Hwan Il Sung

Factors Affecting Clinical Results after Corrective Osteotomy for Lumbar Degenerative Kyphosis

Study Design This study is a prospective, clinical study for lumbar degenerative kyphosis. Purpose To determine the factors affecting postoperative clinical outcomes in patients who undergo corrective osteotomy for lumbar degenerative kyphosis. Overview of Literature Only a small number of studies have reported clinical results for surgery for lumbar degenerative kyphosis. There are almost no studies about prognostic factors that predict postoperative clinical results. Methods This study involved 25 patients who were diagnosed with lumbar degenerative kyphosis and who underwent corrective osteotomy following gait analysis. A pedicle subtraction osteotomy was done at the third lumbar vertebra (L 3). Regarding the fusion level, surgery was done within a range from T10 proximally to S1 distally. Of these, for rigid fixation of a distal part, an iliac screw was used. Pain was evaluated using a 10-point pain scale and a questionnaire about activities. We also evaluated cosmesis and subjective satisfaction using a modified version of the Scoliosis Research Society Outcome-22 (SRS-22) instrument. This assessment was done using a 5-point scale which was designed by us. We assigned patients to group A (good clinical outcomes) if their postoperative pain score was lower than 4 (of 10 points) and if scores indicating activity, cosmesis and subjective satisfaction were higher than 11 (of 15 points). All other patients were assigned to group B (poor clinical outcomes). Results Clinical outcomes were good in 64% of patients (16/25) and poor in 36% (9/25). Regarding cosmesis and subjective satisfaction, there were significant differences between the two groups. There were also significant differences in physical factors of individual patients such as body mass index (BMI): 23.78 ± 2.79 in group A and 26.44 ± 2.75 in group B. On gait analysis, there was a significant difference in the dynamic pelvic tilt: 7.5 ± 3.3° in group A and 11.72 ± 1.89° in group B. Conclusions There is no correlation between preoperative degree of kyphotic deformity and clinical outcomes. The degree of anterior rotation of pelvic tilt does not change significantly; rather, compensatory mechanisms of the pelvis and BMI were found to have more influence. Because neither the degree of satisfaction with clinical outcomes nor the increased activity was relatively higher, a more sincere decision should be made before recommending corrective osteotomy for degenerative lumbar kyphosis.

Effect of Posterior Femoral Clearance on Knee Flexion in Total Knee Arthroplasty

Purpose : To analyze the effect of clearing the protruding posterior femoral condyle from the femoral component (PFC: Posterior femoral clearance) on knee flexion in patients who underwent LCS® rotating platform TKA. Materials and Methods : Twelve patients were male and one hundred seventy-eight patients were female. The patients were divided into the following two groups: Group A (62 patients 84 knees), TKA without PFC; and Group B (128 patients 182 knees), TKA with PFC. The clinical and radiology follow-up were carried out using the HSS score and tibiofemoral angle, and the possibility of squatting was evaluated in each group, respectively. Results : The mean flexion contracture improved 10.8˚ in group A, and 10.3˚ in group B. The mean further flexion improved 13˚ in group A, and 24˚ in group B. The improvement of knee flexion with PFC showed statistical significance. The mean HSS knee scores improved 30.5 points in group A, and 36.3 points in group B. The improvement in the HSS knee score with PFC showed statistical significance. Squatting was possible 50.0% of group A, and 67.4% of group B. Conclusion : PFC is effective in increasing the level of knee flexion and improving the HSS score. PFC can be a good solution for high demand patients, particularly those from Asian countries.