Treatment of Infected TKRA / 대한정형외과학회잡지

PURPOSE: To investigate the causes and to determine the most useful test for the early diagnosis of infected TKRA, and to present the treatment modality and its possible complications. MATERIALS AND METHODS: We reviewed 17 cases, with follow up, among the 18 infected TKRA cases registered from March 1992 to June 2000. Diagnosis of deep infection after TKRA was made by assessing clinical symptoms, laboratory and radiological findings, nuclear scan studies and aspirate culture results. Data were analyzed clinically by HSS score, recurrence of infection and postoperative complications. RESULTS: The overall incidence of deep infection after TKRA was 1.4%. In fourteen of the 17 cases TKRA was revised. In 13 cases, excluding 1 case of infection recurrence after 2-stage TKRA revision, the mean ROM increased from 55o to 86o and the mean HSS score increased from 53 points to 84. Knee fusion was performed in 4 cases, including one case of infection recurrence after 2-stage TKRA revision. CONCLUSION: The most reliable clinical results were achieved after a 2-stage TKRA revision. Knee joint fusion should be considered when the general condition is poor, with an initial diagnosis of infection, and in the presence of skin problems.

Thompson Quadricepsplasty in Ankylosis of the Knee Joint / 대한정형외과학회잡지

PURPOSE: To evaluate the results of Thompson quadricepsplasty in ankylosis of the knee joint by a comparison of the patients'ages, the causes, the duration of the ankylosis and the preoperative range of motion (ROM). MATERIALS AND METHODS: We reviewed 17 patients who received Thompson quadricepsplasty for knee ankylosis between 1991 and 1998, and who could be followed up for more than one year. We compared the results according to the patients'ages, the causes and degree of ankylosis and the duration. Since onset, the postoperative ROM, the final degree of the flexion, the flexion gain (difference between the preoperative and the postoperative ROM), and the loss of ROM (difference between the intraoperative ROM and the postoperative ROM) were also assessed. RESULTS: The preoperative mean arc of motion (26.2degrees, range 0degrees-80degrees) and the mean flexion (30degrees, range 5degrees-90degrees) were significantly increased up to a mean of 98.8degrees (75-100degrees) and 102.1degrees (80-130degrees) respectively. In the severe ankylosis group, the flexion gain was significantly increased. However, the correlation according to the patients'ages, causes and duration of the ankylosis were not statistically significant. The mean loss of ROM was 14.7degrees (-20-30degrees), and it occurred within the postoperative 2 month period in most patients. CONCLUSION: The Thompson quadricepsplasty procedure can be considered to be an acceptable technique for the treatment of ankylosis of the knee joint. Rehabilitation in the postoperative 2 month period is very important for a good outcome.