Hyung Joon Cho

Association Between Comorbid Depression and Osteoarthritis Symptom Severity in Patients with Knee Osteoarthritis

BACKGROUND We sought to investigate the reported association between depression and severity of knee osteoarthritis symptoms stratified by radiographic severity of osteoarthritis and to quantify the contribution made by depression to symptom severity. METHODS Six hundred and sixty elderly Koreans (sixty-five years or older) were evaluated for radiographic severity of knee osteoarthritis on the basis of the Kellgren-Lawrence grading system and also for symptom severity on the basis of the Western Ontario and McMaster Universities Osteoarthritis Index scales. Patient interviews and a questionnaire that made use of a geriatric depression scale were conducted for the purpose of assessing depressive disorders. Regression analyses were performed to assess the relative contributions by radiographic severity and depression severity to Western Ontario and McMaster Universities Osteoarthritis Index scores and to explore any associations between radiographic severity and the presence of a depressive disorder with regard to the risk of symptomatic knee osteoarthritis. Symptomatic knee osteoarthritis was defined as a Western Ontario and McMaster Universities Osteoarthritis Index score of ≥39. RESULTS The presence of a depressive disorder was found to be associated with an increased risk of symptomatic knee osteoarthritis (odds ratio = 5.87 [95% confidence interval, 3.01 to 11.44]). However, the influence of the presence of a depressive disorder was limited to subjects with a radiographic severity of minimal to moderate (Kellgren-Lawrence grade 0 to 3). The presence of a depressive disorder was not associated with the risk of symptomatic knee osteoarthritis in subjects with severe osteoarthritis (Kellgren-Lawrence grade 4). CONCLUSIONS This study indicates that the assessment and management of coexisting depression should be integrated with the assessment and management of knee osteoarthritis, particularly when radiographic changes of osteoarthritis in the knee joint are not severe.

Gender and prevalence of knee osteoarthritis types in elderly Koreans.

We undertook to document sex differences in the prevalence of knee osteoarthritis (OA) at different disease stages in an elderly Korean population. Prevalence of 3 stages of knee OA (radiographic OA, severe radiographic OA, and candidacy for total knee arthroplasty [TKA]) was investigated in 696 elderly (≥65 years old) Korean subjects. Multivariate logistic regression was performed to evaluate associations between the risk factors of OA at these 3 disease stages. The overall prevalence of knee OA was 38.1% for radiographic OA, 26.4% for severe radiographic OA, and 6.5% for advanced OA warranting TKA. Women had much higher prevalence for all 3 stages. Female sex was found to be the strongest predictor for all 3 disease stages, but this was most remarkable for TKA candidates. This study documents that knee OA is highly prevalent among Korean elderly and that elderly Korean women are at much greater risk of requiring TKA.

Execution accuracy of bone resection and implant fixation in computer assisted minimally invasive total knee arthroplasty

While computer assisted total knee arthroplasty (TKA) has been documented to increase the surgical accuracy in the planning process, there is little information about the accuracy in execution processes. We aimed to determine the accuracy of execution processes for bone resections and implant fixation in TKAs performed with the techniques of computer assisted navigation and minimally invasive surgery. Execution deviations, defined as the differences between planned targets and executed results, were evaluated for bone resections and implant fixation in 107 TKAs. In tibia resection, the mean resection thickness, coronal alignment, and sagittal alignment were 0.2mm smaller, 0.3 degrees more valgus, 0.3 degrees less posterior slope than the planned, respectively. In femur resection, the mean resection thicknesses in the medial and lateral femoral condyles, coronal alignment, and sagittal alignment were 0.6mm smaller, 0.8mm smaller, 0.1 degrees more varus, and 0.7 degrees less posterior slope than the planned, respectively. In implant fixation, the mean coronal alignment and degree of extension was 0.7 degrees more valgus and 1.6 degrees decrease than the planned, respectively. Only the occurrence of unacceptable executions in implant fixation had significant effects on the final coronal alignment. The density of a bone and the quality of saw blade had significant effect on the accuracy of bone resections. Execution deviations from planned alignment commonly occur in computer-assisted minimally invasive TKA, resulting typically from the techniques of bone resections and implant fixation, and this information should be considered to improve the surgical accuracy of navigated TKAs.

The reliability and accuracy of measuring anteversion of the acetabular component on plain anteroposterior and lateral radiographs after total hip arthroplasty

There is no single standardised method of measuring the orientation of the acetabular component on plain radiographs after total hip arthroplasty. We assessed the reliability and accuracy of three methods of assessing anteversion of the acetabular component for 551 THAs using the PolyWare software and the methods of Liaw et al, and of Woo and Morrey. All measurements of the three methods had excellent intra- and inter-observer reliability. The values of the PolyWare software, which determines version of the acetabular component by edge detection were regarded as the reference standard. Although the PolyWare software and the method of Liaw et al were similarly precise, the method of Woo and Morrey was significantly less accurate (p < 0.001). The method of Liaw et al seemed to be more accurate than that of Woo and Morrey when compared with the measurements using the PolyWare software. If the qualified lateral radiograph was selected, anteversion measured using the method of Woo and Morrey was considered to be relatively reliable.

Epidemiological characteristics of patellofemoral osteoarthritis in elderly Koreans and its symptomatic contribution in knee osteoarthritis

BACKGROUND Many studies have reported the prevalence of knee osteoarthritis (OA) but have invariably focused on the tibiofemoral (TF) joint and overlooked the patellofemoral (PF) joint. Accordingly, little epidemiological information is available regarding the PF OA. The purpose of the current study was to document the epidemiological characteristics of PF OA in elderly Koreans. METHODS Radiographic assessment was performed for 681 elderly (≥65 years old) Koreans recruited from a community, and symptom severity was evaluated using Western Ontario and McMaster Universities Index (WOMAC) and Short Form-36 (SF-36) scales. Prevalence of different categories of knee OA (isolated PF OA, isolated TF OA and combined PF and TF OA) was calculated. The symptoms of isolated PF OA group and non-OA group were compared. RESULTS The overall prevalence of OA was 22.0% in the PF compartment and 34.1% in the TF compartment. The prevalence of isolated PF OA, isolated TF OA, and combined PF and TF OA was 3.8%, 17.8%, and 19.2%, respectively. Female sex, aging, and obesity were not associated with isolated PF OA. No significant differences were found in any clinical outcome scales between the isolated PF and non-OA groups. CONCLUSION This study documents that OA in the PF joint is common in elderly Koreans, but isolated PF OA is rare. Demographic risk factors are not associated with isolated PF OA, suggesting that isolated PF OA may have a different pathophysiology from other types of knee OA. Our study also indicates that the presence of isolated PF OA should not be construed to be responsible for clinical symptoms.

Longitudinal stress fracture of the patella in a female weightlifter

Stress fractures of the patella are rare injury and occur transversely due to repetitive strenuous forces of the quadriceps muscle and the patellar tendon [1e11]. Longitudinal stress fractures are relatively uncommon, with a limited number of reported cases [12e14]. Non-displaced longitudinal stress fractures of the patella are difficult to identify on the plain radiographs. Moreover, when a fracture line develops on the lateral aspect of the patella, its clinical and radiographic findings are similar to those of bipartite patella, resulting in delayed or incorrect diagnosis. As a result, appropriate opportunities for treatment may be missed, and repetitive external force may cause displacement of the fracture line, which would eventually require surgical management. Here, we report a case of longitudinal stress fracture of the patella that occurred due to repetitive flexion and extension activities of the knee joints, in a 20-year-old female weightlifter. In the early course of this fracture, the possibility of stress fracture was not recognized; hence delayed diagnosis resulted in displacement of the fracture line. Moreover, after displacement, the fracture fragment was even misdiagnosed as a bipartite patella, delaying appropriate treatment. The case highlighted that in the plain radiographic images of professional athletes or heavy workers whose knee joints are subjected to severe stress, the bone fragment localized to the lateral aspect of the patella can be a result not only of a bipartite patella but of a stress fracture of the patella. Written informed consent was obtained from the patient for publishing this case report, including the images.

A rare case of a bisphosphonate-related femoral diaphyseal fracture occurring below a previously fixed compression hip screw (CHS) plate

Bisphosphonates have been widely used for the treatment of osteoporosis and have proven efficacy in reducing the risk of vertebral and hip fracture [1, 2]. Although long-term use of bisphosphonates confirms their safety, questions regarding potential adverse effects due to excessive inhibition of bone remodeling still remain, and there have been recent reports suggesting a strong potential link between prolonged bisphosphonate therapy and atypical fractures of the femur [3–11]. Here, we present a rare case of a 66-year-old woman who sustained an atypical femoral diaphyseal fracture that occurred just below a previously fixed compression hip screw (CHS) plate, which was used for the treatment of an osteoporotic fracture. She used alendronate for more than 10 years to prevent additional osteoporotic fracture. We believe this case is very instructive because it shows another potential problem with the prolonged use of bisphosphonates, which were prescribed to prevent re-fracture after surgical stabilization of the osteoporotic fracture.

An unusual presentation of synovial chondromatosis of the knee in a 10-year-old girl

Synovial chondromatosis commonly occurs in the anterior compartment of the knee joint, predominantly in middle-aged men. It is relatively unusual in female children and is rarely encountered in the synovium beneath the meniscus. The present report describes a rare case of synovial chondromatosis that developed in the synovium just inferior to both menisci of the right knee in a 10-year-old girl. At this unusual age and location, there is a greater probability of missed diagnosis, due to the lack of definite informative incidence, and difficulty in finding the lesions during arthroscopic examinations. In the present case, multiple loose bodies were hidden by the meniscus, and thus, there were no structural abnormalities in the initial arthroscopic views before probing the meniscus. After careful inspection, we found numerous cartilaginous loose bodies and removed them as much as possible with arthroscopy.

Bilateral tenosynovial giant cell tumor of the knee accompanied by chronic ACL tear

Abstract Tenosynovial giant cell tumors, also known as giant cell tumors of the tendon sheath (GCTTS), are a benign soft tissue tumor arising from the synovial tissue of the joint, tendon sheath, or mucosal bursa, or fibrous tissue adjacent to the tendon. Whereas GCTTS can arise in any synovial sheath, they are predominantly found in hand tendon sheaths and rarely in larger joints such as the knee or ankle [1,2]. The rare occurrence in larger joints, combined with a lack of characteristic symptoms, means GCTTS in the knee usually goes unsuspected in clinical diagnosis. Bilateral development of GCTTS is very rare [3]. To our knowledge, this is the first report to describe a case of bilateral intraarticular GCTTS arising from the anterior cruciate ligament (ACL) in both knee joints. The lesions were encountered during reconstruction of the ruptured ACLs.

An Uncommon Case of Bilateral Pathologic Hip Fractures: Antiviral Drug-induced Osteomalacia in a Patient with Hepatitis B

The long-term use of adefovir and tenofovir–antiviral medications commonly used to treat chronic hepatitis B–can be associated with proximal renal tubular dysfunction resulting in significant hypophosphatemic osteomalacia. However, there have been few reports about pathological fractures requiring surgical stabilization in cases of antiviral drug-induced hypophosphatemic osteomalacia. We present the case of a 51-year-old man who sustained bilateral pathological hip fractures associated with antiviral drug-induced hypophosphatemic osteomalacia. To treat a lamivudine-resistant hepatitis-B viral infection, the patient received adefovir for 7 years followed by tenofovir for the subsequent 3 years. He had suffered from polyarthralgia and generalized weakness for 2 years prior to presentation at our clinic. Misdiagnosis and inadequate management of his condition accelerated weakness of the bone matrix and ultimately induced pathological fractures. The patient was managed via cementless total hip arthroplasty on the left hip and internal fixation on the right hip. This case highlights that orthopaedic surgeons should consider the possibility of hypophosphatemic osteomalacia if patients receiving antiviral drugs complain of polyarthralgia and generalized weakness.