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Background: We are not aware of any information on in vivo clinical results at a minimum of five years after posterior cruciate-substituting total knee arthroplasties performed with a highly cross-linked polyethylene insert. The purpose of the study was to evaluate whether the clinical and radiographic results of posterior cruciate-substituting total knee prostheses, including the prevalences of fracture of the polyethylene post, failure of the locking mechanism of the tibial polyethylene insert, and osteolysis, would be similar between patients treated with conventional polyethylene and those treated with highly cross-linked polyethylene. Methods: Three hundred and eight patients with a mean age of 60.3 years (range, twenty-two to sixty-five years) received a posterior cruciate-substituting total knee prosthesis with a conventional polyethylene tibial insert in one knee and the same prosthesis with a highly cross-linked polyethylene tibial insert in the contralateral knee. Twenty patients were men and 288 were women. The mean duration of follow-up was 5.9 years (range, five to 6.8 years). At each follow-up visit, the patients were assessed radiographically and clinically with the rating system of the Knee Society; the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC); and the University of California, Los Angeles (UCLA) activity score. Results: The two groups did not differ significantly (p > 0.05) with regard to the mean postoperative Knee Society total knee scores (93.5 compared with 93.7 points), function scores (82.9 compared with 82.7 points), and pain scores (46.7 compared with 47.1 points); WOMAC scores (16 compared with 15 points); range of motion (129.7° compared with 130.1°); or patient satisfaction assessed with a visual analog scale (7.6 compared with 7.9 points). The mean UCLA activity score was 6.4 points (p > 0.05). There were no significant differences between the two groups with regard to radiographic results. No knee in either group had a fracture of the tibial polyethylene post or failure of the locking mechanism of the tibial polyethylene insert. No knee in either group had osteolysis. One knee (0.3%), treated with highly cross-linked polyethylene, was revised because of infection. Conclusions: The data suggest that clinical and radiographic findings at five years after posterior cruciate-substituting total knee arthroplasty were the same for the patients treated with highly cross-linked polyethylene and those treated with conventional polyethylene. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Background: We are aware of no study that has compared press-fit condylar Sigma fixed-bearing and mobile-bearing total knee prostheses in the same patients after more than ten years of follow-up. The purpose of the current study was to compare these two implants with respect to the functional and radiographic results, prevalence of osteolysis, and overall revision rates at a mean of 12.1 years of follow-up. Methods: The study consisted of a consecutive series of 444 patients (mean age [and standard deviation], 66.5 ± 7.4 years) who underwent simultaneous bilateral total knee arthroplasty, with one side treated immediately after the other. All of the patients received a press-fit condylar Sigma mobile-bearing prosthesis on one side and a press-fit condylar Sigma fixed-bearing prosthesis on the contralateral side. The minimum duration of follow-up was ten years (mean, 12.1 years; range, ten to thirteen years). At the time of each follow-up visit, the patients were assessed clinically and radiographically. Results: Postoperative total knee scores (95 and 94 points), Western Ontario and McMaster Universities Osteoarthritis Index (19 and 18 points), University of California, Los Angeles activity score (both prostheses, 5 points), range of motion (129° ± 6.3° and 127° ± 6.8°), and radiographic findings did not differ significantly between the press-fit condylar Sigma mobile and fixed-bearing designs at the final follow-up. The prevalence of aseptic loosening (1.4% and 1.8%) did not differ significantly between the mobile and fixed-bearing implant designs. No knee in either group had osteolysis. The estimated survival rate with revision as the end point was 98.2% (95% confidence interval, 91% to 99%) and 97.5% (95% confidence interval, 91% to 99%) at 12.1 years for the mobile and fixed-bearing implant groups, respectively. Conclusions: The results of the present long-term clinical study suggest that excellent clinical and radiographic results were achieved with both the press-fit condylar Sigma mobile and fixed-bearing cruciate-retaining total knee designs. We found no significant clinical advantage for a mobile-bearing over a fixed-bearing total knee prosthesis. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

We studied the outcome in culture-positive and culture-negative infected total knee arthroplasty (TKA). We retrospectively reviewed 140 patients with culture-positive and 102 patients with culture-negative infected TKAs. We determined the infection control rate and clinical outcome after repeated debridement, and repeated 2-stage TKA in the culture-positive and culture-negative groups. The mean follow-up was 9.3 years (range 5–14 years) in the culture-positive group and 10.6 years (5–22) in the culture-negative group. The overall infection control rate was 56 % in both groups after the first treatment. The overall infection control rate was 90 % in the culture-positive group and 95 % in the culture-negative group. A functional knee was obtained in 90 % in the culture-positive group and 95 % in the culture-negative group. The data suggest that treatment according to the types of infection in both culture-positive and culture-negative groups after TKA controlled infection and maintained functional TKA with a firm level of fixation for most patients. Repeated debridement and repeated two-stage exchange TKA further improved infection control rates after the initial treatment and increased the likelihood of maintaining a functional TKA.

Several reports have suggested that there is a strikingly low prevalence of deep vein thrombosis (DVT) and pulmonary embolism (PE) after total hip arthroplasty (THA) in Asian patients. We determined the prevalence of DVT and PE after the use of a mechanical compression device only without pharmacological thromboprophylaxis in 459 patients (516 hips). The overall prevalence of DVT was 4.8% (27 of 561 hips). Nine of 27 hips had proximal thrombi. Three patients (0.7%) had asymptomatic PE. In our patients, combinations of absent thrombophilic polymorphisms with low clinical prothrombotic risk factors led to a low prevalence of DVT and virtually no symptomatic PE. Therefore, mechanical compression device only suffices to prevent DVT and PE in Asian patients.

We previously reported our six and 19.4-year results of arthroplasty with the PCA total hip prosthesis. We now report on the performance of this prosthesis at 27-29years. Eighty-eight consecutive primary THAs using a PCA total hip system were performed in 70 patients (mean age, 45.6±11.1years). The mean follow-up was 28.4years (27-29). The mean Harris hip score was 89 points at final follow-up. Thigh pain was reported in 22 hips (25%). The mean annual polyethylene wear was 0.182±0.03mm. There were 75 acetabular (85%) and 40 femoral (45%) osteolysis. The rate of survival after 28.4years as the end point of revision was 66% for the acetabular component and 90% for the femoral component.

Background & Aims The aim of this study was to re-evaluate the diagnostic performance of alpha-foetoprotein (AFP) as a surveillance test for hepatocellular carcinoma (HCC) in patients with hepatitis B virus-related chronic liver disease who were treated with entecavir (ETV). Methods Between January 2007 and August 2012, we analysed 373 treatment-naive patients with HBV-related chronic hepatitis (n = 229) or cirrhosis (n = 144) who were candidates for surveillance test, and were treated with ETV (0.5 mg/day) for longer than 12 months. To minimize the effect of AFP elevation caused by hepatitis activity, serum AFP levels were measured 12 months after the initiation of ETV treatment. Results Hepatocellular carcinoma developed in 28 patients (7.5%) during a median follow-up period of 48.0 months (IQR = 40.5–57.3 months). The area under the receiver operating characteristic curve for AFP was 0.71 (95% CI = 0.59–0.84). The optimal AFP cut-off value was 13 ng/ml, leading to a sensitivity of 50.0%, specificity of 98.8%, positive predictive value of 77.8% and negative predictive value of 96.1%. In multivariate Cox analysis, an older age, the presence of cirrhosis and AFP levels of ≥20 ng/ml at 12 months after treatment were found to be significantly associated with an increased incidence of HCC. Conclusions The role of serum AFP as a surveillance test should be re-evaluated in patients with HBV-related chronic liver diseases who were treated with antiviral therapy.

Post-silicon healing techniques that rely on built-in redundancy (e.g. row/column redundancy) remain effective in healing manufacturing defects and process variation induced failures in nanoscale memory. They are, however, not effective in improving robustness under various run-time failures. Increasing run-time failures in memory, specifically in case of low-voltage low-power memory, has emerged as a major design challenge. Traditionally, a uniform worst-case protection using Error Correction Code (ECC) is used for all blocks in a large memory array for runt-time error resiliency. However, with both spatial and temporal shift in intrinsic reliability of a memory block, such uniform protection can be unattractive in terms of either ECC overhead or protection level. We propose a novel Reconfigurable ECC approach, which can adapt, in space and time, to varying reliability of memory blocks by using an ECC that can provide the right amount of protection for a memory block at a given time. We show that such an approach is extremely effective in diverse applications.

Very few studies have compared alumina-on-alumina ceramic and alumina-on-highly cross-linked polyethylene bearings in the same patient. The purpose of this prospective randomised study was to compare the clinical and radiographic results and the prevalence of osteolysis in cementless total hip arthroplasty using an alumina-on-alumina and alumina-on-highly cross-linked polyethylene bearings in young active patients. We prospectively compared the results of 100 patients (200 hips) who had undergone a cementless total hip arthroplasty with an alumina-on-alumina ceramic bearing in one hip and an alumina-on-highly cross-linked polyethylene in the other. There were 66 men and 34 women with a mean age of 45.3 years (range, 21–49 years) at the time of surgery. The mean follow-up was 12.4 years (range, 11–13 years). The patients were assessed clinically and radiographically at three months, one year, and annually thereafter. Harris hip, Western Ontario and McMaster Universities Osteoarthritis Index, and University of California, Los Angeles activity scores did not show statistically significant differences between the two groups of bearings preoperatively or at the time of final follow-up. Radiographic findings of the component were not significantly different between the two groups. The mean polyethylene linear penetration was 0.031 ± 0.004 mm per year. No hips in either group displayed osteolysis. The Kaplan-Meier survivorship with revision as the end point at 12.4 years was 100 % (95 % confidence interval [CI], 94–100 %) for the femoral component in both groups and 99 % (95 %CI, 93–100 %) for the acetabular component. The clinical and radiographic results of using an alumina-on-alumina ceramic and alumina-on-highly cross-linked polyethylene bearings were similar.

Background: The studies on the short, metaphyseal-fitting anatomic cementless femoral component in patients younger than 30 years of age who had osteonecrosis of the femoral head are absent. The purpose of this current study was to evaluate midterm results of the short, metaphyseal-fitting anatomic cementless femoral component in patients younger than 30 years of age who had osteonecrosis of the femoral head with a particular emphasis on the clinical and radiographic results, thigh pain, stress shielding, revision rate, and osteolysis.

Background: The literature lacks studies that confirm whether the improved radiographic alignment that can be achieved with computer-navigated total knee arthroplasty improves patients’ activities of daily living or the durability of total knee prostheses. The purpose of this study was to determine whether computer-navigated total knee arthroplasty improves the clinical function, alignment, and survivorship of the components. Methods: We prospectively compared the results of 520 patients with osteoarthritis who underwent computer-navigated total knee arthroplasty for one knee and conventional total knee arthroplasty for the other. The assignment of the knee to navigation or not was done randomly. There were 452 women (904 knees) and sixty-eight men (136 knees) with a mean age of sixty-eight years (range, forty-nine to eighty-eight years) at the time of the index arthroplasty. The mean follow-up period was 10.8 years (range, ten to twelve years). The patients were assessed clinically and radiographically with the rating system of the Knee Society and with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at three months, one year, and annually thereafter. Results: Total knee scores, knee function scores, pain scores, WOMAC scores, knee motion, and activity scores did not show statistically significant differences between the two groups preoperatively or at the time of the final follow-up. Alignment and the survivorship of the components were not significantly different between the two groups. The Kaplan-Meier survivorship with revision as the end point at 10.8 years was 98.8% (95% confidence interval [CI], 0.96 to 1.00) in the computer-navigated total knee arthroplasty group and 99.2% (95% CI, 0.96 to 1.00) in the conventional total knee arthroplasty group. Conclusions: Our data demonstrated no difference in clinical function or alignment and survivorship of the components between the knees that underwent computer-navigated total knee arthroplasty and those that underwent conventional total knee arthroplasty. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Background: We are aware of no information about the mid-term performance of the high-flexion total knee arthroplasty, although early results have been reported. The purpose of this study was to evaluate the mid-term results of high-flexion and conventional knee prostheses. Methods: We prospectively compared the results of 100 patients with osteoarthritis who had received a NexGen Legacy Posterior Stabilized (NexGen LPS) prosthesis in one knee and a NexGen Legacy Posterior Stabilized-Flex (NexGen LPS-Flex) prosthesis in the other. Seventy-five patients (150 knees) were women and twenty-five (fifty knees) were men. The mean age was sixty-five years (range, forty-eight to eighty-five years) at the time of the index procedure. The mean duration of follow-up was 10.3 years (range, ten to 10.6 years). The patients were assessed with radiographs, with the rating system of the Knee Society, and with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at three months, one year, and annually thereafter. Results: Total knee scores, knee function scores, pain scores, WOMAC scores, knee motion, and activity scores did not differ significantly between the two designs of the implants, on the basis of the numbers studied, either preoperatively or at the time of final follow-up. One knee in the NexGen LPS-Flex group was revised because of recurrent infection. No knee in either group had aseptic loosening of the components. The Kaplan-Meier survivorship at ten years postoperatively, with revision defined as the end point, was 100% (95% confidence interval, 94 to 100) for the NexGen LPS prosthesis and 99% (95% confidence interval, 93 to 100) for the NexGen LPS-Flex prosthesis. Conclusions: After a minimum duration of follow-up of ten years, there were no significant differences between the two groups with regard to implant survivorship, functional outcome, knee motion, or prevalence of osteolysis. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

The purpose of this study was to evaluate the long-term functional and radiological outcomes of arthroscopic removal of unstable osteochondral lesions with subchondral drilling in the lateral femoral condyle. We reviewed the outcome of 23 patients (28 knees) with stage III or IV osteochondritis dissecans lesions of the lateral femoral condyle at a mean follow-up of 14 years (10 to 19). The functional clinical outcomes were assessed using the Lysholm score, which improved from a mean of 38.1 (sd 3.5) pre-operatively to a mean of 87.3 (sd 5.4) at the most recent review (p = 0.034), and the Tegner activity score, which improved from a pre-operative median of 2 (0 to 3) to a median of 5 (3 to 7) at final follow-up (p = 0.021). The radiological degenerative changes were evaluated according to Tapper and Hoover’s classification and when compared with the pre-operative findings, one knee had grade 1, 22 knees had grade 2 and five knees had grade 3 degenerative changes. The overall outcomes were assessed using Hughston’s rating scale, where 19 knees were rated as good, four as fair and five as poor.We found radiological evidence of degenerative changes in the third or fourth decade of life at a mean of 14 years after arthroscopic excision of the loose body and subchondral drilling for an unstable osteochondral lesion of the lateral femoral condyle. Clinical and functional results were more satisfactory.

A phage-based magnetoelastic (ME) biosensor method was compared with a TaqMan-based quantitative real- time PCR (Q-PCR) method for the detection of Salmonella typhimurium on tomato surfaces. This ME biosensor method utilizes magnetoelastic resonators coated with E2 filamentous phage to bind with and measure the concentration of S. typhimurium . In this study, standard curves, correlations, and limits of detection (LOD) for the ME biosensor and Q-PCR methods were determined by inoculating tomato surfaces with S. typhimurium suspensions in concentrations ranging from 1 to 8 log CFU/tomato. The LOD for the ME biosensor method and Q-PCR were 3 and 2 log CFU/tomato, respectively. In a direct comparison of the detection methods, S. typhimurium suspensions (3 log CFU/tomato) were inoculated on 65 tomato surfaces, then incubated at 37°C and 100% RH for 24 h. After 24 h, S. typhimurium was positively detected by both methods and the quantified concentrations were nearly the same, (6.35 ± 2.03) and (6.34 ± 0.17) log CFU/tomato respectively for the ME biosensor method and the Q-PCR method, which were significantly greater than the concentration determined by the BGS-plate count method (5.33 ± 0.21). Scanning electron microscopy (SEM) was used to confirm the growth of S. typhimurium on the tomato surfaces and the binding of S. typhimurium on the measurement sensors. This study demonstrated that the ME biosensor method was robust and competitive with Q-PCR for S. typhimurium detection on fresh produce.

The purpose of this study was to determine the survivorship of the short, metaphyseal-fitting cementless anatomic stem, hip function, thigh pain, and the stress shielding after total hip arthroplasty in 72 patients (81 hips) with Class A bone, 73 patients (83 hips) with Class B bone, and 85 patients (92 hips) with Class C bone. Survival of the femoral stem at 7 years was similar for all 3 classes of bones (100%, 100%, and 98.2%, respectively). At 7 years after the operation, the mean Harris hip scores (95, 93, and 91 points, respectively), WOMAC scores (11, 12, and 15 points, respectively), incidence of thigh pain (none in all 3 groups), radiographic findings and bone mineral density were not significantly different among the 3 groups.

The purpose of this prospective, randomised study was to evaluate the clinical and radiological results comparing the identical cemented or cementless NexGen total knee prostheses implanted bilaterally in the same patient. Sequential simultaneous bilateral total knee replacements were performed in 50 patients (100 knees). There were 39 women and 11 men with a mean age of 58.4 years (51 to 67) who received a cemented prosthesis in one knee and a cementless prosthesis in the other. The mean follow-up was 13.6 years (13 to 14). At final review, the mean Knee Society scores (96.2 (82 to 100) versus 97.7 (90 to 100)), the mean Western Ontario and McMaster Universities osteoarthritis index (34.5 (4 to 59) versus 35.6 (5 to 51)), the mean ranges of knee movement (124° (100° to 140°) versus 128° (110° to 140°)), mean patient satisfaction (8.1 (sd 1.9) versus 8.3 (sd 1.7)), and radiological results were similar in both groups. The rate of survival of the femoral components was 100% in both groups at 14 years. The rate of survival of the cemented tibial component was 100% and 98% in the cementless tibial component. No osteolysis was identified in either group. Our data have shown no advantage of cementless over cemented components in total knee replacement.

We reviewed the results of 84 total hip replacements performed with a short metaphyseal-fitting anatomical cementless femoral component in 84 unselected consecutive patients with a mean age of 78.9 years (70 to 88). The mean follow-up was 4.6 years (4 to 5). The mean pre-operative Harris hip score was 26 points (0 to 56), which improved to 89 (61 to 100) at the final follow-up. No patient had thigh pain. The mean pre-operative Western Ontario and McMaster Universities osteoarthritis index score was 61 points (48 to 75), which improved to 21 (6 to 46). The mean University of California, Los Angeles activity score was 5.5 points (3 to 7) at the final follow-up. Osseointegration was seen in all femoral and acetabular components. All hips had grade 1 stress shielding of the proximal femur. No acetabular or femoral osteolysis was identified. These results demonstrate that a short metaphyseal-fitting femoral component achieves optimal fixation without diaphyseal anchorage in elderly patients.

There have been comparatively few studies of the incidence of osteolysis and the survival of hybrid and cementless total hip replacements (THRs) in patients younger than 50 years of age. We prospectively reviewed 78 patients (109 hips) with a hybrid THR having a mean age of 43.4 years (21 to 50) and 79 patients (110 hips) with a cementless THR with a mean age of 46.8 years (21 to 49). The patients were evaluated clinically using the Harris hip score, the Western Ontario and McMaster Universities (WOMAC) osteoarthritis score and the University of California, Los Angeles (UCLA) activity score. Radiographs and CT scans were assessed for loosening and osteolysis. The mean follow-up was for 18.4 years (16 to 19) in both groups. The mean post-operative Harris hip scores (91 points versus 90 points), the mean WOMAC scores (11 points versus 13 points) and UCLA activity scores (6.9 points versus 7.1 points) were similar in both groups. The revision rates of the acetabular component (13% versus 16%) and the femoral component (3% versus 4%), and the survival of the acetabular component (87% versus 84%) and the femoral component (97% versus 96%) were similar in both groups. Although the long-term fixation of the acetabular metallic shell and the cemented and cementless femoral components was outstanding, wear and peri-acetabular osteolysis constitute the major challenges of THR in young patients.

We compared the clinical and radiologic results in 55 patients (110 hips) associated with proximally porous-coated titanium stems that were identical in geometry but differed with regard to proximal surface treatment (with or without hydroxyapatite coating). The mean age at the time of the operation was 46.3 years (27-63 years), and mean length of follow-up was 15.6 years (15-16 years). The mean Harris hip score in both groups improved from 39 points and 41 points, respectively, to 93 and 91 points, respectively, at the last follow-up. After 16 years, the cumulative survival for the stem was 100% in both groups and for the cup was 89% in both groups. After long-term follow-up, hydroxyapatite coating on the porous surfaces did not improve or diminish the results of total hip arthroplasty.

We performed a prospective, double-blinded, randomized, and controlled study to assess the clinical efficacy and safety of intra-articular multimodal drug injection after total knee arthroplasty. Two hundred eighty-six patients undergoing simultaneous bilateral total knee arthroplasty were randomized to receive the injection of multimodal drugs in one knee and normal saline solution as a placebo in the contralateral knee. All patients received patient-controlled analgesia for 48 hours after surgery, followed by standard analgesia. Visual analog scores for pain during activity and rest and for patient satisfaction were recorded. The range of motion and blood loss were also recorded. Intraoperative intra-articular injection of multimodal drugs into the knee did not improve patient pain and satisfaction, range of motion, or blood loss compared with the placebo control.

We retrospectively reviewed 474 patients (492 hips) with a contemporary cemented total hip arthroplasty (THA) (mean age, 38.9 years) and 504 patients (532 hips) with a cementless THA (mean age, 39.3 years). Patients were evaluated clinically and radiographically. The mean follow-up was similar (14.5 vs 14.8 years) in both groups. The mean postoperative Harris hip scores (93.6 vs 94.7 points), the mean Western Ontario and McMaster Universities Osteoarthritis Index scores (12 vs 13 points), and the mean University of California, Los Angeles activity scores (6.9 vs 7.1 points) were similar between the 2 groups. Incidence of acetabular osteolysis (16% vs 20%) and femoral osteolysis (8% vs 9%) was similar between the 2 groups. Survivorship of cup (86% vs 82%) and stem (98% vs 98.5%) was similar between the 2 groups. Periacetabular osteolysis constitutes the major challenge in modern THAs in young patients.

The purpose of this study was to determine whether the short, metaphyseal fitting femoral stem would achieve stable fixation without diaphyseal fixation. A total of 126 patients (144 hips) were included in the study, and their mean age was 53.9 years (26-65 years). The mean duration of follow-up was 4.5 years (4-5 years). The predominant diagnosis was osteonecrosis of femoral head (88 of 144 hips, or 61%). The mean preoperative Harris hip score was 45 points, which improved to 96 points by the final follow-up. Western Ontario and McMaster Universities Osteoarthritis score and patient's activity score were improved substantially at the final follow-up. This short, metaphyseal fitting cementless femoral component achieved stable fixation without diaphyseal fixation, and there was minimal stress-shielding bone resorption in the calcar region.

We propose a bidirectional add/drop amplifier (BADA) module with an N/spl times/N arrayed waveguide grating multiplexer. The relative intensity noise that degrades bidirectional transmission system severely is suppressed by interleaved wavelength allocation. With two proposed RADA modules, we demonstrate bidirectional transmission and add/drop multiplexing of 8/spl times/2.5 GWs WDM signal over 120-km conventional single mode fiber with less than 0.6 dB power penalty in the receiver sensitivity.

Pulmonary tumor thrombotic microangiopathy (PTTM) is known as a rare and severe cancer-related pulmonary complication that was first reported by Von Herbay et al. in 1990 [1]. In PTTM cases, endothelial attachment of multiple microscopic tumor emboli induces intimal proliferation of small pulmonary arteries and arterioles combined with secondary thrombosis, which leads to massive reduction of the pulmonary vascular bed and pulmonary hypertension [1-3]. Due to extremely rapid progression of PTTM and non-specific clinical findings, establishing a PTTM diagnosis is very difficult, and nearly all reported cases are diagnosed primarily by autopsy [1,3]. There have only been two PTTM cases reported in Korea, but they were diagnosed by autopsy or shortly before death, and thus any effective treatment was not available [4,5]. There have been only three cases worldwide that have been diagnosed ante mortem and treated effectively [6-8]. We report a 44-year-old woman who did not have a history of cancer but presented with rapidly progressive dyspnea and pulmonary hypertension. She was diagnosed as advanced gastric cancer and related PTTM ante mortem. She was treated effectively with chemotherapy for the underlying malignancy.

Purpose : To evaluate the clinical results of acquired claw toe deformities that had been treated with proximal lengthening of the long toe flexor tendons. Materials and Methods : Seventeen patients with a claw toe deformity due to contracture of the long flexor tendons were treated with proximal lengthening of the long toe flexor tendons from January 1993 to January 2003 and were followed up for at least 1 year. The average age at the time of the operation was 42 years and the average follow-up period was 34 months. Achilles tendon lengthening was also performed in 14 cases with an equinus deformity. At the final follow-up, a residual toe deformity, toe pain during walking, patient's satisfaction, and limitation of the shoe-wear were assessed. Results : At the final follow up, all cases showed a complete correction of a claw toe deformity, and did not have callosity at the toe tip or dorsal aspect of the toes. Toe pain during walking was found in 1 case, and a limitation of the shoe-wear was noted in 6 cases. At the final evaluation, 10 cases were graded as excellent, 6 good, and 1 fair. There was no recurrence of the claw toe deformity or limitation of the toe motion. Conclusion : Proximal lengthening of the long toe flexor tendons is recommended for treating flexible claw toe deformities. The procedure produced excellent results regarding the deformity correction and pain relief.

Sixty-six skeletally immature patients with idiopathic scoliosis were treated with a Prenyl brace and their results were analyzed. Fifty-three patients (80%) showed a satisfactory response. The best results were obtained in patients with lumbar curves and thoracolumbar curves less than 40 degrees. Advantages of this brace are simplicity of fabrication and fitting, patient comfort, patient acceptance and relatively low cost. The disadvantages of this brace are that it is less effective in thoracic curves in the upper thoracic spine, double major curves and kyphosis. It probably causes more significant chest restriction than the Milwaukee brace.