Hip instability is one of the most common causes for total hip arthroplasty (THA) revision surgery. Studies have indicated that lumbar fusion (LF) surgery is a risk factor for hip dislocation. Instrumented spine fusion surgery decreases pelvic tilt, which might lead to an increase in hip motion to accommodate this postural change. To the best of our knowledge, spine-pelvis-hip kinematics during a dynamic activity in patients that previously had both a THA and LF have not been investigated. Furthermore, patients with a combined THA and LF tend to have greater disability. The purpose was to examine spine-pelvis-hip kinematics during a sit to stand task in patients that have had both THA and LF surgeries and compare it to a group of patients that had a THA with no history of spine surgery. The secondary purpose was to compare pain, physical function, and disability between these patients. This cross-sectional study recruited participants that had a combined THA and LF (n=10; 6 females, mean age 73 y) or had a THA only (n=11; 6 females, mean age 72 y). Spine, pelvis, and hip angles were measured using a TrakSTAR motion capture system sampled at 200 Hz. Sensors were mounted over the lateral thighs, base of the sacrum, and the spinous process of the third lumbar,12th thoracic, and ninth thoracic vertebrae. Participants completed 10 trials of a standardized sit-to-stand-to-sit task. Hip, pelvis, lower lumbar, upper lumbar, and lower thoracic sagittal joint angle range of motion (ROM) were calculated over the entire task. In addition, pain, physical function, and disability were measured with clinical outcomes: Hip Disability Osteoarthritis Outcome Score (pain and physical function), Oswestry Low Back Disability Questionnaire (disability), and Harris Hip Score (pain, physical function, motion). Physical function performance was measured using 6-Minute Walk Test, Stair Climb Test, and 30s Chair Test. Angle ROMs during the sit-to-stand-to-sit task and clinical outcomes were compared between THA+LF and THA groups using independent t-tests and effect sizes (d). The difference in hip ROM was approaching statistical significance (p=0.07). Specifically, the THA+LF group had less hip ROM during the sit-to-stand-to-sit task than the THA only group (mean difference=11.17, 95% confidence interval=-1.13 to 23.47), which represented a large effect size (d=0.83). There were no differences in ROM for pelvis (p=0.54, d=0.28) or spinal (p=0.14 to 0.97; d=0.02 to 0.65) angles between groups. The THA+LF group had worse clinical outcomes for all measures of pain, physical function, and disability (p=0.01 to 0.06), representing large effect sizes (d=0.89 to 2.70). Hip ROM was not greater in the THA+LF group, and thus this is unlikely a risk factor for hip dislocation during this specific sit-to-stand-to-sit task. Other functional tasks that demand greater excursions in the joints should be investigated. Furthermore, the lack of differences in spinal and pelvis ROM were likely due to the task and the THA+LF group had spinal fusions at different levels. Combined THA+LF results in worse clinical outcomes and additional rehabilitation is required for these patients.
Performing lateral extra-articular tenodesis (LET) with ACL reconstruction may conflict with the ACLR femoral tunnel. 12 fresh-frozen cadaveric knees were used: at 120 flexion, an 8mm ACLR femoral tunnel was drilled in the anteromedial bundle position via the anteromedial portal. A modified Lemaire LET was performed using a 1 cm-wide iliotibial band strip left attached to Gerdy's tubercle. The LET femoral fixation point was identified 10mm proximal / 5 mm posterior to the LCL femoral attachment, and a 2.4-mm guide wire was drilled, aiming at 0, 10, 20, or 30 degrees anteriorly in the axial plane, and at 0, 10, or 20 degrees proximally in the coronal plane. The relationship between the LET drilling guide wire and the ACLR femoral tunnel reamer was recorded for each combination. When collision with the femoral tunnel was recorded, the LET wire depth was measured.Abstract
Background
Methods
Management and outcomes of fungal periprosthetic joint infection (PJI) remain unclear due to its rarity. Although two-stage exchange arthroplasty is considered a treatment of choice for its chronic features, there is no consensus for local use of antifungal agent at the 1st stage surgery. The purpose of this study was to evaluate the efficacy of antifungal-impregnated cement spacer in two-stage exchange arthroplasty against chronic fungal PJIs after total knee arthroplasty (TKA). Nine patients who were diagnosed and treated for chronic fungal PJIs after TKA in a single center from January 2001 to December 2016 were enrolled. Two-stage exchange arthroplasty was performed. During the 1st stage resection arthroplasty, amphotericin-impregnated cement spacer was inserted for all patients. Systemic antifungal medication was used during the interval between two stage operations. Patients were followed up for more than 2 years after exchange arthroplasty and their medical records were reviewed.Purpose
Methods
There are limited previous findings detailed biomechanical properties following implantation with mechanical and kinematic alignment method in robotic total knee arthroplasty (TKA) during walking. The purpose of this study was to compare clinical and radiological outcomes between two groups and gait analysis of kinematic, and kinetic parameters during walking to identify difference between two alignment method in robotic total knee arthroplasty. Sixty patients were randomly assigned to undergo robotic-assisted TKA using either the mechanical (30 patients) or the kinematic (30 patients) alignment method. Clinical outcomes including varus and valgus laxities, ROM, HSS, KSS and WOMAC scores and radiological outcomes were evaluated. And ten age and gender matched patients of each group underwent gait analysis (Optic gait analysis system composed with 12 camera system and four force plate integrated) at minimum 5 years post-surgery. We evaluated parameters including knee varus moment and knee varus force, and find out the difference between two groups.Background
Methods
Total ankle arthroplasty (TAA) with the use of third generation implants has demonstrated favorable clinical results and improved survival. However, few studies have compared the different types of implants. The purpose of this study was to perform a retrospective evaluation of patient outcomes and complications by comparing TAA procedures performed with HINTEGRA versus MOBILITY systems. Fifty-two consecutively enrolled patients (28 men and 24 women; mean age 64.8 years) underwent TAA using HINTEGRA (21 ankles) or MOBILITY (33 ankles) between September 2004 and July 2012. Visual analog scale (VAS) pain scores and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were determined at each follow-up visit. The radiographs were reviewed to assess component positioning, radiolucency, heterotopic ossification and other factors.Background
Methods
Recent clinical studies have suggested that systemic metal ion levels are significantly elevated at midterm follow-up after ceramic-on-metal (COM) bearing. However, it is not clear whether there is a correlation between patient- and surgical-related factors including the lifestyle and elevated levels of serum metal ions following COM total hip arthroplsty (THA). Two hundred and one patients (234 hips) including 121 COM patients (140 hips) and 80 non-COM patients (94 hips) were enrolled in accordance with the inclusion criteria. The patients were divided into three groups based on the type of surgical bearings used. The Harris Hip Score (HHS), University of California, Los Angeles (UCLA) activity scale score, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were measured, and radiographs were obtained for the analysis. Serum metal ion levels of cobalt and chromium were measured using a high-resolution inductively coupled plasma mass spectrometry. Patient- and surgical-related factors were analyzed to determine which group of patients is at a high risk of metal ion-related problems.Background
Material and Methods
Total knee arthroplasty using navigation system is known to be more effective than conventional methods in achieving more accurate bone resection and neutral alignment. Mobile bearing is also known to reduce wear and automatically correct rotational mal-alignment of the tibia but the long-term follow-up results of more than 10 years are extremely rare. The purpose of this study is to investigate the results of clinical and radiologic long-term follow-up and complications of total knee arthroplasty using navigation and multi-directional mobile bearing. From 2003 to 2006, a total of 111 navigation TKAs using multi-directional mobile bearing design were carried out and reviewed retrospectively. TKAs were performed by two experienced surgeons at one institute. Of the 111 patients, 102 were women and 9 were men. The mean duration of follow-up was 11.4 ± 1.0 years (range, 10.1 to 14.08 years). Clinical outcomes were evaluated in terms of Knee Society Score, Hospital for Special Surgery score, Western Ontario and McMaster University (WOMAC) score, range of motion and complications. Long-term radiological outcomes and survival rates were evaluated at least 10 years. Average preoperative HSS score was 66.5 ± 9.8 and KSS pain and function score were 25.0 ± 11.8 and 44.5 ± 12.3, respectively. Scores improved to 94.1 ± 8.2, 46.6 ± 11.6 and 88.2 ± 14.6 at the last follow up, respectively. Mean preoperative WOMAC scores of 75.8
There are limited previous findings detailed biomechanical properties following implantation with mechanical and kinematic alignment method in robotic total knee arthroplasty (TKA) during walking. The purpose of this study was to compare clinical and radiological outcomes between two groups and gait analysis of kinematic, and kinetic parameters during walking to identify difference between two alignment method in robotic total knee arthroplasty. Sixty patients were randomly assigned to undergo robotic-assisted TKA using either the mechanical (30 patients) or the kinematic (30 patients) alignment method. Clinical outcomes including varus and valgus laxities, ROM, HSS, KSS and WOMAC scores and radiological outcomes were evaluated. And ten age and gender matched patients of each group underwent gait analysis (Optic gait analysis system composed with 12 camera system and four force plate integrated) at minimum 5 years post-surgery. We evaluated parameters including knee varus moment and knee varus force, and find out the difference between two groups.Background
Methods
This meta-analysis was designed to compare the effectiveness and safety of intravenous (IV) versus topical administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty (TKA) by evaluating the need for allogenic blood transfusion, incidence of postoperative complications, volume of postoperative blood loss, and change in hemoglobin levels. Studies were included in this meta-analysis if they assessed the allogenic blood transfusion rate, postoperative complications including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT), volume of postoperative blood loss via drainage, estimated blood loss, total blood loss, and change in hemoglobin before and after surgery in primary TKA with TXA administered through both the intravenous (IV) and topical routes.[Fig. 1]Purpose
Materials and Methods
Computer navigation system offers an inherent advantage to surgeons improving the surgical technique of total knee arthroplasty (TKA) in that it provides constant visual and numerical feedback throughout the procedure. On this basis, this study was designed to explore the chronologic change of surgical outcomes in TKA by a single surgeon with experience of over 50 Imageless navigation-assisted TKA procedures before. Surgical outcomes were analyzed in 295 consecutive total knee arthroplasties treated in period 1 (2011.1–2012.12) in which both navigation (53 knees, P1-NAVI) and conventional technique (106 knees, P1-CON) were used and in period 2 (2013.1–2013.12) in which conventional technique (136 knees, P2-CON) was only used. The study parameters were implantation accuracy, clinical outcome, operation time and complications. Coronal femoral component and tibial component angle, and hip–knee–ankle mechanical axis alignment were evaluated.BACKGROUND
METHODS
THA as primary treatment for displaced femoral neck fractures in elderly still remains a prominent concern. Overall dislocation rate after total hip arthroplasty (THA) is reported form 1∼5%. But, it is quiet different in situation of femur neck fracture in elderly. The THA is associated with higher rates of dislocation (8%∼11%) in eldery compared to hemiarthroplasty even though THA showed better clinical and functional scores. Recently resurgence about THA using DMC comes after improvement of manufacturing technology. The aim of this prospective multicenter study is to assess the rates of dislocation and re-operation for displaced femoral neck fractures in elderly with THA with Dual Mobility Cup (DMC) and to review systematically comparison of previous reports. Up to our knowledge, this is first report from asian conutry about the clinical outcomes THA using DMC for displaced femur neck fracture in elderly. Prospective consecutive groups of patients treated for displaced femoral neck fractures by three surgeons at each three center were included. 131 hips underwent THA with DMC for acute displaced femoral neck fracture in patients aged older than 70 years. Data regarding rates of dislocation and re-operation were obtained by review of medical records. Additionally From 2009 which the US FDA first approved the DMC, the authors searched reports regarding to THA using DMC for displaced femur neck fracture in elderly using the MEDLINE including cases series and comparative studies with bipolar hemiarthroplasty and THA. Therefore, current report was compared with previous reports.INTRODUCTION
METHODS
This meta-analysis was designed to evaluate the effects of computer navigation on blood conservation after total knee arthroplasty (TKA) by comparing postoperative blood loss and need for allogenic blood transfusion in patients undergoing computer navigation and conventional primary TKAs. Studies were included in this meta-analysis if they compared change in haemoglobin concentration before and after surgery, postoperative blood loss via drainage or calculated total blood loss, and/or allogenic blood transfusion rate following TKA using computer navigation and conventional methods. For all comparisons, odds ratios and 95 % confidence intervals (CI) were calculated for binary outcomes, while mean difference and 95 % CI were calculated for continuous outcomes.Purpose
Methods
The patients with high hip dislocation due to the sequelae of septic hip or neglected Developmental Dysplasia of the Hip (DDH) show severely impaired gait pattern. Total hip arthroplasty (THA) for these patients are expected to restore gait pattern by establishing better joint stability and biomechanics. To our knowledge, no study have investigated about objective change in gait parameters after total hip arthroplasty (THA) for these patients. So, we are to prospectively evaluate change in gait patterns after THA. Between 2012 and 2013, 11 patients with highly dislocated hip underwent unilateral THA with subtrochanteric osteotomy. There was 6 patients with DDH sequelae and 5 patients with septic hip sequelae. Spatio-temporal gait analysis was performed preoperatively and at 12 months after THA. We followed the patient 3, 6, 12 months and then annually postoperatively. The gait patterns were analyzed by several parameters such as cadence, speed, stride length, step length, step time, initial double support (IDS), terminal double support (TDS), stance phase and swing phase by a three-dimensional (3D) high-speed motion-capturing system (eight Eagle® cameras; Motion Analysis, Santa Rosa, CA, USA). Also dynamic range of motion (ROM) of hip joint and ground-reaction forces (GFR) were recorded. Clinical outcome was evaluated by using the Harris Hip Score (HHS). Radiographic assessments were evaluated for the changes in leg length discrepancy (LLD).Background
Methods
Myxofibrosarcomas (MFSs) are malignant soft-tissue sarcomas characteristically
presenting as painless slowly growing masses in the extremities.
Locally infiltrative growth means that the risk of local recurrence
is high. We reviewed our experience to make recommendations about
resection strategies and the role of the multidisciplinary team
in the management of these tumours. Patients with a primary or recurrent MFS who were treated surgically
in our unit between 1997 and 2012 were included in the study. Clinical
records and imaging were reviewed. A total of 50 patients with a
median age of 68.4 years (interquartile range 61.6 to 81.8) were
included. There were 35 men; 49 underwent surgery in our unit.Aims
Patients and Methods
Dysphagia is a common complication of anterior
surgery of the cervical spine. The incidence of post-operative dysphagia
may be as high as 71% within the first two weeks after surgery,
but gradually decreases during the following months. However, 12%
to 14% of patients may have some persistent dysphagia one year after
the procedure. It has been shown that female gender, advanced age,
multilevel surgery, longer operating time and severe pre-operative
neck pain may be risk factors. Although the aetiology remains unclear
and is probably multifactorial, proposed causes include oesophageal
retraction, prominence of the cervical plate and prevertebral swelling.
Recently, pre-operative tracheal traction exercises and the use
of retropharyngeal steroids have been proposed as methods of reducing
post-operative dysphagia. We performed a systematic review to assess the incidence, aetiology,
risk factors, methods of assessment and management of dysphagia
following anterior cervical spinal surgery. Cite this article:
The purpose of this study was to validate the usefulness of SPECT/CT as an evaluation method for determining treatment and prognosis for patellofemoral cartilage lesions, based on MRI and arthroscopic findings. From August 2009 to February 2010, SPECT/CT was performed on 80 patients (24 male and 56 female, average 53.3 years old) with chronic anterior knee pain who had no degenerative changes or patellar malalignment on plain radiographs. Radioisotope uptake findings on patellofemoral joint from SPECT/CT were classified into three grades by one nuclear medicine specialist. In the patients who demonstrated poor improvements after conservative treatments, MRI and arthroscopy were performed. Patellofemoral cartilage conditions under arthroscopic finding (ICRS grades) were compared with SPECT/CT grading. In all cases, there were increased uptakes on patellofemoral joints. Eighteen cases showed low uptake (Group 1), 22 cases showed medium uptake (Group 2) and 40 cases high uptake (Group 3). At the follow-up examination after mean 1.7 months, 16 cases of Group 1 (89%), 14 cases of Group 2 (64%) and 28 cases of Groups3 (70%) responded positively to the conservative treatments. For those 22 cases showing poor improvement, MRI and arthroscopy were done. Damage or thinning of patellofemoral cartilage, subchondral cyst, edema and fissuring were observed in every case that underwent MRI. Every arthroscopic case was found that there was patellofemoral cartilage damage. Each of ICRS grade I and grade II was found in 2 cases from Group 1. Two cases of grade II, 4 cases of grade III, and 2 cases of grade IV were found in Group 2. Two cases of grade II, 4 cases of grade III, and 6 cases of grade IV were found in Group 3. There was significant difference in the success rate of conservative treatment between SPECT/CT grade 1 and 2 or 3. And there was significant association between SPECT/CT grade and ICRS grade (P=0.034). SPECT/CT could be a useful modality in determining the treatment and prognosis for patellofemoral cartilage lesions compared with MRI and arthroscopic findings.
To determine whether there is a difference in the metal ion levels among three different metal-on-metal total hip systems: two monoblock large heads and one modular metal-on-metal total hip replacement system in patients who received these implants in our region. A group of 56 patients were recruited that had either undergone total hip replacement (THR) with a Birmingham resurfacing socket, the Durom resurfacing socket, or a Pinnacle metal-on-metal bearing surface. All patients recruited were at least one year following their surgery in order that their ion levels had reached a steady state. We reviewed every patient clinically, radiographically as well as biochemically. Blood was obtained for cobalt (Co) and chromium (Cr) levels. Current radiographs were arranged to assess the stability and mechanics of the total hip systems. All patients signed an informed consent and completed three questionnaires, The Western Ontario and McMaster Universities (WOMAC) index, the Short Form 36 (SF36) and UCLA activity score. A Harris Hip score was completed in order to assess individual hip function. Statistical analysis was performed on the collected data to assess whether there were any other potential influence on the mean levels of Co and Cr.Purpose
Method
We performed a prospective study to examine the
influence of the patient’s position on the location of the abdominal
organs, to investigate the possibility of a true lateral approach
for transforaminal endoscopic lumbar discectomy. Pre-operative abdominal
CT scans were taken in 20 patients who underwent endoscopic lumbar discectomy.
Axial images in parallel planes of each intervertebral disc from
L1 to L5 were achieved in both supine and prone positions. The most
horizontal approach angles possible to avoid injury to the abdominal
organs were measured. The results demonstrated that the safe approach
angles were significantly less (i.e., more horizontal) in the prone
than in the supine position. Obstacles to a more lateral approach
were mainly the liver, the spleen and the kidneys at L1/2 (39 of
40, 97.5%) and L2/3 (28 of 40, 70.0%), and the intestines at L3/4
(33 of 40, 82.5%) and L4/5 (30 of 30, 100%). A true lateral approach
from each side was possible for 30 of the 40 discs at L3/4 (75%)
and 23 of the 30 discs at L4/5 (76.7%). We concluded that a more
horizontal approach for transforaminal endoscopic lumbar discectomy
is possible in the prone position but not in the supine. Prone abdominal
CT is more helpful in determining the trajectory of the endoscope.
While a true lateral approach is feasible in many patients, our
study shows it is not universally applicable.
Hyaluronic acid (Hyalunan, HA), β-1,4-linked D-glucuronic acid and β-1,3 N-acetyl-D-glucosamine polysaccharide, is a nonsulfated glycosaminoglycan(GAG) conserved in the extracellular matrix (ECM). Due to its biocompatibility, biodegradable properties, HA is widely applied for tissue engineering. However, HA also has defects for tissue engineering such as mechanical properties, difficulty of handling. Thus, it is various modified by chemical reaction to produce HA derivative. HA plays an important role in tissue morphogenesis, proliferation and cell differentiation. Ascorbic acid (AA) has an effect on collagen synthesis and bone mineralization. Ascorbate levels also have a significant effect on osteoblast proliferation and alkaline phosphatase (ALP) expression. However AA is weak to heat and light, thus it is easily degradable. Consequently, we conjugated HA with AA in order to make it more stable and effective. In this study, we prepared HA-AA conjugate and evaluated activity of products in pre-osteoblast. To produce more effective conjugation, we synthesised HA derivative, HA-N-hydroxysuccinimide, an activated ester of the glucuronic acid moiety. This HA-active ester intermediate is a precursor for drug-polymer conjugates. The degree of substitution was calculated by NMR analysis. The modified HA was dialysed and lyophilised. The yield of conjugation is calculated by Gel Permeation Chromatography (GPC). After the process, HA was conjugated with AA once again as previously mentioned. In this study, the resultant HA-AA conjugate was tested on MC3T3-E1, murine pre-osteoblast cells. We examined cellular viability (cytotoxicity), proliferation and gene expression. The expression of Type 1 collagen was examined by RT-PCR and western blot. Osteocalcin (OCN), osteopontin (OPN) and bone sialoprotein (BSP), bone proliferation and differentiation marker were detected by RT-PCR. Alkaline phosphatase assay was also performed. For confirmation on bone mineralization, alizarin red staining and von Kossa staining was performed. In conclusion, the in vitro data demonstrate that HA-AA conjugate has an important role in bone formation, as it can increase proliferation and osteogenic differentiation of MC3T3-E1 cells. These observations further support the use of in vivo system for tissue engineering applications.
To date nine cases treated by cementless total ankle arthroplasty for avascular necrosis of the talar body have been described in the English literature. However, these reports show high complication rates including collapse of the talar component, and as a result cementless total ankle replacement is not recommended for the treatment of avascular necrosis of the talar body. The authors report two cases of ankle osteoarthritis with avascular necrosis of the talar body that were treated by cementless mobile bearing total ankle arthroplasty, because preoperative magnetic resonance images and radionuclide bone scanning showed revascularization of the talus. Recent follow-up plain radiographs of ankles showed no loosening or subsidence. The authors conclude that cementless total ankle arthroplasty for the treatment of avascular necrosis of the talar body is likely to be successful if necrotic bone has healed by creeping substitution and has enough strength to support an implant.
