Kyung Jae Lee

Two-stage revision using a modified articulating spacer in infected total knee arthroplasty.

Purpose To evaluate clinical results of two-stage revision using a modified articulating spacer for treatment of infected total knee arthroplasty (TKA). Materials and Methods We retrospectively reviewed 20 cases treated by two-stage revision arthroplasty using a modified articulating spacer under the diagnosis of infected TKA from January 2006 to December 2011. The mean follow-up period was 22.3 months. The first operation consisted of debridement after removal of the prosthesis, reinsertion of the femoral component after autoclaving, and implantation of antibiotic-loaded cement with a new polyethylene in the proximal tibia. Results The mean period between the primary TKA and the first stage operation was 39 months and between the first stage operation and the revision arthroplasty was 3.3 months. The average range of motion (ROM) increased from 69.8° preoperatively to 102.8° postoperatively (p<0.001). The mean Knee Society knee score increased from 33.8 points to 85.3 points (p<0.001). The mean Knee Society function score increased from 35 points to 87.5 points (p<0.001). The mean Hospital for Special Surgery score increased from 57.6 points preoperatively to 82.6 points postoperatively (p<0.001). Two cases (10%) were re-infected after the revision arthroplasty. Conclusions Two-stage revision arthroplasty using an articulating cement spacer can be an effective therapy not only for the treatment of an infected TKA but also for recovery of knee ROM and function.

Indirect reduction of the radial head in children with chronic Monteggia lesions.

Objective: The purpose of this study was to report the long-term follow-up results of chronic Monteggia fractures treated with angulation–translation osteotomy of ulna and closed reduction of the radial head. Design: Retrospective. Setting: Level 1 trauma center. Patients: We retrospectively reviewed 10 missed Monteggia fractures in children. The mean age of the patients was 7.5 years (range, 6–10 years), and there were 2 girls and 8 boys. The mean duration of time between initial injury and initial presentation was 1.7 years (range, 6 weeks to 5 years). Intervention: Closed reduction with ulna osteotomy or lengthening was performed in all 10 cases. Annular ligament reconstruction (ALR) was done in 2 cases. Final follow-up ranged from 3 to 20 years (mean 10 years). Main Outcome Measurement: We assessed preoperative and postoperative radiographs to evaluate the quality of the radial head reduction. Clinical results were assessed according to the functional elbow score devised by Kim et al. Results: Radial head reduction was achieved and maintained in 8 of 10 cases after primary or secondary surgery. The radial head was mildly subluxated in one case and dislocated in another case at final follow-up. ALR was performed in only 2 cases. Open reduction and ALR is not required in every case, and its need should depend on intraoperative stability of radial head. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Surgical outcome of intramedullary nailing in patients with complete atypical femoral fracture: A multicenter retrospective study

BACKGROUND Management of atypical femoral fracture on bisphosphonate therapy still remains controversy and is reported high rate of complications. The aim of this study was to evaluate the outcome of intramedullary nailing in patients with atypical femoral fracture who took bisphosphonate more than one year through the multicenter retrospective study. METHODS We gathered 75 atypical femoral fractures from seven institutions between 2009 and 2014. Among them 46 atypical femoral fractures which met the inclusion criteria was evaluated in this study. The average age was 70.1 years (53-80) and the average duration of bisphosphonate use was 5.1 years (1-15 years). Medical records and radiographs were reviewed to determine time to union, union rate, need for revision surgery, restoration of ambulatory function, and complications. RESULTS Twenty-nine (63%) fractures healed within 6 months without complications. The average time to union except two non-union was 24.9 weeks (11-48 weeks). Two patients (4.3%) underwent revision surgery for non-union and there was no implant failure. Thirty-seven (80.4%) patients achieved their pre-fracture ambulatory function at the final follow up. CONCLUSIONS Although the incidence of delayed bone healing is high in atypical femoral fracture on bisphosphonate therapy even treated with intramedullary nailing, the incidence of revision surgery and implant failure was relatively lower than those of extramedullary devices.

Perioperative Pain Management in Total Hip Arthroplasty: Korean Hip Society Guidelines

Effective perioperative pain management techniques and accelerated rehabilitation programs can improve health-related quality of life and functional status of patients after total hip arthroplasty. Traditionally, postoperative analgesia following arthroplasty was provided by intravenous patient-controlled analgesia or epidural analgesia. Recently, peripheral nerve blockade has emerged alternative analgesic approach. Multimodal analgesia strategy combines analgesics with different mechanisms of action to improve pain management. Intraoperative periarticular injection of multimodal drugs is one of the most important procedures in perioperative pain control for total hip arthroplasty. The goal of this review article is to provide a concise overview of the principles of multimodal pain management regimens as a practical guide for the perioperative pain management for total hip arthroplasty.

Osteochondroma of the bicipital tuberosity causing an avulsion of the distal biceps tendon.

Osteochondromas are one of the most common benign bone tumors. They usually arise from the metaphyses of long bones. Involvement of the bicipital tuberosity is rare. To date, no reports have described avulsed rupture of the distal biceps tendon caused by an osteochondroma of the bicipital tuberosity. This article presents a case of avulsion of the distal biceps tendon secondary to sessile osteochondroma of the bicipital tuberosity in a 65-year-old right-handed sedentary worker who presented with insidious pain and limited motion in his left elbow for 2 months. Intraoperative findings showed a bony mass of 25×23×5 mm with osteocartilaginous nodules on the bicipital tuberosity. The distal biceps tendon with an avulsed bony fragment was displaced proximally, with a 20-mm gap between the tendon and the bicipital tuberosity. After complete excision of the mass, footprint preparation at the bicipital tuberosity was performed using a 4.0-mm burr and anatomic reattachment of the distal biceps tendon with a 5.0-mm suture anchor. The pathologic diagnosis of osteochondroma was confirmed microscopically. We suggest that osteochondroma of the bicipital tuberosity be considered as a cause of painful limitation of forearm rotation or avulsed rupture of the distal biceps tendon.

Bilateral Medial Tibial Plateau Fracture after Arthroscopic Anterior Cruciate Ligament Reconstruction.

Tibial plateau fractures after arthroscopic anterior cruciate ligament (ACL) reconstruction are rare, and only isolated cases have been reported. The authors describe a case of bilateral medial tibial plateau fracture following a minor motorcycle accident in a patient who underwent arthroscopic ACL reconstruction in the past. Two years and four months before the accident, the patient underwent an arthroscopically assisted ACL reconstruction using double-bundle technique on his left knee at a hospital. He had the same surgery using single-bundle technique on his right knee about eight months ago at another hospital. The fractures in his both involved knees occurred through the tibial tunnel and required open reduction with internal fixation. At three weeks after fixation, a second-look arthroscopy revealed intact ACLs in both knees. At five months follow-up, he was able to walk without instability on physical examination. Follow-up radiographs of the patient showed callus formations with healed fractures.

Results of Total Knee Arthroplasty with NexGen LPS-flex Implant Using Navigation System (Brain Lab): Results with a 5-year Follow-up

Purpose To evaluate the clinical and radiological results of patients that underwent total knee arthroplasty (TKA) with a NexGen LPS-Flex implant using a Navigation system (Brain Lab). Materials and Methods Between January 2001 and December 2005, 55 knees in 46 patients which used the NexGen LPS-Flex implant with a Navigation system (Brain Lab) for primary TKA were clinically and radiologically evaluated after a minimum follow-up of 5 years. Evaluation included preoperative and postoperative range of motion (ROM), Knee Society Score (KSS), tibio-femoral angle and postoperative complications. Results Knee ROM was increased from 118.9° preoperatively to 126.9° at the last follow up. In addition, the preoperative flexion contracture improved from 6.5° to 1.8° postoperatively. The mean KSS and functional score were improved from 59.8 and 51.2 to postoperative scores of 86.4 and 85.2 respectively. The rate of appearance of radiolucency in X-ray was 21.8%. One case of superficial skin infection and one case of aseptic loosening were noted as complications but, did not require a revision surgery. Conclusions TKA with NexGen LPS-Flex implant using Navigation system (Brain Lab) showed satisfactory improvement in pain and function, but more long term follow up will be needed to complete verification.

A Simple Way to Improve Visualization and Increase Working Space in Arthroscopy: The Pull-String Technique

A new pull-string technique uses polydioxanone to improve visualization and maintain adequate working space in arthroscopic procedures.

A Comparison between Methicillin Resistant Organism and Non-Methicillin Resistant Organism in 2-Stage Reimplantation ofPeriprosthetic Hip Infection

Background: The prevalence of resistant organisms has increased in periprosthetic hip infection. The purpose of this study is to evaluate the effectiveness of staged reimplantation for the treatment of periprosthetic hip infection caused by methicillin resistant microorganisms. Methods: We performed a retrospective case-control study on 25 consecutive patient (15 men, 10 women) who had periprosthetic hip infection treated using a 2-stage reimplantation. Results: 13 patients infected by methicillin resistant microorganisms were compared with 12 patients infected by non-methicillin resistant microorganisms. The 2-stage reimplantation was possible in all patients. At a mean follow-up of 4.8 years, no significant differences were found between 2 groups with age, sex, body mass index, diabetes, primary diagnosis and kind of primary hip arthroplasty. But methicillin resistant group had much longer period with intravenous antibiotics and oral antibiotics. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) was much higher in methicillin resistant group after 2-stage reimpantation. Harris Hip Score was lower in methicillin resistant group after 2-stage reimplantation. There were 3 recurrent infections after 2-stage reimplantation in methicillin resistant group. But there was no recurrent infection in non-methicillin resistant group. Conclusion: Periprosthetic hip infection caused by methicillin resistant bacterial strain need cautious care of operation and infection control.

Tips and Tricks: Fracture of a Ceramic Insert with modern Ceramic Total Hip Replacement

Results obtained with ceramic bearings in total hip arthroplasty have been disappointing because of increased component loosening rates primarily caused by design issues and use of low-quality ceramic, resulting in fracture and debris generation. Although new-generation ceramics have produced a reduced incidence of fracture, concerns still persist about the fracture of ceramic liners. After investigating the underlying cause of fracture in contemporary ceramic-on-ceramic bearings, we sought to determine the incidence of ceramic liner fracture and to formulate technical guidelines for avoiding catastrophic failure. Between January 2000 and January 2005, we prospectively studied a consecutive series of 147 patients (179 hips) who had undergone primary cementless total hip arthroplasty with modern ceramic-on-ceramic articulation so that we could detect ceramic liner fracture. The mean length of the follow-up period was 3.1 years (range, 2–6.5 years). By the latest follow-up examination, delayed ceramic liner fracture had occurred in 3 hips (1.7%). One liner was chipped during insertion because of eccentric seating of the liner. Head fracture occurred in 2 hips (1.1%). Despite the improved wear characteristics of modern ceramic-on-ceramic articulations, a catastrophic failure with ceramic liner failure was still observed during short-term follow-up monitoring. This finding prompted us to define important technical aspects to be considered to minimize ceramic liner fractures.