Soon-Taek Jeong

Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression

We performed a randomised trial on 37 hips (33 patients) with early-stage osteonecrosis (ON). After the initial clinical evaluation, including plain radiography and MRI, 18 hips were randomly assigned to a core-decompression group and 19 to a conservatively-treated group. All the patients were regularly followed up by clinical evaluation, plain radiography and MRI at intervals of three months. Hip pain was relieved in nine out of ten initially symptomatic hips in the core-decompression group but persisted in three out of four initially painful hips in the conservatively-treated group at the second assessment (p < 0.05). At a minimum follow-up of 24 months, 14 of the 18 core-decompressed hips (78%) and 15 of the 19 non-operated hips (79%) developed collapse of the femoral head. By survival analysis, there was no significant difference in the time to collapse between the two groups (log-rank test p = 0.79). Core decompression may be effective tin symptomatic relief, but is of no greater value than conservative management in preventing collapse in early osteonecrosis of the femoral head.

Tibial bone defects treated by internal bone transport using the Ilizarov method.

Abstract.We reviewed 27 cases of tibial bone defects treated by internal bone transport using the Ilizarov method. The causes of the bone defects were open fractures in 14 segments and infected non-unions in 13. The average length of the defects was 8.3 cm (range, 3–20 cm). There were 21 one-level tibial transports, 3 two-level tibial transports, 1 one-level tibial transport with fibular transport, and 2 fibular transports. At the docking site, 25 segments underwent bone grafting. Eleven of the 25 were Papineau-type open cancellous bone grafts. Acute shortening or docking was performed in 10 segments. Bone union was obtained in every instance. The average time of external fixation was 8 months and the average time to union was 7.1 months. Bone grafting at the docking site is recommended in order to shorten the duration of treatment and to prevent refracture and non-union.Résumé.Nous avons passé en revue 27 cas de perte de substance du tibia traités par «transport osseux interne» conformément à la méthode Ilizarov. Ces anormalies provenaient de fractures ouvertes dans 13. La longeur moyenne des defect osseux était de 8,3 cm (entre 3 et 20 cm). On a effectué 21 «transports tibiaux» de niveau 1, 3 «transports tibiaux» de niveau 2, 1 «transport tibial» avec «transport du péroné», ainsi que 2 «transport du péroné». Dans 25 cas une greffe osseuse a été pratiquée sur le site de réduction. 11 cas des 25 greffes pratiquées étaitent du type Papinau. D’importances réduction ont dûétre effectuées dans 10 cas. Des fusions ont été obtenues dans tous les cas. Le temps moyen de fixation externe était de 8 mois et celui de fusion de 7,1 mois. La greffe osseuse est recommandée sur le site de réduction afin de raccourcir la durée du traitement et de prévenir toute récidive de fracture ou de non-consolidation.

Borderline necrosis of the femoral head.

To determine whether the histologic lesions classified by the system of Arlet et al as Type 2 (granular necrosis of fatty marrow) and Type 3 (complete medullary and trabecular necrosis) always progress to Type 4 (complete necrosis with marginal medullary fibrosis and appositional new bone formation), 10 femoral heads (nine patients) were monitored for 4 years using serial magnetic resonance images. These femoral heads had been diagnosed histologically as having either Type 2 (seven hips) or Type 3 (three hips) necrosis on initial core biopsies. On the initial magnetic resonance image, none of the femoral heads showed any focal lesions indicative of osteonecrosis. In all instances, superselective angiography showed interruption of the superior retinacular artery, and the bone marrow pressure was elevated. During a followup period of 48 to 54 months, no patient had a reactive low signal intensity band develop on T1 weightings, as evidence of a reparative process around the necrotic portion of the lesion, or any other findings of osteonecrosis on magnetic resonance images. These findings suggest that some Type 2 and 3 lesions of Arlet et al may not develop an obvious reactive interface of reparative revascularization and thus may not progress to definite and classic Type 4 osteonecrosis. This study supports the hypothesis that there is an ischemic threshold between reversible intraosseous hypoxia (bone marrow edema syndrome) and irreversible intraosseous anoxia (classic bone infarction or osteonecrosis) and suggests that borderline necrosis occurs in the transition zone of this ischemic threshold and is nonprogressive.

Revision Total Knee Arthroplasty with a Cemented Posterior Stabilized, Condylar Constrained or Fully Constrained Prosthesis: A Minimum 2-year Follow-up Analysis

Background The clinical and radiological outcomes of revision total knee arthroplasty with a cemented posterior stabilized (PS), condylar constrained knee (CCK) or a fully constrained rotating hinge knee (RHK) prosthesis were evaluated. Methods This study reviewed the clinical and radiological results of 36 revision total knee arthroplasties with a cemented PS, CCK, and RHK prosthesis in 8, 25, and 13 cases, respectively, performed between 1998 and 2006. The mean follow-up period was 30 months (range, 24 to 100 months). The reason for the revision was aseptic loosening of one or both components in 15, an infected total knee in 18 and a periprosthetic fracture in 3 knees. The average age of the patients at the time of the revision was 65 years (range, 58 to 83 years). The original diagnosis for all primary total knee arthroplasties was osteoarthritis except for one case of a Charcot joint. All revision prostheses were fixed with cement. The bone deficiencies were grafted with a cancellous allograft in the contained defect and cortical allograft fixed with a plate and screws in the noncontained defect. A medial gastrocnemius flap was needed to cover the wound dehiscence in 6 of the 18 infected cases. Results The mean Knee Society knee score improved from 28 (range, 5 to 43) to 83 (range, 55 to 94), (p < 0.001) and the mean Knee Society function score improved from 42 (range, 10 to 66) to 82 (range, 60 to 95), (p < 0.001) at the final follow-up. Good or excellent outcomes were obtained in 82% of knees. There were 5 complications (an extensor mechanism rupture in 3 and recurrence of infection in 2 cases). Three cases of an extensor mechanism defect (two ruptures of ligamentum patellae and one patellectomy) were managed by the RHK prosthesis to provide locking stability in the heel strike and push off phases, and two cases of recurrent infection used an antibiotic impregnated cement spacer. The radiological tibiofemoral alignment improved from 1.7° varus to 3.0° valgus in average. Radiolucent lines were observed in 18% of the knees without progressive osteolysis. Conclusions Revision total knee requires a more constrained prosthesis than primary total knee arthroplasty because of the ligamentous instability and bony defect. This short to midterm follow-up analysis demonstrated that a well planned and precisely executed revision can reduce pain and improve the knee function significantly. Infected cases showed as good a result as those with aseptic loosening through the use of antibiotics-impregnated cement beads and proper soft tissue coverage with a medial gastrocnemius flap.

Antiapoptotic effects of anthocyanins on rotator cuff tenofibroblasts.

Degeneration of the rotator cuff tendon, which involves apoptosis of the tenofibroblasts, is one of the most common shoulder problems that can lead eventually to a full‐thickness rotator cuff tendon tear. The current authors evaluated both the ability of anthocyanins, which are powerful antioxidants, to reduce apoptosis in oxidation‐stressed rotator cuff tenofibroblasts, and the molecular mechanism for this antiapoptotic action. Anthocyanins demonstrated a dose‐dependent ability to inhibit H2O2‐induced apoptosis in cultured tenofibroblasts, as assessed by MTT assay and FACS analysis. H2O2 increased the phosphorylation of extracellular regulated kinase1/2 (ERK1/2) and of c‐Jun N‐terminal kinase (JNK) and the production of reactive oxygen species (ROS). In contrast, treatment with anthocyanins decreased this activation of ERK1/2 and JNK, as confirmed by Western blot analysis, and reduced the production of ROS, as verified by fluorescent microscopic and FACS analyses. These findings suggest that anthocyanins, by suppressing JNK, ERK1/2, and intracellular ROS production, have a concentration‐dependent antiapoptotic effect on rotator cuff tenofibroblasts exposed to an oxidative stressor, and may have therapeutic potential.

Iliacus hematoma and femoral nerve palsy after revision hip arthroplasty: a case report.

Femoral nerve palsy occurred in a 65-year-old man after he had undergone a revision total hip arthroplasty using cementless components. The magnetic resonance imaging scan showed a mass in the iliacus muscle. The mass showed increased signal intensity on T1-weighted and T2-weighted spin-echo images and contained linear septa and a nodule. The gadolinium-enhanced T1-weighted image showed a rim of significant enhancement in the nodule. The findings of magnetic resonance images were suggestive of iliacus hematoma and of liposarcoma. The patient underwent surgery, and the mass was identified as an iliacus hematoma. The femoral nerve was stretched by the hematoma. After removal of the hematoma, the nerve palsy was improved completely. Iliacus hematoma may occur after total hip arthroplasty, even without anticoagulant therapy. The hematoma might appear to be a liposarcoma on magnetic resonance imaging scans.

Posterior Lumbar Interbody Fusion Using a Unilateral Single Cage and a Local Morselized Bone Graft in the Degenerative Lumbar Spine

Background We retrospectively evaluated the clinical and radiological outcomes of posterior lumbar interbody fusion (PLIF) with using a unilateral single cage and a local morselized bone graft. Methods Fifty three patients who underwent PLIF with a unilateral single cage filled with local morselized bone graft were enrolled in this study. The average follow-up duration was 31.1 months. The clinical outcomes were evaluated with using the visual analogue scale (VAS) at the pre-operative period, at 1 year post-operation and at the last follow-up, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria at the last follow-up; the radiological outcomes were evaluated according to the change of bone bridging, the radiolucency, the instablity and the disc height. Results For the clinical evaluation, the VAS pain index, the Oswestry Disability Index, the Prolo scale and the Kim & Kim criteria showed excellent outcomes. For the the radiological evaluation, 52 cases showed complete bone union at the last follow-up. Regarding the complications, only 1 patient had cage breakage during follow-up. Conclusions PLIF using a unilateral single cage filled with a local morselized bone graft has the advantages of a shorter operation time, less blood loss and a shorter hospital stay, as compared with the PLIF using bilateral cages, for treating degenerative lumbar spine disease. This technique also provides excellent outcomes according to the clinical and radiological evaluation.

Restoration of the Center of Rotation in Revision Total Hip Arthroplasty

We measured the change of the center of hip rotation after the revision of acetabular loosening using an acetabular reconstruction ring and an impaction allogenic bone grafting. Thirty-five revision total hip arthroplasties were performed. The average follow-up was 3.8 years. Horizontal distance was changed from 34.01±10 mm preoperatively to 41.07±6 mm at the latest follow-up. Vertical distance was changed from 32.06±9 mm preoperatively to 20.21±7 mm at the latest follow-up. The Harris hip score was improved from an average of 47 in the preoperative period to 86 at the final follow-up. The restoration of the anatomical hip center has shown to be favorable in terms of functional and radiologic evaluation in total hip revision.

Use of Intramedullary Nonvascularized Fibular Graft with External Fixation for Revisional Charcot Ankle Fusion: A Case Report

We describe a case of Charcot ankle arthropathy in a 43-year-old male patient who underwent revision surgery for tibiotalocalcaneal arthrodesis with a retrograde intramedullary nonvascularized fibular graft. After 3 months of postoperative stabilization with a ring external fixator, successful radiographic union was identified. The findings obtained at 33 months postoperatively showed maintenance of solid fusion and restoration of hindfoot alignment without any complications.

The value of diagnostic ultrasonography in the assessment of a glomus tumor of the subcutaneous layer of the forearm mimicking a hemangioma: a case report

IntroductionA glomus tumor is a rare, benign tumor with atypical clinical symptoms. Because of its small size, it is difficult to diagnose and treat early; therefore, it leads to poor quality of life. Glomus tumors are known to commonly affect the hand and rarely manifest in other areas. Because they simulate neuromas, hemangiomas, and neurofibromatosis, the differential diagnosis is difficult. We performed marginal resection of a solitary forearm mass previously suspected to be a hemangioma or glomus tumor on the basis of ultrasound findings and histologically diagnosed to be a glomus tumor afterward. We report this case to demonstrate the good prognosis of the procedure we used, and we review the relevant literature.Case presentationA 68-year-old Asian man without a particular medical history visited our hospital with a mass with focal tenderness in his left distal forearm that had developed 8 years earlier. The tumor was observed with suspicion of being a hemangioma or glomus tumor based on the location, clinical symptoms, and ultrasound findings taken into consideration together. The biopsy results led us to conclude that the lesion was a glomus tumor.ConclusionsA glomus tumor located in the forearm is very rare. It is often clinically overlooked and is likely to be misdiagnosed as another disease. The patient’s quality of life deteriorates, and, though the disease is rare, it has serious sequelae. Therefore, a quick diagnosis and appropriate treatment must be conducted early. If a mass occurs with serious pain in subcutaneous soft tissue of not the hands but the limbs, it is important to conduct examinations with suspicion of a glomus tumor. Ultrasonography performed quickly may be useful for making the differential diagnosis.