Union Rates of Autologous Bone Marrow, Local Autobone and Biphasic Calcium Phosphate Mixed Graft in Lumbar Posterolateral Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: We examined union rates and clinical outcomes to evaluate the efficacy of using autologous bone marrow along with a local autobone and biphasic calcium phosphate mixed graft with posterolateral fusion in spinal stenosis and spondylolisthesis. SUMMARY OF LITERATURE REVIEW: In lumbar posterolateral fusion, union rates of biphasic calcium phosphate and local autobone mixed graft are low compared to union rates of autogenous iliac bone graft. MATERIALS AND METHODS: Among the patients who had lumbar posterolateral fusion with autologous bone marrow along with local autobone and biphasic calcium phosphate mixed graft between February 2013 and January 2014, we analyzed 40 patients who were available for at least one year of follow-up. There were 22 cases with spinal stenosis and 18 cases with spondylolisthesis. Bone fusion was determined along with the fusion rates based on Lenke's criteria (citation). All patients were evaluated postoperatively at one year, using 3D CT. and the clinical outcomes were assessed using Kim's method (citation). RESULTS: In spinal stenosis, bone union was observed in 19 cases out of 22 (86.4%), and in case of spondylolisthesis, bone union was observed in 16 cases out of 18 (88.9%). In spinal stenosis, the clinical outcomes were: 2 excellent, 16 good, 3 fair, and 1 poor; in other words 18 cases (81.8%) displayed good or excellent outcomes. In spondylolisthesis, 2 excellent, 12 good, 4 fair and 0 poor; in other words, 14 cases (77.8%) showed good or superior outcomes. CONCLUSIONS: Posterolateral fusion using autologous bone marrow along with a local autobone and biphasic calcium phosphate mixed graft showed similar bone fusion rates to using autogenous iliac bone graft. Therefore, this method could serve as an alternative to using autogenous iliac bone graft in posterior lumbar fusion.

Corrigendum: Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report / 대한족부족관절학회지

This correction is being published to correct the corresponding author's name and e-mail information.

Biphasic Calcium Phosphate and Local Autobone Mixed Graft in Lumbar Posterolateral Fusion

STUDY DESIGN: Retroprospective study. OBJECTIVES: To evaluate the efficacy of biphasic calcium phosphate and local autobone mixed graft in cases of spinal stenosis and spondylolisthesis in posterolateral fusion by examining radiologic union rates and clinical outcomes. SUMMARY OF LITERATURE REVIEW: It can be a practical alternative to the use of tricalcium phosphate in hydroxyapatite as a graft aid since using hydroxyapatite mixture in lumbar spine fusion has been reported to lead to a high rate of bone union. MATERIALS AND METHODS: From July 2011 to February 2013, we followed up 107 patients who had lumbar posterolateral fusion using biphasic calcium phosphate composed of HA/TCP (60:40) and local autobone mixed graft. Of these patients, 64 had spinal stenosis and 43 had spondylolisthesis. The bone fusion rate was determined using Lenke's criteria and clinical outcomes were evaluated using Kim's method. RESULTS: In spinal stenosis, bone union was presented in 53 patients (of 64; 82.8%) and in spondylolisthesis, 35 patients (of 43; 81.4%). In spinal stenosis, the clinical outcomes resulted in 20 excellent, 34 good, 9 fair and 1 poor. (84.4%, excellent or good) In spondylolisthesis, the clinical outcomes resulted in 10 excellent, 25 good, 7 fair and 1 poor. (81.4%, excellent or good). CONCLUSION: Posterolateral fusion using biphasic calcium phosphate and local autobone mixed graft showed high rates of bone union and acceptable clinical outcomes, and is considered a satisfactory bone graft aid.

Ankle Salvage Procedure without Internal Fixation for Large Bone Defect after Failed Total Ankle Arthroplasty: A Case Report / 대한족부족관절학회지

In treatment of failure in ankle joint replacement therapy, talar avascular necrosis with massive bone defect, talus fracture with severe comminution and bone defect and ankle dislocation, treatment of large bone defects is considerably important for ankle joint stability and union, therefore, the choice of treatment for large bone defects is use of femoral head or iliac crest bone graft and rigid internal fixation. Because first generation total ankle arthroplasty performed for the first time using a cemented fixation technique requires a large amount of bone resection during re-surgery and there is some possibility of a larger bone defect after removal of implants, in cases where prosthesis for the defect is needed, performance of palliative femoral head or iliac crest bone graft and rigid internal fixation can be difficult. We report on a case of a 48-year-old woman who had experienced ankle pain for 25 years since undergoing total ankle arthroplasty. Because the patient had little ankle motion and rigid soft tissue despite a large bone defect caused by aseptic loosening, a good outcome was obtained only for the femoral cancellous bone graft using allo femoral head without internal fixation.

Union Rates of Local Autobone and beta-Tricalcium Phosphate Mixed Graft in Lumbar Posterolateral Fusion

STUDY DESIGN: A retroprospective study. OBJECTIVES: We used a local autobone and beta-tricalcium phosphate mixed graft with posterolateral fusion in spinal stenosis and spondylolisthesis and evaluated union rates to verify the efficacy. SUMMARY OF LITERATURE REVIEW: Several reports have shown high union rates of posterolateral fusion using beta-tricalcium phosphate. However, in Korea, only one study reported a low union rate. MATERIALS AND METHODS: Forty-two patients who underwent lumbar posterolateral fusion with a local autobone and beta-tricalcium phosphate mixed graft from September 2010 to July 2011 were followed up. There were 32 cases with spinal stenosis and 10 cases with spondylolisthesis. Bone fusion was determined along with the fusion rates based on Lenke's criteria. Clinical outcomes were determined using Kim's method. RESULTS: In spinal stenosis, bone union was presented in 19 cases(59.4%) out of 32 cases and in spondylolisthesis, bone union was presented in 7 (70.0%) out of 10. In spinal stenosis, 12 cases showed excellent outcome, 16 good, 3 fair and 1 poor, 27 cases(87.5%) were superior to the good. In spondylolisthesis, 2 cases showed excellent outcome, 5 good, 3 fair and 0 poor, 8 cases(70.0%) were superior to the good. CONCLUSIONS: Posterolateral fusion using a local autobone and beta-tricalcium phosphate mixed graft showed lower bone fusion rates. We need further studies to enhance the fusion rate when using local autobone and beta-tricalcium phosphate mixed grafts.

Late-Onset Infection of a Total Knee Arthroplasty Caused by Monomicrobial Klebsiella pneumoniae in a Patient with a Periprosthetic Fracture / 대한정형외과학회잡지

Septic arthritis caused by Klebsiella pneumonia in adults is rare and is rarely observed after total knee arthroplasty. Acute or early onset of septic arthritis caused by K. pneumoniae has been reported after total knee arthroplasty. However, to date the only one overseas case of late K. pneumoniae infection after total knee arthroplasty has been reported, with no such case in Korea. In addition, monomicrobial infections by K. pneumoniae are not frequently found but are found primarily in the form of polymicrobial infections. The purpose of this paper is to report on a case in which an 85-year-old female patient, who had undergone a total joint arthroplasty 11 years ago, developed the late onset of septic arthritis caused by monomicrobial K. pneumonia infection with a periprosthetic fracture through literature reviews.