The aim of this study was to assess the clinical and radiological result of the usage of chip bone graft in non-contained type bone defect in primary or revision total knee arthroplasty patients. We investigated 32 patients who had underwent primary or revision total knee arthroplasty from March, 2014 to February, 2017 in our hospital, who had non-contained type of defect. The mean age was 73.1 years. 5 of them were males, while 27 of them were females. 7 of them were primary total knee arthroplasty patients, while 25 of them were revision patients. 8 of them had chip bone graft used both in the femur and tibia. 9 of them had chip bone graft used only in the tibia. The other 15 had chip bone graft used only in the femur. Wire-mesh was used in the 9 patients who had chip bone graft used only in the medial side of the tibia. We used KOOS (Knee injury and osteoarthritis outcome score), HSS (Hospital for Special Surgery knee service rating system) and WOMAC scores to assess the clinical result, before the surgery and at the last follow-up. In addition, we had follow-up x-rays and 3D CT done for the patients to check the mean bone union period. In addition, overall radiologic imaging studies were used for complications such as loosening, osteolysis and lesions with radiolucency.Purpose
Subjects and Methods
The aim of this study was to compare the clinical outcomes of the revision TKA in which trabecular metal cones and femoral head allografts were used for large bone defect. Total 53 patients who have undergone revision TKA from July 2013 to March 2017 were enrolled in this study. Among them, 24 patients used trabecular metal cones, and 29 patients used femoral head allografts for large bone defect. There were 3 males and 21 females in the metal cone group, while there were 4 males and 25 females in the allograft group. The mean age was 70.2 years (range, 51–80) in the femoral head allograft group, while it was 79.1 years (range, 73–85) in the metal cone group. Bone defect is classified according to the AORI classification and clinical outcomes were evaluated with Visual Analogue Scale (VAS), Hospital Special Surgery-score (HSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and ROM. Operation time was also evaluated. We used radiographs to check complications such as migration or loosening. We took follow-up x-rays and 3D CT of the patients, to assess the mean bone union period. Shapiro-Wilk test was done to check normality and Student T-test and Mann Whitney U-test were done for comparison between two groups.Purpose
Method
To compare and analyze the long term follow up clinical & radiological result after utilization of fixed-type & rotating-type implant for high flex both total knee replacement. This paper targeted 45 patients, 90 cases that got high flex both total knee replacement with utilization of fixed-type implant(LPS-flex®) & rotating-type implant(P.F.C® Sigma RP-F) for 1 patient by 1 operator(C.C.H) in our hospital from 2005.01 to 2006.11. Preoperative diagnoses were degenerative arthritis (43 patients, 86 cases), rheumatic arthritis (2 patients, 4 cases), mean age at the operation was 66.4 years old(54∼78), 3 men, 42 women, mean follow up period was 110.8months(97∼120). We compared and estimated Hospital for Special Surgery(HSS) score and Knee Society Score(KSS), Western Ontario and MacMaster Universities Osteoarthritis(WOMAC) score and mean range of motion of knee joint at pre-operation and last follow up for functional & clinical evaluation. And we compared and estimated change of femorotibial angle and radiolucency through erect AP & lateral x-ray at pre-, post-operation and last follow up using American Knee Society Roentgen Graphic Evaluation for radiological evaluation.Purpose
Subject & Method
This study was conducted to assess the clinical and radiologic results of total knee arthroplasty (TKA) with an allogenic bone graft using varus-valgus constrained (VVC) prostheses in knees with severe bone defects and unstable neuropathy. This study included 20 knees of 16 patients who underwent TKA between August 2001 and January 2006 due to unstable knees with severe bone destruction resulting from neuropathic arthritis. At the time of surgery, the mean age of the patients was 56 years. The mean length of the follow-up period was 10.7 years. A VVC condylar prosthesis was used with an allogenic femoral head graft to reconstruct large bony defects. Clinical results were evaluated using the Hospital for Special Surgery (HSS), Knee Society (KS) function, and Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores. Three-dimensional computed tomography (3D-CT) was used to evaluate the radiological parameters, which included the tibiofemoral angle, loosening or osteolysis of components, and incorporation of the bone graft.Background
Methods
The purpose of the study was to evaluate clinical outcomes in patients receiving saphenous neurocutaneous island flaps for reconstruction of soft tissue defects after total knee arthroplasty (TKA). Four patients (2 men, 2women; mean age 61 years) with post-TKA soft tissue defects were treated with saphenous neurocutaneous island flaps between November 2001 and August 2007. The mean follow-up period was 3.5 years. Initial diagnoses were traumatic arthritis, rheumatoid arthritis, arthritis due to previous osteomyelitis and tuberculous arthritis. One patient developed deep infection after TKA, so revision TKA with Nexgen® LPS (Legacy® posterior stabilized) was performed after soft tissue reconstruction. One soft tissue defects developed after TKA with Nexgen® LPS due to long-term steroid use for rheumatoid arthritis. Two cases occurred after placement of Nexgen® LCCK (Legacy® constrained condylar knee). Two cases developed secondary to diabetes mellitus and tuberculous arthritis. Soft tissue defects were located over the patella (1 case), patellar tendon (1 case), and medial side of the knee (2 cases). The flaps ranged in size from 0.03×0.004 m to 0.08×0.05 m. All flaps were proximally based. All flaps survived completely. The postoperative range of motion was between 3° and 100°. Because saphenous neurocutaneous island flaps are well matched with local tissue and are tough, thin, pliable and sensate, they are an ideal option for reconstruction of soft tissue defects after TKA.
The purpose of this study was to compare the clinical and radiological results of the PFC flex mobile bearing design with those of the LPS flex fixed bearing design in high-flex total knee arthroplasty. Between January 2005 and November 2006, forty-six patients who received PFC flex mobile bearing prosthesis in one knee and LPS flex fixed bearing prosthesis in the contralateral knee followed up for a minimum 2 years were evaluated. Clinical results were assessed using the ROM, HSS score, the Knee rating systems of the knee society, WOMAC score and SF-36. Radiological results were evaluated tibio-femoral angle and loosening or osteolysis of components. We subdivided preoperative less 90 degree and more 90 degree in each group. Mean ROM range of last follow up was increased to 131.1 degree in LPS group and 130.1 degree in PFC group. But there was no significant difference between the two groups. HSS score, knee pain and function score, WOMAC score, SF-36 score didn’t differ significantly between two groups. But descending stairs, rising from sitting, bending to the floor more improved significantly in LPS group. T-F angle was changed from preoperative 8.2 degree varus to a postoperative 4.8 degree valgus. No knee had aseptic loosening or osteolysis. Postoperative ROM was increase significantly in both groups. We found no significant differences between the two groups with regard to clinical and radiological parameters excepts descending stairs, rising from sitting, bending to the floor in WOMAC score. There was no aseptic loosening or osteolysis but needed long term observation about these concerns.
To evaluate the radiographic mid-to long-term result of femoral revision hip arthroplasty using impacted cancellous allograft combined with cemented, collarless, polished and tapered stem. Among 27 patients with impacted cancellous allograft with a cemented stem, 28 hips from 26 consecutive patients were analyzed retrospectively. The average patient age was 59 years. The follow-up period ranged 36 months to 10 years, 3 months (mean, 76.6 months). Radiographic parameters analyzed in this study included subsidence of the stem in the cement, subsidence of the cement mantle in the femur, bone remodeling of the femur, radiolucent line, and osteolysis. Radiographic analysis showed very stable stem initially. 27 stems showed minimal subsidence (less than 0.005m) and 1 stem showed moderate subsidence (about 0.008m) in the cement. But there was no mechanical failure and subsidence at the composite-femur interface. Evidence of cortical and trabecular remodeling were observed in all cases. No radiolucent line or osteolysis were found in the follow-up period. There were 4 proximal femoral cracks and 1 distal femoral splitting during operation. The result of cemented stem revision with the use of impacted cancellous allograft was good mid-to long-term. And femoral bone stock deficiency may be reconstructed successfully.
