Yoon Je Cho

Causes and Patterns of Aborting a Robot-Assisted Arthroplasty

For a successful robot-assisted arthroplasty, every step should be executed harmoniously. However, when we encounter serious obstacles during surgery, it is sometimes better to abort the procedure in a timely manner. This study investigated the possible causes and patterns of aborted robot-assisted arthroplasties. Of 100 consecutively planned robot-assisted arthroplasties, 22 cases were aborted. Most involved total knee arthroplasty (21/22 cases). We classified the causes according to the stage at which they occurred and the type of error. Abortions after starting the milling procedure and abortions due to an interactive factor were the most common. We believe that this study can guide surgeons to effective decision making during robot-assisted arthroplasty.

Does Zoledronate Prevent Femoral Head Collapse from Osteonecrosis? A Prospective, Randomized, Open-Label, Multicenter Study.

BACKGROUND Osteonecrosis of the femoral head frequently leads to collapse of the necrotic portion and subsequent degenerative joint disease of the hip, which is the most common diagnosis leading to total hip arthroplasty in young adults. Bisphosphonate therapy has been reported to potentially retard the collapse. We conducted a two-year prospective, randomized, open-label, multicenter study to determine whether zoledronate prevents the collapse and reduces the need for total hip arthroplasty. METHODS We randomly assigned patients who had Steinberg stage-I or II nontraumatic osteonecrosis of the femoral head with a necrotic area of ≥30% to either the zoledronate group or the control group. Patients in the zoledronate group received 5 mg of zoledronate intravenously per year for two years, while patients in the control group did not receive this medication. The primary efficacy outcome was the survival rate in terms of the occurrence of collapse (≥2 mm). The patients were observed for a minimum of two years after enrollment. RESULTS A total of 110 patients (110 hips) underwent randomization; fifty-five patients were assigned to the zoledronate group and fifty-five, to the control group. During the two-year follow-up, twenty-nine femoral heads in the zoledronate group and twenty-two in the control group collapsed (p > 0.05). Nineteen hips in the zoledronate group and twenty in the control group underwent total hip arthroplasty (p > 0.05). CONCLUSIONS Zoledronate for Steinberg stage-I or II osteonecrosis of the femoral head, with a medium to large necrotic area, did not prevent the collapse of the femoral head or reduce the need for total hip arthroplasty. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Etoricoxib in the treatment of Korean patients with osteoarthritis in a double-blind, randomized controlled trial

Abstract Objective: We evaluated the COX-2 inhibitors, etoricoxib and celecoxib, in Korean patients with osteoarthritis (OA). Methods: This study included patients (≥40 years of age) with a clinical and radiographic diagnosis of knee OA. Patients were randomized to etoricoxib 30 mg (qd) or celecoxib 200 mg (qd) in a 12 week randomized, controlled, double-blind study. Prior NSAID users were to demonstrate a worsening of symptoms upon withdrawal of medication. Efficacy endpoints included the time-weighted average change from baseline in the WOMAC VA 3.0 Pain Subscale (100 mm Visual Analog Scale [VAS]; primary endpoint), the WOMAC VA 3.0 Physical Function Subscale (100 mm VAS), and Patient Global Assessment of Disease Status (PGAD) (100 mm VAS). The primary hypothesis was that etoricoxib 30 mg is non-inferior to celecoxib 200 mg as assessed by the primary endpoint (the non-inferiority margin was set at 10 mm VAS). Adverse events (AEs), laboratory parameters, and vital signs were monitored. Results: There were 239 patients (89.5% female; mean age: 63.3 years) randomized to etoricoxib 30 mg (n = 120) and celecoxib 200 mg (n = 119). The differences (etoricoxib vs celecoxib) in least square (LS) mean change (95% CI) for WOMAC Pain, WOMAC Physical Function, and PGAD were −1.63 mm (−5.37, 2.10), −1.32 mm (−4.88, 2.23), and −1.09 mm (−5.48, 3.30), respectively. Drug-related clinical AEs occurred in 6.7% (etoricoxib) and 2.5% (celecoxib) of patients. This study was limited because it was not designed or powered to adequately capture and evaluate rare AEs associated with NSAID treatment. Conclusions: Etoricoxib 30 mg administered once daily in Korean patients with knee OA demonstrated non-inferior clinical efficacy to celecoxib 200 mg over 12 weeks of treatment as assessed by all primary and secondary outcomes. Etoricoxib 30 mg qd and celecoxib 200 mg qd were generally safe and well tolerated. Clinical trial registration: NCT01554163.

Does Osteoporosis Increase Early Subsidence of Cementless Double-Tapered Femoral Stem in Hip Arthroplasty?

Among 320 hip arthroplasties performed between January 2007 and March 2008, patients younger than 50 years old and patients older than 70 with a T-score at the proximal femur less than -2.5 made up the control and study group, respectively. There were 40 patients in each group. We measured stem subsidence, both digital and manual methods. Measurements were made from radiographs taken serially from 2 weeks to 1 year after surgery. The amount of mean subsidence for each group was not different, and all stems showed stable fixation in the final radiographs. Our study suggests that even in osteoporotic proximal femurs, press-fit fixation of double-tapered stems for hip arthroplasty can be safe and effective without excessive early subsidence.

Impingement Between the Acetabular Cup and the Femoral Neck After Hip Resurfacing Arthroplasty

BACKGROUND Loosening, femoral neck fracture, and metal ion release have been well documented after hip resurfacing arthroplasty, but impingement between the acetabular cup and the femoral neck has not. The goal of this study was to analyze radiographic findings that were presumed to represent impingement of the neck after hip resurfacing arthroplasty, and to describe the mechanism of impingement. METHODS Of the 635 hips (579 patients) that underwent hip resurfacing arthroplasty between September 1998 and May 2008, forty hips (6.3%) with positive radiographic findings were available for this study. The mean age of the patients was 34.9 years and there were thirty-five men and five women. The average follow-up was sixty-eight months (twenty-four to 132 months). Radiographic evaluation included an analysis of neck-shaft angle, inclination of the acetabular cup, head-neck ratio, lateral protrusion of the cup, anterior protrusion of the cup, and stem angle to the axis of the femoral neck. RESULTS Impingement between the acetabular cup and the femoral neck occurred in 6.3% of hips and appeared at an average of seven months after surgery. There was no further change two years postoperatively. The impingement findings did not correlate with the clinical outcome, but all instances of impingement were located in the lateral or anterolateral part of the femoral neck along the arc from the center of the femoral head to the lateral edge of the socket. No significant factors were found to be related to the occurrence of impingement. CONCLUSIONS Femoral-neck impingement should be differentiated from notching, narrowing, stress-shielding, or osteolysis of the femoral neck. Although we found no significant factors to explain the impingement found in the hips in our study, it appears that repetitive extreme motion of the involved hip and malposition of the implants can cause impingement after hip resurfacing arthroplasty.

Comparison of short wrist transverse open and limited open techniques for carpal tunnel release: a randomized controlled trial of two incisions

The purpose of this randomized controlled trial was to compare outcomes of limited open and short wrist transverse techniques in patients with carpal tunnel syndrome. In a single centre randomized controlled trial, 84 patients with idiopathic carpal tunnel syndrome were randomized before surgery to limited open or short wrist transverse open carpal tunnel release. The patients were evaluated at 6 weeks, 3 months, 6 months, and 1 and 2 years after surgery. At every follow-up, the Brigham and Women’s Carpal Tunnel Questionnaire scores, scar discomfort, and subjective patient satisfaction were evaluated. Two years after surgery, five patients were lost to follow-up. The groups had similar Brigham and Women’s Carpal Tunnel Questionnaire Symptom Severity and Functional Status scores and subjective satisfaction scores. The incidence of scar discomfort was not significantly different between the two groups on serial postoperative follow-up. Short wrist transverse open release surgery showed similar early postoperative symptoms and subjective and functional outcomes to limited open release. Level of evidence: II

Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures.

Background This paper introduces a percutaneous reduction technique using one or two Steinman pin(s) to reduce sagittally unstable intertrochanteric fractures. Methods A fracture was defined as a sagittally unstable intertrochanteric fracture when posterior sagging of a distal fragment and flexion of the proximal fragment worsens after usual maneuvers for a closed reduction. Of 119 intertrochanteric fractures treated from June 2007 to December 2008, twenty-one hips showed sagittal instability. The sagittal displacement was reduced using a Steinmann pin as a joystick, and stabilized with a nail device. Nineteen hips were followed up for more than one year. The clinical and radiological results were reviewed in 19 hips and compared with those of the remaining cases. Results The demographics were similar in both groups. The mean anesthetic time did not differ. Although the pre-injury and final activity levels were significantly lower in the study group, the degree of recovery was the same. No clinical complications related to this technique were encountered. Radiologically, the reduction was good in all hips in both groups. Union was obtained in all cases without any time differences. Conclusions This less invasive reduction technique is simple and safe to use for this type of difficult fracture.

Periprosthetic Insufficiency Fracture around Radiographically Loose Cemented Stem: A Report of Two Cases.

As the osteoporotic patient population grows, various periprosthetic fractures that cannot be classified appropriately can occur around the femur after hip arthroplasty. We experienced two cases of periprosthetic insufficiency fractures at subtrochanteric area of the femurs around radiographically loose cemented femoral stems. The ages of the patients were 75 years and 83 years. Both patients could not recall any history of trauma before the onset of pain. Both were treated non-operatively. Both healed uneventfully and did not recur after two years of follow up. When the osteoporotic patient with cemented stem showed sudden hip or thigh pain without a history of trauma, great attention should be focused to find this lesion.

Osteochondral Lesion of the Bilateral Femoral Heads in a Young Athletic Patient

Osteochondral lesions of the femoral head are uncommon and few studies have reported their imaging findings. Since joints are at risk of early degeneration after osteochondral damage, timely recognition is important. Osteochondral lesions of femoral head may often be necessary to differentiate from avascular necrosis. Here, we report a case of osteochondral lesions on bilateral femoral heads. This lesion manifested as subchondral cysts in initial radiographs, which led to further evaluation by computed tomography arthrography and magnetic resonance imaging, which revealed overlying cartilage defects.

Asymmetric epiphyseal closure of the femoral head as a potential cause of the primary cam lesion: a case report

Cam-type femoroacetabular impingement is a pathologic condition caused by repetitive impact of the abnormal femur on a normal acetabular rim, resulting in damage to the articular cartilage. Excluding cases with known underlying diseases, the development of primary cam deformity is not well understood. Here, we describe a patient with cam-type femoroacetabular impingement exhibiting delayed epiphyseal closure at the site of the cam lesion. The authors believe that this may represent a cause of primary cam deformity, and hereby report the case with review of the literature.