Sequential Bilateral Hip Fractures in Elderly Patients.

PURPOSE: To evaluate the incidence and presentation of osteoporotic sequential bilateral hip fractures (SBHF) in Center for Joint Disease, Chonnam National University Hwasun Hospital as there are limited studies with variable results reported in Korea. MATERIALS AND METHODS: Records of 507 patients aged >60 years old presenting with osteoporotic hip fractures between 2009 and 2015 were retrospectively reviewed to document the occurrence and presentation of sequential hip fractures; mean post-treatment follow-up was 48 months. Additionally, any correlations between sequential fractures and initial fracture and risk factors were assessed. Bone mineral density (BMD) was measured before and after sequential hip fracture for comparison. RESULTS: There were 246 femoral neck (Group A) and 261 intertrochanteric (Group B) fractures. The cumulative incidence of SBHF was 8.2% (42 patients total; 29 in Group A and 13 in Group B). Average interval of SBHF for Group A and Group B were 37.4 months and 29.9 months, respectively. There was significant correlation between the initial fracture type and sequential fractures, particularly the trochanteric and subgroup of those with neck fractures. Hypertension as a co-morbidity and female sex have been identified as risk factors for SBHF. No significant findings were noted regarding BMD and risk factors in both groups. CONCLUSION: The clinical presentations of SBHF noted here concur with other worldwide studies and may guide efforts to develop relevant programs to prevent SBHF.

Survival and Risk Factor Analysis of Medial Open Wedge High Tibial Osteotomy for Unicompartment Knee Osteoarthritis.

PURPOSE: The purpose of this retrospective study was to evaluate the survival rates and analyze the factors that affect survival rate after primary treatment with medial open wedge high tibial osteotomy (MOWHTO) for medial unicompartmental knee osteoarthritis. METHODS: Clinical evaluation using Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index score and radiographic evaluation, including mechanical axis, were done before and after surgery. The main failure criteria for survival included the conversion to total knee arthroplasty or KSS of <60 points. Furthermore, risk factors that affected the survival after MOWHTO were analyzed. RESULTS: Three hundred thirty-nine knees were included after a minimum of 5 years' follow-up. Their mean age was 56 years, and mean follow-up duration was 9.6 years. The mean KSS and Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly improved after surgery (87.3 and 18.5 points at 5 years and 81.7 and 23.6 points at 10 years). The mean hip-knee-ankle (HKA) angle was corrected from 7.2° varus to 3.4° valgus 1 year after surgery, which was maintained until 10 years after surgery (2.9° valgus at 5 years and 2.3° valgus at 10 years, P > .05). Using Kaplan-Meier survival estimates, the probability of survival for MOWHTO was 96.8% at 5 years, 87.1% at 10 years, and 85.3% at 13 years. The multivariate regression analysis revealed that age ≥65 years (hazard ratio [HR] = 2.34, P = .046), medial compartment cartilage damage International Cartilage Repair Society grade ≥4 (HR = 2.46, I = .045), lateral compartment cartilage damage International Cartilage Repair Society grade≥2 (HR = 3.38, P = .006), postoperative HKA angle <0° (HR = 4.69, P < .001) were associated with failure. CONCLUSION: MOWHTO seems to be a good treatment option for young and active patients with medial knee osteoarthrosis and varus alignment, with acceptable survival rates and satisfactory outcomes. Age ≥65 years, grade 4 cartilage damage in medial compartment, grade ≥2 cartilage damage in lateral compartment, and undercorrection of HKA angle appear to be significant risk factors associated with failure. LEVEL OF EVIDENCE: Level IV: retrospective case series.

Shoulder Joint Infections with Negative Culture Results: Clinical Characteristics and Treatment Outcomes.

BACKGROUND: The incidence of septic arthritis of the shoulder joint is increasing as the population ages. The prevalence of shoulder infection is also increasing because of the growing use of arthroscopy and expansion of procedures in the shoulder. However, cultures do not always identify all microorganisms, even in symptomatic patients. The incidence of negative cultures ranges from 0% to 25%. Few studies have reported clinical features and treatment outcomes of culture-negative shoulder infections. This cohort study addresses culture-negative shoulder joint infections in nonarthroplasty patients. This study aimed to compare clinical characteristics and treatment outcomes of patients with culture-negative results to those with culture-positive results. Our hypothesis was that culture-negative infections would have more favorable outcomes than culture-positive infections. METHODS: We retrospectively reviewed data of 36 patients (17 culture-negative and 19 culture-positive) with shoulder infections between June 2004 and March 2015. The minimum follow-up duration was 1.2 years (mean, 5 ± 3.8 years; range, 1.2-11 years). We assessed preoperative demographic data and characteristics, laboratory markers, imaging and functional scores, intraoperative findings, and postoperative findings of both groups. RESULTS: Culture-negative patients (17/36, 47.2%) had a significantly lower occurrence of repeated surgical debridement (culture-negative vs. culture-positive: 1.2 ± 0.4 vs. 2.4 ± 1.7, p = 0.002) without osteomyelitis. In the multiple logistic regression analysis, the presence of osteomyelitis [odds ratio (OR) = 9.7, 95% confidence interval (CI): 1.0-91.8, p=0.04)] and the number of surgical debridements (OR = 5.3, 95% CI: 1.3-21.6, p=0.02) were significantly associated with culture-positive infections. CONCLUSIONS: Culture-negative infections without osteomyelitis are less severe than culture-positive infections. Culture-negative infections can be controlled more easily and are not necessarily a negative prognostic factor for shoulder joint infections.

Two-stage revision for periprosthetic joint infection of the hip: Culture-negative versus culture-positive infection.

INTRODUCTION: Negative culture findings are common in periprosthetic joint infection (PJI) of the hip. METHODS: Retrospective study was performed to total 84 patients which devided into two groups: culture-negative (n: 27) and culture-positive (n: 57). RESULTS: The reimplantation rate was 96.3% and 91.2% in the culture-negative and culture-positive groups, respectively. The overall infection control rate was 92.6% and 82.4% in the culture-negative and culture-positive groups, respectively. CONCLUSION: Two-stage revision resulted a comparable outcome for the treatment of culture-negative periprosthetic joint infection of the hip compared to the culture-positive group.

Treatment outcome of dome osteotomy of the pelvis combined with trochanteric advancement for sequelae of Perthes' disease.

OBJECTIVE: Disparity in size between femoral head and acetabulum could promote premature degeneration of the hip joint. The purpose of this study was to report the results of Kawamura's dome osteotomy for acetabular dysplasia due to sequelae of Perthes' disease. PATIENTS AND METHODS: Fourteen patients (14 hips) operated between 1999 and 2012 were retrospectively reviewed. There were 9 males and 5 females with a mean age of 29 years (range, 15-54 years). Functional and radiological results were reviewed at mean follow-up of 9 years (range, 4-12 years). RESULTS: Pain relief was obtained in 13 of 14 (92.8%) patients postoperatively. Good to excellent functional outcome was obtained in 10 of 14 (71.4%) patients. Mean Harris hip score was improved from 63 to 84 (p < 0.05) at the final follow-up. Improvement of limping gait was observed in 10 of 14 (71.4%) patients. Center edge angle improved from mean 24° (11-36°) preoperatively to mean 35° (27-46°) postoperatively (p < 0.05), acetabular angle improved from mean 43° (36-49°) preoperatively to mean 37° (32-44°) postoperatively (p < 0.05), acetabular head index improved from mean 69% (50-83%) preoperatively to mean 85% (73-100%) postoperatively (p < 0.05). Progression of arthrosis stage occurred in 3 of 14 (21%) patients. None of the hip with preoperative Stulberg III, 2 of 9 hips with Stulberg IV and 2 of 2 hips with Stulberg V needed conversion to total hip arthroplasty during the follow-up. CONCLUSION: Dome osteotomy of the pelvis combined with trochanteric advancement could give a reasonable treatment outcome for acetabular dysplasia due to Perthes' disease at mid to long-term follow-up. Advanced stage of arthrosis, preoperative Stulberg V and no improvement of limping gait after the surgery possibly associated with poor outcome. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Breakage of the Tail Portion of the Lag Screw during Removal of Proximal Femoral Zimmer Natural Nail: Report of Two Cases with Technical Notes.

Proximal femoral cephalomedullary nailing is one of the treatments of choice for intertrochanteric fracture. Zimmer Natural Nail® (ZNN; Zimmer) is one of the alternatives. We report two cases of broken tail portion of the ZNN lag screw during the removal procedure. This may be the first reported cases in scientific literature with this pattern of failure. We report these cases to highlight one of the possible problems that could occur during removal of this implant which can possibly prolong the operation time significantly if the required device is not prepared.