Ceramic on Ceramic Hybrid Type Total Hip Arthroplasty in Patients with more than 65 years of Age -Minimum 5-year Follow-up Results

Purpose: This study examined the minimum five-year results of hybrid type total hip arthroplasty (THA) with ceramic-on-ceramic articulation and femoral stem fixation using cement in patients older than 65 years. Materials and Methods: From February 1999 to November 2002, a hybrid type THA with ceramic-on-ceramic articulation and femoral stem fixation using cement were performed in 47 patients (47 hips) older than 65 years of age. Among the 47 patients, 29 patients were followed up for more than 5 years. The mean age of these patients was 68.9 years (65~73years). The mean follow-up period was 74.6 months (61~107 months). The postoperative diagnosis included AVN of the femoral head in 21 hips, Osteoarthritis in 2 hips, rhematoid arhthritis in 1 hip, femoral neck fracture in 4 hips and Tuberculosis in 1 hip. The clinical results were analyzed retrospectively by the Harris hip score (HHS), hip and thigh pain, and radiologically by the level of osteolysis around acetabular cup and femoral stem, bone reabsorption by stress shielding, instability, acetabular and femoral stem anteversion, acetabular inclination and the femoral stem fixation site. Results: After surgery, the overall HHS improved from 56.3 +/- 1.4 to 92.3 +/- 1.1 points (p=0.013). Excellent and good results were obtained in 21 (72.4%) and 8 hips (27.6%), respectively. There was no case of thigh pain. Radiologically, there was no acetabular and femoral component osteolysis. Absorption by stress shielding was observed in 6 cases (20.7%) with an acetabular cup and 3 cases (10.3%) with a femoral stem. Bony stability was observed in all cases treated with an acetabular cup and possible loosening in 1 case (3.4%) treated with a femoral stem. Acetabular and femoral stem anteversion was 18.4degrees+/- 1.1 and 13.1degrees+/- 0.9 respectively. Acetabular inclination was 41.5degrees+/- 1.3. The femoral stem was inserted centrally in all cases. Complications included posterior dislocation of 1 hip (3.4%) and periprosthetic fracture of the femur in 1 hip (3.4%). There was no fracture of the ceramic component Conclusion: The mid-term results of hybrid type THA with ceramic-on-ceramic articulation and femoral stem fixation using cement were effective both clinically and radiologically in patients older than 65 years.

Total Knee Arthroplasty using a Medial Pivot Knee: Minimum 2-year Follow-up Results

PURPOSE: To evaluate short-term clinical and radiologic outcomes after Advance(R) total knee arthroplasty (TKA). MATERIALS AND METHODS: We evaluated 226 patients who underwent 348 TKAs using medial pivot knees and who were followed up for more than 2 years. The average follow-up period was 40.6 months. We evaluated clinical outcomes based on range of motion (ROM), Knee Society score, and functional score. Radiographic outcomesand complications were also recorded. RESULTS: The average flexion contracture improved from a preoperative value of 6.2degrees to a last follow-up value of 1.3degrees. The average knee flexion was 114degrees preoperatively and 109degrees at last follow-up. The average knee and functional scores were 43.1 and 50.8, respectively, in the preoperative period and 86.2 and 77.9, respectively, in the postoperative period. Complications included 3 avulsion fractures of the medial collateral ligament, 2 delayed infections, 2 periprosthetic fractures, and 1 patellar dislocation. CONCLUSION: The short-term clinical results associated with medial pivot TKA were acceptable. However, more experience and long-term follow-up will be necessary to better determine the efficacy of this procedure.

The Effect of Demineralized Bone Matrix as a Graft Enhancer in Posterior Lumbar Interbody Fusion Using Cage and Local Bone Chips / 대한척추외과학회지

STUDY DESIGN: A randomized, controlled study OBJECTIVES: We wanted to investigate whether osteogenesis can be enhanced when a small amount of demineralized bone matrix (1 cc/segment) is mixed with local bone chips. SUMMARY OF LITERATURE REVIEW: Demineralized bone matrix (DBM) has been used for spinal arthrodesis. However, there are only a few reports about its use as a composite graft with local bone chips for posterior lumbar interbody fusion MATERIALS AND METHODS: Degenerative spine patients, who would normally be treated by decompression and posterior lumbar interbody fusion with using a pedicle screw system and one cage, were randomly, prospectively selected for whether they would be treated with using local bone chips mixed with 1cc of DBM (Group I: 15 patients and 19 segments) or local bone chips (Group II: 12 patients and 13 segments) for graft material. The sampling bias was investigated for gender, age, endocrine diseases, previous operation, habits (alcohol drinking, smoking), steroid medication, bone mineral density and the amount of local bone. The amount of bone formation was measured at 6 months after operation. On the sagittal and coronal reconstruction CT images, the bone formation outside of the cage was measured, and this was interpreted in a "blinded"fashion by 2 independent doctors who did not take part in the operations. RESULTS: There was no sampling bias between the 2 groups except for age (Group I= 65.3+/-7.1, Group II=58.9+/-6.0, p=0.010). The ratio of local bone chips and DBM was 5.98:1 in Group I. There was moderate concurrence between the 2 interpreters (kappa coefficiency= 0.494, p<0.001 for the sagittal plain images and kappa co-efficiency=0.467, p<0.001 for the coronal plain images) and Group I showed significantly more bone formation (p=0.003). CONCLUSION: DBM that is mixed with local bone chips, even with small amount, enhanced bone formation in the posterior lumbar interbody fusion. This is regarded to act as a graft enhancer to increase the fusion rate, even when using local bone chips for graft material, for the cases that show unfavorable conditions for fusion or for the cases that are prone to loosening of hardware.

The Result of Early Decompression of Progressive Neurologic Deficit after Spine Surgery: A Case Report / 대한척추외과학회지

Two percent of neurological complications after spine surgery for various reasons have been reported. Most are static or improve with time. We encountered two cases of newly developed, progressive neurological deficits with severe pain radiating along the exiting root after posterior decompression, adhesiolysis, posterior lumbar interbody fusion (PLIF) with a cage for spinal stenosis after previous lumbar spine surgery. When explored, the severely tightened and less movable, edematous exiting root was entrapped by a pedicle without evidence of pedicle violation, direct injury, epidural hematoma or iatrogenic foraminal stenosis. A wider decompression with a resection of the pedicle reduced the root course and made it more movable. Immediately, the severe radiating pain subsided and the neurological deficit recovered. A progressive neurological deficit after spinal surgery for spinal diseases with foraminal stenosis can develop as a result of the inordinate manipulation of the root, which may provoke root edema, root self-entrapment around a pedicle and local ischemia. An image test and exploration should be performed immediately in cases of progressive single root neurological deficits immediately after spine surgery. Total decompression, even with a pedicle resection, should be considered to resolve the neurological deficits.

Analysis of Risk Factors Affecting Degeneration of the Acetabular Cartilage after Bipolar Hemiarthroplasty

PURPOSE: This study attempted to investigate the rate of acetabular cartilage wear, as well as the risk factors that are related to degeneration, for patients who were diagnosed with femur neck or intertrochanteric fracture and who underwent bipolar hemiarthroplasty. MATERIALS AND METHODS: 34 patients who were diagnosed with femur neck or intertrochanteric fracture and who underwent bipolar hemiarthroplasty were selected as the study subjects, and they were followed up for more than 2years. We examined potential relationships between the degeneration of acetabular cartilage and the various risk factors by comparing radiographs taken before and after operations. RESULTS: After bipolar hemiarthroplasty, the average degenerative change in the acetabular cartilage was 0.20 mm/yr. Specifically, the average appeared significantly different according to gender (p=0.039, Male: 0.26 mm/yr, Female: 0.19 mm/yr), age (p=0.02, the under 70-year olds: 0.29 mm/yr, the upper 70-year olds: 0.13 mm/yr), the life style, (p=0.037, the stand-up life style: 0.18 mm/yr, the sit-down life style: 0.24 mm/yr), (ED note: stand up and sit down made no sense.) and using femoral stem cementing (p=0.237, cement: 0.22 mm/yr, non-cement: 0.21 mm/yr). The bone mineral density score (p=0.254), activity score (p=0.041), HHS (p=0.027) and femoral stem alignment (p=0.438) were shown to be -3.7, 3.2, 87 and varus 1 degree for people with less than average degeneration of the acetabular cartilage and -3.9, 4.3, 75 and varus 2 degrees for people with more than average degeneration of the acetabular cartilage, respectively. CONCLUSION: The results showed no significant relationship between degeneration of the acetabular cartilage and patient gender, the presence of osteoporosis and using femoral stem cement. The degeneration of acetabular cartilage was faster for young patients, for patients with a sit-down life style, for a higher activity score or for a lower HHS. It is strongly recommended for surgeons to consider the patients' various conditions such as age, activity and a sit-down lifestyle when deciding between hemiarthroplasty and total hip arthroplasty.

Results of Cruciate-Retaining Total Knee Arthroplasty with Maxim(R) System : More than 5-Year Follow Up

PURPOSE: To evaluate the mid-term (over 5 years) clinical and radiologic results of Maxim(R) (Biomet, Warsaw, USA) Cruciate Retaining total knee replacement arthroplasty (TKRA). MATERIALS AND METHODS: Between Feb. 1997 and Nov. 2000, 103 knees in 65 patients who had been followed up for 5 years after TKRA with Maxim(R) Cruciate Retaining were evaluated retrospectively for clinical and radiologic results. RESULTS: The average range of motion increased from 114degrees (80~130degrees) preoperatively to 128degrees (105~130degrees) at the last follow-up. The average range of flexion contracture decreased from 6.5degrees preoperatively to 0.8degrees (0~15degrees) at the last follow- up. In patients with osteoarthritis, the mean preoperative knee score (59.2) and functional score (40.7) improved to 88.6 and 90.1, respectively. In rheumatoid arthritis patients, the mean knee score and functional score also improved from 47.4 and 39.2 to 80.6 and 88.3. Roentgenographic evaluation revealed a radiolucency rate of 19.5%. Complications were deep infection in 2 cases and periprosthetic fractures in 3 cases. The former had received reimplantations. CONCLUSION: The mid-term results of Maxim(R) Cruciate Retaining total knee replacement arthroplasty were reliable and satisfactory in terms of improvements of range of motion, restoration of function, and rare complications. However, long-term follow-up evaluation is necessary.

Revision of Total Hip Arthroplasty Using Extensively Porous-Coated Femoral Stem

Purpose: To report the outcomes of extensively porous-coated femoral stems based on diaphyseal fixation caused by extensive bone loss and osteoporosis of the proximal femur in revision total hip arthroplasty. Materials and Methods: 14 cementless femoral revision procedures performed between Aug, 2000 and Apr, 2003 were reviewed retrospectively. The follow up period ranged from 24 to 53 months, with an average of 33 months. The average age at surgery was 52.3 years, there were 10 males and 4 females. The reasons for the revision surgery were aseptic loosening in 11(78.7%) hips, progressive osteolysis in 1(7.1%), septic loosening in 1(7.1%) and periprosthetic fracture in 1(7.1%). Results: The Harris hip score improved from 50.4 points preoperatively to 88.5 points postoperatively. The complications encountered were a greater trochanteric fracture in 2 hips (14.3%), periprosthetic fracture in 1(7.1%), dislocation of the hip in 2(14.3%), and minimal thigh pain in 2(14.3%). Radiographic evidence of a bone ingrown stem was found in 11 hips (78.6%), and 3 hips (21.4%) showed stable fibrous fixation. Stem subsidence > 5mm was noticed in 1 hip (7.1%) and > 10mm in 2 (14.3%) but there was no further progression after 1 year. Moderate stress-shielding was noticed in 4 hips(28.6%). To date, no significant wear or osteolysis has been observed. Conclusion: An extensively porous-coated revision stem appears to be a reasonable choice in the presence of proximal femoral bone loss as a short term follow up. However, the concerns related to the postoperative complications will require a longer term follow up.