Comparison of the Modified Bröstrom Repair Technique with and without Augmentation Using Suture Tape for Chronic Ankle Instability / 대한족부족관절학회지

Purpose@#The modified Broström repair (BR) technique has yielded good outcomes in patients with chronic ankle instability. This study compared clinical and radiological outcomes between two groups of patients who underwent modified BR or lateral ligament augmentation using suture tapes (ST). @*Materials and Methods@#Seventy-seven patients (ST group [n=47], BR group [n=30]; body mass index <26.61 kg/m2 ; mean age, 30.7±11.0 years [range, 17~39 years]; mean follow-up, 34.0±12.0 months [range, 24~59 months]) were retrospectively reviewed between January 2014 and July 2017. The Foot and Ankle Outcome Score (FAOS), American Orthopedic Foot and Ankle Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS) score, and Sefton grading system were used for clinical assessment. The talar tilt angle and anterior talar translation were measured using the Telos stress device (Telos GmbH, Marburg, Germany) at 150 N for radiological evaluation. @*Results@#FAOS, AOFAS, FAAM, and VAS scores improved in both groups at final follow-up (ST, 91.1±5.2, 93±2, 88.1±4.5, 1.5±0.7 vs. BR, 91.3±5.4, 93±3, 83.3±4.8, 1.2±0.7, respectively; p=0.854, 0.971, <0.001, 0.04, respectively). According to the FAOS, mean sports activity scores for the ST and BR groups at the final follow-up were 90.3±3.2 and 76.6±4.2, respectively, reflecting superior outcomes in the ST group (p<0.001). Sefton grading revealed satisfactory functional outcomes (ST, 91.5% vs. BR, 90.0%) . There was significant improvement in the talar tilt angle and anterior talar translation in both the ST and BR groups (7.6°±1.2°, 10.5±1.8 mm vs. 4.9°±1.1°, 7.9±1.5 mm, respectively; p<0.001). @*Conclusion@#The ST group demonstrated comparable clinical but better improvement in mechanical stability and FAOS sports scores than the BR group.

Outcome of Conservative Treatment of the Zone I, II 5th Metatarsal Base Fracture under Early Weight-Bearing / 대한정형외과학회잡지

Purpose@#To determine how the location, displacement, intra-articular involvement, comminution of a 5th metatarsal base fracture affect results of early weight-bearing treatment. @*Materials and Methods@#From January 2013 to July 2017, 34 cases of 34 patients diagnosed with a fracture of the zone I and II 5th metatarsal base were enrolled. The mean follow-up period was 13 months (6–15 months). One patient was excluded as a refracture during the follow-up period, and 33 patients underwent conservative treatment. Anteroposterior, lateral, and simple oblique radiography and computed tomography of the foot were performed to evaluate the location and displacement of the fracture, the degree of joint involvement, and comminution. In all 33 patients, a short leg cast or boot brace was selected immediately after the injury, tolerable weight bearing was allowed. If the pain disappeared, full weight bearing was performed after wearing a plain shoe or postoperative shoe. As a clinical result, the American Orthopedic Foot and Ankle Society (AOFAS) score was evaluated at the final follow-up. During outpatient follow-up, a simple radiograph of the foot was taken to confirm the time of radiological bone union and return to work. @*Results@#Nine males and 24 females, with an average age of 48.7 years, were enrolled in the study. Twenty-four patients had zone I fractures, and nine patients had zone II fractures. Twenty-two out of 33 patients had a fracture displacement of 2 mm or more. Nine and five patients had joint involvement and comminution, respectively. There was a statistically significant return to work from zone I to zone II. The AOFAS score was excellent at the final follow-up and there was no significant difference. When classifying and comparing the degree of fracture displacement, joint involvement, and comminution, there were no significant differences in the radiological union time and return to work. In all cases, satisfactory results were obtained at the final follow-up. @*Conclusion@#Satisfactory clinical results can be obtained by allowing early weight-bearing regardless of the fracture location, displacement, joint involvement, or comminution in zone I and II 5th metatarsal base fractures.

Operative Positioning Technique for an Intertrochanteric Fracture in a Patient with an Ipsilateral Above-the-Knee Amputation - Technical Note -

A 45-year-old man with a remote history of a left above-the-knee amputation presented to the emergency department with left hip pain after a mechanical fall. This case was an operative challenge because commonly used intraoperative traction methods could not be applied to a patient with an above-the-knee amputation. We describe a rarely utilized surgical technique of applying traction to an amputated extremity via a Steinmann pin during closed reduction and internal fixation of an intertrochanteric fracture.

Efficacy of Temporal Fixation Using Threaded Trans-Calcaneal Pin in Patients with Ankle Fracture-Dislocation or Tibia Pilon Fractures / 대한족부족관절학회지

Purpose@#Ankle fractures with dislocations and pilon fractures at the distal tibia are usually associated with soft tissue damage caused by high-energy damage. Recently, a two-stage operation to perform internal fixation after the application of external fixation devices for stabilizing soft tissues has been accepted as the treatment of choice. This paper reports the clinical result of these injuries treated with threaded trans-calcaneal pin external fixation devices. @*Materials and Methods@#Thirty-three patients diagnosed with ankle fractures with dislocations or tibial pilon fractures without open wounds. They underwent surgical treatment with threaded trans-calcaneal pin external fixation from January 2008 to February were enrolled in this study. This study evaluated the visual analogue scale (VAS), foot function index (FFI), and Olerud & Molander score as well as whether complications occurred. @*Results@#The average VAS showed a meaningful decrease (p<0.001) from 7.4 before surgery to 2.6 after application of the external fixation device, and 1.4 at 12 months after surgery. The FFI also decreased significantly from 84.3 preoperatively to 20.3 at 12 months postoperatively (p<0.001). The Olerud & Molander score averaged 71.4 points, showing good clinical results. Complete bone union was observed in all patients. One patient each underwent debridement due to wound necrosis and infection in the pin insertion site. At the final follow-up, seven patients had posttraumatic ankle joint arthritis, according to a radiological examination. @*Conclusion@#Manual reduction and external fixation using a threaded trans-calcaneal pin is a suitable surgical technique that is easy to perform and shows good clinical outcomes in stabilizing soft tissue damage in fractures and dislocations of ankle fracture or tibia pilon fractures in foot and ankle injury.

Response to: Comparison of Posterior Lumbar Interbody Fusion and Posterolateral Lumbar Fusion in Monosegmental Vacuum Phenomenon within an Intervertebral Disc

No abstract available.

Comparison of Posterior Lumbar Interbody Fusion and Posterolateral Lumbar Fusion in Monosegmental Vacuum Phenomenon within an Intervertebral Disc

STUDY DESIGN: Retrospective. PURPOSE: To compare the clinical and radiological outcomes of posterolateral lumbar interbody fusion (PLIF) and posterolateral lumbar fusion (PLF) in monosegmental vacuum phenomenon within an intervertebral disc. OVERVIEW OF LITERATURE: The vacuum phenomenon within an intervertebral disc is a serious form of degenerative disease that destabilizes the intervertebral body. Outcomes of PLIF and PLF in monosegmental vacuum phenomenon are unclear. METHODS: Monosegmental instrumented PLIF and PLF was performed on 84 degenerative lumbar disease patients with monosegmental vacuum phenomenon (PLIF, n=38; PLF, n=46). Minimum follow-up was 24 months. Clinical outcomes of leg and back pain were assessed using visual analogue scales for leg pain (LVAS) and back pain (BVAS), and the Oswestry disability index (ODI). The radiographic outcome was the estimated bony union rate. RESULTS: LVAS, BVAS, and ODI improved in both groups. There was no significant difference in the degree of these improvements between PLIF and PLF patients (p>0.05). Radiological union rate was 91.1% in PLIF group and 89.4% in PLF group at postoperative 24 months (p>0.05). CONCLUSIONS: No significant differences in clinical results and union rates were found between PLIF and PLF patients. Selection of the operation technique will reflect the surgeon's preferences and patient condition.

Prevalence Study of Adolescent Idiopathic Scoliosis in Ten-, Eleven-Year Olds for 10 Years / 대한정형외과학회잡지

PURPOSE: School screening for adolescent idiopathic scoliosis (AIS) was conducted for 10 years and the prevalence of scoliosis as well as the size and types of curvature were investigated. The outcomes and existing research results were comparatively analyzed and the usefulness of the moire topography as a screening tool was evaluated. MATERIALS AND METHODS: Moire topography was used in screening of 413,351 10- and 11-year-old from 2002 to 2011; simple standing entire spine x-rays of selected examinees were taken. When the Cobb angle was 10degrees or higher, the condition was deemed to be scoliosis, and the size, location, and types of curvature were recorded. RESULTS: The average prevalence over the 10 years was 0.4% (0.3%-0.5%) and the trends in yearly prevalence did not change significantly. The ratio of boys-to-girls prevalence rates for the 10 years was 1.0:3.8. The rate of those with scoliosis whose curvature was 10degrees-19degrees, 20degrees-29degrees, and 30degrees-39degrees was 71%, 24%, and 4%, respectively. King-Moe type III accounted for the largest portion at 45%, followed by type IV at 35%, type II at 11%, type I at 7%, and type V at 5%. CONCLUSION: The prevalence of scoliosis in the subjects was similar for the 10 years but differed from previous research results. The size, location, and types of curvature were similar to those reported in previous research. The differences in prevalence from existing research are considered to be due to the screening method used. Therefore, conduction of additional research on effective screening tests is necessary.

Trapezoid Stress Fracture in a Weight Lifter / 대한정형외과학회잡지

Trapezoid fracture is a rare condition and especially, isolated trapezoid fracture is most rare condition of carpal bone fracture. And principle of treatment has not yet been established. Most of trapezoid fractures can be treated using cast but displaced fracture or fracture combined with other carpal bone fractures may require operative treatment. There have been reports about case of conservative treatment in trapezoid stress fracture but no report about case of operative management. We treated a trapezoid stress fracture in a weight lifting athlete by operative treatment and report the results with literature review.

Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity

BACKGROUND: To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options. METHODS: We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores. RESULTS: A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9degrees +/- 11.7degrees with PSO, 14.3degrees +/- 8.4degrees with SPO, 38.3degrees +/- 12.7degrees with PVCR, and 19.3degrees +/- 7.1degrees with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p < 0.05). Statistical analysis revealed that the ODI score improvements correlated significantly with the postoperative SVA and CCROM (p < 0.05). There was no correlation between the clinical outcomes and spinopelvic parameters. There were 38 surgery-related complications in 25 patients (10.1%). CONCLUSIONS: Corrective osteotomy is an effective method for treating a fixed kyphotic deformity occurring in ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.

Intraocular Pressure Elevation after 0.7 mg Intravitreal Dexamethasone (Ozurdex(R)) Implantation: A One Year Follow-Up

PURPOSE: To investigate the percentage and time of intraocular pressure (IOP) elevation and the factors influencing IOP elevation and treatment. METHODS: Thirty patients (33 eyes) who received intravitreal dexamethasone implantation from July 2012 to December 2013 and followed up more than 1 year were evaluated by measuring Goldmann IOP and confirming changes in IOP. The definition of IOP elevation was IOP above 20 mm Hg or IOP increase greater than 6 mm Hg. RESULTS: In 16 eyes (48.5%), IOP was elevated after intravitreal dexamethasone implantation. The first IOP elevation was mean 2.0 +/- 0.7 months. In 21 eyes which received intravitreal dexamethasone implantation more than twice, the mean intervals of implantation were 4.5 months. In steroid responders, IOP after dexamethasone implantation was significantly increased at 1, 2, 3, 6, and 7 months. IOP increase in the treated eye was significant at 1, 2, 3, 5, and 7 months after dexamethasone implantation. CONCLUSIONS: After intravitreal dexamethasone implantation, IOP was highest at 2 months. Additionally, IOP was elevated in approximately half of the patients (48.5%). Although the intravitreal dexamethasone implantation is effective against various diseases which occur due to macular edema, thorough identification of suitable patients and frequent IOP control is necessary for long-term treatment.

The Impact of Lumbar Lordosis on the Adjacent Segment Disease after Posterior Lumbar Interbody Fusion

STUDY DESIGN: A retrospective study. OBJECTIVES: We analyzed the risk factors and relevance of lumbar lordosis on the incidence of adjacent segment disease after posterior lumbar interbody fusion. SUMMARY OF LITERATURE REVIEW: Maintaining lumbar sagittal balance is important for decreasing the incidence of adjacent segment disease after posterior lumbar interbody fusion. MATERIALS AND METHODS: Among the patients who had undergone posterior lumbar interbody fusion of 1 or 2 levels between August 2001 and October 2008, we analyzed 153 patients who were available for at least three years of follow-up; among the subjects, 115 were males and 38 were females. Mean age among the patients at the time of initial surgery was 60.3 (range, 41-82) and mean followup period was 5.6 years (range, 3-11). The causative diseases were spinal stenosis in 78 cases, degenerative spondylolisthesis in 51 cases, isthmic spondylolisthesis in 23 cases, and degenerative disc disease in 1 case. At last follow-up, there were 52 cases (33.9%) of adjacent segment disease. Among them were found 21 cases (40.4%) of disc degeneration, 17 cases (32.7%) of instability, and 14 cases (26.9%) of simultaneous disc degeneration and instability. A total of 10 patients (6.5%) underwent a revision operation, and the mean period from initial to revision operation was 5.5 years (range, 3.1-10.3). We analyzed the correlation between risk factors of adjacent segment disease and the incidence of the disease depending on the gap between lumbar lordosis and pelvic incidence, and compared the clinical results of the 2 groups using modified Whitecloud classification. RESULTS: The incidence of adjacent segment disease was not statistically significant for patient age, sex, BMD, degree of obesity, causative disease, and the level of previous surgery. However, the incidence of adjacent segment disease was statistically higher in patients who had more than 9 degrees gap between lumbar lordosis and pelvic incidence (p=0.013). In our analysis of clinical results, 63.5% of the group of patients who developed adjacent segment disease and 80.2% of the group without adjacent segment disease had good or satisfactory results (p=0.031). CONCLUSIONS: Maintaining lumbar sagittal balance is important for decreasing the incidence of adjacent segment disease after posterior lumbar interbody fusion, and close observation is needed in patients with 9 or more degrees gap between lumbar lordosis and pelvic incidence.

Modified Capsular Tension Ring Scleral Fixation and Toric Intraocular Lens Implantation in a Patient with Homocystinuria

PURPOSE: Purpose: To report a case of modified capsular tension ring scleral fixation and in-the-bag toric intraocular lens (IOL) implantation in a pediatric patient with severe crystalline lens subluxation due to homocystinuria. CASE SUMMARY: A 9-year-old male diagnosed with homocystinuria and crystalline lens subluxation presented with progressive decrease of visual acuity. Uncorrected distant visual acuity (UDVA) and corrected distant visual acuity were 0.03 and 0.6 in the right eye and 0.01 and 0.5 in the left eye, respectively. Slit-lamp examination showed severe crystalline lens subluxation toward the inferiomedial side in both eyes. Corneal astigmatism in the right eye and left eye was 2.75 diopters (D) and 3.00 D, respectively based on keratometry. A combination of subluxated crystalline lens aspiration, scleral-fixated modified capsular tension ring insertion and in-the-bag toric IOL implantation were performed in both eyes. After continuous curvilinear capsulorhexis, nucleus and cortex of the crystalline lens were removed by irrigation and aspiration. A modified capsular tension ring with 2 fixation hooks (Model 2-L) was inserted into the capsular bag and fixed at the scleral wall. Next, toric IOL was inserted into the capsular bag. UDVA was 0.8 in the right eye and 0.9 in the left eye and 3 months postoperatively, the IOL rotation was less than 3 degrees from intended axis in both eyes. CONCLUSIONS: In a patient with severe congenital crystalline lens subluxation and moderate to severe corneal astigmatism, scleral fixation of modified capsular tension ring and in-the-bag toric IOL implantation is a possible surgical option.

Multiple cannulated screw fixation of young femoral neck fractures

Objective: We wanted to analyze the factors affecting the results of multiple cannulated screws fixation in patients less than 60 years old with femoral neck fracture [FNF]

Methods: We reviewed 52 patients [30 males, 22 females] who were treated with multiple cannulated screws fixation for FNFs. They were followed up for more than one year during January 2002 to December 2012. They were classified by Garden's classification. The anatomic reduction was evaluated by Garden's alignment index on hip both anteroposterior and lateral images. Postoperative complications were analyzed during follow up periods

Results: By Garden's classification, 6 cases were in stage I, 13 cases in stage II, 30 cases in stage III and 3 cases in stage IV. During follow up periods, avascular necrosis of the femoral head was observed in 12 cases [23%] and nonunion was observed in 5 cases [9%]. The 16 patients who had complications underwent total hip arthroplasty [31%]. In non-displaced fracture groups [Garde I, II] did not have AVN nor nonunion. The incidence of complications in displaced fracture group was 51.5%. The complicated cases showed tendency for increased apex anterior angulation of femoral neck on hip lateral images and the result was statistically significant. [p=0.0260]

Conclusion: The patients less than 60 years old who were treated with multiple cannulated screws fixation for displaced FNFs showed the incidence of complications was more than 50%. It needs a cautious approach for anatomical reduction, especially related to anterior angulation on hip lateral image

Treatment and Prognosis of Femoral Insufficiency Fracture Associated with Prolonged Bisphosphonate Use

PURPOSE: This study was conducted to investigate and identify an appropriate fracture treatment method by analyzing patients in whom a femoral incompetence fracture occurred after receiving a long-term bisphosphonate administration. MATERIALS AND METHODS: The subjects of this study were 13 cases out of ten patients among those who had a history of receiving bisphosphonate for more than five years and had a fracture or an imminent fracture with a characteristic radiological finding in the femoral subtrochanteric region and the interfemoral region. The period of the drug administration, bone density, the existence of a prodromal symptom, and bilateral fracture were investigated. RESULTS: In seven out of the 13 cases, the patients complained of painat the femoral and pelvic parts as a prodrome (53.8%), and three of them showed a bilateral fracture (30%). An imminent fracture with a prodrome was observed in six cases (46.2%); for three of these cases, a prophylactic fixture pexis was performed by inserting a metal nail into the medullary cavity, and in two out of these three, a complete fracture was found within 11 months on average (3 to 19 months). In the three prophylactic fixture pexis performed cases, no postoperative complications were found, and a radiological finding of concrescence was seen within one year after the operation. Among the nine operation performed cases after the fracture, non-union was found in two. CONCLUSION: In the patients who have received bisphosphonate for a long periodof time, a prodome may be a useful indicator of a fracture in the femoral subtrochanteric region and the interfemoral region; therefore, a careful observation is necessary. A prophylactic internal fixation is recommended for patients with imminent fracture with a prodome since they have a high risk of a complete fracture is high in them.

Intraosseous Epidermal Cyst of the Distal Phalanx: A Case Report / 대한골관절종양학회지

An intraosseous epidermal cyst is a rare benign cystic lesion. It is thought to result from congenital factors or trauma and can lead to bone destruction because the cyst develops at the soft tissue around the bone. Radiological findings of intraosseous epidermal cysts are a well-defined radiolucent lesion, with cortical expansion. It is important to differentiate an intraosseous epidermal cyst with other disease developed at distal phalanx because its clinical and radiological findings are similar. We report two rare cases of intraosseous epidermal cysts that developed at the distal phalanx.

The Effects of Substrates and Hydrostatic Pressure on Differentiation of Mesenchymal Stem Cell / 대한정형외과연구학회지

PURPOSE: This study investigated the potential of dual differentiation of stem cells into osteo- and chodrogenesis depending on scaffold type even in the same environment. MATERIALS AND METHODS: For the part of the cartilage tissue section, MSCs were suspended in alginate solution and bead droplets were made using 23G syringe. For the bone tissue section, PCL/HA scaffolds were made using the bio-plotting system followed by seeding mesenchymal stem cells (MSCs) onto the scaffolds. Scaffolds with MSCs were cultured in cocktail media containing osteogenic and chondrogenic growth factors for up to 21 days. To provide mechanical environments which articular cartilage experiences in-vivo, intermittent hydrostatic pressure (IHP) was engaged. Various cellular responses were assessed: the quantitative analysis of DNA contents, GAG contents, ALP activities and immunofluorescence. RESULTS: We found that IHP promoted MSCs differentiation into the targeted cell types. That is, MSCs in alginate scaffolds were able to be differentiated into chondrocytes, while those onto PCL/HA scaffolds were able to be differentiated into osteoblasts. CONCLUSION: Depending on the scaffold characteristics MSCs can be differentiated into bone cells or chondrocytes. This technique can provide a cue for the treatment of osteochondral defects utilizing tissue engineering.

The Effects of Substrates and Hydrostatic Pressure on Differentiation of Mesenchymal Stem Cell / 대한정형외과연구학회지

PURPOSE: This study investigated the potential of dual differentiation of stem cells into osteo- and chodrogenesis depending on scaffold type even in the same environment. MATERIALS AND METHODS: For the part of the cartilage tissue section, MSCs were suspended in alginate solution and bead droplets were made using 23G syringe. For the bone tissue section, PCL/HA scaffolds were made using the bio-plotting system followed by seeding mesenchymal stem cells (MSCs) onto the scaffolds. Scaffolds with MSCs were cultured in cocktail media containing osteogenic and chondrogenic growth factors for up to 21 days. To provide mechanical environments which articular cartilage experiences in-vivo, intermittent hydrostatic pressure (IHP) was engaged. Various cellular responses were assessed: the quantitative analysis of DNA contents, GAG contents, ALP activities and immunofluorescence. RESULTS: We found that IHP promoted MSCs differentiation into the targeted cell types. That is, MSCs in alginate scaffolds were able to be differentiated into chondrocytes, while those onto PCL/HA scaffolds were able to be differentiated into osteoblasts. CONCLUSION: Depending on the scaffold characteristics MSCs can be differentiated into bone cells or chondrocytes. This technique can provide a cue for the treatment of osteochondral defects utilizing tissue engineering.

Carpal Tunnel Syndrome in Congenital Radial Dysplasia

Congenital radial dysplasia is a rare disease with the defect or hypoplasia of radial side of forearm and hand. Congenital radial dysplasia is often accompanied by deformities of other parts. However, carpal tunnel syndrome caused by congenital radial dysplasia is very rare. We report one case of 53-year-old man with congenital radial dysplasia who underwent surgery for carpal tunnel syndrome.

Cementless Total Hip Arthroplasty Using a Ceramic on Ceramic Bearing Surface: The Clinical Results of a Minimum 10-year Follow-up for Patients with Short Term Follow-up / 대한고관절학회지

PURPOSE: The purpose of this study is to report on the clinical results of more than 10 years of follow-up after ceramic articulation total hip arthroplasty in patients younger than 50 years old who had reported a result of short-term follow-up. MATERIALS AND METHODS: We studied 25 patients who underwent cementless THA using ceramic on ceramic articulation between Jan 1998 and Dec 2001. They were followed up for 2-4 years, with good results, and could be followed up for more than 10 years. The evaluation of clinical results included Harris hip score (HHS) and occurrence of thigh pain. Radiologic evaluation was based on osteolysis and the stability of components. RESULTS: The mean HHS improved from 57.7 to 93.3 during the period of 2-4 years of follow-up and 91.0 at more than 10 years of follow-up. Two patients experienced thigh pain during the period of 2-4 years of follow-up and none of the patients had thigh pain at more than 10 years of follow-up. On the last radiographs, stable fixation was observed in all cases, except for one case of ceramic fracture. CONCLUSION: Clinical and radiologic observations of cementless ceramic on ceramic articulation THA in active patients younger than 50 years old who reported a favorable short-term result showed a satisfactory long-term result.

The Prognostic Factor of Posterolateral Fusion in Degenerative Spondylolisthesis

STUDY DESIGN: A retrospective analysis of the posterolateral fusion in degenerative spondylolisthesis. OBJECTIVES: Posterolateral fusion has been performed for patients about Meyerding grade1, 2 with degenerative spondylolisthesis in L4-5. We evaluated the prognostic factors of posterolateral fusion, alone for degenerative spondylolisthesis. SUMMARY OF LITERATURE REVIEW: It is reported that posterolateral fusion has almost equal postoperative clinical and radiographic results with the interbody or circumferential fusion for spondylolisthesis. However, there have been some unsatisfactory results after posterolateral fusion alone and the causes are yet unknown. MATERIAL AND METHODS: From January 2002 to July 2008, we analyzed postoperative clinical outcomes of 42 patients who were diagnosed with Meyerding 1 or 2 grade degenerative spondylolisthesis at L4-5. All the patients were classified into group I and group II, based on the clinical outcome evaluation method by Kirkaldy-Willis. Ten patients (Group I) were found to have poor or fair clinical outcomes, while 32 patients (Group II) were found to have excellent or good clinical outcomes. The mean duration of the follow up was 16.3 (12-23) months. We looked into postoperative body mass index and bone mass density, and found degenrative lumbar disc through preoperative MRI, retrospectively. We measured angular motion by dynamic radiographs and preoperative slip angle through a Taillard method. RESULTS: In group I, the average preoperative BMI was 25.7 (21.2~31.4) and the average T score of bone density was -3.0 (-1.9~-4.2). There was 1 case of Grade 3, 3 cases of Grade 4 and 6 cases of Grade 5 by preoperative Pfirmann classification. The average angular motion was 11.8 (9.1~14.2) and the average preoperative slip angle was 8.4 (6.9-9.6). In group II, the average preoperative BMI was 24.3 (20.72~28.1) and the average T score of bone density was -2.1 (-0.9~-3.1). There were 26 cases of Grade 3, 5 cases of Grade 4 and 1 case of Grade 5 by preoperative Pfirmann classification. The average angular motion was 8.8 (6.2~12.1) and the average preoperative slip angle was 6.2 (3.6-7.9). There were statistically significant differences between the two groups in BMI, stage of disc degeneration, preoperative angular motion, and slip angle. (p=0.04, 0.04, 0.05, 0.03, respectively) CONCLUSION: We concluded that posterolateral fusion has exhibited worse clinical results in cases of BMI less than -2.8, disc degeneration greater than grade 4, angular motion greater than 9.4 degrees, and slip angle greater than 7.1 degrees; as such, we need to consider other surgical methods.