Kee-Hyung Rhyu

Radioisotope synoviorthesis with Holmium-166-chitosan complex in haemophilic arthropathy

Summary.  Radiosynoviorthesis is a safe and easy method for synovectomy in haemophilic arthropathy. Various agents have been used in radiosynoviorthesis, especially newly developed agent Holmium‐166‐chitosan complex has good clinical outcome. This study analysed clinical results and radiologic evaluation of radioisotope synoviorthesis using Holmium‐166‐chitosan complex in haemophilic arthropathy. From March 2001 to December 2003, 58 radiosynoviorthesis were performed in 53 haemophiliacs. The average age at procedure was 13.8 years. The Arnold and Hilgartner stage of the patients was from I to IV. Holmium‐166‐chitosan complex was injected in 31 ankle joints, 19 elbow joints and 8 knee joints. Average follow‐up was 33 months since primary procedure. The range of motion of each joint, frequency of intra‐articular bleeding and factor dose used were analysed for clinical assessment. There was no significant improvement of range of motion in affected joints. After procedure, the average frequency of bleeding of the elbow joint has decreased from 3.76 to 0.47 times per month, the knee joint from 5.87 to 1.12 times per month, and the ankle joint from 3.62 to 0.73 times per month respectively (P < 0.05). After treatment, the average coagulation factor dose injected was significantly decreased to 779.3 units per month from 2814.8 units per month before treatment (P < 0.001). Radioisotope synoviorthesis with Holmium‐166‐chitosan complex in haemophilic arthropathy is a very safe and simple procedure with the expectation of a satisfactory outcome without serious complication. It has excellent bleeding control effect on target joint and the need for substitution of coagulation factor concentrate can be reduced.

Cementless total hip arthroplasty for haemophilic arthropathy: follow-up result of more than 10 years

The improvement of prophylaxis and adequate replacement of clotting factors, the quality of life and natural history of haemophilia have been significantly improved. However, significant functional impairment is inevitable. This study was performed to evaluate over 10 years clinical and radiographic outcomes of cementless total hip arthroplasty (THA) for treatment of haemophilic hip arthropathy. Between 1995 and 2003, 27cases of cementless total hip arthroplasties were performed in 23 haemophilic patients. A total of 21 cases from 17 patients were available for follow‐up analysis over 10 years. Modified Harris hip score, the range of motion of the hip joint, perioperative coagulation factor requirements and complications associated with bleeding were evaluated as part of the clinical assessment. For the radiographic assessment, fixation of component, osteolysis, loosening and other complications were evaluated. Clinically, the mean Harris hip score improved from 57 points before the operation to 94 points at the last follow‐up. The mean flexion contracture was 10° preoperatively and 0.9° at the final follow‐up. The further flexion improved from 68.4° to 90.5° after surgery. The mean monthly requirement of factor VIII reduced from 3150 units before surgery to 1800 units at the time of the last follow‐up. There were three cases of rebleeding. In one case, a progressive haemophilic pseudotumour was found. Reoperation for any reason including revision was performed in three cases. We believe that cementless THA in patient with haemophilic hip arthropathy can bring reliable pain relief and functional improvement for longer than 10 years.

Robot-assisted total knee arthroplasty in haemophilic arthropathy

Execution of total knee arthroplasty (TKA) in end‐stage haemophilic arthropathy is challenging because of soft tissue fibrosis, flexion contractures, poor quality of the bone, and the altered bony anatomy. Restoring the lower limb alignment and achieving range of motion (ROM) is difficult. Robots have been used in TKA to reduce the chances of malalignment and improve accuracy and precision. However, there has been no report in literature on use of robots for TKA in haemophilic arthropathy. The aim of this study was to evaluate whether robot‐assisted TKA can be successfully carried out in haemophilic arthropathy and what precision could be obtained.

Clinical and radiologic results after open-wedge high tibial osteotomy in haemophilic knee arthropathy with varus deformity

The previous studies have described only closed‐wedge high tibial osteotomy (HTO) in haemophilic arthropathy (HA).

Transtrochanteric rotational osteotomy for hip arthritis in a young woman

Hip arthritis in a young adult is a common cause of disability. Two broad categories of surgical treatment are available: total hip arthroplasty (THA) and jointpreserving procedures. Whereas THA is extremely effective for middle-aged or elderly persons, unrestricted activity in a young adult may lead to the overloading of artifi cial joints; and 6%–39% revision rates in the long term have been reported. As an alternative to THA, various joint-preserving procedures are considered in young patients. Although transtrochanteric rotational osteotomy (TRO) is indicated for the treatment of osteonecrosis of the femoral head (ONFH), its use was also described in the literature for other indications, such as osteoarthritis. To the best of our knowledge, no case has been reported in the literature after the fi rst description of TRO being used to arrest or reverse degeneration in a patient with hip arthritis. The present case is offered here to highlight the therapeutic dilemma that was faced when offering treatment to a young woman with hip arthritis. We also report the result of TRO in advanced hip arthritis after a 6-year follow-up.