The Effects of Autologous Structural Bone Graft without Internal Fixation on Posteromedial Tibial Bone Defect in Primary Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To evaluate the radiological and clinical outcomes of the standard total knee arthroplasty without internal fixation or extended long stem in tibial bone defect with severe varus deformity. MATERIALS AND METHODS: Between July 2012 and April 2014, 32 patients (45 cases; 4 men and 41 women with a mean age of 74.2 years) who underwent total knee arthroplasty with autologous bone grafting were enrolled for analysis. The mean follow-up period was 34.4 months. The cancellous bone defect site was exposed, and a longitudinal sulcus was made. Subsequently, a premolded bone graft was inserted in the sulcus at 45°. The defect size was measured, and the radiological and clinical results were evaluated. RESULTS: The mean defect size according to the radiograph was found to be 15.31×30.36 mm in the frontal view and 15.46×45.98 mm in the sagittal view. The mean defect size of depth during the operation was found to be 8.38 mm. The preoperative mean varus angle was 14.1° (4.0°–26.9°), and the follow-up mean valgus angle was 5.4° (0.5°–10.5°). The implant position was α=95.7°, β=90.4°, γ=2.1°, δ=89.1° on the follow-up. No implant loosening was observed, and the mean bone union period was 4.3 months. The Hospital for Special Surgery score was improved from a preoperative mean of 50.1 to a postoperative mean of 90.4. CONCLUSION: Standard total knee arthroplasty using autologous structural bone grafting without internal fixation in a tibial bone defect demonstrated a rapid, stable bone healing and excellent radiological and clinical results. Thus the index procedure was considered to be simple, and effective for bone grafting.

Gas Forming Bacterial Infection after Total Knee Arthroplasty / 대한정형외과학회잡지

Postoperative gas-forming bacterial infection is very rare. However, it can be a life threatening problem if not properly addressed. Authors treated a patient who was infected with gas forming Escherichia coli after both knee arthroplasty with incision and drainage, as well as arthroscopic synovectomy and antibiotics. Herein, we report a case of postoperative gas-forming bacterial infection with literature review.

Clinical Outcomes of Arthroscopic Treatment of Calcific Tendinitis of the Shoulder

BACKGROUND: Our study aimed to make a comparative analysis of clinical outcomes of arthroscopic decompression for rotator cuff calcific tendinitis by location of calcific deposits and by its size. METHODS: We enrolled a total of 38 patients, comprising 39 affected shoulders, who underwent arthroscopic decompression for calcific tendinitis. As our clinical scores, we evaluated the UCLA, the ASES, and the VAS scores and analyzed them by calcific location, by calcific deposit size, by the presence or absence of calcific remnants, and by whether concomitant cuff repair was performed. RESULTS: The clinical scores of those whose calcific deposit had an area greater than 77.0 mm2 and of those whose calcific deposit had an area smaller than 77.0 mm2 did not significantly differ (p=0.21 in ASES; p=0.19 in UCLA; p=0.17 in VAS). Nor did the clinical scores significantly differ with respect to the location of calcification (p=0.23). Further, the clinical scores did not significantly differ between those who had calcific remnants and those who did not and between those who received additional cuff repair and those who did not. CONCLUSIONS: We found that the clinical outcomes after arthroscopic decompression of calcific tendinitis were not significantly associated with the cuff tendon in which the calcium deposits are found; the location of the calcium deposits in the supraspinatus tendon (if found in this tendon); the size of calcific deposits; the presence of calcific remnants; and concomitant cuff repairs.

Clinical Outcomes of Arthroscopic Treatment of Calcific Tendinitis of the Shoulder

BACKGROUND: Our study aimed to make a comparative analysis of clinical outcomes of arthroscopic decompression for rotator cuff calcific tendinitis by location of calcific deposits and by its size. METHODS: We enrolled a total of 38 patients, comprising 39 affected shoulders, who underwent arthroscopic decompression for calcific tendinitis. As our clinical scores, we evaluated the UCLA, the ASES, and the VAS scores and analyzed them by calcific location, by calcific deposit size, by the presence or absence of calcific remnants, and by whether concomitant cuff repair was performed. RESULTS: The clinical scores of those whose calcific deposit had an area greater than 77.0 mm2 and of those whose calcific deposit had an area smaller than 77.0 mm2 did not significantly differ (p=0.21 in ASES; p=0.19 in UCLA; p=0.17 in VAS). Nor did the clinical scores significantly differ with respect to the location of calcification (p=0.23). Further, the clinical scores did not significantly differ between those who had calcific remnants and those who did not and between those who received additional cuff repair and those who did not. CONCLUSIONS: We found that the clinical outcomes after arthroscopic decompression of calcific tendinitis were not significantly associated with the cuff tendon in which the calcium deposits are found; the location of the calcium deposits in the supraspinatus tendon (if found in this tendon); the size of calcific deposits; the presence of calcific remnants; and concomitant cuff repairs.

Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures

BACKGROUND: Subcapital femoral neck is known to cause many complications, such as avascular necrosis (AVN) of the femoral head or nonunion, compared with other femoral neck fractures. The purpose of this study was to analyze the incidence of AVN and fixation failures in patients treated with internal fixation using cannulated screws for the subcapital femoral neck fractures. METHODS: This study targeted a total of 84 cases of subcapital femoral neck fractures that underwent internal fixation using cannulated screws. The average follow-up time after surgery was 36.8 months (range, 24 to 148 months). RESULTS: Nine hips (10.7%) showing AVN of the femoral head and 6 hips (7.1%) showing fixation failures were observed. The factors affecting the incidence of AVN of the femoral head after sustaining fractures correlated well with fracture types in the Garden classification (p = 0.030). The factors affecting fixation failure were the degree of reduction (p = 0.001) measured by the Garden alignment index and firm fixation (p = 0.009) assessed using the technique of 3-point fixation through the inferomedial cortical bone of the femoral neck. CONCLUSIONS: The complication rates for subcapital femoral neck fractures were lower than those previously reported; hence, internal fixation could be a primary treatment option for these fractures.

Functional Outcome of Bioabsorbable Suture Anchor and Metal Screw Fixation on Tibial Side for Anterior Cruciate Ligament Reconstruction / 대한스포츠의학회지

The aim of this study was to evaluate the postoperative outcomes of anterior cruciate ligament (ACL) reconstructionuction using 2 additional fixation technique on tibial side. Between October 2008 and February 2012, sixty consecutive patients who underwent ACL reconstruction with allograft for ACL injuries were retrospectively enrolled. All patients were reconstructed with fresh frozen achilles tendon or posterior tibialis tendon allograft. Fixation on tibial side with bioabsorbable suture anchor (BSA) was in 30 patients (group A) and metal screw fixation was in 30 patients (group B). The data was collected at preoperatively and at least 1 years postoperatively, which included KT-2000 arthrometer objectively, and Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) scores subjectively. At the final follow up, the KT-2000 arthrometer improved significantly with an average of 3.28 mm anterior translation in the group A, 3.56 mm in group B. The preoperative mean Lysholm, Tegner and IKDC score was 46.14, 4.86, 63.17 in the group A, and 45.30, 4.40, 54.07 in the group B. The postoperative mean Lysholm, Tegner and IKDC score was 83.80, 8.14, 75.57 in the group A, and 88.75, 7.62, 65.10 in the group B. All functional outcomes were improved significantly (p=0.004) in both groups, but no differences were noted between the 2 groups (p>0.05). Both additional fixation techniques using BSA or metal screw fixation on tibial side in ACL reconstruction improved functional outcomes significantly. BSA technique seems to provide adequate strength suitable for early rehabilitation after ACL reconstruction.