Experience of Complications of Hip Arthroplasty / 대한고관절학회지

No abstract available.

Primary Total Hip Arthroplasty Using Third Generation Ceramic-Ceramic Articulation: Results after a Minimum of Three-years of Follow-up / 대한고관절학회지

PURPOSE: This study assessed the short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems. MATERIALS AND METHODS: Two hundred and seventy two patients (294 hips) with primary total hip arthroplasty using third generation ceramic-ceramic articulation Accolade TMZF femoral stems who had been followed-up for a minimum of 3 years were included. Clinicoradiological results were analyzed and postoperative complications were observed. RESULTS: At final follow-up, mean Harris hip score was increased from 52 to 94 points. On radiogical evaluation, the average acetabular inclination was 42 degrees and the average acetabular anteversion was 15 degrees. Neither osteolysis nor loosening were observed around the acetabulum or proximal femur. Among 294 acetabular cups, 293 cups (99.66%) achieved stable fixation. Regarding the 294 femoral stems, 286 (97.28%) had bony fixation, 7 (2.38%) had fibrous fixation, and none were found to have unstable stem fixation. Proximal bone resorption was observed in 17 hips (5.78%; only Grade 1) and radiolucent lines were observed in 88 hips (29.93%), however, all were around the distal smooth portion of the stems. Postoperative complications included dislocation in 6 hips (2.04%), heterotopic ossification in 3 hips (1.02%), ceramic fractures in 4 hips (1.36%), superficial infection in 1 hip (0.34%), and squeaking in 8 hips (2.72%). CONCLUSION: The short term clinicoradiological results of primary total hip arthroplasty using third generation ceramic-ceramic articulation and Accolade TMZF femoral stems together with Secur-Fit acetabular cups were satisfactory. However, problems such as ceramic fractures and squeaking after arthroplasty were observed. Additional studies are necessary in order to develop methods that may reduce or eliminate these complications.

Simultaneous Bilateral Cementless Total Hip Arthroplasty: a Minimum 17-year Follow-up Study - Comparison Study with Unilateral Cementless Total Hip Arthroplasty - / 대한고관절학회지

PURPOSE: Long-term follow-up results of concurrent bilateral or unilateral cementless hip arthroplasty were compared. MATERIALS AND METHODS: Forty eight and 49 patients with concurrent bilateral and unilateral hip artrhoplasties who had more than a 17-year follow-up time were selected. At final follow-up, mean ages were 69.1 and 66.7 years old in the bilateral and unilateral groups, respectively. Mean follow-up times were 21.5 and 22.4 years in the bilateral and unilateral groups, respectively. Clinical results were attained using Harris hip score and standardized anteroposterior and lateral view X-rays. RESULTS: The bilateral group had mean Harris scores of 44.3(standard deviation 3.78) preoperatively, and 81.2 (10.75) at final follow-up. For the unilateral group, the mean scores were 46.5(3.27) preoperatively, and 80.1 (12.05) at final follow-up. At final follow-up, an acetabular cup was securely located in 78.9% and 82.8% of the bilateral and unilateral groups, respectively, and all cases showed firm fixation of the femoral stem in both groups. Osteolysis around the cup and stem were found in 26.3% and 31.4% of the bilateral group and 16.6% and 17.1% of the unilateral group, respectively. Polyethylene wear rate was 0.17 mm/yr and 0.16 mm/yr in the unilateral and bilateral groups, respectively. Using the Kaplan-Meier method, 17-year survival rates for cup and stem were 78% and 89% in the bilateral group, respectively, and 78% and 86% in the unilateral group, respectively. CONCLUSION: In 17-year long-term follow-up, concurrent bilateral hip arthroplasty was insignificantly different clinically and radiologically from the result of unilateral hip arthroplasty.

Comparison of Simultaneous Bilateral Cementless Total Hip Replacement with Staged Bilateral Cementless Total Hip Replacement in High Risk Anesthesia Group

PURPOSE: Simultaneous bilateral total hip replacement (THR) has some advantages, but the efficacy of simultaneous bilateral THR is still controversial in patients with high risk ASA grade. Presently, we compared simultaneous bilateral to staged THR in high-risk patients according to the ASA grade. MATERIALS AND METHODS: We retrospectively compared 60 high risk patients (ASA grade 3 and 4) with simultaneous cementless total hip replacements with a matched group of 60 patients with staged cementless total hip replacements between January, 1991 and June, 2009. Significance was determined to be p-value < 0.05. RESULTS: Postoperative cardio-vascular complication was found in one case of simultaneous THR, and pulmonary thromboembolism was found in two cases of staged THR and in three cases of simultaneous THR. Wound infection was found in three cases of staged THR and in two cases of simultaneous THR. Delirium was found in four cases of staged THR and in five cases of simultaneous THR. Dislocation developed in two cases of staged THR and in three cases of simultaneous THR. Blood loss was higher in the staged group, but the transfusion amount was higher in the simultaneous group. Postoperative ambulation was initiated earlier in staged THR, but at the final follow-up no statistical significance was observed. Admission time and cost were reduced in simultaneous THR. CONCLUSION: It is considered safe to perform simultaneous cementless bilateral THA in patients with high anesthetic risk, if meticulous preoperative evaluation is done.

Comparison of Conventional and Digital Templating Technique in Total Hip Arthroplasty

PURPOSE: To examine the effectiveness of digital templating in patients who underwent primary total hip arthroplasty by comparing and analyzing the accuracy of acetate and digital templating. MATERIALS AND METHODS: One hundred and nine patients who underwent primary total hip arthroplasty between November 2002 and May 2006 were assigned to the acetate templating group (group I), and 113 patients between June 2006 and April 2009 were assigned to the digital templating group (group II). The sizes of the acetebular cup and femoral stem were examined to determine the accuracy of each method. RESULTS: In group I, acetabular cup accuracy was found in 46.8% of cases, and 94.5% showed a mismatch less than +/- 1 sizes. In the case of the femoral stem, accuracy was found in 53.2% and 92.7% showed a mismatch. In group II, acetebular cup accuracy was observed in 43.4% of cases, and 92.9% showed a mismatch below +/- 1 size. In femoral stem cases, 46.9% were accurate and 93.8% showed a mismatch. CONCLUSION: The accuracy of the digital templating method is equivalent to that of acetate templating, and should replace acetate templating before the operation.

Postoperative Delirium after Hip Arthroplasty in the Elderly

PURPOSE: Our study was done to evaluate the influence of postoperative delirium on the prognosis of hip arthroplasty, and risk factors for postoperative delirium in individuals older than 65. MATERIALS AND METHODS: Among patients who received hip arthroplasty in our hospital (WCH) between March 2004 and March 2008, we chose 193 patients for our study after excluding patients who had preoperative delirium and who had a history of dementia and cognitive dysfunction. We divided our cohort of 193 patients into two groups, 131 patients with postoperative delirium and 62 patients without delirium. We checked for clinical results for hip arthroplasty. We checked for multiple factors related to delirium. RESULTS: The mean hospital stay was 42.4+/-14.0 in the delirium group and 20.4+/-4.3 in the control group; the difference was significant. The mean preoperative cumulative ambulation score was 1.9+/-1.2 in the delirium group and 3.1+/-1.7 in the control group; the difference was significant. In 2 individuals of the control group and 4 of the delirium group, dislocation developed;and there was significant difference. There was a high prevalence of delirium among patients with hip fractures, and of histories of psychiatric diseases, alcohol abuse, liver cirrhosis and cerebral vascular disease. The delirium group had a significantly longer stay in the intensive care unit. On admission, the delirium group had significantly lower sodium and albumin compared to controls. CONCLUSION: Because postoperative delirium after hip arthroplasty makes the prognosis worse, preoperative evaluation and management of risk factors is necessary.

Cemented Bipolar Hemiarthroplasty for Intertrochanter Fracture in Elderly Patients: Minimum 2-Years Follow-up Results

PURPOSE: The purpose of this study was to evaluate the usefulness of bipolar hemiarthroplasty using a cemented femoral stem for treating femoral trochanteric region hip fractures in elderly patients. MATERIALS AND METHODS: This study includes 47 hips were available to be follow up for over 2 years, between December 1995 and December 2002. Clinical evaluation was done using Koval's classification before the fracture and at last follow-up, and Harris's hip score at the last follow up. Radiological evaluation was done via the plain radiographs. RESULTS: The Koval classification was as follows: recovery to the condition before fracture in 15 cases (31.9%), degradation by 1 class in 31 cases (66.0%) and degradation by 2 classes in 1 case (2.1%). The Harris hip score was 84.6 points at the last follow-up. All the cases showed stable fixation of the femoral stem. Postoperative complications were reported as 1 case of pneumonia, 1 case of deep vein thrombosis, 1 case of pulmonary thromboembolism, 1 case of pulmonary edema, 3 cases of stress ulcer, 1 case of superficial infection and 1 case of deep infection. Superficial pressure sore occurred in 1 case, postoperative delirium occurred in 9 cases and partial rupture of the bladder in 1 case. CONCLUSION: Bipolar hemiarthroplasty using a cemented femoral stem was effective and satisfactory for the treatment of elderly patients with intertrochanter fractures. But further studies that will focus on complications are required.

Cementless Bipolar Hemiarthroplasty for Hip Fracture in Patients More than Seventy Years Old with Osteoporosis

Purpose: This study evaluated the effectiveness of bipolar hemiarthroplasty with a cementless femoral stem for hip fractures in patients older than 70 years with osteoporosis. Materials and Methods: This study examined 84 hips with osteoporosis that are available to follow up of more than 2 years, between July 1997 and May 2006. The clinical evaluation was carried out using the Koval classification before the fracture and at the last follow-up, and the Harris hip score at the last follow up. The radiological evaluation was carried out using the plain radiographs. Results: The average follow up period was 31.4 months. The Koval classification was as follows: recovery to the condition before the fracture in 25 cases (30.1%), degradation by 1 class in 56 cases (67.5%) and degradation by 2 classes in 2 cases (2.4%). The Harris hip score was 82.7 points at the last follow-up. One case (1.2%) showed cortical hypertrophy and all cases showed stable insertion of the femoral stem. Conclusion: Bipolar hemiarthroplasty with a cementless femoral stem is effective and satisfactory, both clinically and radiologically, for the treatment of elderly patients with fractures around the hip.

Comparison of the Results of Internal Fixation of Femoral Neck Fracture According to the Fixation Methods

PURPOSE: We wanted to compare the stability, the complications and the patients' functional recovery after undergoing internal fixation with dynamic hip screws or cannulated hip screws for treating fracture of the femoral neck. MATERIALS AND METHODS: Out of one hundred twenty six patients who had fracture of the femoral neck, seventy six patients were treated with cannulated screws and fifty patients were treated with dynamic hip screws from October 2000 to January 2007. The clinical information included the age and gender distribution, the operation time, the total blood loss, the interval from injury to operation, the etiology of the fractures and the functional outcome. The preoperative X-ray information included the fracture type by the Garden stage, the Singh index and the posterior cortex comminution. The postoperative information included the quality of reduction and the pin and screw position. The Garden alignment index, evidence of union, the FIM(TM) score, the complications and the failure rate. RESULTS: No statistical difference was noted between the two fixation methods regarding the gender, the initial fracture displacement, the postoperative reduction or the position of the fixation device, the functional outcome using FIMTM score and the complication. Yet the cannulated screw fixation group showed a significantly shorter operation time and less total blood loss (P<0.05). CONCLUSION: To decrease the operation time and blood loss, cannulated screw fixation is considered to be the more useful fixation method for treating fracture of the femoral neck.

Total Hip Arthroplasty with F2L Multineck Cementless Femoral Stem

PURPOSE: To analyze the results of cementless total hip arthroplasty with a F2L Multineck femoral stem. MATERIALS AND METHODS: A total of 64 patients (73 hips), who underwent cementless total hip arthroplasty with a F2L Multineck femoral stem, SPH acetabular cup and a ceramic liner from December of 1998 to October of 2001 were followed up for at least 4 years, were selected for the clinical and radiological evaluations. RESULTS: At the final evaluation, 63 patients had an improved average Harris hip score ranging from 51.4 preoperatively to 95.1. None of the patients had any significant leg length inequality. Thigh or inguinal pain was observed in 3 hips (1 hip of femoral stem subsidence and 2 hips of damaged ceramic parts), for which revision total hip arthroplasty was performed. Hip dislocation occurred in 2 hips within 2 weeks after surgery and conservative management was performed after a closed reduction. CONCLUSION: Total hip arthroplasty with a F2L Multineck femoral stem produced satisfactory results. Postoperative complications such as hip dislocation and leg length inequality could be minimized by modulating the anteversion angle, femoral offset and leg length with multineck femoral stem.

Pathologic Changes of Blood vessels and Extracellular Matrix in the Subsynovial Connective Tissue of Idiopathic Carpal Tunnel Syndrome / 대한정형외과연구학회지

PURPOSE: The purpose of this study is to investigate pathologic changes of blood vessels and perivascular tissue in subsynovial connective tissue (SSCT) of idiopathic carpal tunnel syndrome (CTS) by examining elastin distribution and vascular morphology and by observing ultrasturctural changes of extracellular matrix using transmission electron microscope (TEM). MATERIALS AND METHODS: The Verhoeff-van Gieson stain was used to identify histopathology and to localize elastin in the SSCT of the middle finger flexor digitorum superficialis (FDS) within the carpal tunnel in ten CTS patients and ten cadaver specimens as control group. In each specimen, the elastin density within and around vessels was calculated with image analyzing software including Adobe photoshop 6.0 and Scion image analysis. The vessel number per unit area and the mean thickness of vessel walls were also calculated. The ultrastructural changes of SSCT were compared between the specimens of both groups by TEM. RESULTS: The mean elastin density within vessels was 0.10 +/- 0.03 (p=0.001) in the CTS group and 0.18 +/- 0.04 in the control group. The mean elastin density around vessels was 0.15 +/- 0.04 in the CTS group and 0.23 +/- 0.04 in the control group (p=0.002). The mean number of vessels per unit area (0.00155 mm2) was 0.36 +/- 0.12 in the CTS group and 0.15 +/- 0.10 in the control group (p=0.002). The mean thickness of blood vessels was 38.10 +/- 20.60 micrometer in the CTS group and 18.90 +/- 3.68 micrometer in the control group (p=0.023). In general, the severer the vascular hypertrophy and obstruction, the less elastin noted within and around blood vessels. The TEM showed some important ultrastructural changes in SSCT of CTS. Generally, SSCT contained two kinds of cells, fibroblast-like cells and macrophage-like cells. And these cells and elastin were dispersed among collagen fibrils. In SSCT of control group, the collagen fibrils showed round margin and uniform diameter in transverse section, and showed similar thickness in longitudinal section. However, in SSCT of CTS, the collagen fibrils had irregular margin called "spiraled collagen"and variable diameter in transverse section, and uneven thickness in longitudinal section. In addition, the elastolysis and the phagocytosis of the changed collagen fibrils were observed. CONCLUSION: SSCT of CTS showed significant decrease of elastin density within and around vessels along with degenerative histopathological vascular changes. In addition TEM revealed ultrastructural abnormalities like metamorphosis of collagen fibrils, phagocytosis of spiraled collagen fibrils and elastolysis. Therefore, it is suggested that pathology of CTS may involve active cellular processing related to ischemic cellular environmental changes in carpal tunnel as well as well known pathology of nerve.

Femoral Revisional Arthroplasty using Proximal Modular Femoral Stem: Short Term Follow Up / 대한정형외과학회잡지

PURPOSE: The aim of this study was to evaluate the clinical and radiological results of a cementless femoral revision using a proximal modular stem for 38 hips (38 patients) with femoral osteolysis after primary total hip arthroplasty. MATERIALS AND METHODS: Thirty-eight hips (38 patients), which had been revised with a proximal modular femoral component were included in this study. All 38 patients were treated using the posterolateral approach. The minimum follow-up period was 2 years. The stem stability was checked radiographically and the hip function was evaluated using the Harris hip score. RESULTS: Thirty-eight patients were follow-up for an average of 3.2 years. The Harris hip score was improved from an average of 49 points to an average of 84 points. Radiographically, satisfactory results were noted in 20 (52.6%) of the 38 hips at the latest follow-up. Complications were encountered in 8 hips (21%). An intraoperative femoral crack were encountered in 6 hips; circumferential wiring in 4 hips, and screw fixation in 2 hips. All 6 femoral cracks were healed within 3 months. Postoperative hip dislocation occurred in 2 hips (5.3%), which was successfully managed by manual reduction and abduction brace for 6 weeks. CONCLUSION: The short or midterm clinical and radiological results of cementless femoral revision using proximal modular stem for the hips with femoral osteolysis were satisfactoy. However it is believed that a longer follow-up is needed.

Total Hip Arthroplasty with Hydroxyapatite-Coated Anatomic Femoral Stem / 대한정형외과학회잡지

PURPOSE: To evaluate minimum 5-year results of total hip arthroplasty using a hydroxyapatite (HA)-coated anatomic femoral stem. MATERIALS AND METHODS: Fifty hips in 46 patients, received total hip arthroplasty using a HA-coated anatomic femoral component, between March 1992 and April 1995, 39 hips (36 patients) were available for this study. RESULTS: The mean preoperative Harris hip score of 55.2 points increased to 91.5 points at one year, but reduced to 81.9 points at the last follow-up. Radiolucency was seen in 5 hips (12.8%) on the last follow-up radiograms. Femoral osteolysis occurred in 7 hips (17.9%) on the last follow-up radiograms. Four femoralstems (10.3%) were revised due to femoral osteolysis and loosening. The average duration between index operation and revision was 123 months. CONCLUSIONS: The HA-coated anatomical femoral stem gave an increased Harris hip score and lowered the incidence of thigh pain, however it did not prevent osteolysis due to polyethylene wear.

Ceramic on Sandwich Ceramic Bearing Primary Cementless Total Hip Arthroplasty (Result of 2 to 5 years follow up) / 대한정형외과학회잡지

PURPOSE: To evaluate the short term clinical and radiological results of ceramic on sandwich ceramic bearing a primary cementless total hip arthroplasty. MATERIALS AND METHODS: Seventy-five hips, which underwent a total hip arthroplasty with sandwich typed liners as an index operation between December 1998 and October 2001 were examined. The mean follow-up period was 34.3 months, and the mean ages at surgery was 56. The clinical results were evaluated using the Harris hip score and the level of thigh pain. In addition, the radiolucent line, the subsidence of the stem, the migration of the acetabular cup, or osteolysis, proving and proof of loosening. RESULTS: The mean preoperative Harris hip score of 51.8 points was improved to 94.3 points at the final follow-up after surgery. Two cases were the fracture of ceramic components in postoperative three year. One of them was a fracture of the ceramic head and the other was a fracture and dislocation of the liner. Radiologically, there was one case of femoral stem subsidence and radiolucent line. CONCLUSION: The minimum 2-year clinical and radiological results of using ceramic sandwich ceramic bearing were satisfactory. However, breakages (fractures) of the ceramics have become an issue. Satisfactory clinical results can be obtained by limiting the acetabular inclination ranges from 40degrees to 45degrees, using a ceramic head with a larger diameter to increase the ratio between the diameter of the femoral head and neck, avoiding the use of a flange, reducing of the diameter of the femoral neck, the use of a thick-rimmed liner and improving the quality of the ceramic set. Therefore, the use of a sandwich ceramic liner needs to be reconsidered.

Dissociation of Sandwich Ceramic Liner: A Case Report / 대한정형외과학회잡지

In total hip replacement with a sandwich ceramic liner, liner dissociation is rare. We experienced one case of sandwich ceramic liner dissociation at 3 years 7 months after total hip replacement in avascular necrosis of the femoral head. The patient was treated by revisional total hip arthroplasty and a new sandwich liner and head were fitted. We describe this one rare case and review the literature.

Minimum Five Year Follow-Up Study of Porous-Coated Versus Hydroxyapatite Porous-Coated Cementless Total Hip Replacement / 대한정형외과학회잡지

PURPOSE: To compare the results of hydroxyapatite (HA) -coated with porous coated prosthesis for a minimum of five years. MATERIALS AND METHODS: We reviewed radiographs of 43 patients in HA group (48 cases) and 44 patient in porous group (48 cases) that followed for a minimum of five years after primary cementless total hip arthroplasty. Average follow up period was 6.2 years in HA group and 6.8 years in porous group. RESULTS: Harris hip score was improved to 78.1 point in porous group, 90.9 point in HA group at 6 months after surgery, but at last follwo up, 94 point in HA group, 96 point in porous group, there was no significancy. Thigh pain was noted 22.9% in porous group and 6.3% in HA group at 6 months after surgery (P=0.047) . At last follow up, thigh pain was noted 6.3% and 2.1% respectively. The mean wear of polyethylene liner was 1.36 mm in porous group and 1.72 mm in HA group (P=0.067) . Endosteal bone formation of femoral stem was noted 56.3% of porous group and 91.7% of HA group at one year after surgery, but there was 97% of endosteal bone formation was noted in both group at last follow up. Osteolysis around acetabular cup was noted 8.3% in porous group and 10.4% in HA group, and osteolysis around femoral stem was noted in 20.8%, 37.5% respectively. CONCLUSION: The results of HA coated implant was better than that of porous group at initial, but there was no significant differency at last follow up. The difference in rate of osteolysis and polyethylene wear between both groups were not significant at the last follow up. Final acceptance must await follow-up at least of 10 to 15 years in comparison with current hip prostheses.

The Clinical and Radiographic Results of Primary Cementless PCA ( Porous-Coated Anatomic ) Total Hip Arthroplasties: Minimum 10-Year Follow-up Study / 대한정형외과학회잡지

PURPOSE: To assess the long-term results of primary cementless PCA total hip arthroplasty. MATERIALS AND METHODS: We reviewed radiographs of 35 patients (43 hips) and evaluated clinical results of 44 patients (53 hips) who were followed up for a minimum of 10 years (10 to 12.8 years) after primary cementless PCA total hip arthroplasty. RESULTS: The average preoperative Harris hip score was 50.3 point and average postoperative Harris hip score was 87.5 point at 1 year and 81.3 point at last follow-up. On last follow-up, radiographic findings showed that femoral stability was considered stable by bony ingrowth in 39 cases (90.7%), stable by fibrous ingrowth in 1 cases (2.3%), and unstable in 3 case (7.0%). Pelvic osteolysis occurred in 5 cases (11.6%) and femoral osteolysis in 17 cases (39.5%). Loosening of implant was observed in 3 cases (7.0%) around femoral stem and in 6 cases (14.0%) around acetabular socket. The mean linear wear of polyethylene liner was 1.37 mm (range 0.1 mm to 4.73 mm), and the linear wear rate was 0.25 mm/year. Eight of the 9 acetabular components that failed in our study had an acetabular component size of 55 mm or smaller. CONCLUSIONS: The result of primary cementless PCA total hip arthroplasties was acceptable up to 10 years, but osteolysis and polyethylene wear became more common with time. Therefore, we recommend that patients with PCA total hip arthroplasties should be followed up carefully over the long term and a modification in articulation material is required to reduce osteolysis and polyethylene wear.

Treatment for Painful Bipartite Patella Using Vastus Lateralis Tendon Release / 대한정형외과학회잡지

Nine patients, who had ten painful bipartite patellae, were managed with a new operative tech nique in which the vastus lateralis insertion to the painful patellar fragment is detached subpe riosteally while the continuity of the tendon-periosteum complex to the main portion of the patella is preserved. A grossly mobile patellar fragment was removed in 3, fragment that showed minimum mobility was left in situ in 5 and fragment that had significant articular component was fixed with 4.0 mm cancellous screw in one. All of the patients had prompt relief of pain and returned to full sports activity within three months of the operation, 2 of 5 patellas that had not been removed united by bone to the main portion of the patella within 2 years post-operatively. Overall, 10 knees had excellent results at an average of four years post-operatively.

Mechanism of Hypercallus Formation in Patients with Concomitant Fracture and Head injury / 대한정형외과연구학회지

We built the hypothesis that the hypertrophic callus formation is mediated by beta-endorphin that stimulates secretion of GH and increase circulation growth factor activity in head injury patient. We classified 4 groups such as 5 normal person(control), group I;5 patients with only fracture, group II;5 patients with fracture and head injury, group III; 5 patients with only head injury, group IV. We obtained the samples of serum from each group at 0, 2, 4, 6, 8 weeks after trauma and assessed the serum level of GH, GHRH, somatostatin. The serum level of GH was statisticallyu higher in group III, IV than group I, II. There was not significant difference in serum level of GHRH. The serum level of somatostatin was higher in group II, III, IV than group I, but there was no statistical significance in each group. GH has a important role in hypertrophic callus formation in severe head injury patients, but there was no evidence that the mechanism is mediated by beta-EndorphinGHRH & somatostatin-GH-GF-1, beta-FGF axis. There may be a another mechanism in increasing GH that was stimulated by beta-endorphin in thalamus and lateral ventricle, and it should be necessary for further evaluation of it.

Functional Leg Length Inequality Following THA / 대한정형외과학회잡지

This is a follow up study on consecutive series 50 patients of total hip arthroplasty to assess for transient leg-length inequality. The authors report a clinical experience of 50 patients who have been pelvis tilt before total hip replacement. Retrospectively reviewed for the presence of pelvic obliquity preoperative and at the 1, 3 and 6 months follow-up visits. The results were as follows. Fourty-eight patients(96%) with functional leg length inequality related pelvic obliquity were improved within 6months postoperative follow up period after total hip arthroplasty. Two patients(4%) had persistent functional leg length inequality that affected factors-old age, female and soft tissue tightness due to pelvic obliquity. We believe that in most of these patients, the transient functional leg length inequality has a self-limited course, whereas in a small number, the profoud sense of inequality remains.