Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines / 대한고관절학회지

Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty.

Measurement of Necrotic Lesion in Osteonecrosis of Femoral Head

PURPOSE: The size of the necrotic lesion is known to be the most important prognostic factor in osteonecrosis of the femoral head (ONFH). We evaluated the accuracy and relationship of three different measuring methods of necrotic lesions for ONFH. MATERIALS AND METHODS: Sixty hips that had ONFH were measured on an MRI by two orthopaedic surgeons using Steinberg, Kim, and modified Kerboul methods. Based on the lesion size of the necrosis as measured with the computerized Steinberg method, the hips were divided into Group I (small lesion: less than 15%), Group II (medium lesion: 15~30%), and Group III (large lesion: more than 30%). Data of the Kim and modified Kerboul methods were reclassified by statistical analysis according to the groups classified by the Steinberg method. RESULTS: Average lesion size of Group I (16 hips) was 10.92%, the average size of Group II (33 hips) was 21.68%, and the average size of Group III (11 hips) was 36.80%. We established a new criteria of the Kim and modified Kerboul methods based on Steinberg. The Kim method was reclassified into Groups I (less than 18%), II (18~33%), and III (33% or more). And the modified Kerboul method was divided into Groups I (less than 200.6degrees), II (200.6~262.4degrees), and III (more than 262.4degrees) as well. CONCLUSION: New criteria for the Kim and modified Kerboul method would be a useful indicator for the prognosis and treatment plan in ONFH.

Long-Term Results of Total Hip Arthroplasty with an Extensively Porous Coated Stem in Patients Younger than 45 Years Old

PURPOSE: This study analyzed the long-term results of cementless total hip arthroplasty using an extensively porous coated stem in patients younger than 45 years old. MATERIALS AND METHODS: The clinical and radiographic results of 45 hips from 38 patients who underwent cementless total hip replacement arthroplasty with an AML prosthesis were reviewed retrospectively. The average follow-up was 12 years (range, 10-15 years). RESULTS: The average Harris hip score at the time of final follow-up was 87.3 (range 77-94) points. Forty two hips (93.3%) showed excellent and good clinical results. Osteolysis occurred around the stem in 20 hips (44.4%) and around the cup in 26 hips (57.8%). Stress-mediated femoral resorption was observed in 33 hips (73.3%) at 10 years. There was no incidence of resorption progressing after 5 years postoperatively. There was no stem loosening. Five hips were revised for osteolysis, cup loosening and polyethylene wear. CONCLUSION: The long term results of total hip arthroplasty using an extensively porous coated stem were acceptable, and there was no case involving the progression of proximal bone resorption.

Clinical Results of Autoiliac Cancellous Bone Graft Combined with Implantation of Autologous Bone Marrow Cells for Osteonecrosis of the Femoral Head / 대한정형외과학회잡지

PURPOSE: We prospectively analyzed the clinical results of auto-iliac cancellous bone graft with autologous bone marrow mononucleated cell implantation for osteonecrosis of the femoral head. MATERIALS AND METHODS: In a prospective evaluation, 45 hips in 37 patients with osteonecrosis of the hip were treated with auto-iliac cancellous bone graft after core decompression combined with implantation of autologous bone marrow cells. The average duration of clinical follow up of the patients was 32 months. Core decompression of the femoral head was performed and most of the necrotic part of the head was removed. Auto-iliac cancellous bone grafting was then done to fill up the defect, and this was followed by cell therapy with implantation of autologous monocytes isolated from the iliac bone marrow. RESULTS: The mean Merle d' Aubigne and Postel score improved from 11.6 points preoperatively to 15.5 points. Collapse of the femoral head developed in 13 hips, of which 12 hips showed an extensive lesion on the preoperative radiogram. Total hip replacement surgery was performed in 9 hips: 8 hips were due to progressive collapse of the femoral head with clinical deterioration, and 1 hip was due to postoperative bacterial infection. The preoperative stages of the 8 hips that were converted to THRA were stage II in 1 hip, stage III in 4 hips and stage IV in 3 hips. The head preservation rate according to the preoperative stage was 94.4% in stage II, 77.8% in stage III and 66.7% in stage IV. CONCLUSION: Auto-iliac cancellous bone grafting combined with implantation of autologous bone marrow cells after core decompression showed a good clinical results on the short term follow-up. Long term follow-up studies are still necessary to validate this point.