Effect of medial open wedge high tibial osteotomy on progression of patellofemoral osteoarthritis.

PURPOSE: This study aimed to investigate the effect of medial open wedge high tibial osteotomy (MOWHTO) on patellofemoral joint osteoarthritis (PF OA) progression and its outcome according to the degree of preexisting PF OA. MATERIALS AND METHODS: Patients who underwent biplane MOWHTO between January 2006 and December 2018 were retrospectively reviewed. The patients were divided into two groups according to the degree of PF OA: non-PF OA [Kellgren-Lawrence (K-L) grade 0-1] and PF OA (K-L grade 2-3). Propensity score matching was performed between the two groups, and comparative analysis was performed on clinical scores and radiographic parameters and grade. RESULTS: After propensity score matching, 83 patients were selected for each group. At postoperative follow-up, clinical scores were improved significantly compared with preoperative scores in both groups; however, there were no significant differences between the groups. There were also no significant differences between the two groups in radiographic parameters. The radiographic grade of PF OA indicated a slight progression in osteoarthritis in both groups; however, PF OA tended to progress further in the PF OA group. CONCLUSIONS: MOWHTO did not result in significant differences in outcomes at postoperative follow-up; however, preexisting PF OA contributed to PF OA progression after MOWHTO.

Conservative treatment using a sponge cast for transfer fractures in nursing home patients.

BACKGROUND: Transfer fractures in the lower limbs of bedridden and chair-bound nursing home patients can result from trauma induced by the usual lifting, moving, turning, or transferring maneuvers. Treatment entails immobilization for pain control and position change; however, splints/hard casts increase the risk of pressure sores. Therefore, we evaluated the use of a sponge cast. MATERIALS AND METHODS: Between March 2011 and October 2017, 17 patients with a lower limb transfer fracture due to transferring maneuvers in a nursing home were recruited. We evaluated the improvement in pseudo-motion and divided the patients as having bony union, fibrous union, or remaining pseudo-motion. We also investigated the occurrence of pressure sores due to immobilization up until the final follow-up. RESULTS: Femur fractures occurred in 15 patients and lower leg fractures in two. Six of the 15 femur fractures were periprosthetic (four hip arthroplasty and two knee arthroplasty). Pseudo-motion was improved in 15 of 17 cases, within an average of 17.3 weeks for the improvement (14-23 weeks; bony union: 11 cases and fibrous union: four cases). Pseudo-motion remained in two cases: one periprosthetic fracture around the knee arthroplasty and the other, a femur neck fracture. No pressure sores occurred. CONCLUSIONS: A sponge cast appears to be one of the effective treatment options available for bedridden or chair-bound patients with a lower limb fracture due to its low risk of complications and satisfactory clinical results.

Effect of surgical approach for contralateral side hip arthroplasty in below knee amputees: a retrospective cohort study.

BACKGROUND: The gluteus medius muscle plays a very important role in the stability of the gait, especially in patients with amputation of the lower limbs. Therefore, choosing the appropriate type of approach for hip arthroplasty is very important. Hence, this study aimed to compare the outcomes and complications between the anterolateral approach (ALA) and posterior approach (PA) for hip arthroplasty in patients with contralateral below knee amputation. METHODS: From January 1999 to November 2014, 67 patients who underwent hip arthroplasty with contralateral below knee amputation were retrospectively analyzed. The study subjects were divided into two groups: the PA group (33 cases) and the ALA group (34 cases). The results of the clinical functional recovery with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Harris Hip Score, and activity of daily living scale were compared between the two groups. During the follow-up period, complications related to gait such as fall, dislocation, and periprosthetic fractures (PPFs) were investigated. RESULTS: The Harris Hip Score (p = 0.024) and the activity of the daily living scale (p = 0.043) of the ALA group were significantly lower at 3 months compared to the PA group, but no significant difference was observed between the two groups from 6 months postoperatively to the last follow-up. The WOMAC score was not significantly different between the two groups. Within 3 months after surgery, falls occurred in 3 cases in the PA group and in 11 cases in the ALA group (p = 0.019) Dislocation and PPF were caused by prosthesis-related trauma. Two dislocations and 1 PPF occurred 8 years postoperatively in the PA group. PPF occurred in 3 patients in the ALA group, of which 2 occurred within 3 months after surgery. CONCLUSION: Orthopedic surgeons should pay particular attention in patients with hip arthroplasty on the contralateral side hip who had below knee amputation because functional recovery is delayed until 3 months after ALA compared with PA.

Subscapular and Pectoralis Major Sparing Deltopectoral Approach for Reverse Total Shoulder Arthroplasty.

In reverse ball shoulder replacement, surgery is usually performed using a deltopectoral approach or an anterosuperior transdeltoid approach. The deltopectoral approach is to incise the pectoralis major to upper 1/3 to 1/2, and subscapularis tendon should be removed at the lesser tuberosity of the humerus. This approach has the problem of breaking the shoulder deltoid instead of incising the rotator cuff. Therefore, we report a detailed procedure of reverse ball shoulder replacement using approach without incision of the pectoralis major muscle and subscapularis muscle.

Mid-to long-term results of total hip arthroplasty after contralateral lower extremity amputation.

OBJECTIVE: There is limited literature concerning the outcomes and role of THA as a surgical option for amputee patients. The aim of this study is to determine the mid-to long-term survival and complication rates of cementless total hip arthroplasty (THA) in patients with contralateral below knee amputations. METHODS: A retrospective review of 54 patients with below knee amputation were perfomed who underwent THA for osteoarthritis of the contralateral hip over a 5-year period between 1999 and 2014. Patients were monitored for at least 5 years and assessed with the Harris Hip Score and activities of daily living scale and by evaluating migration or osteolysis around the acetabular cup and femoral stems (amputee group). The amputee group was compared with a control group (non-amputee group) with the same number of patients. RESULTS: Differences in the Harris Hip Score (p = 0.021) and activities of daily living scale (p = 0.043) between the two groups were statistically significant lower in the amputee group at 3 months after surgery. However, no differences were found between the groups from 6 months postoperatively to the last follow-up (Harris Hip Score p = 0.812, activities of daily living scale p = 0.885). Radiologically, any cups or stems showed no signs of migration or osteolysis. In the amputee group, dislocation was found in 1 patient 2 months after arthroplasty (p = 0.315) and long stem revision surgery were performed on two patients due to periprosthetic fracture (p = 0.153). CONCLUSIONS: THA performed on the contralateral side of patients with below knee amputation is considered to be an effective treatment with good clinical and radiological results at mid-to long-term follow-up. LEVEL OF EVIDENCE: Level IV, therapeutic study.

One-year Survival Rates and Functional Recovery in Veterans Who Suffer from Hip Fractures: Evaluation of Commissioned Hospitals' System through Comparison between Veterans Hospitals and Commissioned Hospitals.

PURPOSE: This study was performed to compare the: i) 1-year survival rate of patients with hip fractures, ii) factors affecting mortality in patients with hip fractures, and iii) results of functional recovery at commissioned hospitals (CH) and veterans hospitals (VH) to characterize the quality of care provided in the Korean commissioned hospital system. MATERIALS AND METHODS: The study population consisted of 183 veteran patients (84 and 99 treated at a single VH and 39 CH, respectively) who underwent hip fracture surgery between January 2010 and February 2015. This study compared baseline characteristics (i.e., age, comorbidities, fracture types and surgical treatment approaches) of the two groups vs. clinical outcomes, and evaluated the waiting time, length of hospital stay, total medical expenses, mortality rate within one year, and functional recovery at last follow up. RESULTS: There were no significant differences in age, fracture types, comorbidities, ambulatory status before fracture, waiting time, or length of hospital stay between the two groups, however, the total medical cost was higher in the CH group (P=0.009). There was no significant difference in mortality within one year after hip fracture (P=0.224) or functional recovery at last follow-up (P=0.463) between the two groups. CONCLUSION: The results of this study confirm that the Korean commissioned hospitals system is operating in accordance with its purpose. However, further studies are needed to better characterize the medical expenses of CHs vs. veterans hospitals.

What Is Important in Selecting a Designated Hospital for the Korean Veterans with Hip Fractures?

PURPOSE: The Korea Veterans Health Service (KVHS) implemented the 'designated hospital system' so that veterans can receive prompt medical attention at hospitals near their residences when experience medical emergencies, including hip fractures. We analyzed the hospital-selection process of Korean veterans following a hip fracture. We then evaluated (the validity and considerations) for choosing designated hospitals. MATERIALS AND METHODS: The study population consisted of 183 veteran patients (84 treated at a single veterans hospital and the remaining 99 treated at 39 designated hospitals) who underwent hip fracture between January 2010 and February 2015 in the Honam region of South Korea. The subjects were divided into the 'nearest group' (those who chose the hospital closest to their residences) and the 'non-nearest group' (those who did not choose the hospital closest to their residences). We compared the age, ambulatory status, combined disease and fracture type, factors that we speculated may impact hospital choice. RESULTS: Although the patients had difficulty moving due to hip fractures, 116 (63.4%) patients choose hospitals that were not closest to their residences. Patients with three or more comorbidities (P=0.028) and older ages (P=0.046) were statistically more likely to fall into the non-nearest group. Ambulatory status and fracture type were shown not to significantly impact choice between nearest and non-nearest hospital. Patients in the non-nearest group tended to seek care at larger hospitals. CONCLUSION: Korean veterans with hip fractures tended to seek care at larger hospitals, regardless of distance. We must therefore consider the number of beds and departments when choosing designated hospitals.