Suk Ku Han

Treatment of Femoral Neck Fractures With Bipolar Hemiarthroplasty Using a Modified Minimally Invasive Posterior Approach in Patients With Neurological Disorders

Bipolar hemiarthroplasty is a useful treatment for displaced femoral neck fractures in elderly patients. Although uncommon, dislocation is problematic, particularly in older patients, and those with neurologic disorders are at an increased risk for this complication. Recently, a modified posterior approach to the hip intended to enhance hip joint stability by preserving the short external rotators was described. Therefore, the dislocation rate was compared after bipolar hemiarthroplasty using the modified or standard minimally invasive posterior approach.A retrospective analysis was performed of 67 patients older than 65 years with displaced femoral neck fractures and neurological disorders who underwent bipolar hemiarthroplasty using the modified and standard approaches in 28 and 39 hips, respectively. Follow-up averaged 19.3 months. Dislocation rates for the treatment and control groups were 0% and 7.7%, respectively (P<.01). No significant difference existed in postoperative bleeding, operative time, or length of hospital stay between groups. These data suggest a lower dislocation rate after bipolar hemiarthroplasty via the modified, short external rotator-sparing approach for treating displaced femoral neck fractures in elderly patients with neurological disorders.

Surgical Treatment of Piriformis Syndrome

Background Piriformis syndrome (PS) is an uncommon disease characterized by symptoms resulting from compression/irritation of the sciatic nerve by the piriformis muscle. Uncertainty and controversy remain regarding the proper diagnosis and most effective form of treatment for PS. This study analyzes the diagnostic methods and efficacy of conservative and surgical treatments for PS. Methods From March 2006 to February 2013, we retrospectively reviewed 239 patients who were diagnosed with PS and screened them for eligibility according to our inclusion/exclusion criteria. All patients underwent various conservative treatments initially including activity modification, medications, physical therapy, local steroid injections into the piriformis muscle, and extracorporeal shock wave therapy for at least 3 months. We resected the piriformis muscle with/without neurolysis of the sciatic nerve in 12 patients who had intractable sciatica despite conservative treatment at least for 3 months. The average age of the patients (4 males and 8 females) was 61 years (range, 45 to 71 years). The average duration of symptoms before surgery was 22.1 months (range, 4 to 72 months), and the mean follow-up period was 22.7 months (range, 12 to 43 months). We evaluated the degree of pain and recorded the responses using a visual analog scale (VAS) preoperatively and 3 days and 12 months postoperatively. Results Buttock pain was more improved than sciatica with various conservative treatments. Compared with preoperatively, the VAS score was significantly decreased after the operation. Overall, satisfactory results were obtained in 10 patients (83%) after surgery. Conclusions PS is thought to be an exclusively clinical diagnosis, and if the diagnosis is performed correctly, surgery can be a good treatment option in patients with refractory sciatica despite appropriate conservative treatments.

Treatment of subtrochanteric nonunion of the femur: whether to leave or to exchange the previous hardware.

OBJECTIVE Our aim was to compare the clinical results of two different methods for treatment of subtrochanteric nonunion: an additional fixation to the previous hardware, and exchange of previous hardware. METHODS We retrospectively analyzed 19 cases of subtrochanteric nonunion, and compared clinical results from 10 cases (Group 1) with exchange of the previous hardware, and 9 cases (Group 2) with retained previous hardware and an additional fixation. Autogenous bone grafting were performed for all cases. The mean age of the patients was 49.1 years in Group 1, and 48.2 years in Group 2. The mean follow-up period was 19.3 months. RESULTS The union rate was 100% in Group 1, and 77.8% in Group 2 (p<0.05). The average time of union was 7.6 months in Group 1, and 6.9 months in Group 2. The mean preoperative leg length discrepancy (LLD) was 8.3 mm in Group 1, 10.0 mm in Group 2; and the mean final LLD was 13.9 mm in Group 1, and 11.2 mm in Group 2. The mean length of hospital stay was 23.8±3.3 days in Group 1, and 18.2±2.7 days in Group 2; the mean amount of blood transfusion was 960 ml in Group 1, and 647 ml in Group 2; and the mean operative time was 3.7±0.8 hrs in Group 1, and 2.7±0.6 hrs in Group 2 (p<0.05). CONCLUSION The union rate in patients with exchange of the previous hardware was better than in those with retained hardware in the treatment of subtrochanteric nonunion by complete removal of the interposed fibrous tissue and meticulous bone grafting leading to a biological environment to achieve bony union.

Comparison of Perioperative Blood Loss in Primary Non-cemented Total Hip Arthroplasty for Rapidly Destructive Coxarthrosis and Osteonecrosis of the Femoral Head.

Purpose The purpose of this study is to compare the perioperative blood loss in primary non-cemented total hip arthroplasty (THA) performed for rapidly destructive coxarthrosis (RDC) with the perioperative blood loss in primary non-cemented THA for typical osteonecrosis of the femoral head (ONFH). Materials and Methods From January 2000 to December 2013, 19 patients were diagnosed with RDC (group 1) and 40 patients were diagnosed typical Ficat stage IV ONFH (group 2), comparison of perioperative blood loss between group 1 and group 2 in primary noncemented THA was done. Patients with preoperative usage of steroid or anticoagulants medication and with hemodynamic abnormal blood test results were excluded. The blood loss was measured up to the fifth post operation day and calculated with formula proposed by Mercuriali, Inghilleri and Nadler. Results Non-compensated blood loss calculated in milliliters of red blood cells was 362 mL (standard deviation [SD], 187; range, 77-675) in group 1 and 180 mL (SD, 145; range, 53-519) in group 2. Compensated blood loss was 630 mL (SD, 180; range, 380-760) in group 1 and 503 mL (SD, 260; range, 190-1, 505) in group 2. The total blood loss after primary non-cemented THA is greater when surgery is performed for RDC than for ONFH, with the volume of 992 mL (SD, 300; range, 457-1, 434) in group 1 and 683 mL (SD, 360; range, 226-1, 975) in group 2 respectively. Conclusion Total perioperative blood loss was significantly greater in RDC than in ONFH in primary non-cemented THA.

Expression of RANKL/OPG in Joint Fluids of Periprosthetic Osteolysis

Purpose: This study evaluated the expression level of Receptor Activator of NF-B Ligand (RANKL), Osteoprotegerin (OPG) and other pro-inflammatory cytokines in the osteoarthritic and periprosthetic joint fluid in order to characterize the role of these regulatory proteins in periprosthetic osteolysis. Materials and Methods: Joint fluid specimens taken from 47 patients undergoing hip or knee reconstructive surgery were analyzed by enzyme-linked immunoassay (ELISA) in order to determine the relative protein expression level of RANKL, OPG, IL-1, IL-6 and TNF-. The fluid from joints with osteoarthritis (15 cases, Group I), implants revised without associated osteolysis (15 cases, Group II) and failed implants with radiographically moderate to severe osteolysis (17 cases, Group III) were compared. The fluids from all cases with implants (Group II and III) was combined (Group IV) and compared with the osteoarthritic joint fluids. Results: RANKL was present in all the fluids at similar concentrations. The OPG levels were significantly lower (2.2-3.9 fold) in Groups II and III than in Group I (pconcentration was significantly higher in Groups II, III and IV and with Group III being the highest (12.1 fold) (p levels were 2.0 times higher in Group III and significantly higher in all implant cases (Group IV) are analyzed(p=0.03). Conclusion: Permissive RANKL protein expression coupled with suppressed OPG levels and enhanced osteoclastogenic cytokine expression results in periprosthetic osteolysis.