• Korean Journal of Clinical Laboratory Science
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• v.48 no.4
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• pp.321-326
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• 2016

This study aimed to analyze the changes of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) measured in acute infection within four weeks post artificial joint surgery to predict potential infection in early stages, provide rapid treatment, and prevent the abuse of antibiotics. This study included 50 patients with acute infection and 50 patients without any symptoms of infection, among patients who received artificial joint replacement surgery on the lower limbs in a four-week period. CRP was the highest two-to-three days after surgery. with $5.77{\pm}3.69$ and $5.17{\pm}3.48$, respectively, in those with infection and without infection. Thereafter, the value rapidly reduced in those without infection. However, it increased again to $3.16{\pm}2.87$ in the group with infection according to the bimodal curve (p<0.001). ESR was the highest two-to-three days after surgery, with $58.8{\pm}24.63$ and $44.08{\pm}21.48$, respectively. Thereafter, the value slowly reduced in those without infection. However, it was increased again to $47.62{\pm}26.26$ in those with infection according to the bimodal curve p<0.001). As this study shows, if there is an increasing trend for CRP and ESR after artificial joint replacement surgery, it may be possible to question whether patients are acutely infected post surgery. In particular, this result is expected and regarded as a useful factor for diagnosing infection due to the high level of sensitivity and uniqueness for CRP.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.167-174
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• 2012

Purpose: The purpose of this study is investigation of clinical and functional outcomes in homogeneous group with positive culture after arthroscopic management for pyogenic knee arthritis and analysis of factors affecting those outcomes. Materials and Methods: Thirty-two patients with positive culture after arthroscopic management were included. Mean follow-up period was 41.6 months. Clinical evaluation included death related to infection, recurrence, time to normalize erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), duration of administration of intravenous antibiotics and readmission. Radiographic evaluation was performed according to Kellgren and Lawrence. The prevalence of total knee arthroplasty was investigated and functional evaluation included modified Lysholm, Tegner activity and Korean version of the Western Ontario and McMaster Universities (K-WOMAC) score. Results: Staphylococcus aureus was identified in 21 patients. Time to normalize ESR and CRP was 78.0 and 67.6 days, respectively. Two patients died while there were six recurrences and five readmissions. Rate of recurrence was significantly high in patients with chronic renal failure (P=0.034) and incidence of readmission was associated with higher radiographic grade of osteoarthritis and rate of reoperation (P=0.032 and P=0.006, respectively). At the final follow-up, radiographic grade worsened in 21 patients and was associated with those at first visit. Five arthroplasties were performed. Average modified Lysholm score, Tegner activity score and K-WOMAC score were 53.5, 2.7, 44.2 points, respectively. Conclusion: The severity of osteoarthritis on final radiographs was associated with those at first visit. Patients with higher grade of osteoarthritis at first visit showed higher incidence of readmission and those with chronic renal failure demonstrated higher chances of recurrence.

• Journal of the Korean Orthopaedic Association
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• v.54 no.3
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• pp.244-253
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• 2019

Purpose: Total hip arthroplasty was performed using a direct anterior approach (DAA) on an ordinary operation table and a short femoral stem. The clinical radiographic results were evaluated by a comparison with those performed using the modified hardinge (anterolateral approach, ALA) method. Materials and Methods: From January 2013 to November 2015, 102 patients who underwent total hip arthroplasty using DAA (DAA group) and the same number of patients using ALA (ALA group), both performed by a single surgeon, were compared and analyzed retrospectively. The operation time and amounts of bleeding were compared, and the improvement in post-operative pain, ambulatory capacity and functional recovery of the hip joint were checked. The location of insertion of the acetabular cup and femoral stem were evaluated radiologically, and the complications that occurred in the two groups were investigated. Results: The amount of bleeding was significantly smaller in the DAA group (p=0.018). Up to 3 weeks postoperatively, recovery of hip muscle strength was significantly higher in the DAA group (flexion/extension strength p=0.023, abduction strength p=0.031). The Harris hip score was significantly better in the DAA group for up to 3 months (p<0.001) and the Koval score showed significantly better results in the DAA group up to 6 weeks (p≤0.001). The visual analogue scale score improvement was significantly higher in the DAA group by day 7 (p=0.035). The inclination angle (p<0.001) and anteversion angle (p<0.001) of the acetabular cup were located in the safe zone of the DAA group more than in the ALA group, and there was no statistically significant difference in the position of the femur stem and leg length difference. During surgery, two cases of greater trochanter fracture occurred in the DAA group (p=0.155). Conclusion: The DAA performed in the ordinary operation table using a short femoral stem showed post-operative early functional recovery. Because a simple to use fluoroscope was used during surgery with an anatomical position familiar to the surgeon, it is considered to be useful for the insertion of implants into the desired position and for an approach that is useful for the prevention of leg length differences.

• Clinics in Shoulder and Elbow
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• v.12 no.2
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• pp.255-263
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• 2009

Purpose: An osseous defect in the glenoid and humeral head is closely associated with recurrence of anterior shoulder instability. The purpose of this article is to describe the open surgical techniques and introduce our experiences with anterior instability with a significant osseous defect. Materials and Methods: We reviewed the articles that have focused on and/or mentioned the affect of osseous defects on anterior shoulder instability. The open surgical techniques and its related pearls are summarized in this review. Results: Accurate evaluation for the size and location of the osseous defect is critical for preventing recurrence after restoration of the anterior capsulolabral structure. The glenoid bone restoration techniques include the coracoids transfer (the Bristow procedure and the Latarjet procedure) and a structural iliac bone graft. Rotational humeral osteotomy and an osteoarticular allograft could be used for repairing a significant posterosuperior humeral defect (Hill-Sachs lesion). Shoulder arthroplasty may be tried for treating a humeral bone defect, but more study on this is needed. Conclusion: Open surgical restoration decreases the risk of recurrence anterior shoulder instability that is combined with a significant osseous defect. Arthroscopic surgery currently has limitations for treating an osseous defect, but it will become useful in proportion to the development of arthroscopic instruments and techniques in the future.

• Journal of Yeungnam Medical Science
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• v.9 no.2
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• pp.218-223
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• 1992

Serum C-reactive protein(CRP) levels and erythrocyte sedimentation rates(ESR) were measured in 46 patients treated with uncomplicated primary hip replacements, 39 total tip replacements and 7 bipolar hip replacements. In uncomplicated primary hip replacements, ESR levels were slightly elevated preoperatively and were variable postoperatively. But CRP was normal before surgery and elevated in postoperative course, but back to normal within three weeks in most cases. Early success of hip arthroplasty is indicated by normalization of CRP within three weeks, regardless of ESR. Since ESR seems to react somewhat differently from the CRP, both methods are useful in the monitoring of complications after hip arthroplasty.

• Journal of the Korean Arthroscopy Society
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• v.16 no.2
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• pp.153-159
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• 2012

Purpose: This study aims at evaluating our results with a 5-year follow up of arthroscopic pull-out suture repair of posterior root tear of the medial meniscus. Materials and Methods: This study enrolled 30 cases who underwent a arthroscopic pull-out suture repair to treat the posterior root tear of the medial meniscus from January 2001 to May 2005 and followed up at least 5 years. The average follow-up period was 76 months (range, 60-90 months). Clinical results by use of the Lysholm knee score and radiographic grade by use of the Kellgren-Lawrence classification were evaluated and second-look arthroscopy was done in all cases. The clinical results were compared with trauma history, obesity, varus deformity and time to operation. Results: At the last follow up, the Lysholm knee score improved from 55 points to 86 points. For the radiological results, 23 cases displayed maintenance or improvement of the medial joint space on the follow up X-ray, but 7 cases displayed decrease of the medial joint space, and 1 case was lately performed total knee replacement due to progressive osteoarthritic change. Conclusion: Arthroscopic pull-out suture repair has a good result at 27 cases (90%) in minimum 5 years follow-up. The clinical improvement was significantly reduced in more severe varus angle.

• Journal of the Korean Orthopaedic Association
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• v.53 no.6
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• pp.459-465
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• 2018

Of the many factors that affect the clinical outcomes of orthopedic surgery, the surgical procedure is the most important. Robotics have been developed to perform the surgical procedures more accurately and consistently. Robotic surgical procedures in the orthopedic field were developed 20 years ago. Some designs of surgical robots have disappeared due to practical problems and complications, and an another design of surgical robots is emerging. To date, the use of robot surgery in arthroplasty is still controversial in terms of the clinical outcomes, practicality, and cost-effectiveness, even though it has been reported to be effective in the alignment and positioning of components in the field of artificial joints. Early robotic surgery was based mainly on active robot surgery according to the scheduled operation without the intervention of the operator. Recently the semi-active system of robotic surgery has been introduced. In a semi-active system, the robot constrains the surgeon to a haptic boundary defined by the computer based on the 3-dimensional imaging preoperative plan, and the operator can change the preoperative plan through real-time feedback during operation.

• Journal of Biomedical Engineering Research
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• v.20 no.1
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• pp.37-44
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• 1999

Because of bone resorption, wear of ultra-high molecular weight polyethylene(UHMWPE) in total knee arthroplasty has been recognized as a major factor in long-term failure of knee implant. The surface damage and the following harmful wear debris of UHMWPE is largely related to contact stress. Most of the previous studies focused on the contact condition only at the articulating surface of UHMWPE. Recently, contact stress at the metal-backing interface has been implicated as one of major factors in UHMWPE wear. Therefore, the purpose of the is study is to investigate the effect of the contact stress for different thickness, conformity friction coefficient, and flexion degree of the UHMWPE component in total knee system, considering the contact conditions at both interfaces. In this study, a two-dimensional non-linear plane strain finite element model was developed. The results showed that the maximum value of von-Mises stress occurred below the articulating surface and the contact stress was lower for the more conforming models. All-polyethylene component showed lower stress distribution than the metal-backed component. With increased friction coefficient on the tibiofemoral contact surface, the maximum shear stress increased about twofold.

• Journal of the Korean Orthopaedic Association
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• v.54 no.1
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• pp.30-36
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• 2019

Purpose: This study examined the effects of gender, age, underlying disease, duration after onset of symptoms, preoperative invasive procedures, bacterial culture of joint fluid, and stage of infection by the Gachter classification on the prognosis of patients with infectious knee arthritis who underwent arthroscopic surgery. Materials and Methods: From June 2014 to December 2016, 51 patients who underwent arthroscopic surgery for infective knee arthritis were enrolled in this study. The average follow-up period was 14.2±2.1 months (range, 12-20 months). The subjects were 27 men (52.9%) and 24 women (47.1%), with an average age of 55.1±17.6 years (range, 13-84 years). A preoperative evaluation of the joint aspiration with a count of more than 50,000 leukocytes and a polymorphonuclear leukocyte count of 95% or more was performed. All patients underwent arthroscopic surgery and postoperative continuous joint irrigation. Results: The initial mean value of the C-reactive protein decreased from 9.55±6.76 mg/dl (range, 1.51-31.06 mg/dl) to a final mean of 0.74±1.26 mg/dl (range, 0.08-6.77 mg/dl); the mean duration of C-reactive protein normalization was 27.6±18.9 days (range, 8-93 days). Among the 51 patients who received arthroscopic surgery and antibiotics, 44 patients (86.3%) with infectious knee arthritis completed treatment with improved clinical symptoms, such as fever, pain, and edema, and the C-reactive protein decreased to less than 0.5 mg/dl. Finally, 5 cases were treated with two or more arthroscopic operations, and 2 cases were converted to arthroplasty after prosthesis of antibiotic-loaded acrylic cement. Conclusion: The duration of surgery after the onset of symptoms and the stage according to the Gächter classification are important prognostic factors for predicting the successful treatment of infectious knee arthritis. On the other hand, the other factors were not statistically significant. Nevertheless, patients with bacteria cultured from the joint fluids appear to reflect the treatment period because the period of normalization of the C-reactive protein is shorter than that of the control group.