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Purpose The purpose of this study was to evaluate the efficacy of unicompartmental knee arthroplasty (UKA) in young active Asian patients by analyzing clinical outcomes, complications and survival rates. Materials and Methods Eighty-two knees were evaluated with a minimum follow-up of 5 years after Oxford phase 3 UKA in patients less than 60 years of age at the time of surgery. Their mean age was 54.7 years (range, 44 to 59 years). The mean follow-up period was 8.9 years (range, 5.3 to 12 years). Kaplan–Meier survivorship analysis was used to estimate implant survival. Results Including 3 bearing dislocations, 1 medial tibial collapse and 1 lateral osteoarthritis, the total complication rate was 6.1% (5/82). Of the 3 cases of bearing dislocation, 2 cases were resolved by replacing with a thicker bearing and 1 case was converted to total knee arthroplasty (TKA) due to repeated dislocation. The two knees with a medial tibial collapse and a lateral osteoarthritis were converted to TKA. The 10-year cumulative survival rate using Kaplan-Meier survival method was 94.7% (95% confidence interval: 88.7%–100%). Conclusions Oxford medial UKA was reliable and effective in young active Asian patients providing good clinical results and survival rate in the mid-term follow-up.

The purpose of this study is to investigate the likelihood of unicompartmental knee arthroplasty (UKA) in patients with chondrosis in the patellofemoral joint. We evaluated the pain and functional changes in the patellofemoral joint of 62 patients who underwent medial UKA for medial compartmental osteoarthritis with symptoms in the patellofemoral joint. They were analyzed by the patellofemoral score of Lonner at postoperative 3months, 6months, 1year, and 2years prospectively. Preoperatively, the grade by total score was poor in all 62 cases, but it was improved to 36 excellent (58%), 16 good (26%), and 10 fair (16%), and there were no poor cases at 2years. The last follow-up showed satisfactory results in pain score, function score, and total score (p0.05). Regarding this result, we believe chondrosis in the patellofemoral joint is not a contraindication to UKA, even in patients with patellofemoral joint symptoms.

Background: The authors report the results of preserving the infrapatellar branch of the saphenous nerve during unicompartmental knee arthroplasty to prevent lateral skin numbness. Methods: All 100 cases had medial compartmental osteoarthritis and a minimally invasive technique had been used. The mean follow-up duration was two years and eight months (range, 24 to 42 months). Results: The classification according to the location of this nerve was observed as either Mochida Type I with 76 cases (76%), Type II with 16 cases (16%), and unclassified type with 8 cases (8%). In Type I, the nerve was saved in 62 cases (82%), but could not be preserved in Type II because of the surgical procedure. These results showed that the mean distance from the joint line to the nerve of Type I was 9.13 mm (range, 4 to 15 mm) and the nerve passed inferiorly. Conclusions: This study showed the location of this nerve can be predicted ahead of the procedure, which will help preserve it during the surgery.

In recent years, there has been an increasing interest in peri-articular injections (PAI) to control post-operative pain after total knee arthroplasty (TKA). Previous studies have evaluated the effect of PAI using multimodal analgaesic protocols, but the concomitant use of patient-controlled analgesia (PCA) may has masked the genuine effects of PAI. We investigated the efficacy of PAI compared with PCA and determined whether conventional PCA can be effectively replaced with PAI after TKA.Eighty patients undergoing unilateral TKA were randomised into two groups. The PCA group consisted of patients who used PCA after surgery, while the PAI group included patients who did not use PCA post-operatively but were given PAI during surgery. We measured changes in visual analogue scale (VAS) scores, straight leg raising (SLR), range of motion (ROM) and consumption of antiemetics or analgaesics.Pain levels in the PAI group were significantly lower than in the PCA group during two weeks post-operatively (p 0.05).; functional recovery in the SLR test showed no difference between groups (p 0.05).; mean ROM showed no difference; (p 0.05) and there was no difference in the number of patients who needed additional analgaesics. However, antiemetic use was significantly lower for the PAI group (p 0.05).PAI offered improved pain control and minimal side effects compared with PCA. Thus, PAI can replace conventional PCA for controlling post-operative pain after TKA.

The purpose of this article is to review the early complications of minimally invasive mobile-bearing unicompartmental knee arthroplasty by analyzing the first 100 consecutive cases. All cases were medial unicompartmental arthroplasties with a follow-up of at least 24 months (range, 24-51 months). Seven revision procedures were performed due to 2 fractures of the medial tibial plateau, 1 loosening of the femoral component, and 4 dislocations of the meniscal bearing. The early results as determined by The Knee Society scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and postoperative range of motion were satisfactory. However, there exists a high rate of early failures, which occurred during the initial learning curve. Therefore, surgeons must be aware that in order to minimize these complications, attention to detail is mandatory.

Purpose: To evaluate the efficacy of surgical treatment through retrospective comparison of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs open plate fixation in the treatment of the distal femur fractures. Materials and Methods: Thirty-one patients with distal femur fractures from January 2002 to December 2010 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 17 patients treated with MIPPO, and group B was comprised of 14 patients treated with open plate fixation. Clinical outcomes including operation time, transfusion rate, rehabilitation, range of motion, and interval change of postoperative C-reactive protein (CRP) were evaluated to assess postoperative inflammatory reaction, postoperative complications and clinical results with the use of Sanders criteria. Results: The operative time was 86/135 min and transfusion volume was 0.8/1.9 unit respectively. The postoperative 3-day and 7-day CRP were 7.4/1.5 mg% in group A and 10.3/2.4 mg% in group B, showing more minimal tissue injury and early recovery in group A. There were no significant differences in clinical results by Sanders criteria in both groups. Conclusion: Both MIPPO and open plate fixation for the treatment of distal femur fractures showed comparably good results. However, the MIPPO technique is superior to group B in view of minimal tissue injury and operation time and was proven to lessen the transfusion rate.

208 통신저자:송 무 호 부산시 동래구 충렬대로 187, 부산대동병원 정형외과 Tel:051-550-9396ᆞFax:051-553-7575 E-mail:redmaniak@freechal.com 접수: 2011. 10. 29 심사 (수정): 1차 2011. 11. 16, 2차 2012. 2. 10, 3차 2012. 3. 29 게재확정: 2012. 5. 10 Address reprint requests to:Moo Ho Song, M.D. Department of Orthopedic Surgery, Daedong Hospital, 187, Chungnyeoldaero, Dongnae-gu, Busan 607-711, Korea Tel:82-51-550-9396ᆞFax:82-51-553-7575 E-mail:redmaniak@freechal.com 골다공성 잠재성 추체 골절의 진단과 추체 성형술

Study Design: A retrospective study. Objectives: To evaluate the effectiveness of unilateral extrapedicular approach in the treatment of osteoporotic compression fracture, as compared to transbipedicular approach. Summary of Literature Review: There has been no comparative study assessing this topic. Materials and Methods: 115 patients presenting with percutaneous vertebroplasty between Mar. 2002 and Feb. 2009, were divided into three groups: Group A (43 vertebrae; 29 patients) who were treated with bipedicular approach, Group B (66 vertebrae; 47 patients) treated with early cases of unilateral extrapedicular approach, and Group C (43 vertebrae; 39 patients) treated with late cases of unilateral extrapedicular approach. We analyzed radiological test results including the volume of injected cement and the distribution of intravertebral body, cement leakage, height restoration and kyphosis correction. Statistical analysis was done using SPSS. Clinical results were analyzed using VAS scores. Results: The mean follow-up period varied from one year at minimum to seven years and six months at maximum. The mean volume of injected cement was 3.39cc/5.39cc/3.79cc for groups A, B and C respectively. Cement leakage was at 13.4/34.8/12.8% in each group. Cement leakage was higher in group B, but most leakage took place in early cases that we tried to inject more and more cement in early inexperienced period. Bilaterally well distributed cement in the vertebral body was at 85.7/76.9% in groups B and C respectively. VAS scores improved from 8.4/8.3/8.5 preoperatively to 2.0/2.0/1.6 postoperatively. Conclusions: Percutaneous vertebroplasty treated with unilateral extrapedicular approach can lessen perioperative operating time. This treatment led to clinical and radiologic results that were comparable to those with a bilateral transpedicular approach.

Intraneural ganglion of the tibial nerve is very rare. We have experienced a case of the intraneural ganglion cyst in the tibial nerve and medial plantar nerve, which was located at the level of the ankle and foot. A 29-year-old male suffered from lumps causing numbness around the medial aspect of the sole and great toe. But there was no weakness and change of the motor function. We excised the cystic mass successfully and the neurologic symptoms disappeared.

The plica is a remnant of the synovial folds during the coalescence of three compartments of the knee at 8 weeks of fetal development. The plica are classified according to their corresponding anatomic sites of the knee, such as suprapatellar, medial patellar, infrapatellar and lateral patellar plica. The medial patellar plica is considered to be the one most likely to cause problems and has been well documented in the literature. However, there are very few reports of problems being caused by lateral plica. We encountered one case of pathologic lateral plica that was excised by arthroscopy. We report this case with a review of the relevant literature.

Acquired hemophilia due to the acquisition of antibodies to factor VIII is quite rare, and is associated with conditions such as pregnancy, lymphoma and autoimmune disorders. However, surgical trauma has not been recognized as a cause of factor VIII inhibitors. There have only been 4 cases (3 abdominal surgery, 1 coronary bypass surgery) reported in the world thus far. We experienced acquired hemophilia associated with Total Knee Arthroplasty. This syndrome presents with abrupt bleeding in the first few days after surgery and may cause life-threatening complications. We report a case of acquired hemophilia that was cured with immunosuppressive therapy with a review of the relevant literature.

A deep infection following a prosthetic joint replacement is a serious complication with an incidence ranging from 1 to 2% of patients undergoing total prosthetic surgery. The common invading organisms are staphylococci, streptococci and gram negative bacillus. A candida infection after a prosthetic joint replacement is very rare, and a diagnosis is difficult because of the indolent nature of the clinical symptoms and signs as well as its rarity. We report a case of candida infection after a TKA, which was treated successfully by a staged reimplantation.

Purpose: To compare the results associated with the standard medial parapatellar approach and the midvastus approach in primary total knee arthroplasty. Materials and Methods: A total of 70 cases who underwent total knee arthroplasty were evaluated. All patients have varus deformity in standing AP view, but subluxation of the patella on the Merchant view was excluded. Medial parapatellar approach (35 cases) and midvastus approach (35 cases) were used. The operation time, blood loss, incidence of lateral release, time to perform straight leg raising, time to get flexion, range of motion, VAS, Knee Society Knee Scores, tibio-femoral angle and patella tilt were compared. The results were analyzed using the student's t-test. Results: No significant difference was noted between medial parapatellar and midvastus approach regarding to the operation time, blood loss, range of motion, VAS and Knee Society Knee Scores (p>0.05). However, midvastus approach provide two significant advantages of the incidence of lateral release (40% vs 6%) and the time to perform straight leg raising (4.5 days vs 1.9 days) (p

Purpose: To assess the effectiveness of suction drainage following total knee arthroplasty in terms of blood-saving and local complications. Materials and Methods: A total of 67 patients who underwent primary total knee arthroplasty were evaluated. There were 35 drained and 32 undrained total knee arthroplasties. The total amount of blood loss and transfused were calculated in each patient. Any local or systemic complications were recorded. Results: No significant difference was noted between drained and undrained total knee arthroplasties regarding; wound healing, recovery of knee motion, or associated local or systemic complications. However, blood loss (1078 cc versus 298 cc) and transfusion amounts (2.8 unit versus 0.6 unit) were significantly higher in the drained group than in the undrained group. Conclusion: Following primary total knee arthroplasty, a lack of drainage did not cause significant wound healing problems, but it reduced blood loss and transfusion requirements. Wound drainage following total knee arthroplasty has been a tradition, but this study shows no benefits from a postoperative drainage system in primary total knee arthroplasty.