Revision Total Hip Arthroplasty Using an Extensively Porous Coated Femoral Stem

BACKGROUND: To determine the benefit of an extensively porous coated femoral stem in patients receiving revision total hip arthroplasty. METHODS: This study reviewed the results of 35 patients who received a revision total hip arthroplasty with extensively porous coated femoral stem between August, 1996, and December, 2002. The mean follow-up period was 77.5 months. The clinical and radiological results were evaluated by the Harris hip score and serial roentgenographic findings. RESULTS: The preoperative and postoperative Harris hip score was 68.3 and 92.5, respectively. Radiographically, none of the acetabular components showed any evidence of migration, tilt, rotation, or shedding of metal particles. In addition, none of the femoral components showed evidence of subsidence, pedestal, or shedding of metal particles. Twenty-two hips had a mild stress shield and 2 hips had a moderate stress shield. The perioperative complications encountered were deep vein thrombosis (1 case), mild heterotopic ossification (4 cases), intraoperative periprosthetic fractures (1 case), and nonunion of the trochanteric osteotomy site (2 cases). CONCLUSIONS: Extensively porous coated femoral stems and acetabular components produce excellent clinical and radiological results in revision total hip arthroplasty.

Primary Total Hip Arthroplasty in Systemic Lupus Erythromatosus / 대한류마티스학회지

OBJECTIVE: The purpose of this study is to evaluate the short term results of total hip arthroplasty (THA) for avascular necrosis in patients with systemic lupus erythematosus (SLE). METHODS: This is a retrospective case control, matched pair study. Ten patients (15 hips) with SLE and avascular necrosis of the femoral head (AVNFH) underwent THA. Eight patients (12hips) with a minimum follow up of 2 years were reviewed. To determine whether these patients had results similar to those of patients with other diagnosis, we formed a control group of 12 patients who had 12 THA. They were matched for age, sex, BMI, activity, follow-up period, and type of implant with SLE group. The clinical and radiographic results were evaluated by Harris hip score (HSS) and serial radiographic findings, respectively. RESULTS: There was no complication during the perioperative period. In the SLE group, HHS was from 67.3 preoperatively to 97.7 at last follow-up. In the control group, HHS was from 70.1 preoperatively to 97.8 at last follow-up. On the last roentgenograms, none of acetabular components demonstrated any evidence of migration, tilt, rotation or shedding of metal particles in both groups. All femoral components demonstrated no evidence of subsidence, pedestal, or shedding of metal particles in both groups. CONCLUSION: Patients with SLE and AVNFH had excellent results after THA. Results were not different from that of patients who had hip replacement for other diagnoses. Therefore, it is considered that uncemented THA was useful treatment method for the patient who had SLE and AVNFH.

Total Hip Arthroplasty in the Fused Hip

PURPOSE: The purpose of this study is to analyze the clinical and radiological results of performing primary total hip arthroplasty (THA) in patients with a fused hip and to compare the results with that of patients with avascular necrosis of the femur head (AVNF). MATERIALS AND METHODS: 19 patients (21 hips) with a fused hip(s) were retrospectively reviewed. We analyzed them clinically with using the Harris hip score (HHS), and radiologically with performing serial radiograms and we then compared them with the results of the patients in the AVNF group. RESULTS: The mean HHS was improved from 59.2 to 85.8. The VAS improved from 6.5 to 2.2 and the leg length discrepancy (LLD) improved from 27.5 mm to 12.5 mm. As complications, wound infection occurred in 3 hips, heterotopic ossification occurred in 8 hips and recurrent dislocation occurred in one hip. Although a radiolucent line was found in 4 acetabular cups and 6 femoral stems, there was no progression. Osteolysis was found in 1 acetabular cup. CONCLUSION: The results of THA in patients with a fused hip were excellent. Comparing with the AVNF group, improvement of the hip motion and LLD were much better. The improvement of the VAS and HHS showed similar results between the groups. However, the final results of the HHS, VAS, LLD and the range of motion of the hip were worse, and the complication rate was higher.

Total Knee Arthroplasty Without Patellar Resurfacing / 대한정형외과학회잡지

PURPOSE: To Analyze the Clinical Results of the Total Knee Arthroplasty without Patellar Resurfacing. MATERIALS AND METHODS: One hundred and eight Total Knee Arthroplasties (Nexgen(R), Zimmer, USA) without resurfacing of the patella, were performed between February 1995 and September 1999, and 89 cases followed up for more than 36 months were analyzed in this study. The follow up period ranged from 36 to 70 months (average 52 months). The diagnosis was degenerative joint disease in 83 cases (93%), rheumatoid arthritis in 5 cases (6%) and avascular necrosis of medial femoral condyle in 1 case (1%). The clinical results were evaluated according to Knee Society Clinical Rating System. RESULTS: The mean preoperative knee score was 34 points (range 5-63 points) according to the Knee Society Clinical Rating System, and the mean preoperative functional score was 38 points (range, 10-61 points). The mean postoperative knee score was 91 points (range 65-98 points) and the mean postoperative functional score 89 points (range, 63-100 points). The current study shows that patellar complications associated with unresurfacing did not occur, with the exception of 2 cases of persistent peripatellar pain, which resolved by a postoperative 6 months with conservative treatment. The patellofemoral joint space was also well preserved even at the 3 and 5 year follow-ups. CONCLUSION: Complications of total knee arthroplasty, such as patellar dislocation or subluxation, rupture of the patellar tendon, and fracture of the patella, can be avoided by not resurfacing the patella. On the basis of our results, there is little evidence to support routine patellar resurfacing in total knee arthroplasty.

Tuberculous Subdeltoid Bursitis with Rice Bodies

A 41-year-old woman with a 2-month history of diffused swelling and persistent dull pain in her right shoulder was examined. Magnetic resonance imaging (MRI) findings revealed subdeltoid bursitis and rice bodies with normal surrounding tissue and shoulder joint. Arthoscopic debridement and biopsy of the subdeltoid bursa were performed. Histologic examination of the bursal tissue showed granulomatous tissue with typical caseous necrosis. A positive culture of Mycobacterium tuberculosis confirmed the diagnosis of tuberculosis. We report on the clinical, radiological and athological findings in a patient with tuberculous subdeltoid bursitis accompanied by multiple rice body formation without coexisting active bone and joint tuberculosis, and conduct a literature review.

Local Bone versus Autogenous Iliac Bone Graft for Posterolateral Lumbar Fusion in the Same Patient / 대한척추외과학회지

STUDY DESIGN: A prospective study. OBJECTIVES: To determine the usefulness of local bone obtained from laminectomy and decortication as graft bone instead of autogenous iliac bone in posterolateral lumbar spinal fusion. MATERIALS AND METHODS: Thirty-one patients underwent posterolateral lumbar spinal fusion with pedicle screw instrumentation. Local bone was inserted in the right side of intertransverse space and autogenous iliac bone was in the left side. We compared fusion rate in the radiographs at postoperative 6 week, 3 month, 6 month and 1 year. RESULTS: Radiographic fusion grading of local bone was 20 cases of grade 1, 8 cases of grade 2, 2 cases of grade 3 and 1 case of grade 4. Fusion grading of autogenous iliac bone was 24 cases of grade 1, 4 cases of grade 2 and 3 cases of grade 3. Bone fusion was complete after 9.1 months in local bone and 7.2 months in autogenous iliac bone. No significant differences was found between the two groups. CONCLUSION: The local bone in posterolateral lumbar fusion is appropriate for satisfactory fusion instead of autogenous iliac bone if the amount of local bone is sufficient and decortication of the fusion bed is proper.