Mid-term Results of Revision Total Hip Arthroplasty Using Delta Ceramic-on-Ceramic Bearing.

Background: Delta ceramic-on-ceramic (CoC) articulation affords excellent outcomes in primary total hip arthroplasty (THA). However, the safety and reliability of this bearing in revision THA need more evidence. This study aimed to report complications, radiological changes, clinical results, and survivorship of revision THA using Delta CoC articulation at minimum 5-year follow-up. Methods: We reviewed 118 revision THAs (113 patients: 68 men and 45 women) performed with use of Delta CoC bearing. Their mean age was 58.7 years (range, 30-90 years) and their mean body mass index was 24.6 kg/m2 (range, 15.2-32.5 kg/m2). These patients were followed up for 5-12 years (mean, 7.2 years). We evaluated squeak, grinding sensation, ceramic fracture, dislocation, periprosthetic joint infection (PJI), periprosthetic fracture, prosthetic loosening, ceramic wear, osteolysis, modified Harris hip score (mHHS), and survivorship with any reoperation after the revision as the endpoint. Results: Two patients (1.7%) had grinding sensation, but no patient had ceramic fracture. Reoperations were necessary in 9 hips (7.6%) due to PJIs in 2, stem loosening in 2, cup loosening in 2, recurrent dislocation in 2, and periprosthetic fracture in 1. No hip had measurable wear or osteolysis. The average mHHS improved from 53.3 points before the revision to 82.3 points at the final follow-up. Survivorship was 91.6% (95% confidence interval, 86.3%-96.9%) at 12 years. Conclusions: The Delta ceramic bearing appeared a reliable option for revision THA, showing encouraging mid-term results with acceptable survivorship and a low complication rate.

Hip Fracture Management during the COVID-19 Pandemic in South Korea.

BACKGROUND: The purpose of this study was to introduce a screening system for coronavirus disease 2019 (COVID-19), to evaluate the overall orthopedic management in hip fracture patients during the COVID-19 pandemic in South Korea, and to compare the surgical results in hip fracture patients during the COVID-19 pandemic with those of the previous year. METHODS: Hip fracture patients who visited emergency rooms were screened at the screening clinics before admission. The medical management was carried out with the medical staff wearing surgical masks, meticulous hand hygiene observed, and a minimum distance of 2 m between patients maintained. The demographics, operative parameters, and surgical results of patients treated during the pandemic were compared with those from the previous year. RESULTS: From January 2020 to July 21, 2020, 119 patients with hip fractures (33 men and 86 women) were admitted to our institution for surgical treatment. Five patients showed symptoms of pneumonia, but no patient was positive for COVID-19. The mortality rate during the study period was 4.2%, and none of the patients died due to COVID-19. The interval between admission and surgery and the length of hospital stay were significantly shorter (p = 0.008, p = 0.002) and the proportion of spinal anesthesia was greater in hip fracture patients during the COVID-19 pandemic compared to those from the previous year (p = 0.011). CONCLUSIONS: The COVID-19 screening system for hip fracture patients has proven to be effective in preventing intrahospital spread of the disease. Hip fracture surgery performed during the COVID-19 pandemic has shown comparable results without any COVID-19 infection and COVID-19-related mortality.

The Influence of Femoral Internal Rotation on Patellar Tracking in Total Knee Arthroplasty Using Gap Technique.

BACKGROUD: Femoral internal rotation in total knee arthroplasty (TKA) is well known as one of the main causes of patellar maltracking. Although femoral internal rotation in TKA is considered unacceptable due to the risk of patellar maltracking, it is sometimes required for ligament balancing. We evaluated the influence of femoral internal rotation on patellar tracking in TKA performed using the gap technique. METHODS: From April 2008 to May 2018, 1,612 cases of TKA were done. Among them, 245 cases of TKA for osteoarthritis were followed up for at least 1 year and included in this study. We compared patellar tracking in two groups; group I consisted of 99 cases whose femoral rotation was less than 0° and group II consisted of 146 cases whose femoral rotation was 3°-5° external rotation. Preoperative femoral rotation was measured with the condylar twist angle (CTA) by using computed tomography. The patella was replaced in all cases. Patellar tracking was evaluated with patellar tilt angle (lateral tilt [+] and medial tilt [-]) in the merchant radiograph. Statistical analysis was done using Mann-Whitney U-test. Clinical assessment was performed using the Knee Society clinical rating system. RESULTS: The preoperative CTA was 5.3° ± 1.6° in group I and 5.4° ± 1.6° in group II, showing no statistically significant difference between groups (p = 0.455). Intraoperative femoral rotation was -0.5° ± 0.8° in group I and 3.9° ± 0.8° in group II when the gap technique was used (p < 0.001). The postoperative patellar tilt angle was -0.4° ± 3.6° in group I and 0.1° ± 4.1° in group II with no statistically significant difference (p = 0.251). CONCLUSIONS: Compared with femoral external rotation, femoral internal rotation with ligament balance in TKA was not more associated with patellar maltracking. Therefore, patellar tracking might be related with ligament balance in flexion regardless of the anatomic femoral rotational alignment.

Clinical Effects and Complications of Pedicle Screw Augmentation with Bone Cement: Comparison of Fenestrated Screw Augmentation and Vertebroplasty Augmentation.

BACKGROUND: Pedicle screw augmentation with bone cement has been experimentally demonstrated to increase the pullout strength. However, the mechanisms of screw loosening are complicated and interacting. Although vertebroplasty augmentation and fenestrated screw augmentation have been compared in many studies, there has been no comparative study on their clinical effects and complications in real clinical settings. We investigated clinical effects of bone cement augmentation of a pedicle screw and differences according to augmentation methods. METHODS: Of the total 241 patients who had osteoporosis and underwent posterior pedicle screw fixation without anterior bone graft between January 2010 and December 2016, 132 patients with ≥2 years of radiological follow-up were included in this retrospective study. The patients were divided into group I (unaugmented) and group II (bone cement augmented). Group II was subdivided into II-S group (solid screw augmented) and II-F group (fenestrated screw augmented). The incidence of screw loosening was compared between groups I and II. Cement leakage, screw loosening, and screw fractures were investigated in the subgroups. RESULTS: In total, 36 of 71 (52%, group I) unaugmented cases and 96 of 170 (56%, group II) augmented cases were followed up for ≥2 years. Of the total 78 solid screw augmented cases, 42 (56%) were in II-S group; 54 of the total 92 (59%) fenestrated screw augmented cases were in II-F group. Groups I and II were homogenous regarding demographic characteristics; II-S and II-F groups were also homogenous. The incidence of screw loosening was 50.0% (18/36) in group I and 7.3% (7/96) in group II (p < 0.001). Cement leakage developed in 2 of 42 (4.8%) cases in II-S group and in 5 of 54 (9.3%) cases in II-F group (p = 0.462). Screw loosening developed in 6 of 42 (14.3%) cases in II-S group and in 1 of 54 cases (1.9%) in II-F group (p = 0.041). Screw fracture developed in none of 42 cases in II-S group and in 3 of 54 cases (5.6%) in II-F group (p = 0.254). CONCLUSIONS: In osteoporotic patients, bone cement augmentation of a pedicle screw decreased the incidence of screw loosening, and fenestrated screw augmentation was more effective than vertebroplasty augmentation.

Fine Microstructured In-Sn-Bi Solder for Adhesion on a Flexible PET Substrate: Its Effect on Superplasticity and Toughness.

A novel In-Sn-Bi solder with a low electrical resistivity of 14.3 × 10-6 Ω cm and a melting temperature of 99.3 °C was produced for use in adhesive joining on a flexible poly(ethylene terephthalate) substrate. We determined that the fine microstructure of the In-based solder (which had an average phase size of 62.2 nm) strongly influenced its superplasticity and toughness at diffusive temperatures of 55-85 °C because the late-forming BiIn intermetallic compound (IMC) suppressed the growth of two other IMCs, In3Sn and In0.2Sn0.8, which formed earlier in the soldering process. Thus, an elongation of 858.3% and toughness of 36.0 MPa were obtained at a temperature of 85 °C and a strain rate of 0.0020 s-1. However, due to phase boundary fracturing, the phase-refined solder exhibited a slightly more brittle nature (with an elongation of 74.3%) at room temperature compared with a standard In-Sn solder consisting only of the In3Sn and In0.2Sn0.8 IMCs, which had a slightly larger phase size of 84.9 nm and higher ductility (with an elongation of 80.7%). In terms of superplastic deformation, the conventional fracture system based on the Hall-Petch effect transformed into phase boundary sliding at the solder operating temperature, significantly enhancing ductility.

Can We Prevent a Postoperative Spinal Epidural Hematoma by Using Larger Diameter Suction Drains?

BACKGROUND: Epidural hematoma is a rare but serious complication. According to previous studies, it is not prevented by suction drains. This study evaluated the following alternative hypothesis: the larger the diameter of a suction drain, the less the remaining epidural hematoma after spinal surgery. METHODS: This was a randomized prospective study. Patients who underwent posterior lumbar decompression and instrumented fusion were divided into two groups: the large drain (LD, 2.8-mm-diameter tube) and small drain (SD, 1.6-mm-diameter tube) groups according to the diameter of the suction drains. All patients were consecutive and allocated alternately according to the date of operations. Suction drains were removed on day 3 and magnetic resonance imaging was performed on day 7 postoperatively. The size of remaining hematomas was measured by the degree of thecal sac compression in cross section using the following 4-point numeric scale: G1, less than one quarter; G2, between one quarter and half; G3, more than half; and G4, more than subtotal obstruction. RESULTS: There were 39 patients with LDs and 38 with SDs. They did not differ significantly in terms of sex, number of fusion segments, revision or not, antiplatelet medication, intraoperative injection of tranexamic acid. However, patient age differed significantly between the two groups (LD, 63.3 years and < SD, 68.6 years; p = 0.007). The two groups did not differ significantly in terms of prothrombin time, activated partial thromboplastin time, platelet number, blood loss, or operation duration. However, platelet function analysis exhibited a significant difference (LD, 164.7 seconds and < SD, 222.3 seconds; p = 0.002). The two blinded readers showed high consistency (Kappa value = 0.740; p = 0.000). The results of reader 1 were as follows: LD and SD had 21 and 21 cases of G1, 9 and 11 cases of G2, 6 and 6 cases of G3, and 3 and 0 cases of G4, respectively. The results of reader 2 were as follows: LD and SD had 22 and 23 cases of G1, 7 and 9 cases of G2, 7 and 6 cases of G3, and 3 and 0 cases of G4, respectively. There was no difference between the two groups (reader 1, p = 0.636; reader 2, p = 0.466). CONCLUSIONS: The alternative hypothesis was rejected. Therefore, postoperative spinal epidural hematoma would not be prevented by LD.

Particular Features of Surgical Site Infection in Posterior Lumbar Interbody Fusion.

BACKGROUND: Previous reports have observed differences only in infection rates between posterolateral fusion and posterior lumbar interbody fusion (PLIF). There have been no reports that describe the particular features of surgical site infection (SSI) in PLIF. In this study, we endeavor to identify the distinguishing characteristics and risk factors of SSI in PLIF. METHODS: Our study undertook a review of a case series of an institute. Patients who had undergone PLIF consecutively in the author's hospital were reviewed. Two proactive procedures were introduced during the study period. One was irrigation of the autolocal bone, and the other was the intradiscal space irrigation with a nozzle. Infection rate and risk factors were analyzed. For subgroup analysis, the elapsed time to a diagnosis (ETD), clinical manifestations, hematologic findings, and causative bacteria were examined in patients with SSI. RESULTS: In a total of 1,831 cases, there were 30 cases of SSI (1.6%). Long operation time was an independent risk factor (p = 0.008), and local bone irrigation was an independent protective factor (p = 0.001). Two cases of referred SSI were included in the subgroup analysis. There were 6/32 (19%) superficial incisional infections (SII), 6/32 (19%) deep incisional infections (DII), and 20/32 (62%) organ/space infections (O/SI). The difference of incidence among three groups was significant (p = 0.002).The most common bacteria encountered were methicillin-resistant Staphylococcus epidermidis followed by methicillin-resistant S. aureus in incisional infections, and no growth followed by S. epidermidis in O/SI. ETD was 8.5 ± 2.3 days in SII, 8.7 ± 2.3 days in DII and 164.5 ± 131.1 days in O/SI (p = 0.013). CONCLUSIONS: The rate of SSI in PLIF was 1.6%, with the most common type being O/SI. The causative bacteria of O/SI was of lower virulence than in the incisional infection, and thus diagnosis was delayed due to its latent and insidious feature. Contamination of auto-local bone was presumed attributable to the progression of SSI. Irrigation of auto-local bone helped in the reduction of SSI.

Bilateral Femoral Neck Insufficiency Fractures after Use of a Long-term Anti-resorptive Drug Therapy for Osteoporosis: A Case Report.

A 78-year-old woman developed an insufficiency fracture on her right femoral neck without trauma after four years of treatment with a bisphosphonate. Her fracture was fixed by two screws and her anti-osteoporotic drug was changed from an anti-resorptive to an anabolic agent. Seven months later, however, she sustained similar insufficiency fracture on the left femoral neck and was treated with the same method. She developed right inguinal pain again approximately eight months after her right side operation. The results of imaging tests revealed that her insufficiency fracture was converted to complete fracture, and that the fracture gap had widened as well. Her right hip was revised with hemiarthroplasty. A histological exam of the fracture site revealed evidence of decreased bone healing. Long-term administration of anti-resorptive drug prevents bone healing and remodeling and can result in atypical fractures of the femoral neck. Osteosynthesis was difficult to accomplish despite the application of proactive fixation. Therefore, more rigid fixation and careful postoperative treatment should be considered.

[Trends in nursing research in Korea: research trends for studies published from the inaugural issue to 2010 in the Journal of Korean Academy of Nursing and the journals published by member societies under Korean Academy of Nursing Science].

PURPOSE: The purpose of this study was to identify trends for studies published in the Journal of Korean Academy of Nursing and journals published by member societies from inaugural issues to 2010. METHODS: A total of 6890 studies were analyzed using descriptive statistics. RESULTS: Quantitative studies accounted for 83.6% while qualitative studies accounted for 14.4%. Most frequently used research designs were quasi-experimental (91.1%) for experimental research and survey (85.2%) for non-experimental research. Most frequent study participants were healthy people (35.8%), most frequent nursing interventions, nursing skills (53.5%), and 39.8% used knowledge, attitude and behavior outcomes for dependent variables. Most frequently used keyword was elderly. Survey studies decreased from 1991 to 2010 by approximately 50%, while qualitative studies increased by about 20%. True experimental research (1.2%) showed no significant changes. Studies focusing on healthy populations increased from 2001-2005 (37.5%) to 2006-2010 (41.0%). From 1970 to 2010, studies using questionnaire accounted for over 50% whereas physiological measurement, approximately 5% only. Experimental studies using nursing skill interventions increased from 1970-1980 (30.4%) to 2006-2010 (64.0%). No significant changes were noted in studies using knowledge, attitude and behavior (39.9%) as dependent variables. CONCLUSION: The results suggest that further expansion of true experimental, qualitative studies and physiological measurements are needed.

The effect of luteolin-7-O-beta-D-glucuronopyranoside on gastritis and esophagitis in rats.

This study evaluated the inhibitory action of luteolin-7-O-beta-D-glucuronopyranoside, luteolin which was isolated from Salix gilgiana leaves, and omeprazole on reflux esophagitis and gastritis in rats. Reflux esophagitis and gastritis were induced surgically and by the administration of indomethacin, respectively. The intraduodenal administration of luteolin-7-O-beta-D-glucuronopyranoside decreased the ulcer index, injury area, gastric volume and acid output, and increased the gastric pH compared with luteolin. Luteolin-7-O-beta-D-glucuronopyranoside significantly decreased the size of the gastric lesions that had been induced by exposing the gastric mucosa to indomethacin. The malondialdehyde content, which is the end product of lipid peroxidation, was increased significantly after inducing of reflux esophagitis. The malondialdehyde content was decreased by Luteolin-7-O-beta-D-glucuronopyranoside but not luteolin or omeprazole. Luteolin-7-O-beta-D-glucuronopyranoside has a more potent antioxidative effect than luteolin. Luteolin-7-O-beta-D-glucuronopyranoside is a promising drug for the treatment of reflux esophagitis and gastritis.

Carbon monoxide as a novel central pyrogenic mediator.

Carbon monoxide (CO) are produced by heme oxygenase (HO), and HO was detected in hypothalamus. However, the roles of CO produced in hypothalamus was not fully elucidated. So, we tested the effects of CO on body temperature because preoptic-anterior hypothalamus was known as the presumptive primary fever-producing site. CO-saturated aCSF (4 microl, i.c.v.) and hemin (10 microg, i.c.v.) elicited marked febrile response. Pretreatment with indomethacin completely inhibited CO- and hemin-induced fever. Zinc protoporphyrin-IX (10 microg, i.c.v.) or ODQ (50 microg, i.c.v.) partially reduced hemin-induced febrile response. Dibutyryl-cGMP (100 microg, i.c.v.) produced profound febrile response and this febrile response was attenuated by indomethacin. These results indicate that endogenous CO may have a role as a pyrogenic mediator in CNS and CO-mediated pyresis is dependent on prostaglandin production and partially on activation of soluble guanylate cyclase.

Combination of vitamin C and rutin on neuropathy and lung damage of diabetes mellitus rats.

We investigated the role of vitamin C or rutin on neuropathy and lung damage of diabetic mellitus (DM) rats. Norepinephrine content was significantly decreased in sciatic nerves'of DM rats compared with non-DM controls but vitamin C had no effect on decreases of norepinephrine. 2,4-dinitrophenylhydrazine (DNPH) incorporation, which is biomarker of protein oxidation, was increased in sciatic nerve of DM rats as compared with normal control. However, vitamin C had no effects on increases of DNPH incorporation. We measured the content of conjugated dienes (CD) as a biomarker of lipid oxidation in sciatic nerve. CD was increased in DM as compared with normal control. Vitamin C or rutin had no effects on increases of CD. However, Rutin plus vitamin C significantly decreased the content of CD as compared with DM rats. In lung of DM rats, DNPH incorporation or CD was increased as compared with normal control. Vitamin C or Rutin had no effects on increases of CD. However, Rutin plus vitamin C significantly decreased the content of DNPH incorporation or CD in lung tissue. Vitamin C caused marked pathological changes such as the increases of parenchyma and the thickening of alveolar septa in the lung of DM. Rutin had protective effects on the pathological changes in the lung of DM rats. In conclusion, Vitamin C had no effects on oxidative parameter, such as DNPH incorporation or CD, and on the decreases of norepinephrine content in DM rats. Vitamin C caused the marked pathological changes in the lung of DM rats but rutin had protective effects against the pathological changes.