Ho Hyun Yun

Calcific Tendinitis of the Rectus Femoris

This article describes calcific tendinitis of the rectus femoris treated with a local injection of a mixture of steroid and local anesthetic under C-arm control. From March 2004 to May 2005, 6 patients were treated for calcific tendinitis of the rectus femoris at our institution and followed for at least 2 years. The male:female ratio was 1:5, and mean patient age was 41 years (range, 33-49 years). Calcifications were located in the direct head in 1 patient and in the reflected head of the rectus femoris in 5. One patient underwent open surgical removal and 5 were treated with a local steroid and anesthetic injection. The patient undergoing surgical removal obtained immediate pain relief but reported discomfort in the wound area for 10 days postoperatively. The 5 patients receiving injections achieved dramatic pain relief within 2 days; follow-up radiographs revealed complete calcification disappearance within 16 weeks of treatment in all 5. No patient had experienced recurrence or complications at >2-year follow-up. Prompt diagnosis and early treatment with a local injection of a mixture of steroid and local anesthetic under C-arm control successfully relieved symptoms and facilitated a return to normality.

The Use of the Posterior Lesser Trochanter Line to Estimate Femoral Neck Version An Analysis of Computed Tomography Measurements

We hypothesized that the lesser trochanter could be a useful guide for estimating femoral component version during total hip arthroplasty. We conducted a study of 88 patients to evaluate the relationship between the posterior lesser trochanter line (PLTL) and the femoral neck axis (FNA) using computed tomographic scans. The mean angle between the PLTL and the FNA was 17.4° ± 7.1° (range, -1.6° to 36.5°). The PLTL angle correlated (r(2) = 0.67-0.72) with the FNA angle. Intraclass correlation coefficient values showed a high level of intraobserver and interobserver agreement in the angles between the PLTL and the FNA. We found a constant relationship between the lesser trochanter and the FNA, and femoral neck version can be estimated, using the PLTL, with reasonable reliability.

A validation study for estimation of femoral anteversion using the posterior lesser trochanter line: an analysis of computed tomography measurement.

The aim of this study was to introduce a simple and reliable intraoperative reference guide to reproduce the normal femoral anteversion during total hip arthroplasty (THA). We hypothesized that the posterior lesser trochanter line (PLTL) could be a useful guide for estimating femoral anteversion during THA. We conducted a study of 56 men (112 hips) to evaluate the relationship between the PLTL and the femoral anteversion using computed tomography scans. The mean femoral anteversion was 9.0° ± 8.1° (range, -16.2° to 32.9°). The PLTL angle correlated (r(2) = 0.12, P < 0.05) with the femoral anteversion. We found a constant relationship between the PLTL and femoral anteversion, and the PLTL may be used as a guide for estimating the femoral stem anteversion during femoral stem fixation.

Reliability of a PowerPoint method for wear measurement after total hip arthroplasty: a retrieval study using 3-dimensional laser scanning.

The purpose of this study was to evaluate the reliability of the PowerPoint (PP) (2007 Version; Microsoft, Redmond, Wash) method for measuring polyethylene liner wear after total hip arthroplasty. Seventeen retrieved polyethylene liners were included in this study. Wear volumes were calculated using the PP, the Dorr and Wan, and 3-dimensional (3D) laser scanning methods. Spearman correlation coefficients for wear volume results indicated strong correlations between the PP and 3D laser scanning methods (range, 0.89-0.93). On the other hand, Spearman correlation analysis revealed only moderate correlations between the Dorr and Wan and 3D laser scanning methods (range, 0.67-0.77). The PP method can be used to monitor linear wear after total hip arthroplasty and could serve as an alternative method when computerized methods are not available.

Characterization of Progression of Pelvic Osteolysis After Cementless Total Hip Arthroplasty: Computed Tomographic Study

A retrospective analysis of 63 primary total hip arthroplasty cases was done using repeated computed tomography scans to evaluate the pelvic osteolytic lesions in early stage. The progression rate of osteolysis of hips with small osteolytic volume less than 766.97 mm(3) in initial CT was 85.82 mm(3)/year, and that of hips with osteolysis more than 766.97 mm(3) was 456.3 mm(3)/year (P < 0.001). Younger patients less than 52 years old with good Harris Hip Scores (more than 80) frequently showed much faster progression in volume of osteolytic lesions. The rate of osteolysis was accelerated when the amount of osteolysis reached a certain threshold volume in active young patients in a cascade manner even in early stage.

Fifteen-year results of precoated femoral stem in primary hybrid total hip arthroplasty.

Background There has been controversy whether methylmethacrylate precoating of the cemented femoral stem is a solution for aseptic loosening or rather contributes to increased failure rates in cemented total hip arthroplasties. Methods On a retrospective basis, we analyzed 76 primary hybrid total hip arthroplasties from 63 patients with precoated, cemented femoral stems between October 1990 and December 1995. The mean age of the patients was 46.8 years (range, 22 to 77 years) with a minimum follow-up of 14 years (mean, 15.5 years; range, 14 to 19.5 years). Third generation cementing techniques were employed in all cases. Results Twenty-four out of 76 cases (31.6%) showed aseptic loosening of the femoral stems, of which 23 stems were revised at an average revision time of 8 years (range, 3 to 14.8 years). The main mode of loosening was cement-stem interface failure in 22 hips (91.7%). Twenty-one out of 24 failed hips (87.5%) demonstrated C2 cementing grades (p < 0.001). Kaplan-Meier survivorship analysis using radiographic aseptic loosening of the femoral stem as the endpoint for failure showed survival rates of 76.5% at 10 years (95% confidence interval [CI], 71.4 to 81.6) and 63.2% at 19 years (95% CI, 57.3 to 69.1). Conclusions An early failure of the precoated femoral stem in this study was mainly due to an insufficient cementing technique. Achievement of good cement mantle may improve the survival rates.

Femoral stem displacement during closed reduction of a dislocated bipolar hemiarthroplasty of the hip

This article describes a case of femoral stem displacement during closed reduction of a redislocated bipolar hemiarthroplasty of the hip in a 72-year-old woman who had undergone bipolar hemiarthroplasty using a polished, tapered cemented femoral stem. The polished, tapered cemented femoral stem is vulnerable to displacement when exposed to traction forces. Six days after bipolar hemiarthroplasty, the patient experienced her first dislocation, and immediate reduction of the dislocated hip was easily achieved. However, on the ninth postoperative day, redislocation occurred, and this time, reduction was not achieved. Subsequent radiographs revealed an unreduced state with posterosuperior dislocation of the hip and dissociation of the femoral stem at the cement-stem interface with proximal migration. Open reduction was then performed, and it was noted that the bipolar prosthesis had dislocated posterosuperiorly, the neck of the femoral stem was incarcerated between the short external rotators, and the femoral stem had migrated proximally by approximately 8 cm. The femoral stem was repositioned by freeing it from the short external rotators and gently tapping it into the cement mantle. Our surgical solution is questionable, because the stability of the stem is likely to be inadequate. According to the established study, no difference in stuffiness was observed before extraction and after reinsertion, which supports the surgical solution we chose. Pre-reduction analysis should be conducted to determine the cause and status of a dislocation, and open reduction should be performed if closed reduction fails when treating dislocated bipolar hemiarthroplasty patients.

Use of Auxiliary Locking Plates for the Treatment of Unstable Pertrochanteric Femur Fractures

Pertrochanteric femur fractures are successfully treated by orthopedic surgeons worldwide, but maintaining the reduction status or fixation of the greater trochanter is sometimes difficult in unstable cases in elderly patients. Several biomechanical advantages have been reported in locking plates when compared with conventional plates; locking plates provide angular and axial stability, better rigidity, and no toggling, and they preserve periosteal blood supply. The authors describe the use of auxiliary locking plates in unstable pertrochanteric femur fractures in elderly patients. Mini locking plates are simple, straightforward, and versatile enough to be used in elderly patients.

Idiopathic retroperitoneal fibrosis mimicking periprosthetic hip infection

Total hip arthroplasty (THA) provides pain relief for those suffering from severe osteoarthritis, inflammatory arthritis, post-traumatic arthritis, developmental dysplasia, osteonecrosis of the femoral head, and end stages of several other hip diseases [1]. Despite the high rates of long-term success, THA is not without failure [1]. Periprosthetic hip joint infection is one of the frustrating complications for the patient. Although there are no ‘‘gold standard’’ diagnostic tools, proper diagnosis is essential for successful treatment [2]. Idiopathic retroperitoneal fibrosis (IRF) is a rare syndrome characterized by the development of fibrosclerotic tissue in the retroperitoneum, which often leads to encasement of the ureters [3]. Ureteral obstruction causing acute or chronic renal insufficiency is the most common and severe complication of IRF [4, 5]. Serum markers of inflammation are usually, but not invariably, elevated [6]. It is known that involvement of the upper urinary tract may produce referred pain to right and left lower abdominal quadrants, testis/labia and even to the groin area, mimicking hip origin pain [7]. In this report, a case of IRF combined with osteolysis of the acetabular component is presented. Referred groin pain from IRF with elevated inflammatory laboratory findings can lead to misdiagnosis of periprosthetic hip joint infection. Revisional THA was performed for osteolysis and steroid therapy was used for IRF.