Hospital case volume is shown to be associated with postoperative outcomes in various types of surgery. However, conflicting results of volume-outcome relationship have been reported in hip fracture surgery. This retrospective cohort study aimed to evaluate the association between hospital case volume and postoperative outcomes in patients who had hip fracture surgery. We hypothesized that higher case volume would be associated with lower risk of in-hospital and one-year mortality after hip fracture surgery. Data for all patients who underwent surgery for hip fracture from January 2008 to December 2016 were extracted from the Korean National Healthcare Insurance Service database. According to mean annual case volume of surgery for hip fracture, hospitals were classified into very low (< 30 cases/year), low (30 to 50 cases/year), intermediate (50 to 100 cases/year), high (100 to 150 cases/year), or very high (> 150 cases/year) groups. The association between hospital case volume and in-hospital mortality or one-year mortality was assessed using the logistic regression model to adjust for age, sex, type of fracture, type of anaesthesia, transfusion, comorbidities, and year of surgery.Aims
Methods
Cross-linked polyethylene (XLPE) has shown reduced wear rates as compared to conventional polyethylene, but the long-term effect of this on the incidence of osteolysis remains unclear. In addition, the measurement of osteolysis on plain radiographs can underestimate the incidence and extent of osteolysis. Therefore, we evaluated the wear rate, incidence and volume of osteolysis at a minimum follow-up of ten years using three-dimensional computed tomography (3-D CT), a more accurate and sensitive method for detecting and measuring the size of osteolysis than plain radiographs. Between 2000 and 2004, 233 primary THAs were performed using 28-mm cobalt-chrome femoral head on first-generation XLPE (Longevity®, Zimmer, Warsaw, IN) with cups of identical design. Fifty-five patients (57 hips) deceased, eight patients (8 hips) were lost and four patients (4 hips) were revised due to recurrent dislocation (2 hips) or infection (2 hips). Among the remaining 164 hips, 95 hips underwent 3-D CT scanning (Aquilion® 64, Lightspeed Ultra® 16 or Optima® 660) at minimum 10 years (range, 10.0 to 15.2) and were included in this study. Mean age at the time of THA was 56.2 years and average body mass index was 23.5 kg/m2. Average cup size was 55.4 mm whereas mean inclination and anteversion angle of cups on CT scan were 40.1 and 17.4 degrees, respectively. Average follow-up period was 12.8 years. 2D wear rate was measured using PolyWare® 3D Rev 7 software (Draftware Inc, Vevay, IN). Osteolysis was strictly defined as a localized area of trabecular loss with a sclerotic margin. Osteoarthritic cyst and age-related osteoporosis were excluded using perioperative CT scan and magnetic resonance imaging or serial plain radiographs. The incidence, location, and volume of osteolysis were measured.Background/Purpose
Materials and Methods
Total hip arthroplasties (THAs) with ceramic bearings are widely performed in young, active patients and thus, long-term outcome in these population is important. Moreover, clinical implication of noise, in which most studies focused on ‘squeaking’, remains controversial and one of concerns unsolved associated with the use of ceramic bearings. However, there is little literature regarding the long-term outcomes after THAs using these contemporary ceramic bearings in young patients. Therefore, we performed a long-term study with a minimum follow-up of 15 years after THAs using contemporary ceramic bearings in young patients with osteonecrosis of the femoral head (ONFH) less than fifty. Among sixty patients (71 hips) with a mean age of 39.1 years, 7 patients (7 hips) died and 4 patients (4 hips) were lost before 15-year follow-up. The remaining 60 hips were included in this study with an average follow-up period of 16.3 years (range, 15 to 18). All patients underwent cementless THA using a prosthesis of identical design and a 28-mm third-generation alumina head by single surgeon. The clinical evaluations included the modified Harris hip score (HHS), history of dislocation and noise around the hip joint: Noise was classified into squeaking, clicking, grinding and popping and evaluated at each follow-up. Snapping was excluded through physical examination or ultrasonography. Radiographic analysis was performed regarding notching on the neck of femoral component, loosening and osteolysis. Ceramic fracture and survivorship free from revision were also evaluated.Background/Purpose
Materials and Methods
This study aims to identify the efficiency of biomechanical and bioactive properties of the bovine cortical bone cage treated with conditionally surface demineralization. The procured bovine femoral bones were got rid of lipid, protein, and blood materials by chemical process such as 3% hydrogen peroxide and 70% ethanol. The long shaft bones were cut by band saw. Several bone cages were processed by milling machine. The cortical bone cages were demineralized by 0.6N HCl treatment with various conditions, which were the tendency of HCl treatment time, position, direction. After neutralization with pH 7.0, phosphate buffered saline washing and freeze drying process, the vial vacuum packed bone cages were sterilized by 25kGy gamma irradiation. The SEM and EDS system were proceeded for morphology and Ca content in various layers of bone cage. In vitro test for cell viability and differentiation, extracted supernatant from each bone cage by tissue culture was treated in MC3T3E1 cells. For indentifying releasing materials, the others were carried for quantitative analysis by ELISA. After each conditioned period, mRNA expression was compared by RT-PCR. The axial compression and bending strength were measured by universal testing machine (UTM) for biomechanical property. Between the outer layer and inner layer of bone cage for 2 hour’s HCl, there was concentrated Ca extracted layer. The tendency of Ca content and direction of demineralised treatment had effects on the compression and elastic strength. In vitro test, initial Osteogenic transcription factor’s mRNA expression and quantitative result of releasing material had rewarding regulation by HCl-treatment time and treated direction. Conditionally surface demineralized bone cage had good osteoconduc-tivity and osteoinductivity for spinal interbody fusion.
We report the results of Oxford unicompartmental knee arthroplasty after short term follow up. Twenty nine knees from 26 patients who had undergone Oxford unicompartmental knee arthroplasty from March 2002 to February 2006 were reviewed. There were 1 male(1 knee) and 25 females(28 knees) and average age was 65.9 years. The preoperative diagnosis was 22 cases of medial osteoarthritis and 7 cases of osteonecrosis of medial femoral condyle. The postoperative knee society pain and function score, Lysholm score and HSS(Hospital for Special Surgery) score were improved compared with preoperative scores. The AP tibiofemoral angle was improved from varus 2.8° preoperatively to valgus 6.6°. Three cases of medial tibial condyle fracture were occurred and 1 case of overhang of tibial component was observed. Three cases were revised due to component loosening. Even though high incidence of complication and loosening were observed, the clinical results of Oxford unicompartmental knee arthroplasty were improved in short term follow up. We thought that thorough preparations should be done prior to surgery and there was room for the improvement of femoral component design for the stability against rotational torque such as two pegs on the femoral component.
