Total Knee Arthroplasty for Severe Flexion Contracture in Rheumatoid Arthritis Knees.

Flexion contracture deformities, as well as severe varus and valgus deformities of the knee joint, accompany osteoarthritis or rheumatoid arthritis (RA). In particular, severe flexion contracture deformity of the knee joint is often found in patients with RA, which renders them nonambulatory. This report describes a 26-year-old female patient diagnosed with RA 10 years ago. She had chronic joint pain, severe flexion contracture, valgus deformity in both knees, and limited range of motion in both knees and became nonambulatory. She underwent a total knee arthroplasty (TKA) and serial casting and physical therapy to restore stable joint movement and correct knee joint deformity. Her pain was successfully relieved, and she was able to walk after surgery. Here, we report the excellent results of TKA in this RA patient with severe flexion contracture of both knees.

Reliability of MRI findings for Symptomatic Extraforaminal Disc Herniation in Lumbar Spine.

STUDY DESIGN: A retrospective study PURPOSE: This study examined the reliability of the MRI findings in detecting symptomatic extraforaminal disc herniation in the lumbar spine. OVERVIEW OF LITERATURE: There are no reports of the characteristics and reliable MRI findings of extraforaminal disc herniation. METHODS: Thirty age-and gender-matched asymptomatic volunteers and 30 patients with symptomatic extraforaminal disc herniation, who underwent surgery between March 2006 and Dec 2008, were enrolled in this study. All subjects underwent spinal MRI. The following parameters were evaluated: the presence or absence of focal eccentricity of the disc, change in the diameter of the nerve root, and displacement of the nerve root at the extraforaminal zones. Radiologic studies were reviewed blindly and independently by 3 spine surgeons. RESULTS: The overall agreement in determining the presence or absence of a symptomatic extraforaminal disc herniation between the three reviewers was 89.4% (161/180). The consensus showed focal eccentricity of the disc in 33 cases (55%), a change in diameter in the nerve root in 31 cases (51.7%), and a displacement of the nerve root in 23 cases (38.3%). An assessment of the paired intraobserver and interobserver reliability revealed mean Kappa statistics of 0.833 and 0.667 for focal eccentricity of the disc, 0.656 and 0.556 for a change in the diameter of the nerve root, and 0.669 and 0.020 for a displacement of the nerve root, respectively. CONCLUSIONS: There are three possible MRI findings that can be used to determine the presence or absence of symptomatic extraforaminal disc herniation. Among these MRI findings, focal eccentricity of the disc was found to be the most reliable.

Consideration of the femoral head cartilage thickness in preoperative planning in bipolar hemiarthroplasty.

PURPOSE: Bipolar hemiarthroplasty (BH) is one of the commonly performed orthopedic procedures for the treatment of displaced fractures of the femoral neck. However, despite the common use of the BH, little has been written on preoperative planning for this operation. The purpose of this study was to assess the neglected subject which is about the cognition of the femoral head cartilage in planning a BH. METHODS: We reviewed a group of 62 consecutive patients in whom cemented BH had been performed by one surgeon. A total of 31 patients underwent BH with consideration of the femoral head cartilage thickness in preoperative planning. The anteroposterior radiographs of this group were compared to those of a group of 31 patients who underwent BH without consideration of the femoral head cartilage thickness in preoperative planning. We measured the limb length and offset with reference to the normal contralateral hip and the cartilage thickness of the hip joints postoperatively. RESULTS: There were significant reduction in the limb-length discrepancy (LLD) (mean 0.4 mm lengthening compared with 1.6 mm shortening; P < 0.001) and improvement of the femoral offset ratios of the operated hips to the normal contralateral hips (mean 99.9% compared with 96.8%; P = 0.032) in the group of patients with consideration of the femoral head cartilage thickness in preoperative planning. CONCLUSIONS: The femoral head cartilage should be considered when determining the level of femoral neck resection in order to reduce postoperative LLD when planning a bipolar hemiarthroplasty. Accurate and careful preoperative planning can result in balanced hip reconstruction by equalizing limb lengths and restoring the offsets.

Open reduction of a chronic proximal dislocation after total hip arthroplasty.

We report an unusual case of a chronic prosthetic dislocation that was caused by the buttonholing of a prosthetic femoral head by anterior soft tissue, which impeded reduction. A surprisingly good functional result was achieved by an open reduction and revision operation on a 56-year-old man, who had a chronic dislocation of a total hip prosthesis. Successful treatment with open reduction of a chronic proximal dislocation after total hip arthroplasty has not been reported previously in the literature.

Posterior approach with posterior soft tissue repair in revision total hip arthroplasty.

We investigated the influence of the posterior approach with soft tissue repair in revision hip arthroplasty by evaluating the rate of early posterior dislocation. Ninety-one patients (96 hips) who had undergone revision hip arthroplasty through the posterior approach were observed for 1 year or until dislocation occurred. Fifty-six revision hip arthroplasties were performed using the posterior approach with soft tissue repair technique. The results of these procedures were compared with those of 40 revision hip arthroplasties that had been performed using the posterior approach without soft tissue repair. The dislocation rate of 10.0% in 40 hips using the posterior approach without soft tissue repair was reduced to 1.9% in 56 hips using the posterior approach with soft tissue repair.

True femoral anteversion during primary total hip arthroplasty: use of postoperative computed tomography-based sections.

This study investigated a reference line that is closer to the true femoral anteversion on only the cutting surface of the proximal femoral neck during a femoral stem insertion in a cementless total hip arthroplasty. A postoperative computed tomography of both hips from 33 consecutive patients after a unilateral primary cementless total hip arthroplasty with an avascular necrosis of the femoral head was taken to observe the positioning of the stem and its correlation with the true anteversion of the contralateral side. The average of the midcortical angle was 14.1 degrees +/- 6.8 degrees on the lesion side and 0.1 degrees +/- 1.3 degrees more than the true anteversion on the contralateral side. This study has shown that anteversion using a midcortical line between the anterior cortical line and the posterior cortical line is compatible with the true femoral anteversion. However, further investigation is required to confirm the true femoral anteversion.