Ji-Hoon Baek

Management of Acute Calcific Tendinitis Around the Hip Joint

Background: Although the natural history of calcific tendinitis within the rotator cuff of the shoulder is established, the natural history of calcific tendinitis around the hip joint remains unknown. Purpose: To examine the duration of symptoms including pain, the location of calcific tendinitis around the hip joint, the radiologic course of calcium phosphate crystals, and the proportion of patients who required surgical treatment. Study Design: Case series; Level of evidence, 4. Methods: Thirty hips (29 patients) with acute calcific tendinitis were treated between January 2010 and December 2012. Level of subjective hip pain using the visual analog scale pain score, radiologic type, and the location and size of calcium deposits were measured during a follow-up period of 12 to 32 months. Results: The 29 patients included 7 men (24%) and 22 women (76%) with a mean age of 51.5 years (range, 28-78 years). All visual analog scale pain scores significantly improved from a mean of 7.1 to 0.8 at the latest follow-up (P < .001). The most common site of calcium deposition was the tendon of the gluteus medius. During follow-up, calcium deposition completely resolved in 5 of 20 hips. Symptoms in 23 patients (24 hips) responded to nonoperative treatment. Two patients (2 hips) were treated with ultrasound-guided local anesthetic and steroid injection. Four patients (4 hips) with long duration (>3 months) of severe pain, solid type, and large size (range, 96-416 mm2) were treated with arthroscopic excision. Conclusion: Nonoperative treatment in patients with acute calcific tendinitis of the hip joint might be successful in most patients. Surgical treatment is of value for patients experiencing prolonged severe pain, solid type, and large size.

Arthroscopic reduction and internal fixation of acetabular fractures

AbstractArthroscopic reduction and screw fixation of acetabular fractures have not been reported. In this case report, arthroscopic treatment for acetabular fracture is reported for two patients. A 49-year-old man diagnosed with acetabular posterior wall fracture was treated by arthroscopic reduction and fixation using two screws. A 20-year-old woman who diagnosed with anterior column fracture was fixed using a screw using the arthroscopic technique prior to open reduction and internal fixation in the iliac bone fracture. Arthroscopic reduction and fixation in some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. Level of evidence V.

Poor prognosis in elderly patients who refused surgery because of economic burden and medical problem after hip fracture.

Although many studies have assessed mortality and morbidity of conservative treatment after hip fracture in elderly patients, the mortality of conservative treatment done because of economic burden is unclear. Among 451 patients diagnosed with displaced hip fracture during 3 yr, 28 patients (Group I) were enrolled as conservative treatment. Fifty-six patients matched in age, gender, ASA score, and diagnosis (Group II) who had undergone surgical treatment were used as the control group. The causal factors of non-operative treatment and mortality rate and functional recovery were evaluated according to the causal factors of patients with surgical procedure. Ten patients (36%) in Group I involved medical problems and 18 (64%) by economic burdens. The cumulative mortality rate over 3, 6, 12, and 24 months was 54%, 61%, 64%, and 82% in Group I and 9%, 11%, 14%, and 21% in Group II, respectively. At the latest follow-up, all five patients in Group I displayed a nonfunctional ambulatory state, whereas only seven of 44 patients in Group II were in a nonfunctional ambulatory state. Non-surgical treatment following hip fracture that is done because of the economic burden is associated with substantially high mortality and serious functional loss.

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.

Knowledge on osteoporosis of prescriber according to level of medical institute.

Purpose There are gaps between the treatment guideline and clinical practice of osteoporosis showing low compliance. Although attitude and knowledge of prescriber have been known to be associated with the low compliance in real clinical practice, no study has assessed the knowledge of prescriber regarding osteoporosis in accordance to the level of medical institution. We compared the knowledge on osteoporosis of general practitioners with that of practitioners in a tertiary referral hospital. Materials and Methods In May 2012, 40 general practitioners and 40 practitioners in a tertiary referral hospital were evaluated using a modified Facts on Osteoporosis Quiz. Results The level of knowledge of general practitioners was similar with that of practitioners in a tertiary referral hospital (p=0.386). And, both groups were lack of knowledge of effect of physical exercise. Conclusion The level of knowledge on osteoporosis was not associated with the level of medical institute, and the effect of physical exercise should be stressed in an educational program on osteoporosis for practitioners.

Radial nerve recovery after thermal injury due to extruded cement during humeral revision in total elbow arthroplasty

Thermal injury to the radial nerve caused by cement leakage is a rare complication after revision elbow arthroplasty. Several reports have described nerve palsy caused by cement leakage after hip arthroplasty. However, little information is available regarding whether radial nerve injury due to cement leakage after humeral stem revision will recover. In a recent study, radial nerve palsy occurred in 2 of 7 patients who had thermal injury from leaked cement during humeral component revisions. These patients did not regain function of the radial nerve after observation. We present a case of functional recovery from a radial nerve palsy caused by cement leakage after immediate nerve decompression in revision elbow arthroplasty[Fig. 1.2].

Is It a Simple Stress Fracture or Bisphosphonate-related Atypical Fracture?

A number of reports regarding atypical fractures of the femur have raised questions concerning the possible correlation between long-term bisphosphonate treatment and the occurrence of insufficiency fractures in the proximal femur. However, clinically, it is often confused whether is it a fatigue fracture because of implant induced stress concentration or a bisphosphonate-related atypical fracture, especially in a patient with a subtrochanteric fracture who receive bisphosphonate therapy after open reduction and internal fixation, such as dynamic hip screw (DHS) fixation for previous ipsilateral femoral neck or intertrochanteric fracture. The authors experienced a case of a progressive femoral insufficiency fracture in a woman who had been on Fosamax (Alendronic acid with Vitamin D; Merck & Co. Inc, NJ, USA) therapy for four years after ipsilateral femoral neck fracture treated with a two hole DHS system. Despite a high suspicion of an insufficiency femoral subtrochanteric fracture by bone scan, the occult fracture progressed to a displaced femoral subtrochanteric fracture one year after. The fracture site was fixed with a 6 hole DHS plate, and six months after reoperation the patient had no symptoms and the fracture site had united without any complication.