Sung Jung Kim

Femoral lengthening over an intramedullary nail using the external fixator Risk of infection and knee problems in 22 patients with a follow-up of 2 years or more

Background The time for femoral lengthening is shortened if external fixation is combined with intramedullary nailing. However, several complications have been reported with this procedure. Patients and methods We retrospectively reviewed the outcome of femoral lengthening performed over an intramedullary nail using external fixation in 22 patients. These patients were followed for a mean of 3.2 (2-5.2) years. The mean age was 22 (13-35) years at the time of the index procedure. The mean lengthening was 5 (2.7-8.1) cm and the external fixator was removed after median 20 (8-30) weeks. The mean external fixation index was 24 (11-35) days/cm and the mean consolidation index was 43 (26-55) days/cm of lengthening. Results 3 patients who had a past history of infection or open trauma developed osteomyelitis which required removal of the nail. There were 4 knee joint complications when the lengthening was over 20%, including posterior knee subluxation and patella subluxation. In 1 patient, the lengthened segment collapsed with breakage of locking screws. Interpretation Although lengthening over a nail can reduce the duration of external fixation, caution is required to prevent major complications.

Primary Total Hip Arthroplasties Using Harris-Galante Porous Coated Cementless Prosthesis: Mean 10-Year Follow-Up Results

Purpose : The purpose of this study was to analyze the intermediate to long-term results of primary total hip arthroplasties with a Harris-Galante prosthesis. Materials and Methods : Among 97 consecutive total hip replacements with Harris-Galante prosthesis in 85 patients, 76 hips in 67 patients were evaluated clinically and roentgenographically. The mean follow-up was for 10.1 years (range 6.2-13 years). Clinical and radiographic evaluations including osteolysis, stability of prosthesis, and wear of polyethylene were performed. Statistical analysis was conducted to find the relevant factors influencing osteolysis. The survivorship of overall and each acetabular and femoral component was analyzed by Kaplan-Meier method. Results : The Harris hip score averaged 44 points at preoperatively and improved to 89 points at the most recent follow-up. Pelvic osteolysis was found in 3 hips (4%) and femoral osteolysis was found in 32 (42%). The linear polyethylene wear rate was averaged 0.13 mm/year. Nine femoral components and two acetabular components were revised. There were 2 recurrent dislocations, 3 periprosthetic fractures and 4 infections. The probability of survival of the femoral and acetabular component at a mean 10 years was 81% (range 71- 93%) and 96% (range 91-100%) by the Kaplan-Meier method. Conclusion : The intermediate to long-term follow up of primary total hip arthroplasty with Harris-Galante prosthesis revealed a low failure rate of acetabular component and a relatively high failure rate of the femoral component which was usually related with loosening and osteolysis.

Color Doppler Sonography Surveillance for Deep Vein Thrombosis after Hip Replacement Surgery

Purpose : The purpose of this study was to validate the value of Duplex Color Doppler Ultrasonography (DDU) in post-operative deep vein thrombosis (DVT) after hip replacement surgery. Materials and Methods : From September 1998 to June 2000, 138 cases (130 patients) were eligible for a minimal one-year follow-up. DDU was carried out between the 7th and 10th postoperative in all cases, patients wore a compressive stocking on the lower extremity. Results : DVT occurred in five cases (4%), four cases occurred at 10th postoperative day and one case was occurred after one month. DVT occurred in the femoral vein in all cases. Three cases had clinical symptoms such as pain and localized edema. However, no case complained of systemic pulmonary symptoms. Conclusion : The incidence of DVT obtained from DDU after replacement hip surgery was very low (4%) with early mobilization and a compressive stocking. No case of DVT progressed to symptomatic pulmonary embolism. DDU was valuable for detecting DVT in the proximal thigh as a screening test.