000 hip arthroplasties using the Bencox® hip stem were analyzed, starting from its initial release (September 2006) until June 2014. Patients in this consecutive series underwent surgery for fractures (n=552), arthritis (n=155), avascular necrosis (n=209), and revisions (n=84). Of these 1,000 cases, patients with a minimum follow-up of at least 1 year (n=616) were retrospectively analyzed for radiographic and clinical outcomes (i.e., Harris hip score). The stability of the prosthesis was evaluated by examining subsidence. RESULTS: During the follow-up period (mean follow-up period of 54.8 months), there were 2 cases requiring revision of the femoral stem–both were caused by periprosthetic fractures and neither involved stem loosening. The mean Harris hip score during follow-up was 95.5. Bone ongrowth occurred in 95% of patients; no cases of subsidence or aseptic loosening of the stem were detected, and no cases of postoperative complications such as ceramic breakage were observed. CONCLUSION: Clinical and radiographic evaluations of hip arthroplasty using the Bencox® hip stem revealed excellent outcomes with an average of 54.8 month follow-up in a consecutive series of 1,000 cases.

Acetabular Cup Revision Arthroplasty Using Morselized Impaction Allograft / 대한고관절학회지

The rate of acetabular cup revision arthroplasty is gradually rising along with an increased risk of osteolysis and prosthesis loosening over time and an increase in life expectancy. The goals of revision total hip arthroplasty are: i) implant stability through reconstruction of large bone defects, ii) restoration of range of motion and biomechanics of the hip joint, and iii) normalization of uneven limb lengths. In acetabular cup revision arthroplasty, stable fixation of acetabular components is difficult in the presence of severe bone loss (e.g., evidence suggests that it is challenging to achieve satisfactory results in cases of Paprosky type 3 or higher bone defects using conventional techniques). The author of this study performed acetabular revision to manage patients with large areas of defective bones by filling in with morselized impaction allografts. These allografts were irradiated frozen-stored femoral heads acquired from a tissue bank, and were applied to areas of an acetabular bone defect followed by insertion of a cementless cup. When this procedure was insufficient to obtain primary fixation, a tri-cortical or structural allograft using a femoral head was carried out. Structural stability and bone incorporation were confirmed via long-term follow-up. This study aims to review conventional surgical techniques and verify the utility of surgical procedures by analyzing the author's surgical methods and discussing case reports.

Treatment of Periprosthetic Femoral Fractures Following Hip Arthroplasty / 대한고관절학회지

PURPOSE: This study was performed to assess potential improvements in clinical outcomes when applying recent advanced hip arthroplasty surgical techniques and understand the potential relationship between bone mineral density (BMD) and surgical outcomes. MATERIALS AND METHODS: Among 37 cases of periprosthetic femoral fractures after hip arthroplasty treated between March 2014 and September 2016, all included a follow-up of at least one year and were included in this study. Outcomes were evaluated using the Beals and Tower's criteria. BMD was examined in 27 of 37 cases and the relationship between osteoporosis and treatment outcomes was analyzed. Advanced hip arthroplasty surgical approaches varied depending on the fracture type: i) open reduction with wiring for Vancouver A, ii) open reduction with double plate fixation for Vancouver B1, iii) revision THA with long stem for Vancouver B1-Nonunion, B2 and B3, and iv) open reduction with double plate fixation for Vancouver C. RESULTS: When assessed using the Beals and Tower's criteria, 33 out of 37 (89.2%) patients were excellent and 4 (10.8%) were poor. These outcomes were an improvement compared with series I (81.8%). When analyzed according to the Vancouver classification, patients with type A (n=8), type B1 (n=16), and type B2 (n=2) were all excellent, the patients with type B3 were excellent (n=1) and poor (n=1), and the patients with type C were excellent (n=6) and poor (n=3). The mean BMD was −2.6 (T-score) in 27 of 37 cases and −4.4 in 4 cases with poor prognosis. Osteoporosis was statistically correlated to those classified as poor by Beals and Tower. CONCLUSION: The results of the analysis suggest that applying new surgical hip arthroplasty treatment approaches leads to improved outcomes compared with the author's previous study. When treating periprosthetic femoral fractures following total hip arthroplasty, an appropriate internal fixation method should be selected, at least in part based on the Vancouver classification. In addition, osteoporosis may be a major prognostic factor for the outcomes of surgical treatment.

Wiring Techniques for the Fixation of Trochanteric Fragments during Bipolar Hemiarthroplasty for Femoral Intertrochanteric Fracture: Clinical Study and Technical Note / 대한고관절학회지

PURPOSE: Femoral intertrochanteric fractures are common in the elderly. Appropriate surgical fixation of trochanteric fracture fragments can restore normal anatomical structure and ambulation, and can aid in the recovery of biomechanical function of the hip. We evaluated clinical outcomes of bipolar hemiarthroplasty using a wiring technique for trochanteric fracture fragment fixation. MATERIALS AND METHODS: From September 2006 to February 2015, a total of 260 cases underwent simultaneous bipolar hemiarthroplasty and wire fixation. A total of 65 patients (69 hips) with an average age of 78 years and more than one year of follow-up was included in the study. Using pre-, postoperative and follow-up radiograms, we evaluated wire fixation failure and also assessed changes in walking ability. RESULTS: Loosening or osteolysis around the stem was not observed; however, we did observe bone growth around the stem (54 cases), cortical hypertrophy (6 cases), a wide range of sclerotic lines but no stem subsidence (1 case), wire breakage (9 cases), and fracture fragment migration with no significant functional deficiency (2 cases). CONCLUSION: Our study showed that additional wiring for trochanteric fracture fragment fixation following bipolar hemiarthroplasty can help restore normal anatomy. The added stability results in faster rehabilitation, and good clinical and radiographic outcomes. We recommend this procedure in this type of fracture.

Proximal Tibia Stress Fracture Caused by Primary Degenerative Knee Osteoarthritis with Varus Deformity / 대한정형외과학회잡지

Stress fractures of the tibia are relatively common in military and young people. However, stress fracture of the proximal tibia is rare in elderly patients, but has been reported in association with osteoporosis, Paget disease, rheumatoid arthritis, pyrophosphate arthropathy, and knee deformities. We experienced a 65-year-old patient who did not have a chronic disease, with a stress fracture with primary degenerative knee osteoarthritis with varus deformity, which occurred at the proximal tibia, and we report on this unusual case with a literature review.

The Current Concepts of Total Hip Arthroplasty / 대한고관절학회지

No abstract available.

Result of a Minimum Five-Year Follow-Up of Hip Arthroplasty Using the Bencox(R) Hip Stem / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to report the results of artificial hip arthroplasty with minimum five-year follow-up using the Bencox(R) (Corentec) hip stem, the first total hip prosthesis developed in Korea. MATERIALS AND METHODS: We evaluated 27 hips in patients with femoral neck or intertrochanteric fracture (fracture group) and 58 hips in patients with arthritis or osteonecrosis of the femoral head (arthritis group) who underwent hip arthroplasty using a Bencox(R) hip stem in combination with Bencox(R) bipolar cup and Bencox(R) acetabular cup between September 2006 and February 2008. Patients in the fracture group underwent bipolar hip arthroplasty, and those in the arthritis group underwent total hip arthroplasty. RESULTS: During the follow-up period, there were no cases of revision of the femoral stem. Mean Harris hip score was 94 at the latest follow-up in (femoral neck or intertrochanteric) the fracture group, and improved from 57 preoperatively to 98 at the latest follow-up in the arthritis (or avascular necrosis) group. Radiographically, endosteal bone ongrowth was found in 23 of 27 cases in the fracture group (85.2%) and 56 of 58 cases in the arthritis group (96.6%). Stem loosening, infection, dislocation, and ceramic breakage were not noted. CONCLUSION: Clinical and radiographic evaluations of hip arthroplasty using the Bencox(R) hip stem showed excellent outcomes with a minimum of five-year follow-up.

Bipolar Hemiarthroplasty with Cementless Femoral Stem for Unstable Intertrochanteric Fractures / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cementless femoral stem for treating unstable intertrochanteric fractures in elderly patients. MATERIALS AND METHODS: This study included 41 hips of 41 patients who were followed up for over 2 years after bipolar hemiarthroplasty using cementless femoral stem between October 2006 and November 2008. The mean follow-up period was 33 months (24-42 months). RESULTS: At the last follow-up, the mean Harris hip score was 81.3 points. All stems were stable without significant changes in alignment or progressive subsidence. There were no cases of leg length discrepancy over 5 mm. There were 3 cases of wire fixation breakage and 1 case of posterior hip dislocation. CONCLUSION: The short-term results over 2 years of clinical and radiological evaluation of cementless bipolar hemiarthroplasty and wire fixation were satisfactory in elderly patients with unstable intertrochanteric fracture.

Preoperative B-type Natriuretic Peptide as a Predictor of Postoperative Cardiac Events Following Orthopedic Elderly Patients

BACKGROUND: The aim of this study was to evaluate the value of preoperative plasma B-type natriuretic peptide (BNP) level in predicting postoperative in-hospital major adverse cardiac events (MACE, defined as atrial fibrillation, congestive heart failure, nonfatal myocardial infarction and cardiac death) in elderly patients undergoing orthopedic surgery. METHODS: Between March 2010 and September 2011, data from 156 patients (aged 65 years or older) who underwent scheduled or emergent orthopedic surgery, were investigated. Screening for postoperative in-hospital MACE was performed using clinical criteria. RESULTS: MACE occurred in 12 patients (7.7%). The BNP level was significantly higher in patients with MACE than in those without (median, 152.0; interquartile range [36.3 to 352.8] pg/mL vs. median, 36.8; interquartile range [15.5 to 98.1] pg/mL, p=0.005). The BNP level was positively correlated with the revised cardiac risk index score (r=0.300, p=0.001). In a receiver operating characteristic (ROC) analysis for MACE, the ROC for BNP was 0.746 (95% confidence interval, 0.602 to 0.891). At the optimal cut-off point (BNP=110 pg/mL), the sensitivity, specificity and positive and negative predictive values were 66.7, 81.2, 22.0% and 96.6%, respectively. On multivariate analysis, preoperative BNP was an independent predictor for MACE (odds ratio, 5.091; p=0.018) after adjusting for baseline confounding factors such as diabetes mellitus and history of cerebrovascular accident. CONCLUSION: The preoperative BNP level may be a useful tool in stratifying the risk for MACE in elderly patients undergoing orthopedic surgery.

Periprosthetic Femoral Fractures after Hip Arthroplasty

Periprosthetic femoral fractures are increasing. In a periprosthetic femoral fracture, treatment is difficult and complications are common. The result of total hip arthroplasty becomes poor. The study sought to determine the cause and risk factors of periprosthetic femoral fracture after total hip arthroplasty, and discusses treatment according to the guidelines of the Vancouver classification.

Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty / 대한정형외과학회잡지

PURPOSE: To determine results of treatment according to the guidelines of the Vancouver classification in periprosthetic femoral fractures after total hip arthroplasty. MATERIALS AND METHODS: Among 44 cases of periproshtetic femoral fractures after hip arthroplasty treated between Aug. 1991 and Feb. 2008, thirty-two cases with minimum follow-up greater than one year were included. Outcomes were evaluated using the Beals and Tower's critieria. RESULTS: Outcomes were excellent in 27 cases, and poor in 5 cases. Four of 5 cases with poor result were due to non-union. Three cases were treated with internal fixation and 1 case was treated with a conservative method. One case with a poor result was due to loosening of the cemented stem of a Vancouver type B1 fracture. Loosening of the stem after mid to long term follow up occurred in an additional 4 cases (3 cases with a cemented stem in a type B1 fracture, 1 case with a cemented stem of a type C fracture). Loosened stems were revised with a long revision stem. CONCLUSION: For type B1 periprosthetic fractures around a cementless stem, and for type B2, type B3 periprosthetic fractures, treatment according to the guidelines of the Vancouver classification showed excellent results. However, type B1 periprosthetic fractures around a cemented stem showed poor results with non-union or stem loosening. Hence, more rigid fixation using a bone graft or revision of the stem is needed. In type C periprosthetic fractures in osteoporotic patients, closer attentions is needed to avoid complications.

The History of Total Hip Arthroplasty

Because of increases in degenerative diseases and trauma of the hip joint, diverse treatment modalities have been developed. Because of this increase in demand in the field of hip joint medicine, the need for scientific studies in orthopaedics have been considered to be more important. In fact, currently, total hip arthroplasty is the most commonly performed reconstructive hip procedure. Total hip arthroplasty evolved as a result of many improvements in the design of a femoral head prosthesis, the availability of suitable component materials and manufacturing techniques, a better understanding of hip mechanics, and the need for resurfacing the acetabulum. An awareness of the history of hip arthroplasty is necessary to appreciate not only its current status, but also its future. This article discusses the history of and current trends in hip arthroplasty including implant design, materials, and the renewed interest in resurfacing procedures, minimally invasive techniques and robotic surgery.

Long-term Follow-up Results after Hip Arthroplasty using a Cementless Spotorno (CLS) Femoral Stem / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the long-term clinical and radiological findings in patients who underwent total hip arthroplasty using a CLS femoral stem. MATERIALS AND METHODS: We evaluated 40 patients (47 hips) who underwent total hip arthroplasty using a CLS femoral stem between 1988 and 1992. The average patient age at the time of operation was 45.3 years, and the average duration of follow-up was 17 years 3 months (range, 15 years to 19 years 10 months). RESULTS: No femoral stem revisions were performed. The average Harris hip score improved from 51.9 preoperatively to 94.9 at final follow-up. Radiographically, small osteolytic lesions were found in 17 cases (36.2%), and endosteal bone formations were found in 44 cases (93.6%). Acetabular cup loosening occurred in 3 cases, and acetabular cup revisions were performed. Additionally, a liner change was performed in 1 case. One periprosthetic fracture and one dislocation were noted. CONCLUSION: Fifteen-to-twenty-year follow-up results after total hip arthroplasty using a CLS femoral stem were excellent, with no patients requiring femoral stem revision.

Treatment of Infected Total Hip Arthroplasty

PURPOSE: To analyze the effectiveness of a two-stage revision surgery for an infected total hip arthroplasty. MATERIALS AND METHODS: Between 1988 and 2005, twenty-four patients (24 hips, 18 males, 6 females) with documented infection of total hip arthroplasty were reviewed and followed for at least two years postoperatively. The preoperative and postoperative clinical and radiologic findings and blood laboratory work were compared. Eight arthroplasty cases were performed through retention of the femoral stem and removal of the acetabular cup with cementing by impregnated antibiotics in the first stage of the operation, and subsequent acetabular cup revision in the second stage of the operation. RESULTS: After the first stage of the operation, infectious organisms were cultured in 19 patients, and isolated Staphylococcus aureus was cultured in 14 patients. The mean follow-up period was 8.2 years, and the average Harris hip score improved to 88.4 points at last follow-up. Radiologic osteolysis was noted in 5 cases, and possible loosening was demonstrated in 1 case. The erythrocyte sediment rate (mm/hr) and C-reactive protein (mg/L) were 43.8/14.2 preoperatively and 17.9/8.3 postoperatively. There were 2 recurrences of infection, for an eradication rate of 91.7% (22 of 24). CONCLUSION: Two-stage revision for an infected total hip arthroplasty proved to be an excellent method with a high eradication rate.

Results of Revision Hip Arthroplasty using Cemented Femoral Stem

PURPOSE: To analyze clinical and radiological follow-up results of patients who underwent revision hip arthroplasty with a cemented stem. MATERIALS AND METHODS: This study reviewed the records of 31 patients (34 hips), who underwent revision hip arthroplasty with a cemented stem between February, 1993 and May, 2004 after an average follow-up of eight years. There were 14 segmental type hips according to the femoral bone defect using the AAOS classification. According to the Paprosky classification, there were 7 and 5 type IIC and type III hips indicating a severe bone defect. Immediate postoperative cement mantle grades were grades A and B(26 hips) and grade C, D(8 hips). RESULTS: The Kaplan Meier survival rate of the cemented stem was 80.7% at 8 years. Re-revision hip arthroplasty was performed in 5 hips, in whom aseptic loosening occurred 4 hips, and infection occurred 1 hip, which was cured by re-surgery. Immediately after the operation, 4 out of the 5 re-revision cases were classified as C & D in the Barrack classification of the cement mantle. Overall, an inadequate cement mantle led to a poorer survival rate. CONCLUSION: The results of revision hip arthroplasty using a cemented stem were not so good. However, the cemented stem might be used in cases considered unsuitable for a cementless stem if a good cement mantle could be achieved using a skillful cement technique.

Cementless Total Hip Arthroplasty with Use of the COREN Hip System

PURPOSE: To report the results of a minimum three-year follow-up of cementless total hip arthroplasty using the COREN Hip System(R) (Corentec, Seoul, Korea), which is the first total hip prosthesis developed in Korea. MATERIALS & METHODS: A total of 57 patients (68 hips) who had undergone cementless total hip arthroplasty using the COREN Hip System(R) between July 2003 and March 2004 were analyzed clinically and radiographically after a minimum follow-up of three years after the index arthroplasty. RESULTS: The mean Harris hip score improved from 46 points preoperatively to 95 points at the one-year follow-up and to 99 points at the three-year follow-up. All the patients reported a good or excellent satisfaction with the results of surgery. All prostheses showed radiographic evidence of stable bony fixation, and no hips showed evidence of osteolysis or prosthesis loosening. During the follow-up period, there were no complications such as a deep infection, dislocation or ceramic fracture in any hip, and no revision surgery was required. CONCLUSION: The clinical and radiographic evaluations of Cementless total hip arthroplasty using the COREN Hip System(R) showed excellent outcomes after a minimum follow-up duration of three years.

5-12 Year Results of Femoral Revision Total Hip Arthroplasty using the Wagner Revision Stem / 대한정형외과학회잡지

PURPOSE: To analyze the results of a 5-12 year (mean, 7 years, 5 months) follow-up of femoral revision THA using the Wagner(R) stem. MATERIALS AND METHODS: Of 79 revision THA patients enrolled in the study between March 1991 and January 2000, there were 64 cases of aseptic loosening (69 hips, 44 males and 20 females) during a minimum 5-year follow-up. In addition, postoperative complications and clinical and radiographic results were evaluated. RESULTS: The Harris hip score improved from 48.6 to 91.2 points, postoperatively. There were 3 revisions due to failed stem fixation and aseptic loosening. The Kaplan-Meier survivorship analysis, with failure defined as a removal of the Wagner(R) stem, revealed a 97.1% survival at a 12-year follow-up. Besides the revisions, there were 66 hips that were hip-related symptom-free. However, there was claudication in 1 case. Radiographic findings included subsidence of the implant (5 cases, 7.5%, all less than 10 mm), calcar femorale atrophy (4 cases, 6.0%), stress shielding (4 cases, 6.0%), and heterotopic ossification (5 cases, 7.5%). Postoperative peroneal nerve palsy (2 cases) resolved completely within the following 6 months. CONCLUSION: We obtained a stable fixation and satisfactory results in the cases we studied using the Wagner(R) revision stem.

Total Hip Arthroplasty in Patients who had Previous Infection of the Hip with LegLength Discrepancy / 대한정형외과학회잡지

PURPOSE: To analyze the results of a minimum of three-year follow-up in patients with a severely deformed sequelae pyogenic hip, who had undergone total hip arthroplasty with a simultaneous limb length correction. MATERIALS AND METHODS: The postoperative complication, clinical and the radiographic results were analyzed in 74 out of 102 patients, who were followed for a minimum of three years between December 1987 and May 2003. The average age was 42.8 years. The average follow-up duration was 4 years and 11 months. There were 50 tuberculosis infections, 24 pyogenic infections, and 23 fused hip cases. The average leg length shortening was 4.1 cm (range, 1.0-10.0 cm). RESULTS: Preoperative Harris hip score improved to 90.2 postoperatively from 65.0 (range, 25-92.5) preoperatively. Leg length shortening was corrected by 0.4 cm (0.0-3.0 cm). Radiographically, excluding the 3 revisions, no case met the criteria of definite loosening. The postoperative complications included the recurrence of tuberculosis (2 cases), and variable nerve palsies, including femoral nerve (3 cases), and a sciatic nerve (3 cases). These patients completely recovered from nerve palsy. B-K amputation, after the postoperative exacerbation of circulation to the affected limb, was needed in one case with a preoperatively undetected femoral artery occlusion. CONCLUSION: Although, restoring the normal limb length in the severely deformed pyogenic hip sequelae patients requires highly demanding surgical techniques, with a relatively higher incidence of postoperative complications, it is possible to achieve a higher level of patient satisfaction and definite gait improvement.

New Wiring Method for Lesser Trochanter Fixation in Unstable Intertrochanteric Fractures: Technical Note

In unstable femoral trochanteric fracture, we usually used transversing K-wires through the lesser trochanter to achieve an anatomical reduction, and using sliding hip screws. However, in patients with comminuted lesser trochanter or osteoporosis, an intrusion of the wire into the lesser trochanter and/or iatrogenic intertrochanteric fractures were often resulted. Those who were not familiar with a technique of puncturing two holes through the lesser trochanter might have had to face some difficulties. In order to overcome aforementioned drawbacks, the authors had quite satisfactory results by employing the method of passing each of two wires above and below the iliopsoas muscle, and they were twisted posteriorly and then anteriorly; and finally they were pulled together posteriorly. Through this technique, both firm fixation of the lesser trochanter and more stable bony union were obtained.