Revision Total Hip Arthroplasty using Allogenic Impaction Bone Grafts and Cemented Cup in Acetabular Bone Deficiency: Minimum Seven Years Clinical and Radiological Analysis

PURPOSE: This study examined the minimum seven years clinical and radiological results of revision total hip arthroplasty using an allogenic impaction bone graft and a cemented cup in an acetabular bone deficiency. MATERIALS AND METHODS: Fifty two revision total hip arthroplasty procedures performed on forty nine patients between March 1992 and June 1998 and followed for more than minimum seven years were examined. The clinical and radiological results were evaluated by Harris hip score and roentgenography including anterior-posterior view of pelvis and lateral view of operated hip. RESULTS: The mean Harris hip score was 47 points preoperatively, 81 points at three years after revision, and 84 points at seven years. The radiological evaluation revealed osseous union that trabeculated between grafted bone and host bone within four months in 47 hips, a complete grafted bone-cement radiolucent line of two millimeters or more in at least one zone in 5 hips at two years and in 7 hips at the seven year follow-up. CONCLUSION: We recommend the technique using an allogenic impaction bone graft and cemented cup to reconstruct an acetabular cavitary defect in revision total hip arthroplasty.

Treatment of Deep Infection Following Repair of Achilles Tendon Rupture / 대한족부족관절학회지

PURPOSE: Theaim of this study was to review the results of treatment for deep infection following repair of Achilles tendon rupture using reverse sural arterialized flap and/or flexor hallucis longus transfer. MATERIALS AND METHODS: Five cases of Achilles tendon infection in five patients were treated using reverse sural arterialized flap and/or flexor hallucis longus transfer at our hospital with followed up of average 23.6 months (range, 13-43 months). Three patients were male and average age at surgery was 52.0 years (range, 42-59 years). Clinical results were evaluated by the method of Percy and Conochie, and the isokinetic peak torque value was interpreted according to the guideline of Sapega. RESULTS: The clinical result was excellent in three cases, good in one case and fair in one case. The isometric peak torque value for 30 degrees per second was normal in two cases, possibly abnormal in one case, and probably abnormal in two cases, and for 120 degrees, normal in one case, probably abnormal in four cases. Five cases in five patients were satisfied with the result of treatment. CONCLUSION: We can expect satisfactory results of treatment for deep infection following repair of Achilles tendon rupture using reverse sural arterialized flap and/or flexor hallucis longus transfer.

Treatment of Superficial Peroneal and Sural Nerve Lesions Unrelated to Laceration / 대한족부족관절학회지

PURPOSE: To review the results of surgical treatment for superficial peroneal and sural nerve lesion unrelated to laceration. MATERIALS AND METHODS: Eleven superficial peroneal and sural nerve lesions in eleven patients were surgically treated at our hospital with follow up of average 20.7 months (range, 9-64 months). The anatomical locations of the lesion were on superficial peroneal nerve in seven patients including two patients having ganglion and sural nerve in four patients. Two patients were male and the average age at surgery was 41.5 years (range, 23-57 years). Six cases developed after repetitive sprain and five cases had no trauma history. Clinical results were assessed according to the criteria of Pfeiffer and Cracchiolo. RESULTS: The methods of operation were proximal resection of the nerve lesion in nine cases and removal of ganglion only in two cases. The results were excellent in four cases, good in five cases, fair in one case and poor in one case. Ten cases (10 patients) were satisfied with the result of treatment. CONCLUSION: We can expect satisfactory results of surgical treatment for superficial peroneal and sural nerve lesion unrelated to laceration.

Effects of Hyaluronan on Proliferation and Differentiation Cultured Chondrocyte / 대한정형외과연구학회지

OBJECTIVES: Recent basic science studies continue to further our understanding of the fundamental mechanisms that likely underlie the therapeutic benefits of hyaluronan derivatives. The purpose of this study is to elucidate the effects of hyaluronan on ATDC5 proliferation and differentiation. METHODS: ATDC5 cells derived from mouse teratocarcinoma have the capacity to differentiate along a number of connective tissue pathways and are an attractive source of chondrocyte precursor cells. In this study, hyaluronan influencing ATDC5 chondrogenesis were investigated using an bone block culture system. The cell proliferation was analyzed by MTT assay. To validate ATDC5 differentiation we studied ALP activity, collagen content and western blot of Hsp40. RESULTS: In cell proliferation, ATDC5 cells didn't show significant difference between controls and hyaluronan-treated cultures. But hyaluronan induced ALP activity and increased collagen accumulation. Hyaluronantreated ATDC5 cells expressed Hsp40 mRNA and protein within 24 hours. CONCLUSIONS: Hyaluronan-induced chondrogenic differentiation was not associated with ATDC5 cell proliferation. Hyaluronan-induced Hsp40 in cells can protect the cell function from damaged protein. These data provide new insights into regulatory mechanism defining pharmacological effects of hyaluronan.

The Treatment of Infected Non-union of Long Bones with Plate and Screws

PURPOSE: To evaluate the usefulness of internal fixation with plate in treating infected nonunion of long bone. MATERIALS AND METHODS: From March 1993 to February 2004, ten patients who underwent internal fixation with plate and cancellous bone graft on account of infected nonunion of long bone were retrospectively examined. The medical treatment were composed of thorough and adequate debridement of necrotic tissue, irrigation and plate fixation. Two patients were operated on with bridging plate method. Autologous cancellous bone graft was performed in 6 patients. In 2 cases, it was performed 4 weeks after internal fixation. RESULTS: In 9 patients, radiographic union appeared on the average of 6.8months and infections were cured before union occurred. CONCLUSION: Internal fixation with plate is a useful method for the solid fixation in the treatment of infected nonunion. The general concern was that the inserted hardware worsened the infection, which was overcomed with the operative techniques as bridging plate, debridement and cancellous bone graft.

A Study on the Proteins that Interact with Human Nebulin SH3 Domain / 대한정형외과연구학회지

OBJECTIVE: bjective: By identifying the unknown substance responsible for binding with nebulin SH3 domain within the sarcomeric Z-line, we tried to find out Z-line structure which plays an important role on muscle contraction and maintenance of muscle funtion. METHOD: First, the bait plasmid was made by binding the DNA binding domain of Gal4 protein of yeast and the SH3 domain. Second, library plasmid was made by binding activation domain and human skeletal cDNA library. Then, the base sequence of the clone, produced by combining the two proteins expressed by transgenically converted plasmid in yeast, was analyzed. RESULT: We screened out six true positive clones and analyzed the base sequence of the two of six clones. We identified them to be alpha-actinin2. CONCLUSION: We can theorize that Neublin SH3 domain and alpha-actinin2 plays a vital role for the integration of Z-line. Thus, this is an important data in further studying muscle functions, mechanisms, and muscular disease as well.

Heterotopic Ossification Around the Hip in an Adult Spastic Patient / 대한정형외과학회잡지

PURPOSE: To review the results of resections of heterotopic ossification around the hip in patients with central nervous system injuries. MATERIALS AND METHODS: Heterotopic ossification was resected in ten hips of eight patients and followed for at least one year. Average age was 38.1 years (range, 21-56 years). We reviewed the charts and the radiographs for overall patient function, location of the lesion, radiographic evidence of maturation and any recurrence. Heterotopic ossification was resected regardless of the result of bone scan. RESULTS: All patients showed improved function. Three minimal recurrences and one moderate recurrence were identified at the last follow-up radiography, but the range of motion had not decreased due to recurrence. CONCLUSION: Severe heterotopic ossification around the hip in patients with spastic paralysis was resected, and it was found that the range of motion was improved in all patients and that the chance of recurrence was minimal, even though the bone scan showed hot uptake on the bone scan.

Surgical Treatment of Cervical Myelopathy Due to Soft Disc Herniation / 대한정형외과학회잡지

PURPOSE: To analyze the characteristics and surgical results in cervical myelopathy patients caused by soft disc herniation. MATERIALS AND METHODS: From June 1997 to August 1998. The authors treated cervical myelopathy patients who had a soft disc herniation. We evaluated the symptoms and signs, simple X-rays, the MRI, the JOA score and Hirabayashi's recovery rate. RESULTS: On simple X-ray, the narrowest A-P diameter was 13 mm, as the average was 14.9 mm, and no bony structural stenosis was found. On MRI, the average of the cord compression was 2.92 mm, and the average A-P compression ratio was 40.2%. An intermediate to high signal change in the cord was found in 8 cases. All patients improved after surgery and the average Hirabayashi's recovery rate was 61.1%. CONCLUSION: If, cord compression due to posterior soft disc herniation is severe, patients can have cervical myelopathy. Lateral disc herniation can also be a cause of cervical myelopathy. Cervical myelopathy due to soft disc herniation can be treated with a good results by using an anterior discectomy and interbody fusion method.

Ganglion around the Cruciate Ligament in the Knee / 대한정형외과학회잡지

PURPOSE: To evaluate clinical diagnosis, treatment and results of the intraarticular ganglion of the knee joint. MATERIALS AND METHODS: From April 1996 to May 1999, nine patients were taken arthroscopic excision of the intraarticular ganglion. Diagnosis was based on history, thorough physical examination and MRI and confirmed by biopsy. RESULTS: As seen in the internal derangement of the knee, symptoms of the intraarticular ganglion were varied from asymptom to pain, effusion and limitation of motion. After arthroscopic excision, eight of nine patients were improved satisfactorily. CONCLUSION: The diagnostic rate of the intraarticular ganglion in the knee would be increased after the introduction of MRI and the results would be improved using arthroscopy. In the case of chronic nonspecific knee pain and limitation of motion, the possibility of the intraarticular ganglion might be considered.

Studies on Unreduced Fragments in Closed Interlocking Nailing of Comminuted Femoral Fracture / 대한정형외과학회잡지

PURPOSE: During interlocking nailing the displaced butterfly fragments can be left in situ or reduced by opening the fracture site. The purpose of this study is to investigate the fate of the displaced comminuted butterfly fragments when left unreduced and factors that influences fracture union in comminuted femoral fracture after closed interlocking nailing. MATERIALS AND METHODS: Out of 95 closed interlocking nailings done for fractured femur from July 1990 to July 1993, 43 femoral fractures that had comminuted fragments larger than 1 cm were followed for more than 18 months postoperatively, The correlations between the size of the comminuted fragments, its distance from the femoral shaft, the angulation of the fragment, the gap of the main fracture sites and bone union were analyzed. RESULTS: The distance between the fragment and the femoral shaft and angulation spontaneously decreased gradually, even the fractures having inverted fragments were united uneventfully, and the union rate of the fractures with gap less than 3 mm was higher than those with gap greater than 3 mm. CONCLUSIONS: The displaced fragment need not be reduced by open method and minimizing the fracture gap is recommended in increasing the union rate.

Analysis of Arthroscopic Management for Degenerative Knee / 대한정형외과학회잡지

PURPOSE: To correlate clinical results of arthroscopic debridement of degenerative knee with preoperative factors. MATERIALS AND METHODS: A retrospective survey of 61 patients (81 knees) with degenerative arthritis of knee treated with arthroscopic debridement from June 1995 to June 1997 was conducted. The average follow-up period was 22.7 months (12-35 months). There were 6 male and 55 female patients. The average age was 61.1 years. The arthroscopic procedure included excision of osteophytes, removal of loose body, meniscal trimming, synovectomy and irrigation of the knee joint. Statistical analysis was done for parameters such as knee alignment, joint space narrowing, flexion contracture, meniscal tear, articular cartilage degeneration, age, follow-up period and preoperative Insall knee score. RESULTS: A statistically significant difference in clinical results was noted in the separate subgroups for radiographic alignment (chi-square test, P=0.007) and degree of cartilage degeneration (P=0.006). Those patients with joint space narrowing, flexion contracture, meniscal tear or low Insall knee score had poor results after arthroscopic surgery. CONCLUSIONS: Though the result of arthroscopic debridement of degenerative knee is known to be unpredictable, some preoperative factors are correlated with poor outcomes, and arthroscopic treatment should be carefully selected.

Revision Arthroplasty using Thtoplast - HA Composites for Acetabular Bone Deficiencies / 대한정형외과학회잡지

Sixty-eight revisions of total hip arthroplasties from sixty-one patients were performed using allogenic cancellous chip bone and fine granules of HA for bone deficiencies of the acetabulum at two hospitals in Seoul since September 1992. In our practice, acetabular deficiencies were classified into two broad categories, which were based on our provisional treatment protocol. For the segmental deficiencies of the acetabulum, we employed the method of using the cemented acetabular component. In the mean time, Ling technique of impaction graft with PMMA cement were also employed. For the cavitary deficiencies of the acetabulum, we used several types of uncemented ingrowth cups with HA granules and Tutoplast was used to further ameliorate the bony integration. In addition, we obtained good results in cavitary deficiencies of the acetabulum with C.L.S. Expansion Cup and Ringloc fin Cups which seem that initial stability during the cup installation were remarkable. Unfortunately, we had 5 cases of clinical failure, which consist of bone graft incorporation, where eventual resorption of the graft and implant migration were resulted. Nevertheless electromicroscopic finding of interface taken from failure showed partial new trabecular formation and physicochemical bonding near the host bone bed in some cases. Although primary stability of reconstructive surgery was acceptable, Tutoplast - HA granule composites have similar effect of incorporation to host bone compared with other method of allogenic bonegraft storage, which remodeled after 5 years. Thus, this phenomenon requires further investigation of molecular biological role of tissue substance known as cytokine, as well as microscopic histology.

The Effects of Arthroscopic Lavage Combined with Percutaneous multiple Drilling in Patients with Degenerative arthritis of knee

42 knees with degenerative arthritis underwent arthroscopic lavage and 7 knees underwent arthroscopic lavage combined with multiple bone drilling in between 1994 and 1995 and followed average 12 months. Clinical evaluation using the hospita1 for specia] surgery knee scores (HSS scores) was done at last follow up and classified into 4 groups: excellent (90-99), good (80-89), fair (70-79) and poor (less than 70). The results were as follows: l. Of the 42 knees of the lavage group, 6 knees (16%) was excellent, 14 knees (33%) good, ]7 knees (40%) fair and 5 (11%) knees poor. Success group (Excellent & Good) were achived in 20 knees (49%). 2. Of 17 knees treated with arthroscopic lavage comhined with multiple bone drillig resulted in excellent in 9 knees (53%), good in 4 knees (23%), fair in 2 knees (12%) and poor in 2 knees (12%). Success group were achived in 13 knees (76%). 1n conclusion, we helieve that multiple bone drilling in conjunction with arthroscopic lavage has more favorable effect on the pain relief for degenerative osteoarthritis of the knee than arthroscopic lavage only.

Revision Total Hip Arthroplasty Using Allogenic Chip Bone Grafts and Cement in Acetabular Bone Deficiencies: Minimum Two Year Clinical and Radiological Analysis / 대한정형외과학회잡지

The purpose of this study was to analyze the minimum two year clinical and radiological results of revision total hip arthroplasties using allogenic chip bone graft and cement in acetabular bone deficiencies. Thirty six revision total hip arthroplasties that had been performed in thirty four patients between Sep. 1992 and May. 1994 at Seoul Paik Hospital and had followed more than two years were included in this study. The clinical result was evaluated by Harris hip score. The mean Harris hip score was 48 points preoperatively, 88 points at final follow-up, a mean of 3 years after revision. In radiological evaluation, osseous union between grafted bone and host bone was seen within 4 months in thirty two hips (89%), a complete grafted bone-cement radiolucent line of two millimeter or more in at least one zone was seen in seven hips (19%) and acetabular component migration was seen in six hips (17%) at postoperative 3 year follow-up radiograph. At the time of follow-up, five hips (14%) had been revised a second time: three for aseptic acetabular loosening, two for infection. In conclusion, we recommend the technique using allogenic chip bone graft and cement to reconstruct the acetabular bone deficiencies in revision total hip arthroplasties, though other technique will be recommend in severe segmental acetabular deficiencies or previous infection.

Effects of Steroids and vitamin D Derivatives on Differentiation and Proliferation of Cultrured Osteoblast Cells / 대한정형외과학회잡지

This study was designed to evaluate of the effects ofB-estradiol, progesterone, dexamethasone, hydrocortisone, calcitriol and alfacalcidol on the cell proliferation and differentiation in the rat osteoblast-like osteosarcoma cells ROS 17/2.8. The proliferation of ROS 17/2.8 cell treated with 1 M B-estradiol, 1 M progesterone, 1 M hydrocortisone, 1 M dexamethasone, 10 (-8) M calcitriol and 10 (-8) M alfacalcidol was decreased by 19%, 56%, 60%, 64%, 28% and 38% of control, respetively. Production of TGF-Bl by ROS 17/2.8 cells treated with B-estradiol, progesterone, hydrocortisone, dexamethasone, calcitriol and alfacalcidol was elevated by 30%, 18%, 60%, 48%, 405% and 452% of control, respectively. Alkaline phosphatase activity of ROS 17/2.8 cell treated with hydrocortisone, dexamethasone, calcitriol and alfacalcidol was increased by 3.4 times, 12.9 times, 10.0 times and 5.1 times of control, respectively, but with B-estradiol and progesterone decreased by 39% and 10% of control respectively. Northern blot experiments demonstrated that calcitriol and alfacalcidol increased mRNA levels of both osteocalcin and osteopontin.

Surgical Treatment of Cervical Disc Herniation / 대한정형외과학회잡지

To evaluate the results of anterior decompression and fusion with autogenous bone graft for cervical disc disease, the authors reviewed 18 cases of cervical disc herniation which were treated surgically at Inje Univ. Paik Hosp. from 1990 to 1994 with special interest in the thickness of the bone graft. All cases have been followed for more than 12 months. We try to know the clinical results of anterior decompression and fusion with autogenous bone graft. At this treatment, controversial point is a ideal thickness of graft and the width of distraction. Therefore, we follow up the correlation between thickness of graft on roentgenogram and clinical results. The clinical results were satisfactory as excellent in 11 cases, good in 5 cases according to criteria of Robinson et al. Successful fusion occured in 16 cases within 3 months after their initial procedure, and fusion failure resulted in 2 cases. 3mm distraction from baseline disc height was considered ideal thickness of graft after anterior decompression and all cases healed successfully. We concluded that 3mm distraction from baseline disc height is necessary for successful decompression & fusion.

Extraspinal Tuberculosis of Bone and Joint / 대한정형외과학회잡지

Recently, tuberculosis of bone and joint is decreased with good nutrition and environment, development of preventive medicine and improvement of treatment regimen. But it is still one of the common inflammatory diseases in Korea, and must be considered in the differential diagnosis of common orthopedic complaints. There are few reports on extraspinal tuberculosis of bone and joint. Forty one cases of extraspinal tuberculosis of bone and joint were studied in our department from January 1988 to August 1993. The results were as follows; l. Extraspinal tuberculosis of bone and joint were 41 cases (39 patients, 27.8% of 147 tuberculosis of bone and joint including spine). 2. The proportion of children and young adults was 56%, hips were involved in 11 cases, knee joints in 8 cases, ankle joints in 6 cases, feet in 6 cases and elbow joints in 5 cases. 3. Coexisting pulmonary tuberculosis was found in 19 patients and active lesion in 15 patients. 4. Confirmative diagnosis could be made by smear and culture of the lesion or pathologic findings or recently available polymerase chain reaction(PCR) method. 5. Various treatment, such as antituberculous medication, external immobilization, synovectomy, curettage and bone graft, arthrodesis, had been carried out. 6. Reactivation of other site was found in 7.3%(3 cases) and resistant tendency was found in 9.7%(4 cases).

Postoperative Complications of Peritrochanteric Fractures in Elderly over 65 years / 대한정형외과학회잡지

The mortality and morbidity of peritrochanteric fractures in the elderly are great due to preexisting diseases, the osteoporosis, and poor general conditions. Since the complications sometimes lead to death, it is utmost important to reduce the complications and to prevent them. Authors had experienced 42 peritrochanteric fractures over 65 years old from January, 1988 to December, 1992. Age incidence was distributed from 65 to 93 years. The sites of fractures were 17 femoral neck, 24 intertrochanteric, 1 subtrochanteric. The mortality at postoperative 6 months was 10.2%. The postoperative complications were 6 cardiovascular diseases, 3 pneunonia, 3 pressure sore etc. The results according to interval between injury and operation were not significant, but reducing risk factors following check-up of general conditions was significant. It was necessary in treatment of elderly peritrochanteric fractures to check the general conditions, to reduce risk factors, to choose appropriate method of operation and anesthesia, and to operate as soon as possible by experienced surgeon. Postoperative early ambulation was also significant at good results. The percutaneous pinning under local anesthesia was an recommendable method in patients with severely poor general conditions.

The Treatment of Tibial Shaft Fractures using AO Unreamed Interlocking Nail / 대한정형외과학회잡지

The fractures of tibial shaft are common and open injury are also frequenly accompanied. Since the AO unreamed interlocking nail is solid type compared to present tubular type nail, it has no dead space, and without reaming the intramedullary blood supply can be preserved and the soft tissue trauma can be minimized. Therefore it can be used with minor risk of infection in the treatment of open tibial shaft fractures without secondary operation such as in the cases using external fixaters. Especially in Orientals, whose tibial medullary canal is narrower than Smm, it can be used ideally. From October 1991, we have experienced 14 cases of tibial shaft fractures treated with AO unreamed interlocking nail. Among 14 cases, the open fractures were 8, 4 cases were type 1 and 4 cases were type 2 by Gustilo classification. Among 6 cases of closed fractures, 4 cases had risk of post operative infection due to accompanying soft tissue injuries, such as abrasion or bulla and 2 cases had narrow intramedullary canal less than 8mm. There was no postoperative infection in all cases including open fractures, and the soft tissue defect could be reconstruted by muscle transfer, etc. The AO unreamed interlocking nail is thought to be recommendable in the treatment of open tibial shaft fracture, closed fracture with risk of postoperative infection, and also the fracture with narrow canal diameter less than 8mm.

High Tibial Osteotomy / 대한정형외과학회잡지

High tibial osteotomy is a useful procedure in the treatment of early stage osteoarthritis of the knee which is confined to the medial compartment. But long term follow-up study of high tibial osteotomy has not been provided yet and its prerequisite for a successful result still remains unrevealed. Since the osteoarthritis can progress after the osteotomy, it may result in the loss of correction and recurrence of pain and require conversion to total knee replacement arthroplasty. We studied clinically and radiologically the long term result of high tibial osteotomy in 11 patients(16 knees) who had been treated at the Department of Orthopaedic surgery of Seoul Paik Hospital during the period from January, 1978 to May, 1989, and follow-up for longer than 4 years. Preoperative mean varus angle was 6.4 degrees and immediate postoperative mean valgus angle was 8.6 degrees and final mean valgus angle was 4.7 degrees. The average loss of correction angle was 3.9 degrees. At 2-year follow-up, the results of 16 knees were as follows; excellent in six knees, good in seven knees. The final results at average 7.2-year follow-up were excellent in four knees, good in six knees and one knee was converted to total knee replacement arthroplasty. The results showed deterioration of clinical results and loss of correction with time after osteotomy. However, in more than half of the cases the results were good or excellent at the final follow-up, We, therefore, conclude that high tibial osteotomy is still a useful procedure in osteoarthritis of the knee if performed with a precise surgical technique and an adequate overcorrection more than 10 degrees.