Hyung-Min Ji

Sarcopenia and Osteoporosis.

Public health strategies designed to accomodate the ever-increasing human lifespan are urgently required. A good clinical understanding of frailty, as well as knowledge regarding how to prevent it, will therefore be required in order to overcome this challenge. Sarcopenia is an important component of the frailty syndrome, and its association with osteoporosis can lead to fractures and incident disability. Therefore, this review examined the literatuire pertaining to the association of sarcopenia with osteoporosis in order to assess preventive strategies.

Supine Versus Standing Radiographs for Detecting Ischiofemoral Impingement: A Propensity Score-Matched Analysis.

OBJECTIVE The purpose of this study was to assess parameters of ischiofemoral impingement on supine and standing anteroposterior hip radiographs and to suggest optimal cutoff points for detection of ischiofemoral impingement. MATERIALS AND METHODS A retrospective study included patients with a clinical history of hip pain. All hip joints with evidence of quadratus femoris muscle edema on MR images were included in the ischiofemoral impingement patient group. An age- and sex-matched control group was derived from the same cohort by propensity score matching. On radiographs, two readers independently measured the following parameters: ischiofemoral space, quadratus femoris space, hamstring tendon area, ischiofemoral distance on supine radiograph, ischiofemoral distance on standing radiograph, and femoral neck-shaft angle. Group differences in parameters were assessed by Mann-Whitney U test. The intraclass correlation coefficient and the ROC AUC were obtained. Correlations between radiographic and MRI measures were assessed with Pearson correlation and Bland-Altman plot analyses. The Youden J index was used to select optimum cutoff points for each parameter. RESULTS There were 30 patients (44 hip joints; mean age, 54.8 ± 11 years) in the ischiofemoral impingement group and 88 patients (88 hip joints; mean age, 51.8 ± 13.4 years) in the control group. There were significant group differences in ischiofemoral space, quadratus femoris space, ischiofemoral distance on supine radiograph, ischiofemoral distance on standing radiograph, and neck-shaft angle (p < 0.05). Ischiofemoral distance on supine and standing radiographs exhibited good discriminative ability (AUC > 0.80). The optimal cutoff points for ischiofemoral distances on supine and standing radiographs were 19.9 and 19.1 mm for reader 1 and 21.1 and 17.0 mm for reader 2. Ischiofemoral space, quadratus femoris space, ischiofemoral distance on supine radiograph, and ischiofemoral distance on standing radiograph exhibited nearly perfect interobserver agreement (r > 0.8). CONCLUSION Ischiofemoral distances on supine and standing hip radiographs had good diagnostic performance and can be used as a screening tool, with optimal cutoff points.

Advantage of Minimal Anterior Knee Pain and Long-term Survivorship of Cemented Single Radius Posterior-Stabilized Total Knee Arthroplasty without Patella Resurfacing

Background The single radius total knee prosthesis was introduced with the advantage of reduced patellar symptoms; however, there is no long-term follow-up study of the same. The purpose of this study was to determine the survival rate of single radius posterior-stabilized total knee arthroplasty and patellofemoral complication rates in a consecutive series. Methods Seventy-one patients (103 knees) who underwent arthroplasty without patellar resurfacing using a single radius posterior-stabilized total knee prosthesis were followed up for a minimum 10 years. Clinical evaluation using Knee Society knee and function scores and radiologic evaluation were performed at regular intervals. Anterior knee pain as well as patellofemoral complications were evaluated with a simple questionnaire. The Kaplan-Meier product-limit method was used to estimate survival. Results Seventeen patients (23 knees) were excluded due to death (12 knees) or lost to follow-up (11 knees). Of the 80 knees enrolled, all femoral components and 78 tibial components were well fixed without loosening at final follow-up. Two revisions were performed because of tibial component loosening and periprosthetic joint infection. One patient with tibial component loosening refused to have revision surgery. No obvious tibial insert polyethylene wear was observed. The survivorships at 132 months were 96.7% using revision or pending revision as end points. Anterior knee pain was present in 6 patients (6 knees, 7.5%) at the latest follow-up. No patellofemoral complication requiring revision was encountered. Conclusions The single radius posterior-stabilized total knee prosthesis demonstrated an excellent minimum 10-year survivorship. The low rates of implant loosening and 7.5% of anterior knee pain as a patellofemoral complication are comparable with those reported for other modern total knee prosthesis.

Combination of measures of handgrip strength and red cell distribution width can predict in-hospital complications better than the ASA grade after hip fracture surgery in the elderly

BackgroundEarly detection of a high-risk patient following hip fracture surgery is of paramount clinical importance. American Society of Anesthesiologists (ASA) grading is an easy and efficient index in predicting a worse outcome. The red cell distribution width (RDW) and handgrip strength, are gaining interest as a prediction tool as well. Accordingly, the objective of this study was to investigate the potential association between ASA, RDW and grip strength and detect the effects of combining RDW and grip strength for predicting early complication after hip fracture surgery in the elderly.MethodsEighty-three consecutive patients operated with hip fracture surgeries were identified retrospectively. Age, gender, diagnosis, RDW, handgrip strength and ASA grade were recorded. Admission to the intensive care unit (ICU), length of ICU stay, transfer to other departments, in-hospital death, and readmission were investigated as early complications. Logistic regression analysis was applied to evaluate the estimates in predicting complications, and receiver operating characteristics curves were constructed to compare the estimates and decide which method is more accurate.ResultsAfter the surgery, 52% of the patients were admitted to the ICU. From the analyses, RDW and grip strength had no significant relation with each other. However, the ICU stay was correlated with RDW and grip strength but not for the ASA grade. A higher ASA grade and grip strength could independently predict ICU admission. The combination of RDW with grip strength outweighed the ASA grade in predictive ability.ConclusionsThe current study indicated that combining RDW and grip strength measures can be efficient and clinically relevant in predicting early postoperative complications after fragility hip fracture in the elderly. Due to the objectivity and availability of those two approaches, patient care, and functional outcomes are expected to be improved by adopting these measures in the clinical setting.

Three Dimensional CT-based Virtual Patellar Resection in Female Patients Undergoing Total Knee Replacement: A Comparison between Tendon and Subchondral Method

Background Due to its small size, variable shape, and lack of distinct anatomical landmarks, osteoarthritic knees make a precise patellar resection extremely difficult. Methods We performed virtual patellar resection with digital software using three dimensional computed tomography scans of knees from 49 patients who underwent primary total knee replacement at our hospital. We compared 2 commonly used resection methods, the tendon method (TM) and the subchondral method, to determine an ideal resection plane with respect to the symmetry and thickness of the patellar remnant. Results The TM gave a thicker resected patella, and a less oval cut surface shape, which gives better coverage for a domed prosthesis. Both methods, however, gave a symmetric resection both superior-inferiorly, as well as mediolaterally. Conclusions Although TM appears statistically better with respect to the thickness and cut surface shape, only further intraoperative studies with long-term clinical follow-up may provide us with the most appropriate patellar resection method.

Does femoral offset recover and affect the functional outcome of patients with displaced femoral neck fracture following hemiarthroplasty

BACKGROUND Restoring preoperative horizontal femoral offset (FO) promised good functional outcome in patients receiving total hip arthroplasty. However, relatively little was known regarding the clinical relevance of restoring the offset in patients with bipolar hemiarthroplasty to treat displaced femoral neck fracture. Therefore, the objective of this study was to evaluate postoperative FO accurately and verify its relation with functional outcome. METHODS One hundred elderly patients who received bipolar hemiarthroplasty to treat displaced femoral neck fracture were identified. Preoperative CT scanning of contralateral hip joint and reconstruction of images led to rotation-free FO. By referencing postoperative implant specification and comparing to measured values in Picture Archive and Communication System, rotation-free postoperative FO and the amount of change were acquired. Postoperative Harris Hip Score (HHS) and Modified Barthel Index (MBI) were evaluated to measure functional outcome at 12-month after the surgery. Patients with significant FO change were identified. Multiple regression analysis was conducted to determine if the FO change might independently affect the outcome regardless of confounding factors. RESULTS The mean preoperative offset was 37.4±2.5 increased by 12.7±9.6% after the surgery. Only 25.0% of postoperative offset after hemiarthroplasty was changed within ±5% of preoperative offset. A total of 45.0% of postoperative offset changed within ±10% while 77.0% of postoperative offset changed within ±20%. 23% of patients whose FO changed more than 20% showed significantly worse outcome score than the patients whose FO change remained within ±20% of initial value. Mean MBI and HHS were negatively correlated with FO change. After adjusting for confounding factors, significant correlation remained between modification of FO and MBI, but not between FO change and HHS (B=4.576; β=0.235; 95% confidence interval of B: 0.534 to 8.135). CONCLUSIONS FO was not properly restored in 23% of subjects receiving bipolar hemiarthroplasty due to femoral neck fracture. FO restoration independently predicted fair MBI after the surgery. Therefore, surgeons should pay attention to restoring FO with meticulous templating.