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Background As the frequency of total knee arthroplasty (TKA) is increasing, long-term follow-up of patients has become essential, and the frequency of revision total knee arthroplasty (R-TKA) due to the occurrence of various complications has also increased. There is controversy regarding which approach has minimal complications and an adequate visual field in R-TKA. Therefore, we compared the clinical and radiological results between the extensile medial parapatellar (EMP) approach and tibial tubercle osteotomy (TTO) for R-TKA. Methods Between March 1, 2000, and December 31, 2015, we compared 35 patients who underwent the EMP approach and 31 who underwent the TTO approach for R-TKA. In this study, the preoperative range of motion (ROM) was an important criterion for the choice of approach in R-TKA. The EMP approach was applied to patients with a ROM above 60°. The TTO approach was applied to patients with knee flexion limited to 0°-30°. We clinically assessed knee ROM, Knee Society scores, and Hospital for Special Surgery scores at the time of the last follow-up. We radiographically measured femorotibial alignment and patellar height. We also examined the complication rates. The average length of the TTO was 1.0 × 2.5 cm × 10 cm. We used 3 or more 3.5-mm half-threaded screws. Results The mean postoperative ROM of the knee joint at the time of the last follow-up was 103° (flexion contracture 5° and further flexion 108°) in the group that underwent the EMP approach and 101° (flexion contracture 4° and further flexion 109°) in the group that underwent the TTO approach. The mean Knee Society scores were 86 (71-96) and 85 (72-94), and the mean Hospital for Special Surgery scores were 82 (70-93) and 83 (68-92) for the 2 groups, respectively, with no statistically significant difference. The mean femorotibial angles were 0.6° (±3.3°) and 0.1° (±2.9°), and the mean Insall-Salvati ratios were 1.0 (±0.34) and 0.8 (±0.14), respectively, with no statistically significant difference. The group that underwent TTO achieved bone union at an average of 11.8 weeks after surgery. In the group that underwent the EMP approach, 2 patients had extensor lag of more than 10°. In the group that underwent TTO, 2 subjects had skin necrosis at the operative site. Conclusion The clinical and radiological outcomes were similar in the 2 groups after R-TKA. To increase the ROM and obtain adequate exposure, TTO is also considered a useful surgical approach. However, complications related to TTO should be minimized. Level of evidence Therapeutic level III, retrospective comparative study.

Purpose A basicervical femoral fracture is defined as a fracture of base of neck of femur that occurs medially from intertrochanteric line above lesser trochanter. In this study, we intended to evaluate radiological and clinical results of basicervical femoral fractures treated by intramedullary nailing. Materials and Methods Fifteen patients, who underwent intramedullary nailing among 50 patients, out of 50 who were diagnosed with basicervical femoral fractures from July 2012 to May 2015 were studied. All of 15 patients' fracture were two-part basicervical fractures. Using radiography, we characterized the: i) state of reduction, ii) location of the lag screw, iii) tip apex distance (TAD), and iv) sliding distance of lag screw and bone union. Additionally, we performed clinical assessment before injury and at final follow-up. Results In radiological assessment, we achieved acceptable reduction state in all patients. All lag screws were fixated on appropriate locations. Mean TAD was 17.3 mm (11.0-21.1 mm), which showed insertion point of

Symptomatic aneurysmal bone cysts with expansible lesions in the pelvis are rare in children. The management of an aggressive vascular lesion in a female child is challenging. The standard treatment for aneurysmal bone cysts is accompanied by a high risk of local recurrence. A 12-year-old female presented with a history of pelvic pain for 5 months. Plain radiographs and magnetic resonance imaging showed a very large expansile lytic lesion arising from the right iliac bone. Intralesional curettage, electric cauterization, chemical sclerotherapy and allogeneic bone graft were performed through the window of the iliac crest. At a follow-up consultation 3.5 years post-surgery, the child had painless full-range movement in the hip joint with no recurrence. Although many treatment options are described, our patient was treated successfully using curettage and allogeneic bone graft without recurrence.

Purpose: The purpose of this study is to analyze the results of acute acromioclavicular joint dislocation treatment with coracoclavicular ligament augmentation using Tight-Rope (Arthrex). Materials and Methods: From October 2009 to March 2011, 30 patients with acute acromioclavicular joint dislocation underwent coracoclavicular ligament augmentation using Tight-Rope and were followed up for at least 12 months after surgery. The radiologic results were qualified according to serial plain radiographs, and the clinical results according to University of California - Los Angeles (UCLA) Shoulder Scale, Constant score, and VAS pain score. Results: Using the UCLA scoring system, excellent results were observed in 22 cases (73%), good results in five cases (17%), fair results in two cases (7%), and a poor result in one case (3%). The average Constant score was . According to radiologic results, anatomical reduction was achieved in 26 cases, and two cases showed a moderate loss of reduction, and two cases showed complete re-dislocation. Clinical results for patients with re-dislocation were unsatisfactory and reoperation was required. Conclusion: Coracoclavicular ligament augmentation using Tight-Rope is a good option providing reliable functional results in patients with acute acromioclavicular joint dislocation.

The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair. A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6 months postoperatively. The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p

We aimed to identify the clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears of all sizes with a modified tension band suture technique.Among 63 patients who underwent arthroscopic rotator cuff repair for a full-thickness rotator cuff tear with the modified tension band suture technique at a single hospital between July 2011 and March 2013, 47 were enrolled in this study. The mean follow-up period was 29 months. Visual analog scale scores, range of motion, American Shoulder and Elbow Surgeons scores, Constant scores, and Shoulder Strength Index were measured preoperatively and at the final follow-up. For radiologic evaluation, we conducted magnetic resonance imaging 6 months postoperatively and ultrasonography at the final follow-up. We allocated the small and medium tears to group A and the large and massive tears to group B and then compared clinical outcomes and repair integrity.Postoperative clinical outcomes at the final follow-up showed significant improvements compared with those seen during preoperative evaluations (P .001). However, group B showed worse clinical results than group A. Evaluation with magnetic resonance imaging performed 6 months postoperatively and ultrasonography taken at the final follow-up revealed that group B showed a significantly higher retear rate than did group A (69% vs. 6%, respectively; P .001).Arthroscopic repair with the modified tension band suture technique for rotator cuff tears was a more suitable method for small to medium tears than for large to massive tears.

NOD2 is mainly expressed in human monocytes/macrophages and intestinal epithelial cells and has been speculated to play in gut physiology. However, whether NOD2 is expressed in vascular endothelium is not currently determined. Human umbilical vascular endothelial cells (HUVECs) minimally expressed NOD2 gene, whereas stimulation of HUVEC with bacterial LPS, IL-1beta, or TNF-alpha resulted in significant up-regulation of NOD2. NOD2 protein was mostly localized in the cytoplasm. Overexpression of wild-type NOD2 (WT-NOD2) gene induced NF-kappaB-dependent transcriptional activity and this activity was further increased by muramyl dipeptide (MDP). Otherwise, down-regulation of WT-NOD2 gene by antisense NOD2 abolished NF-kappaB-dependent transcriptional activity mediated by either WT-NOD2 itself or MDP. Since vascular endothelial cells, like macrophages and epithelial cells, are critical targets for the circulating bacterial molecules such as MDP, collectively, the results presented here suggest that NOD2 may play an important role in recognizing structural patterns of bacterial pathogen in the endothelium.

The interface between bone tissue and metal implants undergoes various types of mechanical loading, such as strain, compression, fluid pressure, and shear stress, from daily activities. Such mechanical perturbations create suboptimal environments at the host bone-implant junction, causing an accumulation of wear particles and debilitating osseous integration, potentially leading to implant failure. While many studies have focused on the effect of particles on macrophages or osteoprogenitor cells, differential and combined effects of mechanical perturbations and particles on such cell types have not been extensively studied. In this study, macrophages and osteoprogenitor cells were subjected to physiological and superphysiological mechanical stimuli in the presence and absence of Ti particles with the aim of simulating various microenvironments of the host bone-implant junction. Macrophages and osteoprogenitor cells were capable of engulfing Ti particles through actin remodeling and also exhibited changes in mRNA levels of proinflammatory cytokines under certain conditions. In osteoprogenitor cells, superphysiological strain increased proinflammatory gene expression; in macrophages, such mechanical perturbations did not affect gene expression. We confirmed that this phenomenon in osteoprogenitor cells occurred via activation of the ERK1/2 signaling pathway as a result of damage to the cytoplasmic membrane. Furthermore, AZD6244, a clinically relevant inhibitor of the ERK1/2 pathway, mitigated particle-induced inflammatory gene expression in osteoprogenitor cells and macrophages. This study provides evidence of more inflammatory responses under mechanical strains in osteoprogenitor cells than macrophages. Phagocytosis of particles and mechanical perturbation costimulate the ERK1/2 pathway, leading to expression of proinflammatory genes.

The purpose of this study was to compare the early clinical results of arthroscopic extensor carpi radialis brevis (ECRB) release with and without bone decortication in the treatment of lateral epicondylitis.Thirty-eight patients who were surgically treated for lateral epicondylitis between 2004 and 2008 were included in this retrospective review. Among these 38 patients, 19 underwent arthroscopic ECRB release and 19 patients underwent both ECRB release with decortication of the lateral epicondyle. Outcome measures included pain assessment measured by visual analog scale (VAS) preoperatively, on postoperative day one, at two and 4 weeks postoperatively, and at the final follow-up visit. Functional evaluation was made with the Mayo Elbow Performance Index and grip strength measurement.Patients who underwent simple ECRB release had significantly less pain than patients who underwent ECRB release and decortication immediately postoperatively (p0.05). This group also showed a lower VAS score on exertion 2 weeks and 4 weeks after simple ECRB release (p0.05). The mean time taken to return to work was 24.2 ± 18.3 days in the group that underwent simple ECRB release and 39 ± 22.7 days in the group that underwent ECRB release with decortication (p0.05).Arthroscopic release of the ECRB is an effective method of treatment in patients with recalcitrant lateral epicondylitis. Decortication of the lateral epicondyle leads to increased pain postoperatively and did not improve clinical results.

대퇴골 전자부 골절은 대부분의 경우 골다공증을 동반한 고령층에서 많이 발생하며, 평균 수명의 증가로 그 발생 빈 도가 증가 추세에 있다. 골절 치료의 목적은 정확한 정복 및 견고한 내고정을 통해 조기 보행을 시행함으로서 고령 환자에서 흔한 술 후 합병증을 예방하고 조기에 골유합을 얻는데 있다. 그러나 골다공증이 심하여 골절 양상이 분쇄 상이거나 불안정성을 보이는 전자부 골절의 경우 정복 및 내고정이 어려우며 술 후에도 내고정물의 실패와 골절부 위의 심한 함몰이 발생하는 합병증이 문제라고 할 수 있다. 지금까지 대퇴골 전자부 골절의 치료에 많은 기구들이 고안되어 왔다. 특히 골절 부위의 압박력을 얻을 수 있는 활강 압박 고나사와 생체 역학적인 장점이 있는 골수강 내 고정술이 대표적이다. 활강 압박 고나사는 전자부 골절의 치료에서 양호한 결과를 보고하고 있으나 불안정성 골절 에서는 과도한 활강으로 인한 정복 소실, 내반 및 외회전 변형, 지연 나사의 골두 내 천공 등 여러 가지 문제를 보고 하고 있다. 그래서 짧은 지렛대로 인한 생역학적 안정성 Submitted: Januarry 7, 2011 1st revision: February 11, 2011 2nd revision: April 13, 2011 3rd revision: April 26, 2011 Final acceptance: April 26,2011

Purpose: This study evaluated the results of acetabular medial wall osteotomy to reconstruct the acetabulum in dysplastic hip during total hip arthroplasty. Materials and Methods: We clinically and radiologically evaluated 30 hips of 30 patients with secondary hip osteoarthritis caused by congenital hip dislocation or acetabular dysplasia who underwent total hip arthroplasty (THA) between March 1999 and October 2002. The average age of subjects was 46.5 years(17 to 73 years), and the mean follow-up period was 5 years(5.3 to 8.7 years). In 26 cases, a cementless hemispherical acetabular cup was inserted in the true acetabulum; in 4 cases a reinforced ring was inserted. Only 2 hips needed structural bone grafting. Results: The average Harris hip score improved from 56.3 points preoperatively to 93.2 points at the last follow up. Radiographic analysis revealed no aseptic loosening or radiolucent line, and showed stable bony fixation at the true acetabulum. The mean thickness of the medial acetabular wall postoperative was 20.5 mm(10 to 36 mm). Bone union of the medial wall was observed at a mean of four months postoperatively. Conclusion: Acetabular medial wall osteotomy can maintain the integrity of the acetabular medial wall while achieving enhanced acetabular coverage and more normal hip biomechanics.

85 통신저자:양 정 환 전북 익산시 신용동 344-2 원광대학교 의과대학 정형외과학교실 Tel:063-859-1360ᆞFax:063-852-9329 E-mail:bakgom95@hanmail.net *본 논문은 2009년도 원광대학교 교비 지원에 의해서 수행되었음. 접수: 2008. 8. 31 게재확정: 2009. 3. 9 Address reprint requests to:Jung Hwan Yang, M.D. Department of Orthopaedic Surgery, School of Medicine, Wonkwang University, 344-2, Shinyong-dong, Iksan 570-711, Korea Tel:82-63-859-1360ᆞFax:82-63-852-9329 E-mail:bakgom95@hanmail.net 감마 금속정을 이용한 대퇴골 전자간 골절 치료의 합병증

Purpose: To analyze the clinical and radiographic results after revision total knee arthroplasty (TKA) using NexgenⓇ LCCK (LegacyⓇ knee constrained condylar knee, Zimmer, Warsaw, IN) with allograft. Materials and Methods: Twenty patients (21 knees) taken revision TKA were analyzed. The average age of the patients was 69.2 years old and the average of follow-up duration was for 2 year to 8 years 2 months (average 3 years 5 months). The clinical result and radiographic measurements were assessed using the Hospital for Special Surgery (HSS) knee rating score and the roentgenographic method of the American Knee Society. Results: The mean interval from TKA to revision surgery was 6 years 4 months. In all cases, allograft was used. The average range of motion was increased from 93o to 107o, HSS score was increased from an average of 45 to 87 points. Postoperative femorotibial alignment was averaged 5.7o valgus. In all cases, radiolucency was below 4 scores and there was no loosening of implant. But, three radiopaque lines around a stem. There were wound dehiscence in 1 case and superficial infection in 2 cases. Conclusion: Satisfactory results were obtained in revision TKA using a NexGenⓇ LCCK with allograft. But, this study is favorable for the long term follow-up.

Synovial chondromatosis is an uncommon lesion, which is characterized by cartilaginous and osseous metaplasia of the joint synovium. Synovial chondromatosis usually involves a large joint and rarely occurs in the hand. Intra-articular synovial chondromatosis during the hand should be considered in the differential diagnosis of swollen, stiff or painful joints. Other possible diagnoses include osteoarthritis, rheumatoid arthritis, gout, trauma and chronic infection. Moreover, if enchondral ossification of loose bodies is not seen a diagnosis of synovial chondromatosis can not be made preoperatively. Intra-articular synovial chondromatosis is a benign condition and surgical synovectomy remains the most effective treatment. The authors report a case of synovial chondromatosis of the fifth metacarpophalangeal joint.

24 통신저자:권 석 현 전북 익산시 신용동 344-2번지 원광대학교병원 정형외과 Tel:063-859-1360ᆞFax:063-852-9329 E-mail:osksh@wonkwang.ac.kr *본 논문의 요지는 2006년도 대한정형외과학회 추계학술대회에서 발표되 었음. *본 논문은 2007년도 원광대학교 교내연구비의 지원을 받아 이루어졌음. Address reprint requests to:Seok Hyun Kweon, M.D. Department of Orthopaedic Surgery, Wonkwang University Hospital, 344-2, Sinyong-dong, Iksan 570-711, Korea Tel:82-63-859-1360ᆞFax:82-63-852-9329 E-mail:osksh@wonkwang.ac.kr 개방성 경골 원위부 골절에서 2단계 지연 최소 침습적 경피적 금속판 고정술

Purpose: This study evaluated the operability for disease of lumbar intervertebral disc (LID) of practi- tioners and pay doctors of orthopedic surgeons and neurosurgeons by examining their websites. Materials and Methods: From March 2006 to April 2006, we searched the internet using the key words orthopedic surgery and neurosurgery, with NAVER as the portal site. There were 68 homepages of orthopedic hospitals and physician's offices (OHP) and 27 homepages of neurosurgical hospitals and physician's offices (NHP). Each homepage was visited in order to survey the operability for disease of an intervertebral disc and the number of board of orthopedists and neurosurgeons. Statistical analysis was carried out using a chi-square test. Results: In 45.6% (31/68) of OHP and 85.2% (23/27) of NHP, the operation for LID was performed and there was significant difference (p

Purpose : The purpose of this study was to assess the results of posterior cruciate ligamentretaining and posterior cruciate ligament-sacrificing total knee arthroplasty using PFC Sigma rotating-platform (RP). Materials and Methods : The subjects for this study were 43 patients who had undergone total knee arthroplasties by means of PFC Sigma RPs from February 2002 to July 2002 and, thereafter, had been observed for a period of at least 36 months. Twenty-two of the patients were categorized to group I, which retained the posterior cruciate ligament and 21 to group II, which substituted for the ligament. All the patients were evaluated for pre- and post-operative ranges of motion, the Hospital for Special Surgery (HSS) knee rating system, and radiographic analysis. Results : The average flexion contracture was 6.5˚ (±1.0˚) in group I and 6.7˚ (±0.8˚) in group II pre-operatively, and 1.1˚ (±0.3˚) in group I and 0.9˚ (±0.2˚) in group II at the last follow-up. The average active range of knee motion improved from 87.6˚ (±6.5˚) in group I and 86.6˚ (±6.1˚) in group II pre-operatively, to 123.0˚ (±7.8˚) and 125.1˚ (±7.3˚), respectively, at the last follow-up. The average HSS score improved from 41.1˚ (±7.1˚) in group I and 40.3˚ (±5.3˚) in group II preoperatively, to 87.3˚ (±6.0˚) and 88.9˚ (±4.9˚), respectively, at the last follow-up. There was also improvement in the average tibio-femoral angle from 8.0˚ in varus to 5.7˚ in valgus in group I and from 10.9 in varus to 5.4˚ in valgus in group II. Radiolucent lines were observed in 4 cases from group I and in 1 case from the group II. No significant progressive periprosthetic osteolysis was observed in the follow-up radiographs of both groups. Conclusion : There were no clinical and radiographic differences between the posterior cruciate ligament-retention and ligament-substitution groups, which indicates the necessity for long-term observation.

Thoracic disc herniation is a rare condition in which a posterior approach, extrapleural approach, posterolateral approach, or transthoracic approach is currently used. The posterior approach is not recommended in thoracic disc herniation surgery because of the risk of spinal cord injury. The transthoracic approach makes it possible to remove the intervertebral disc and is considered a standard method. However, due to an extensive transverse skin incision, division of the latissimus dorsi muscles, and rib resection, the conventional open approaches involve a risk of complications, such as infection and post-thoracotomy pain syndrome; and a long period of rehabilitation and recovery is required. Excision of the intervertebral disc under thoracoscopic guidance can reduce the damage to the skin and muscles, but the equipment and surgical materials are expensive and a long learning curve is required. Therefore, we report a case and a new muscle splitting transthoracic approach that can be performed by incising 10 cm of skin longitudinally and preserving the serratus anterior and latissimus dorsi muscles.