Introduction

Hip resurfacing arthroplasty (HRA) with metal-on-metal bearing is currently emerging as a major evolution of hip arthroplasty. It could be an alternative to total hip arthroplasty. HRA also may allow young patients to perform high sports activities. It preserves proximal femoral bone stock and keeps the medullary canal intact. A large diameter of the femoral head provides wider range of the hip motion. Incidence of dislocation is very low. Most of HRA have been reported for young patients with stage of osteoarthritis. But, reports of HRA for osteonecrosis of the femoral head (ONFH) are rare and the outcomes are uncertain.

Introduction: The aim of this study is to analyze the mid-term result of cementless total hip arthroplasty(THA) performed in hemophilic arthropathy of the hip.

Materials and Methods: Of the 22 hips (19 patients) that underwent cementless THA under the diagnosis of hemophilic arthropathy from Aug. 1995 to June. 2002, 20 hips (17 patients) that can be followed more than five years were enrolled. The average age was 35.1 years. All of the patients had type A hemophilia. There was no patient who had antibody for factors or positive test for HIV. The mean follow-up period was 99.6 (61–147) months. As a clinical assessment, we evaluated Harris hip score, hip range of motion, amount of transfusion and factor replacement, perioperative bleeding and the problems associated with the use of coagulation factors and the bleeding itself after the surgery. As a radiological assessment, we evaluated the stability and fixation of the components, various bone responses around the implants and complications such as loosening and osteolysis.

Results: The average Harris hip score improved from 62.4 before surgery to 93.6 at the final follow-up. The hip range of motions in all plane significantly increased after the operation. During and after the surgery, an average of 3.2 units of packed RBC was transfused and an average of 46000 units of coagulation factors was injected. All patient obtained significant pain relief and improvement walking ability after the operation. The episode of re-bleeding was observed in four cases. In one of them, severe osteolysis around the pelvis and femoral stem was noted due to a huge pseudotumor. Radiographically, all components except one cup showed stable fixation at the final follow-up. The osteolysis was noted in three cups and three stems each. As a re-operation, one morsellized bone graft for osteolysis and one cup revision for a loosened cup were performed at 134 and 40 months after the index operation. One case of pseudotumor is waiting for the surgery.

Conclusion: Unlike the worrisome results of cemented THA, meticulously performed cementless THA for the moderate or severe hemophilic arthropathy is safe and greatly effective in reducing the pain, increasing the range of hip motion and improving the walking ability. However, special attention should be paid to the possible complications associated with re-bleeding such as pseudotumor around the hip. To obtain best result multidisciplinary team approach is mandatory.

Introduction: This study reports a technique and result in the application of an intramedullary tibial nail for patients undergoing an open-wedge proximal tibial osteotomy.

Materials and Methods: Fourteen knees of 10 patients with genu varum were treated with proximal tibial osteotomy using an intramedullary tibial nail. The average age at the time of operation was 25 years old. Tibial osteotomy was performed percutaneously through multiple drilling from the average 8.7cm below the joint line and no bone graft was performed in all cases. Concomitant fibular osteotomy was performed in 9 cases. The clinical and radiographic records were reviewed for a minimum 2 years follow up.

Result: Union of the osteotomy site was obtained in all knees at a mean of 3.5 months in both anteroposterior and lateral radiographs. The mean postoperative correction angle was 11 degrees in femorotibial angle in frontal plane (P< 0.05). But significant change of tibial posterior slope was not determined (P> 0.05). The osteotomized tibia was lengthened average 6mm in postoperative anteropsterior radiograph. Range of motion of the knee was full at the latest follow up. There was no significant complication such as infection, deep venous thrombosis, nerve palsy, or implant failure.

Conclusion: Open-wedge proximal tibial osteotomy using an intramedullary tibial nail for genu varum provides firm initial stability and early rehabilitation. Furthermore, there is no need of bone graft and no significant alteration in tibial slope after surgery. Thus this technique can be a viable option for the proximal tibial osteotomy in the treatment for genu varus.