Sequential Hip Fractures in Elderly Osteoporotic Patients / 대한고관절학회지

PURPOSE: The purpose of this study was to evaluate the clinical features and risk factors of sequential bilateral hip fractures in elderly osteoporotic patients. MATERIALS AND METHODS: A total of 661 patients who had undergone surgical treatment for osteoporotic hip fractures from April 2001 to June 2011 were retrospectively reviewed. Thirty six patients who had experienced sequential bilateral hip fracture were classified as the BHF group and the rest of the patients were classified as the non-BHF group. Various clinical features, such as T-score of the proximal femur, dwelling pattern, any symptom of dizziness or dementia, health status by ASA classification, BMI, and history of osteoporosis treatment were reviewed and the risk factors of sequential bilateral hip fractures were evaluated. RESULTS: Mean age of subjects in the BHF group and the non-BHF group was 78.4 years(68-90 years) and 78.0 years(58-99 years), respectively. Mean time interval from initial fracture to second fracture in the BHF group was 29.9 months(2-102 months). No significant differences in T-score of proximal femur (P=0.276), dwelling pattern (P=0.623), dizziness or dementia (P=0.180), health status (P=0.399), and BMI (P=0.629) were observed between the two groups. Eight patients(22.0%) in the BHF group and 254 patients(40.6%) in the non-BHF group were treated with bisphosphonate medications due to osteoporosis during a period of at least one year or more (P=0.028). CONCLUSION: Sequential hip fractures in elderly osteoporotic patients over the age of 70 were the result of low energy trauma, and most second fractures occurred within three years from initial injury. A multidisciplinary approach to prevention of a slip and treatment for osteoporosis are considered important to prevention of second hip fractures.

Posterior Cruciate Ligament Retaining Total Knee Arthroplasty

The posterior cruciate ligament (PCL) is a central stabilizer of the knee joint and it contributes to anteroposterior, valgus/varus and rotational stability. The PCL guides femoral rollback if it is preserved with proper tension during total knee arthroplasty. Maintenance of the joint line position, more conservation of bone and the possibility of reduced wear by absorption of shear forces are the potential advantages of posterior cruciate ligament retention. But an overly tensioned PCL increases polyethylene wear and on the other hand a lax PCL induces paradoxical femoral rollback and instability during knee flexion. So careful attention is needed in order to achieve the proper tension of the PCL during total knee arthroplasty, and sacrificing the PCL is considered in cases of severe deformity of the knee joint or progressive rheumatoid arthritis.

The Short-term Result of NexGen CR-Flex(R) Total Knee Arthroplasty

PURPOSE: The purpose of this study is to evaluate the result of primary total knee arthroplasty(TKA) with using NexGen CR-Flex(R) (Zimmer, Warsaw, IN, USA) after a follow-up of at least 2 years. MATERIALS AND METHODS: A total of 63 patients (98 knees) were included in this study. The same surgeon performed all the TKAs between August 2005 and May 2006 with using NexGen CR-Flex(R). The patients' age ranged from 52 to 81 years, and the mean follow-up period was 28 months. The patients were assessed clinically and radiographically with using the HSS score, the possibility that they could squat or kneel, the tibiofemoral angle, the radiolucency and the posterior condylar offset. RESULTS: The mean HSS score was 58.3 points preoperatively, and it was 91.1 points at the last follow-up. The mean range of motion improved from 123.2degrees preoperatively to 137.1degrees postoperatively. Forty-nine patients (78%) were able to squat and 24 patients (38%) could kneel down at the last follow-up. The mean tibiofemoral angle was 6degrees of varus preoperatively, and 7degrees of valgus postoperatively. And there was no radiolucency in any case. The mean posterior condylar offset was 26.1mm preoperatively and 27.2 mm postoperatively. CONCLUSION: TKA with using NexGen CR-Flex(R) showed favorable results at a mean follow-up of 28 months. Adequate patient selection, restoration of the posterior condylar offset and thorough clearing of posterior condylar osteophytes are thought to be the key elements to achieve a satisfactory range of motion after TKAs.